Grove Court

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

During our assessment of this key question, we found improvements were being made in assessing people’s risks, managing incidents, managing medicines, and the safety of the care home environment. However, further improvements were still required to ensure staff received all their training, care plans were updated effectively, requirements of the mental capacity act were complied with, and food and medicines were stored safely.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us there was a learning culture at the care home. One person told us, “Following an incident, staff managed to get me urgent medical attention and I believe staff learned a lot from what happened.” Another person told us, “Staff are always learning."

Staff told us there was a good learning culture at the care home. One staff member told us, “The manager is always going through things with me to ensure I am doing things right. Quality assurance staff are also very helpful and have a focus on learning.” Another staff member told us, “Since the last inspection, I feel we have really improved as a service and with the care we give residents.”

Although the provider had systems in place to promote a culture of learning, these were not always effective. For example, where a person required their skin to be monitored following an incident, there was no evidence this was done. Where staff were required to complete refresher training, this had not always been completed in a timely way. Staff could make suggestions on improving care through team and one-to-one meetings. People could raise any concerns or make suggestions through residents’ meetings and surveys and management acted on these.

People told us they received safe care. One person told us, “Since the new manager came in, we have been having meetings with my social worker to review my care and look at ways of increasing my independence.” Another person told us, “Since I have been here, my mobility has declined, and the staff have supported me to move to a downstairs room and I feel safe with them. Staff ring for an ambulance straight away if needed and keep my family involved.”

Staff told us people received safe care. One staff member told us, “I feel people are safe here as we treat them with respect and compassion. Care plans tell us about how support people to make healthier choices and if people people’s health needs change, we liaise with the GP.” Another staff member told us, “For one person with specific communication needs, we provide assistive technology to alert them in the event of a fire and we ensure they have an interpreter when attending health and social care reviews.”

We received mixed feedback from professionals visiting the care home. One professional told us, “We completed a joint risk assessment with the provider regarding a resident. We found the provider to have a positive approach to risk and enabled the resident to achieve outcomes in a safe and managed way.” Another professional told us they were supporting the provider to make improvements however there were still some issues with the quality of care plans, risk assessments and monitoring systems.

The provider worked with people and partner agencies to establish and maintain safe systems of care, in which safety is managed, monitored and assured. The provider ensured continuity of care. For example, where people’s needs had changed and there was concern about how those needs could be managed at the service, the provider was working with partner agencies to provide an accurate assessment and to manage those needs effectively while other options were considered. Where referrals to external agencies were required to meet people’s needs and risks, these were made in a timely way.

People told us the provider dealt with safeguarding issues when required. One person told us, “When somebody stole something from me, staff acted straight away, and I was satisfied how they addressed the matter.” Another person told us, “When I had a fall, I pressed the emergency button and staff came straight away. I was so glad to see them and they checked me over before helping me to get up. I now have a bed sensor in place and staff check on me when it goes off.”

Staff told us they followed the safeguarding policy and knew how to safeguard people. One staff member told us, “When there was a recent safeguarding issue, we addressed the concerns and made a referral to the local authority safeguarding team.” Staff understood the Mental capacity Act 2005 and how to include people in decisions about themselves. One staff member told us, “One resident has specific dietary needs and we encourage them to eat and drink healthily however we understand that they can make their own choices because they have the mental capacity to do so.” Another staff member told us, “For one resident, we need to act in their best interests and can anticipate if they are in pain by their body language.”

While we did not observe any incidents requiring a safeguarding response, we observed staff communicating with people with respect and kindness.

People were protected from the risk of abuse. There was an up-to-date safeguarding policy in place which was in line with local procedures. Accidents and incidents were investigated, and safeguarding referrals were made to the local authority, where required, and the Care Quality Commission were notified of these concerns. Themes and trends from incidents were analysed and measures were put in place to promote people’s safety. Staff had completed their safeguarding training and knew how to identify and act on safeguarding concerns. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguarding (DoLS). We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty had the appropriate legal authority and were being met. Although staff were knowledgeable of the principles of the MCA, a mental capacity assessment had not been completed for a person they felt lacked the capacity to access the community independently. A DoLS referral had not been done. When we told the manager about this, they assessed the person’s capacity and made a referral to the local authority for a DoLS assessment.

People told us staff supported them to manage their risks safely. One person told us, “I have recently been diagnosed with a serious health condition and staff support me to go to all my medical appointments. When I had health issues the other day, staff were very quick in getting me medical assistance.” Another person told us, “I feel safe knowing staff are always there when I need them. They review my care with me. Staff help me with my mobility and washing and treat me with dignity and respect. Staff always explain what they are doing when they are helping me.”

Staff told us they support people to manage their risks safely and involve people in their care. One staff member told us, “We are having a placement review for somebody who has mobility risks. They have capacity so we encourage them to use their walking frame. They also have a sensor mat in their room which we respond to when needed.” Another member of staff told us, “We work closely with other agencies to manage people’s risks. One person requires 2 staff members when we support them with personal care as this gives them reassurance and helps them to feel safe. We support another person to access the community however if they wish to go alone, we offer them advice on how to keep themselves safe. We are working with the local authority to review their care as their needs have changed.”

We observed staff supporting people safely to manage their risks. Where one person required support with attending a medical appointment, staff supported them safely with their mobility needs and treated them with kindness and compassion. Staff arranged a taxi and accompanied them to the medical appointment.

Systems in place to manage people’s risks were not always effective. The management team were working with staff to ensure care plans and risk assessments were reviewed and updated where required however they recognised there were further improvements required. Although risk assessments were completed and included details about people’s risks, care plans were not always reviewed when required or contained enough information about people’s needs. For example, when a person’s physical health had declined, the provider had supported them with repositioning and made a referral for a pressure mattress to maintain healthy skin. However, although there was no evidence the person’s skin had deteriorated, there was no information included in their care plan about how the provider was supporting them with this. Although an investigation had taken place in relation another person’s skin issue and weekly monitoring was put in place as a result, there was no evidence this was being followed by staff. However, there was no evidence of harm as a result of this omission. People had Personal Emergency Evacuation Plans in place (PEEPs) to ensure they could be evacuated safely in the event of an emergency.

People felt the care home environment was safe and there had been improvements. One person told us, “There have been improvements in the care home environment following redecorating.” Another person told us, “Although I have mobility needs, I am able to use the lift and get around the home safely.”

Staff told us improvements had been made in the safety and appearance of the care home. The operations manager and interim care home manager told us previous issues with the care home environment identified by the care quality commission and local authority had been addressed and systems in place to monitor and address safety issues had been strengthened.

Issues identified with the safety of the environment in the last inspect inspection had been resolved. Exposed radiator pipes identified on the last inspection had been covered and the utility room housing the boiler had been resurfaced and secured. On this assessment we observed discarded contents from renovations between the external office and garden space. We also observed a pile of loose bricks at knee level and on the ground adjacent to the garden wall. When we told the management team about this, they removed the obstacles and secured the affected areas straight away. We observed an interaction between a person and the operations manager where the person explained they had been advised by the interim care home manager to remove bags they had placed in the corridor outside their room as they posed a fire risk.

The provider had effective systems in place to monitor the safety of the environment. Environmental checks took place and where safety issues were identified, an action plan was in place to ensure they were resolved. The fire risk assessment was up-to-date, and issues identified had been acted on. Fire safety equipment had been serviced and PAT testing was due to be completed in line with requirements. Fire alarm tests and evacuation drills were undertaken to ensure people could be evacuated safely in the event of a fire. Where there were risks associated with smoking, risk assessments were in place to guide staff how to manage people’s risks safely.

People told us they received safe care from staff who knew them and treated them with kindness and respect. One person told us, “Staff are really nice and speak to me in a very caring and respectful way. They are well trained and do their jobs properly.” Another person told us, “Staff are well trained and meet my needs. The care is good, and I enjoy living here.”

Staff told us they were given training to carry out their roles and provided good care. One staff member told us, “When I started working here, I had a DBS (Disclosure and Barring Service) and was given an induction. I have had all my training including safeguarding and Mental Capacity Act. Since the new manager came in, there has been a lot more support and I attend regular one-to-one meetings where we discuss performance.” Another staff member told us, “I shadowed other staff members when I first started and only worked alone when I felt comfortable. The atmosphere is a lot better now under the new management and they have a more positive approach to training. The quality assurance managers are really helpful for my learning, and they have put on dementia and drug and alcohol dependency training.”

We observed staff supporting people safely and treating them with compassion and kindness.

Staff had not always received their required refresher training. While this was discussed in one-to-one meetings with the staff affected, training was not then completed in a timely way. When we told the provider about this, they put a plan in place to ensure this training was completed. We discussed with the provider the need to ensure staff had received specific training to enable them to communicate effectively with people with additional communication needs. There were enough staff on duty to meet people's needs. The provider used a dependency tool to calculate the numbers of staff they needed. Staff were safely recruited. New staff were subject to pre-employment checks such as reviewing their education and employment history, references from previous employers and Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. This information helps employers make safer recruitment decisions. The provider undertook checks on new staff before they started work. This included checking their identity, their eligibility to work in the UK, obtaining at least two references from previous employers. Risk assessments were in place where the provider was not able to obtain two references. Team meetings, one to one meetings and daily handovers were in place to support staff to provide safe care to people.

People told us they lived in a clean environment and there had been improvements in the décor.

Staff had received infection control and food safety and hygiene training and wore personal protective equipment (PPE) where required. The management team told us they employed a domestics worker in the week and care staff covered cleaning tasks in the evenings and at the weekend.

We observed staff using appropriate personal protective equipment when preparing food and drinks and when supporting people with their medications. A domestics worker was completing cleaning tasks during our onsite visits and the environment appeared clean and tidy in people’s rooms and communal areas.

Systems in place to minimise the risk of spreading infection were not always effective. We identified refrigerated food items were not labelled with opened dates. Although we found no evidence people had been harmed, people had been at risk of eating unsafe foods. When we told the management team about this, they discarded the items straight away and added a check to the IPC audits carried out by the manager. Where issues were found during health and safety audits, these were resolved by the provider. For example, issues with incorrect temperature readings found in food safety audits resulted in refrigerator and freezer thermometers being replaced. Where water safety checks identified water temperature concerns, Thermostatic Mixing Valves (TMVs) were installed. Legionella assessments were carried out in line with requirements and remedial action was taken where required. Staff were provided with appropriate personal protective equipment and had received training to support with minimising the risk of infection. There was an up-to-date infection prevention control policy in place.

People told us staff supported them to take their medication safely. One person told us, “Staff have been really helpful. I have had some issues with my antibiotics and staff arranged for them to be changed. Staff are really good at making sure I get my pain medication when I need it.” Another person told us, “Staff support me with my medications and explain what they are giving me.” Another person told us, “Staff give me my medication at the moment, but we are working towards me becoming more independent with this.”

Staff told us they had received medicines training and people received their medicines safely. One staff member told us, “We now have consistent procedures to ensure people receive their medication safely. We have really improved in how we give medication, with recording and storing them.” Another staff member told us, “I do my medication training annually. We cover everything regarding medication, and I am up to date.”

Although improvements had been made with how the provider received, stored, administered and recorded medicines, further improvements were required. While the medicines policy included information about the safe refrigerated medicines temperature range, this information was not included on the monitoring log used by staff. Not all staff knew the correct refrigerator temperature range and some records indicated the temperature had fallen below the recommended range. This meant we were not assured issues would be escalated when required. However, when we told the management team about this, they responded straight away by updating their monitoring log to include information about the safe temperature range and discussed this with staff. Medicine Administration Records [MAR] were completed. The provider carried out audits to ensure there were no mistakes. Staff involved in handling medicines had received medicines training. At the time of our assessment, the medicines policy was being reviewed by the provider.