The Grove Care Home is registered with the Care Quality Commission (CQC) to provide care and accommodation for a maximum of 52 older people, some of whom may be living with dementia. Accommodation is provided over two floors and all rooms have en-suite toilet facilities; some rooms have a small kitchen so people can make themselves drinks and snacks. At the time of this inspection, there were 44 people using the service.We undertook this unannounced inspection on the 24 and 26 October 2017. We last inspected the service on 1 and 2 December 2016 and found the provider was meeting the fundamental standards of relevant regulations. At that time, we rated The Grove Care Home as ‘Good’ overall and ‘Good’ in four out of the five key questions; we rated the well-led key question ‘Requires Improvement’ to ensure the improvements found during that inspection were sustained over time. We carried out this inspection in response to recent complaints and concerns that local commissioners had raised following their visit. During our inspection on 24 and 26 October, we identified shortfalls throughout the service and breaches of regulations.
The service had 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.
The provider's systems to assess, monitor and improve the quality of the service provided had not been effective in identifying and addressing all the issues highlighted during our inspection or consistently driving improvements in line with their own action plans. This lack of robust quality monitoring meant there was inconsistency in how well the service was managed and led. Following the inspection, we were given assurance that additional resources and senior management support were provided to the registered manager to address the improvements needed at the service.
There were shortfalls in the administration and recording of some people’s medicines. We also found one person’s medicines had been out of stock for a period of time. There was limited guidance for staff around the use of ‘as needed’ medicines, to ensure consistent administration.
We found shortfalls with the standards of hygiene in areas of the home. There was a strong stale odour in the lounge and we also found items of furniture and equipment which were damaged and could not be cleaned effectively.
The training, supervision and support provided to staff were inconsistent and did not ensure they were confident and competent in their role.
We saw people had assessments of their needs prior to admission to the service and staff completed risk assessments and care plans. Whilst some of these were person-centred and tailored to people’s individual needs, others lacked important information. This meant staff may not have full and up to date information about people’s needs.
We found some people’s risk assessments had not been completed or updated if their needs had changed. We found gaps in the risk management of some areas of the environment. Staff had not always followed the provider’s incident reporting procedures and the registered manager completed three notifications retrospectively.
Some redecoration had taken place but we also observed areas of the service were looking tired and in need of refreshing. Improvements could be made with providing a more dementia-friendly environment. Although there was no renewal programme in place, the registered manager gave assurances that the home was scheduled for refurbishment early in 2018.
Staff had knowledge of safeguarding procedures and were aware of their responsibilities for reporting any concerns. The local safeguarding team had directed the registered manager to complete investigations into four complaints about standards of care; we will report on this at the next inspection.
We received a mixed response from people who used the service and relatives about staffing levels. Staff considered the staffing numbers were satisfactory overall, but improvements were needed with the management of short notice sickness and the staff allocation systems. We observed times when people were not supervised appropriately and staff were not visible. We have made a recommendation that the provider reviews the deployment and supervision of staff on shifts.
We found staff ensured they gained consent from people prior to completing care tasks. They worked within mental capacity legislation when people were assessed as not having capacity to make their own decisions.
Suitable recruitment procedures were in place to ensure staff employed to work at the home were safe working with vulnerable people.
A range of activities were provided and people told us they enjoyed these. However, people also told us they wanted more opportunities to go out. Relatives told us they could visit at any time and we saw staff supported people who used the service to maintain relationships with their family.
People praised the staff and we observed some kind and caring interactions between staff and people who used the service. However, we also saw occasions where staff practice compromised people's privacy and dignity. The registered manager took action to address these shortfalls.
Staff completed assessments of people’s nutritional needs and monitored their weight. They referred people to dieticians when required. We saw the menus provided people with a choice of nutritious meals and people told us they liked the meals provided to them. Although we observed people were served drinks and offered a biscuit, we have made a recommendation to improve people’s accessibility to drinks in the lounges and the range of snacks offered between meals.
People’s healthcare needs were met. People told us they had access to their GP, dentist, chiropodist and optician should they need it. The service kept records about healthcare visits and appointments.
People told us they had no complaints but would feel comfortable speaking to staff if they had any concerns. We saw the complaints policy was readily available to people who used or visited the service. There were systems in place to enable people to share their opinion of the service provided and the general facilities at the home.
We identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which related to safe care and treatment, staff training and supervision, providing personalised care and having good governance systems in place. You can see what action we told the registered provider to take at the back of the full version of the report.