Archived: Grove House

Grove House is a ‘care home’. Grove House accommodates 63 people. The service is accredited for intermediate care people who are funded by the NHS. At the time of the inspection 27 people lived at the service, across three separate units, each of which had separate adapted facilities. One of the units specialises in providing care to people living with dementia.

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

People’s relatives told us there were enough staff available to help when needed. Comments included, “There always seems to be sufficient staff when I visit” and “Staff are always available to support my relative, they are very attentive to their care and support needs”. Staff were available to promptly assist people throughout our inspection and staffing levels were regularly monitored, reviewed and amended when needed by the registered manager.

People’s relatives told us the home was a safe place to live. One person commented, “My relative is very happy and I can tell [relative] looks well-groomed and well. They work well with [relative] and manage risks as well. They really invest their time to make sure [relatives] quality of life is good”. Staff had received safeguarding training and understood their role in recognising and reporting safeguarding concerns.

We observed a helpful, caring and attentive culture amongst staff at the home. Staff were familiar with the people they were supporting and had a good rapport with them.

Relatives told us they had communication with staff at the home and staff helped them to keep in touch with their loved ones whilst COVID-19 visiting restrictions have been in place. One relative commented, “We' are able to communicate through video calls and we have had window visits too. [Relative] has dementia but for me it’s useful, [relative] is always clean and looks well”.

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 24 January 2020).

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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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 coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Grove House is a nursing home that providing accommodation and nursing, personal for up to 63 older people, some of whom are living with dementia. The service is accredited for intermediate care people who are funded by the NHS. The service is provided by Four Seasons (JB) Limited. At the time of the inspection 60 people lived at the service.

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

People living at Grove House and their relatives told us that their experience of using the service was overall very positive and very caring. People consistently told us how they were treated with kindness, compassion and respect. They had mixed comments about meals and activities provided. Staff and visitors noted improvements to the service since the manager commenced in post.

Quality assurance processes were regularly carried out to show actions and improvements to the service since the new manager commenced in post. However quality assurance systems needed further improvements with record keeping, development of the environment and management of meals. This was a breach of regulations for good governance.

The home was clean and staff used appropriate techniques to prevent the spread of infection. Some areas of maintenance were noted, such as windows were misted and some broken and in need of repair.

We have made a recommendation regarding the environment.

People were supported with various activities including occasional trips out, visiting entertainers and in-house activities such as bingo and various other games.

Care plans and risk assessments were in place and generally contained the correct level of information in relation to the support people needed. However, some areas within the records needed improving, especially for pressure area care and supporting people socially.

Staff received appropriate training and were knowledgeable about how to protect people from abuse. Staff felt supported and listened to. However, records needed updating to show improved record keeping for managing people's supervision and appraisals.

People could express their views in a variety of ways. Regular meetings were held, annual surveys were carried out and there was a complaints procedure in place. We saw that complaints had been recorded and responded to in line with this policy.

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. 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

The last rating for this service was ‘requires improvement’ (published June 2019.) 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 improvements had been made and the provider was no longer in breach of regulation 12 but were in breach of regulation 17.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in relation to 'good governance' at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.

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.

The infection control practices carried out by staff were effective and there was monitoring of the infection control and cleaning practices at the home.

People's experience of using this service:

Medicines were not managed safely, and our findings were that the medication procedures were not monitored effectively.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions. However, no information about how to safely administer medicines covertly had not been obtained from a pharmacist or other reliable sources.

Relatives told us they thought they received safe care. Staff were knowledgeable about safeguarding procedures and how to raise any concerns they had. Risks to people had been assessed and measures put in place to reduce these risks. We found that actions were taking place by staff or monitored by the management team.

Feedback from relatives was predominately good. They told us staffing levels were mainly good but at times more staff were required. All said they thought their relatives were receiving good respectful care and their needs were met. All six relatives told us that they were happy with the care.

There were vacancies at the home that were being advertised. We saw sufficient numbers of staff on duty on the two days of the inspection. Safe recruitment practices had been followed, and all records required were in place. The provider did not use agency staff a new initiative had been introduced for staff to work overtime to provide continuity to the people living at Grove House.

The food served at the home was of an adequate standard except for the special diets that were liquidised and did not look appetising. Relatives we spoke with told us that they thought the food was plentiful and good quality. People's nutritional needs were known by staff; however, records of food supplements were not completed, and we were unsure of quantities provided.

The building was in the process of having a refurbishment with an action plan being provided. Works had taken place that was observed to be in a good state of repair and people and relatives told us they were comfortable. The décor was conducive for people living with dementia and had been decorated so as not to look the same in areas so people walking down corridors could recognise their doors.

The service worked with other professionals and agencies to help ensure people's needs were met effectively. Advice provided was clearly recorded however at times they were not being followed by staff.

We looked at the systems to gather feedback from people regarding the service and there were completed satisfaction survey audits that informed outcomes and actions taken. The feedback was positive. The systems in place for audits and management oversight were in place however there were issues where we found the medication audits did not reflect our findings and they were not effectively addressed.

Rating at last inspection: We inspected this service on 31 October and 1 November 2018 and 20 December 2018, published on 24 January 2019. We found that the service had changed to requires improvement. We found breaches of the regulations concerning people's dignity, their safe care and treatment and the governance of the home.

Why we inspected: scheduled/planned inspection based on previous rating of Requires Improvement. We received an improvement plan required from the last inspection. We had received concerning information in relation to staffing levels not being sufficient to meet the care needs of the people living there. We looked at staffing levels as part of this comprehensive inspection.

Enforcement: The service met the characteristics of Inadequate in one key question of safe. And repeated requires improvement in effective, and well-led. More information will be in the main report.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme.

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

Grove House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Grove House is a purpose-built care home over three floors. It is registered to provide care to up to 63 people. At the time of our inspection there were 57 people living in the home. The ground floor was for people who are elderly and who had general nursing needs and the top floor was for people with dementia. The middle or first floor had been designated for intermediate care patients who were funded by the NHS.

Grove House requires a registered manager. 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 service had a registered manager who had been in post for three months at the time of our inspection.

The systems and processes around medication administration require improvement as record-keeping showed that there were omissions and inconsistencies. Skin integrity checks had not been completed and referrals to the falls team had not been done. There was a lack of information about infection control.

People who lived in the home were able to receive appropriate healthcare services. Medication records were poorly recorded and lacked detail. We were concerned that people's privacy and dignity were not enabled sufficiently. Most people’s privacy and dignity were respected; however we did find that some staff entered their rooms without knocking or calling out and some people told us that clothes either got mixed up or went missing and sent to the laundry and that they sometimes had to wear other people’s clothes.

The care records in many cases were incomplete and inaccurate and did not show that the care was person centred. It was not clear from the records that people’s assessed needs and choices had been met although most people we talked with told us that they were happy with their care. We found that risk assessments lacked detail and were not up to date. However, people told us that staff treated them as individuals. Staff were clear that they knew how to care about each person and showed us how they found out about them.

We found that the quality assurance processes in the home had not identified the issues we found and were not sufficiently robust. Confidential records were not always stored securely.

Consent to care and treatment was carried out in line with legislation.

People told us that staff treated them well and with kindness and compassion. People told us that they had been asked about their views on the service. It was not clear from the records that they had had an active involvement in making decisions about their care and treatment.

People told us they felt safe and we saw that robust recruitment procedures had been followed and that there appeared to be sufficient staff on duty. There was a safeguarding policy and staff had been trained in how to raise concerns about safeguarding.

We saw that the registered manager had made improvements to various systems since they had been in post and had plans to further improve many aspects of the service.

Most people did not know how to formally complain and there was minimal information available for them apart from notices on two noticeboards and in a general brochure. People did say that if they had any issues they would go to a senior member of staff and that it would be resolved.

Although the home was accredited by the nationally recognised, end of life program called ‘six steps’, very recent evidence of the records of the deceased person showed that the programme had not been followed properly.

The building was purpose-built and the service had recently begun a refurbishment programme. However, the colour schemes were mainly neutral and the signage was poor. We discussed the best practice outlined in various dementia environment studies with the registered manager and have made a recommendation about this.

Staff worked well with other health and social care teams to deliver effective care, support and treatment and this was particularly evident in the intermediate care unit.

The new registered manager had a clear vision and had developed a strategy to develop the service, support and train the staff and promote a positive, inclusive and person-centred service. This process was at the beginning and further work needed to be done in order to achieve and fully implement this.

The registered manager was clear about their role and the legal requirements of the registered person and a registered service. They demonstrated that they worked in partnership with the provider and other agencies to improve the care and support of people who lived at Grove House and were clear in their aims and objectives.

You can see what action we told the provider to take at the back of the full version of the report.

The service is registered to provide accommodation and nursing or personal care for up to 63 people.

The service was divided into floors, with general nursing on the ground floor, intermediate care on the first floor and dementia care on the second floor. At the time of our inspection, there were 39 people residing as permanent residents and 22 people who were in intermediate care (IMC). IMC beds are funded by the local NHS trust and social services for periods of up to six weeks post discharge from hospital. The aim was to support people who no longer required acute hospital support and people were accommodated in the home to enable their ongoing rehabilitation and to enable people to return to their own homes safely.

This was the first inspection of the service since it had changed its legal entity, more usually known as ‘the provider’. The service provided a predominantly nursing care service, with a specialist dementia care unit as well as the IMC unit.

The service required a registered manager. 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 registered manager had been in post for two years.

There were enough qualified and experienced staff to meet people’s needs and keep them safe. Where there were shortfalls, the home used their own bank staff and their permanent staff to cover the shortfall. The required checks had been carried out when new staff were recruited. Staff were trained and knew how to report concerns about care, safeguarding adults and also knew about the homes policies, procedures and how to ‘whistle-blow’.

We found that the home was clean and well maintained and records we looked at showed that the required health and safety checks were carried out. Medicines were managed safely and records confirmed that people always received the medication prescribed by their doctor.

Where appropriate, applications had been made to the local authority for Deprivation of Liberty Safeguards. People were happy with their meals and choices were always available.

The members of staff we spoke with had good knowledge of the support needs of the people who lived at the home. The staff we met had a cheerful, pleasant and caring manner and they treated people with respect and ensured their dignity. The relatives we spoke with expressed their satisfaction with the care provided.

People were registered with local GP practices and had visits from health practitioners as needed. The care plans we looked at gave information about people’s care needs and how their needs were met.

We found that there was a friendly, open and inclusive culture in the home. Staff expressed some concerns to us which we discussed with the registered manager. The registered manager told us that they knew about these concerns and that they were being addressed. We saw evidence to support this.

People we met during our visits spoke highly of the registered manager and the staff. Staff told us that the registered manager was approachable and supportive. Some staff had some issues with certain aspects of the home, such as the hot water system. Regular quality audits were completed and these identified where improvements were needed and who should do them and by what date.