Grove Court is a residential care home providing personal and nursing care to up to 12 people. The service provides support to people with mental health support needs. At the time of our inspection there were 9 people using the service.
People’s experience of using this service and what we found
Quality assurance systems in place were not always effective at identifying concerns and looking for ways to improve the quality and safety of care. Risks were not always assessed and planned for, which could leave people’s health and wellbeing at risk. Despite this, staff generally knew people well. Medicines were not always managed safely. Some improvements had been made to the cleanliness of the service; however, the home was still being refurbished and this was not yet completed. Some records were poorly completed and did not evidence people were always being kept safe. Overall, people had a good relationship with staff, however, 2 staff used some inappropriate language to refer to a person and this had to be challenged.
There were enough safely recruited staff and staff had appropriate checks in place. Staff felt supported in their role. There were no restrictions on visiting. The registered manager and provider were aware of their duty of candour. The registered manager was responsive to feedback. The service worked in partnership with other organisations and professionals.
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 generally 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 requires improvement (published 16 June 2023).
The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.
Why we inspected
We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. This inspection was also prompted by a review of the information we held about this service.
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 requires improvement. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘All inspection reports and timeline’ link for Grove Court on our website at www.cqc.org.uk.
Enforcement
We have identified breaches in relation to assessing and reducing risks to people’s health and wellbeing, medicines management and quality assurance systems at this inspection.
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.
Grove Court is a care home providing personal care to up to 12 people. The service provides support to adults with mental health conditions. At the time of our inspection there were 11 people using the service. Grove Court is an adapted building with shared areas for people to access independently.
People’s experience of using this service and what we found
The provider had not assessed all environmental risks and where risks were identified actions were not always taken to keep people safe. Hygiene levels in the care home were not always effectively maintained which meant people were at increased risk from the spread of infections.
Quality assurance systems needed to be more robust to identify all environmental risks which could place people at risk of harm. Actions needed to be taken swiftly to address areas of concern when this had been identified.
People were supported by enough suitably trained and safely recruited staff. People were kept safe from the risk of abuse. People’s medicines were safely managed.
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.
Staff worked with other professionals to achieve good outcomes for people. People were involved in their care planning and had input into the service.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 8 February 2019).
Why we inspected
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 received concerns in relation to infection control practices, safeguarding, mental capacity, care planning and food and fluid monitoring. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
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 changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Grove Court on our website at www.cqc.org.uk.
Enforcement
We have identified breaches in relation to people’s safety in the environment, the cleanliness of the premises and the governance of the service at this inspection.
Please see the action we have told the provider to take at the end of this report.
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.
We found the following examples of good practice.
New care plans had been put into place to address the impact COVID-19 had on people. Additional activities supported the wellbeing of people who ordinarily enjoyed regular access to the community.
People were reminded by staff about the importance of good hand hygiene and signs within the home supported this. People wore masks when in communal areas and encouraged each other to social distance.
Staff wore personal protective equipment in line with guidance and were knowledgeable about what PPE they needed to use for different tasks.
Additional PPE was stored in sealed folders in people's bedrooms and stocks were replenished daily by staff. This supported staff to have easy access to PPE without taking up unnecessary space.
The home had implemented an enhanced cleaning schedule to maintain the cleanliness of the home. People informed us staff carried out regular cleaning and that high touch areas were cleaned throughout the day.
Further information is in the detailed findings below.
People’s experience of using this service:
People were safe and protected from the risk of abuse and avoidable injuries. People were supported by staff that were trained and received support in their role.
People were treated with kindness and compassion by staff who knew them well and understood their preferences. People could make choices for themselves and were encouraged to be independent. People’s privacy and dignity was respected.
People received person centred care from staff that understood their preferences and were supported to do things they enjoyed. People were involved in the planning and review of their care.
People’s views were sought and listened to and were used to make improvements to the service.
Systems were in place to monitor the quality of the service and the registered manager identified areas for improvement.
The management team encouraged a positive learning culture and this was promoted with staff.
The service met the characteristics of Good;
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection: At the last inspection the service was rated Good (report published 1 September 2016).
Why we inspected: This was a scheduled inspection based on previous rating.
There was a registered manager in post. 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.
We spoke with people who use the service, the staff that support them and other professionals that have contact with the people who live there.
People we spoke to told us they felt safe. Staff knew how to recognise abuse and knew how to report concerns if they suspected someone was being abused.
Risks to people had been assessed and appropriate actions put in place to minimise the risks. People were supported to take positive risks and accessed the community regularly.
Staffing levels were sufficient to support peoples’ current needs. Recruitment practices meant that appropriate checks were in place to ensure staff were fit to work with vulnerable adults. Staff training and on-going training ensured staff had the skills and knowledge to support people effectively.
People received their medication safely and there were systems in place to store medicines correctly and document administration.
People were encouraged and supported to make their own decisions where possible and staff knew about the principles of the Mental Capacity Act 2005 (MCA).
People’s physical and mental health were monitored and appropriate referrals were made to health services when required.
Staff treated people in a caring manner and people told us they liked the staff.
People were involved in planning their care and making choices. The care plans reflected peoples’ current needs and were regularly reviewed. People were encouraged to partake in activities and access the local community.
Systems were in place to monitor the quality of the service and issues identified were acted upon and resolved.
We spoke with people who used the service who told us that they were happy with the care and support they received. One person told us, 'I like it here, I always feel comfortable'. Another person told us, 'It's good here. I like the staff and I can choose what I want to do'.
We saw that the provider had systems in place that prevented the risk of cross infection. We saw staff used protective equipment during our inspection and staff we spoke with understood the importance of infection control. People we spoke with told us that staff wore gloves and aprons and the service was always kept clean.
We found that the provider had undertaken the necessary checks to ensure that staff employed at the service were suitable to work with vulnerable people. Staff told us that they had received training to undertake their role.
The provider had an effective complaints system in place. Complaints were investigated and people's concerns were listened to and acted on. People we spoke with told us they knew how to complain if they needed to.
People were having their physical and mental health care needs met. They were supported to access their GP, had eye and dental checks and received any specialist care they needed. People's mental health needs were identified and plans were in place to respond if they needed extra support to maintain their mental wellbeing.
The provider gave people information about safeguarding issues and what they could do it they felt they were being abused. Staff were trained to identify and respond to any incidents of abuse.
Staff received the training and support to provide people with the support they needed. They completed induction training when they started work and undertake additional formal qualifications to develop and improve their knowledge and skills.
The service had systems in place to review and monitor the care people received. Opportunities were provided for people to express their views both about their individual care and about the whole service.