Archived: Grove House

Grove House is a residential care home providing accommodation and personal care to up to 31 people in an adapted building. The service provides support to older adults, some of whom are living with dementia. At the time of our inspection there were 18 people using the service.

People’s experience of using this service and what we found

The service was not always safe. Environmental and health-related risks to people were not always well managed. People did not always receive their medicines safely. Accident and incident forms were not always completed, so lessons could not always be learnt. The provider did not always follow recruitment policies to ensure staff were recruited safely. However, people were protected from the risk of abuse and infection prevention and control measures were appropriate.

Staff did not always have the support and training needed to meet people’s needs. People had not been referred to healthcare professionals when their mobility needs had changed. Risks to people’s nutrition and hydration were not always well managed. People did not always receive consistent support with their hygiene needs and preferences. However, the home was well presented and people could personalise their bedrooms.

Although improvements had been made since the last inspection, systems and processes had not always been operated effectively to ensure people received a safe service where quality was able to improve consistently. The provider did not always understand or comply with regulatory requirements. However, people’s care plans were written in a person-centred way, and there were systems to receive feedback from people and their relatives.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 25 August 2022). There were breaches in regulation. This service has been in special measures since 25 August 2022. During this inspection, although we have found some improvements have been made, the provider remains in breach of regulations. The provider will remain in special measures as the service remains rated inadequate overall.

Why we inspected

At our last inspection, we carried out an unannounced focused inspection on 20 June 2022. Breaches of legal requirements were found. As a result, we imposed conditions on the provider’s registration and served a Warning Notice with a compliance deadline for improvement.

We undertook this focused inspection to check whether the provider had complied with the imposed conditions due to urgent risks found in relation to regulation 13, and the Warning Notice we previously served in relation to regulations 11, 12, 17 and 18, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Grove House on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to people’s health and safety, person centred care, staffing and governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Requires improvement’. However, the service remains in ‘special measures’. We do this when services have been rated as ‘Inadequate’ in any Key Question over two consecutive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Grove House is a residential care home providing accommodation and personal care to up to 31 people in one adapted building. The service provides support to older adults, some of whom are living with dementia. At the time of our inspection there were 22 people using the service.

People’s experience of using this service and what we found

The service was not safe. People were not consistently protected from abuse and improper treatment as allegations of abuse were not always identified or referred appropriately. People were at risk of injury as a result of poor falls management. Risks to people’s health and safety had not been sufficiently assessed or mitigated and care plans were not always in place to guide safe practice. Lessons were not always learnt following incidents. There was a risk people may not receive their medicines as prescribed because safe medicines practices were not followed. Staff did not always use personal protective equipment (PPE) effectively to reduce the risk of infection.

There were not enough staff employed to ensure the safe and effective running of the home and staff were not always deployed effectively. Staff did not always have adequate training to meet people’s needs and there was a lack of formal systems to support staff and manage performance. Feedback about the quality of the food was poor and there was a risk that fluctuations in people’s weight may not be identified. Although people were supported to access support from external health professionals, care plans did not contain up to date information about their health needs. The environment was pleasant and well maintained.

People were not supported to have maximum choice and control of their lives and there was a risk staff may not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The home was not well led. Although people and their relatives were generally positive about individual staff members, the culture of the home was not person centred. Governance systems and audits were not effective in identifying or addressing areas for improvement. The provider did not have sufficient oversight of the operation of the home, consequently poor practices had been allowed to develop. Feedback from people, staff and families was not used to drive improvement at Grove House.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was good (published 11 January 2019).

Why we inspected

The inspection was prompted in part due to concerns received about leadership and management of the home. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, safeguarding, staffing, consent and governance at this inspection.

Immediately after the inspection visit, we wrote to the provider and asked them to take action to address our most serious concerns. Although the provider responded with details of action they were taking, we were not assured that all risks were mitigated. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found the following examples of good practice.

¿ The service had clear visiting protocols in place with robust infection, control and prevention procedures that all visitors were required to follow. This included guidance upon arrival relating to personal, protective equipment (PPE), COVID-19 testing and a health screening questionnaire.

¿ Staff had allocated time to spend with people talking and supporting them with activities of their choice. Staff also supported people to maintain regular contact with their friends and relatives.

¿ The service had an infection control policy in place which staff followed. The service had Personal Protective Equipment (PPE) stock, and staff confirmed the provider always ensured they had an adequate supply.

¿ Staff received training in relation to infection prevention and control. Staff told us how they managed risks in relation to COVID-19 such as how they took part in regular testing, we observed staff to be wearing the correct Personal Protective Equipment (PPE) throughout our inspection.

¿ Domestic staff spoke with knowledge and confidence on how they ensured a clean environment, this included regular cleaning of high touch areas. The cleaning records evidenced that these tasks were consistently completed

Grove House is registered to provide personal care and accommodation for up to 31 adults, including people living with dementia. On the day of our inspection there were 25 people using the service.

The service was last inspected on 28 April and 02 May 2017. The service was rated ‘Requires Improvement’. There was no clear management structure in place and staff did not always receive the training necessary to meet people’s needs. We also found people, particularly those living with dementia, experienced inconsistent levels of support to maintain interests and meaningful activities.

During this inspection we checked to see whether improvements had been made, we found improvements had been made and this contributed to the service receiving a rating of ‘Good’ in all the key areas.

Since our last inspection there had been a change in the management of the service and a new registered manager had been appointed and registered since June 2018. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons.’ Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Improvements had been made to the training staff had received. This had developed staff’s understanding on providing care to people living with dementia. This also included improved understanding, in how to provide and engage people living with dementia in social activities, occupation and stimulation. The systems that monitored quality and safety had been improved upon with plans for further development. The service was continually driving forward improvements and an action plan was in place.

Staff were aware of their responsibilities to protect people from abuse and avoidable harm, they had received safeguarding training and had policies and procedures to support their practice. Accidents and incidents were reviewed and action was taken to reduce further reoccurrence. This included reviewing how risks were managed and advice and guidance was sought from extremal healthcare professionals when required. Risks associated with people’s individual needs, including the environment were assessed and planned for, and regularly reviewed.

The environment and equipment was found to be clean and staff followed best practice guidance, in the prevention and control of infections.

People were supported by sufficient numbers of staff that were deployed appropriately, to meet their individual needs. The provider had robust safe staff recruitment procedures to ensure as far as possible, staff employed were safe to provide care and treatment.

People received their prescribed medicines safely and best practice guidance was followed. This included staff receiving ongoing training and competency assessments, in the management of medicines.

Staff received an induction and ongoing training and support to ensure their knowledge, skills and competency were safe and effective. Staff were knowledgeable about people’s health conditions and worked effectively with external healthcare professionals to support people’s needs. Systems were in place to share information about people’s health conditions with other healthcare professionals, to ensure people’s ongoing needs were known and understood.

People received a choice of meals and drinks and were assisted to eat and drink where required and their independence was encouraged and supported.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People received care that respected their privacy and dignity. Staff were knowledgeable about people’s needs, routines and preferences and encouraged independence

Information about independent advocacy services was available. People and or their relative, were involved as fully as possible in how care and treatment was provided.

Staff had information to support them to understand people’s needs, preferences and diverse needs. The provider’s complaint Spolicy and procedure had been made available to people who used the service, relatives and visitors. People’s end of life wishes had been discussed and planned with them.

People, relatives, staff and professionals were positive about the service provided and how the registered manager led the service. People received opportunities to feedback their experience of the service and the provider acted to make changes to feedback received.

There was a registered manager at this service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons.’ Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During our inspection visit we observed that staff were friendly and approachable. When possible, they spent time sitting with people to offer them comfort or stimulation. We observed staff delivering care which met people’s individual care needs and which supported them in a respectful and appropriate way.

Accidents and incidents were investigated and plans put in place to reduce risk. All people had a risk assessment to ensure staff understood the risk to them and what to do to mitigate this risk.

There were training and processes in place to keep people safe and staff followed these. People’s physical and mental health was generally promoted. However staff were not trained to meet the special needs of people such as people living with dementia. Medicines were administered and recorded as prescribed.

We saw staff ensured people were comfortable. We saw people were supported in a relaxed and unhurried manner. However some people had to wait longer than they wanted to for assistance with eating. Staff were caring and communicated well with people. People were offered choices at meal times and some were seen to enjoy their food. However lunch was a solitary event. Attempts had not been made to make this a social occasion.

Staff focused on people they were caring for rather that the task they were carrying out. Staff spoke in a positive manner about the people they cared for and had taken the time to get to know people’s preferences and wishes. Staff had a good understanding of people’s needs and this was demonstrated in their responses to people and recognition of when people required additional support. However, none of the staff we spoke with knew people’s history.

People’s privacy was respected. People had their independence promoted. Where possible they were offered choice on how they wanted their care delivered and were given choices throughout the day.

People were supported to maintain relationships with family and friends. Visitors were welcomed at any time. Records we looked at were personalised and had included decisions people had made about their care including their likes, dislikes and personal preferences.

There were very few activities for people to partake in. We saw they were left un-stimulated through the days of our visit.

People, relatives and staff spoke well of the registered manager and felt the home was starting to be well-led.

Most staff were aware of their roles and responsibilities for people’s care. The provider and registered manager had systems in place to review the service and to ensure the service responded to the on-going needs of people.

Staff’s moral was generally good. However they found the management structure confusing and often received conflicting directions from the management team that was not always in people’s best interests.

Our inspection was unannounced and in response to concerns raised. We visited this service on 24 June and on 17 July 2014. We attended a strategy meeting held by the local authority as concerns were raised about various issues at the home. As part of our joint working with the local authority we were able to follow up on concerns raised about people's safety.

The evidence we collected helped us to answer five key questions; is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, staff and visiting relatives told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

The home was a converted older property. People we spoke with told us they liked their rooms. We found that people's rooms were personalised, clean and tidy. In parts of the building there were rooms with unlocked doors, that for safety reasons should not be accessed. The boiler room was left unlocked and some hot pipes were exposed. This had the potential of being unsafe for a person using the service. During the second inspection visit the safety adjustments that we had identified had been acted on by the provider.

We saw people were supported to receive their medicines safely and in the way they preferred. Medicines used at the home were stored and administered appropriately. We found a small number of recording errors for when medicines were administered.

We observed that there were enough staff available to meet people's needs. For example during the day time to ensure people were safe there was at least one staff member checking the lounge areas. We observed staff to provide safe care.

People received care from staff who were kind and caring towards them. One person told us 'Staff are all lovely here. I feel at ease. I always lock my room for extra security, I ring my bell and staff come to me frequently. They make me really feel at home.'

Linked to a recent concern, we found that the provider needed to improve their response to situations that could place people at risk. A safeguarding investigation by the local authority was in progress because of this.

The Mental Capacity Act 2005 (MCA) is a law providing a system of assessment and decision making to protect people who do not have capacity to give consent themselves. The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards and was in the process of submitting an application in line with legal requirements.

Is the service effective

People whose records we looked at had an individual care plan which set out their care needs. Families told us they had been involved in contributing to their relative's care plans. We observed people's routines at different times of the day. We saw they were given choices with their meals and took part in the activities provided. Other agencies were asked to visit as appropriate to advise and provide treatment. People told us that they liked the staff and received the right support. One person told us, "It is nice here, they're all very friendly".

We found people were cared for by staff who had received appropriate training and supervision to enable them to carry out their roles effectively.

Is the service caring?

Six people told us they were happy with the care at the home and they said staff were good with them.

One person told us 'I'm happy with the staff. If I look upset or feel down they ask me to make sure I'm okay. They give me a kiss on the cheek in the morning and this makes me feel good'.

We spoke with staff who were able to describe the care they provided for each of the people we selected.

Is the service responsive?

One relative told us they found the manager to be responsive because when they complained about the appearance of the home action was taken. We found that on the second inspection visit actions had been taken by the manager and provider to improve the comfort of people using the service. This included environmental adjustments and improved staffing levels to support people at the home.

Is the service well led?

People we spoke with told us they would discuss any concerns with staff or the manager and felt they could air their views when they wished. We saw the provider had quality assurance procedures that included monthly audits including regular meetings with staff, meetings with relatives and a clear complaints procedure.

Further checks to review safeguarding measures were needed. The provider confirmed that audits were all up to date to ensure people's safety.

During our visit we observed that the interaction between staff and people was caring and friendly. The residents were observed smiling at staff and appeared at ease.

People we spoke with told us they felt safe living at the home. One person told us that staff were 'Marvellous and I am not afraid to go to any of them.' Another person told us they were 'Quite satisfied and felt safe' at the home.

There were suitable arrangements in place to ensure that people were consulted and involved in making decisions about their care. Where people could not make decisions there were systems in place to ensure decisions were being made in people's best interests.

We saw that care plans were sufficiently detailed to ensure staff were aware of people's needs. The care plans were personal and described people's preferences.

People received their medicines regularly and there was accurate recording of medication stocks. However medicines were not always stored or handled appropriately.

Staff told us that they were frequently busy but told us people's care needs came first. We saw that there were systems in place to maintain regular staffing levels. Our observations at our visit indicate that staffing levels are sufficient to meet people's needs.

Where care plans were in place we found these were well detailed, personalised and described people's choices and wishes. We found however that for some aspects of care, particularly where people had the capacity to present in a challenging manner there were not clear plans in place to ensure people received safe and appropriate care.

We found that staff were aware of safeguarding adult procedures, but incidents were not always being reported or investigated in a prompt manner.

The provider had effective recruitment and selection processes in place. We found people were supported by suitably qualified, skilled and experienced staff.

There were systems in place to handle complaints and people told us they would feel confident about raising concerns. There was some information made available to people about how to complain, but this was not up to date.