The Grove

The Grove is a residential care home providing personal and nursing care for up to 38 people. At the time of the inspection the service was supporting 31 people. The service occupies a detached building with a lift to access upper floors.

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

We last inspected the service in December 2021. At that time, we noted improvements were being made by the provider. However, several recommendations were made where further improvements were required, and the rating remained requires improvement in Safe and Well led. At this inspection the service had taken action to meet the recommendations.

Visiting healthcare professionals told us they had seen recent improvements in the service provided. They told us, “They take advice and carry out any care required. We have no concerns” and “Things are definitely much better. They always email us if they are concerned about anything in a timely manner.”

There were enough permanent and agency staff on duty and rotas showed staffing levels were adequate. People and staff confirmed that staffing had been a challenge during a recent Covid-19 outbreak but the dependency on agency staff had reduced and recruitment was going well. Staff confirmed there were generally enough staff available to support people living at the service and to meet their individual needs.

There were walkie-talkie handsets in place to support staff to communicate when working throughout the service. There were still occasions when handsets were either not working or not being used by some staff. This was being closely monitored by the manager and office manager. The provider acknowledged this issue at the last inspection and told us they were looking at replacing the current system with a more reliable one. This had not yet taken place. We have made a recommendation about this in the well led section of this report.

The service had completed moving people’s paper care plans to an electronic care planning system. This had improved how people’s needs, risks and reviews were recorded. Whilst not all staff had completed specific formal training on line to use the new electronic system, we were assured that all staff were using it to some extent at the time of this inspection.

Handover records had improved and contained information on people’s health conditions and needs. This included where people needed their nutrition and fluids monitored.

People received their medicines as prescribed. Paper medicine administration records were being used. There were regular checks and audits of aspects of medicines management and this monitoring was identifying further improvements which were being implemented.

People were relaxed and comfortable with staff and had no hesitation in asking for help from them. Staff were caring and responded to calls for support from people in a timely manner.

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

Accidents and incidents were recorded and monitored. Regular audits of these records showed the service had taken action to support people where patterns and trends were evident.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately. Staff were informed about people’s changing needs through shift handovers and records of the care provided for people.

People told us they felt safe and happy living at The Grove. Comments included, "Everything is really fine now," "I tell the (staff) if there is anything wrong, and they sort it all out” and “We looked at a lot of places before I came here and we knew immediately that this was the one, and I am very happy here. The food is good and I am fussy, but I always have something to eat that I like offered to me.”

Staff morale had improved and they were happy working at the service. Staff told us, “I left when things were bad last year but as soon as I heard things had improved so much I came back. Several of us did this,” “It is so much better now. I love it here” and “The manager and the office manager are amazing they have really made a difference here.”

The service had found it challenging to recruit to a vacant chef post. People told us they had been aware of changes in the kitchen staff and some said changes in the quality of meals had been noticed. However, the manager assured us that a new chef was about to commence work in the coming weeks.

The service had just come to the end of their first outbreak of Covid-19 since the pandemic began. We were assured that risks in relation to the Covid-19 pandemic had been managed appropriately. Staff had access to appropriate PPE and hand washing facilities, which they used effectively and safely. The service was following current guidance regarding testing and visiting arrangements.

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 required improvement (Published 13 November 2021) At this inspection the service rating has improved to good.

Why we inspected

This focused inspection was to follow up on recommendations made at our last inspection and only covers our findings in relation to the key questions Safe, Effective and Well-led.

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.

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 improved to good. 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 The Grove on our website at www.cqc.org.uk.

The Grove is a residential care home providing personal and nursing care for up to 38 people. At the time of the inspection the service was supporting 25 people. The service is in one building and equipped with facilities to support people who require residential care.

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

We last inspected the service in July 2021. At that time, we had concerns regarding the management of the service and the service was rated overall Requires Improvement and Inadequate in Well Led.

Since that inspection the management status had improved. A new manager commenced shortly after the previous inspection. The manager was supported by an office manager and the provider visited the service weekly. The Provider is required to ensure there is a manager registered with the Care Quality Commission (CQC) who is in day to day control of the service. The provider had recruited to this post in August 2021. The manager told us they were at the point of submitting an application to register with the commission.

At the previous inspection, systems to monitor the operation and governance of the service were judged inadequate. At this inspection we found systems to assess and monitor the quality and safety of the care provided had been developed and implemented. While we saw evidence that governance was improving, we have made recommendations in respect of improving audits, providing effective communication handsets and ensuring the staff culture continues to develop. These systems were seen to be improving the quality and identifying and driving improvement.

We found there were enough permanent and agency staff on duty and rotas showed staffing levels were adequate. However, staff told us there were times when people did not receive the care and support at the times they wanted it. Staffing rotas assured us there were generally enough staff available to support people living at the service and to meet their individual needs. The provider acknowledged there were occasions when staff absence was short notice, and this had the potential to affect service provision.

There were walkie-talkie handsets in place to support staff to communicate when working on the various floors around the home. However, staff told us there were not enough handheld sets and that constantly changing batteries had posed some restrictions. The provider acknowledged this issue and was looking at replacing the current system with a more reliable one. We have made a recommendation about this.

The service had recently introduced an electronic care planning system. This had improved how people’s needs, risks and reviews were recorded and demonstrated how care and support was being delivered. However, there were some gaps in the records due to the transition from paper to electronic recording. We judged this had not had a negative impact on people’s welfare and managers were aware of the issues and addressing it.

Staff knew people well and there had been no impact on the support people received. Handover records contained information on people’s health conditions or needs. However, where people needed their nutrition and fluids monitored it was not included. We have made a recommendation about this.

At previous inspections we found medicines records were not in place or consistently completed. At this inspection we found improvements in medicines management but there was further improvement to medicines records needed and we have made a recommendation about this.

People were relaxed and comfortable with staff and had no hesitation in asking for help from them. Staff were caring and responded to calls for help from people in a timely manner. Staff knew how to keep people safe from harm. We found the service calmer and more relaxed than at previous inspections.

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

At the previous two inspections we identified the service was not monitoring reports of accidents or incidents in order to identify any trends or patterns. At this inspection we found improvements in how accidents and incidents were reported. There was evidence the service reflected and learnt from incidents when things go wrong. Regular audits of these records showed the service had taken action to support people where patterns and trends were evident.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately. Staff were informed about people’s changing needs through shift handovers and records of the daily care provided for people. However, care staff told us on the day of the inspection the handover had been earlier than normal, and they had missed it. They told us this was not a normal occurrence. We advised the manager about this and they agreed to take immediate action.

There were mixed views on meals. Some people told us they thought the meals could be improved. We shared this with the manager who was aware of some of the issues and was in the process if taking action to address it.

We were assured that risks in relation to the COVID pandemic had been managed appropriately. Staff had access to appropriate PPE and hand washing facilities, which they used effectively and safely.

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 13 November 2021) The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We carried out an unannounced inspection of this service on 20 July 2021. Breaches of legal requirements were found. We undertook this focused inspection to check they 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.

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.

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 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 reports’ link for The Grove on our website at www.cqc.org.uk.

The Grove is a residential care home providing personal and nursing care for up to 38 people. At the time of the inspection the service was supporting 26 people.

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

We last inspected the service in May 2021. At that time, we had concerns regarding the management of the service and the service was rated Requires Improvement. Since that time the management situation has not improved. Before the inspection we were aware the previous interim manager had left. An office manager was in post at the inspection. They had made improvement in some of the administrative systems. Since 2016 the service had not always met regulatory requirements. At the last inspection we identified checks and monitoring had not always been completed. At this inspection we found no improvement. Systems and processes were being frequently changed and not effectively implemented, embedded or monitored. This demonstrated governance systems were not effective.

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There remained a requirement for the service to have a registered manager as part of a condition of registration. An interim manager commenced employment at The Grove shortly after the site inspection.

At the previous inspection staff told us they felt communication was not effective. At this inspection we found no improvement. Communication between people, staff and families was not effective. People and staff had approached CQC and the local authority with their concerns as they felt they were ‘not heard’ by management.

At the last inspection we found medicines records were not in place or consistently completed. At this inspection we found further deterioration in medicines management. There was no oversight, checks or audits in place. Records of medicines were not always recorded as required. Records showed gaps, so it was not possible to evidence if people had been given their medicines.

At the previous inspection we found risks were not always assessed and monitored. At this inspection there had been no improvement. Care plans and risk assessment information was not up to date. There had been no reviews of people needs for some time. Some people’s needs had changed. This meant staff did not have an up to date record in order to respond to people’s current needs. However, staff knew people well and there had been no impact on the support people received. Agency staff had limited knowledge of people’s needs. Handover records did not contain any detail of people’s health conditions or needs.

At the previous inspection we identified the service was not monitoring reports of accidents or incidents in order to identify any trends or patterns. No improvement had been made during this inspection. There was no evidence the service reflected and learnt from issues and incidents when things go wrong. When things went wrong reviews and investigations were not sufficiently thorough.

The provider remained under the local authority’s whole home safeguarding procedures due to the high number of alerts made over recent months. The commission had also been made aware of some of the concerns raised through safeguarding. Some of these were being investigated at the time of the inspection. The management team were cooperating with the safeguarding team, quality assurance team and CQC to investigate these concerns.

There had been significant changes in the staff team in recent months. There was currently a heavy reliance on agency staff. We observed staff supporting people in a task centred way rather than person centred, this was due to staffing levels and agency staff not being familiar with people using the service. Staff told us they were ‘rushed’ most of the time. Other staff told us things were getting better because they had a new staff roster which meant they had a regular shift pattern. There was no evidence of staffing levels impacting people’s safety.

The service was not ensuring satisfactory recruitment checks were in place to ensure staff were recruited safely. Files requested could not be located. Gaps in employment not explained or followed up. References from previous employees were not always followed up.

The service was not always following its own guidance for COVID-19. A checklist at the entrance instructed staff to take visitors temperatures when entering the home. On arrival we were asked for evidence of a negative Lateral Flow Test (LFT), we did not receive a temperature check.

Most people we spoke with were satisfied with the measures being taken when visiting their relatives. People told us they had LFT tests and waiting for the result before being allowed their pre booked visit to their family member. However, one person told us they had not always been asked to wait for the result before visiting in the external rooms the home provides. We have reminded the provider of the necessity of ensuring all visitors receiving a negative test before they visit their family member.

At the previous inspection we found cleaning checklists had not always been completed. At this inspection we were assured checklists had been reviewed and were consistently completed by the housekeeper.

At the previous inspection the provider could not provide evidence to demonstrate fire, legionella and equipment checks were being done. At this inspection we saw evidence these checks had been carried out. Work to meet fire regulations was continuing.

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 22 June 2021) and there was a breach of regulation. The provider was asked to complete an action plan after the last inspection to show what they would do and by when to improve. We did not receive the action plan prior to this inspection. At this inspection enough improvement had not been made and the provider was still in breach of regulations. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We received concerns in relation to staffing and the quality of care people received. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 and Well Led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to infection control, good governance and staff training 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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Grove is a residential care home providing personal and nursing care for up to 38 people. At the time of the inspection the service was supporting 27 people.

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

Risks to people were not always assessed or monitored. Health and safety checks of the environment and equipment had not been consistently completed. Medicines management records were not all in place or completed consistently.

There was no registered manager in post and there had been a lack of consistent leadership in the service. The provider had not been able to visit the service throughout the pandemic. Checks and monitoring of the service had not always been completed or identified areas for improvement. The lack of effective oversight of staff and the service had resulted in the quality of the service deteriorating.

Relatives and staff told us the communication from the service was not effective and had caused anxiety.

People told us they felt safe living in the service. Staff confirmed they understood how to recognise abuse and would feel confident reporting any concerns they had. Recruitment checks were completed before staff were able to start working in the service.

We were assured the service was taking action to reduce the risk of cross infection.

People told us they were happy living in the service. The deputy manager had started holding residents and team meeting to help ensure people’s concerns and ideas were heard, and staff understood their responsibilities.

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 20 November 2019).

Why we inspected

We received concerns in relation to staffing and the quality of care people received. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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.

The overall rating for the service has changed from Good to Requires improvement. This is based on the findings at this inspection.

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

You can see what action we have asked the provider to take at the end of this full report.

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

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.

We have identified breaches in relation to how risks to people were understood and recorded, health and safety checks of the environment, medicines and how the provider monitored the quality of the service and implemented learning to improve the service.

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

Follow up

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.

The Grove provides accommodation with personal care for up 38 people. There were 33 predominantly older people using the service at the time of our inspection.

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

People told us they felt safe being supported by staff. Staff understood risks to people and how to help reduce them.

People received their medicines on time from staff who had received training in medicines administration. Medicines were ordered, stored, and disposed of appropriately.

Staff were recruited safely in sufficient numbers to ensure people’s needs were met.

People were supported by staff who had the skills and knowledge to meet their needs.

Staff had received appropriate training and support to enable them to carry out their role safely. Some staff required updates to their training and this was being arranged. Staff meetings were used to remind staff of best practice and to discuss any concerns about people’s needs. Staff told us they felt well-supported by senior staff and the manager.

People told us, “If you have to live in one of these places then this is probably the best one” and “I feel perfectly safe and happy here.”

Relatives told us, “Absolutely fantastic, we are really delighted with the new leadership team. They (The manager and the head of care) are so honest and open and so hardworking,” “I cannot think of a single thing I would change, I would love to live here myself” and “It is all lovely.”

Where concerns had been identified, staff recorded people’s food and drink intake. However, there was not always evidence these records had been monitored or totalled. We have made a recommendation about this in the effective section of this report.

There were systems and processes in place to monitor the Mental Capacity Act, and associated Deprivation of Liberty Safeguards assessments and records. People were able to make choices about their life and how their care and support were provided. This information was reflected in people’s care plans. Staff understood the importance of respecting people’s wishes and choices.

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. Any restrictive practices were regularly reviewed to ensure they remained the least restrictive option and were proportionate and necessary.

The staff had not always effectively recorded when people had appointed specific lasting powers of attorney to act on their behalf when they were not able to make their own decisions. We have made a recommendation about this in the effective section of this report.

Everyone had a care plan which was regularly reviewed and updated. These provided staff with guidance and direction to enable them to meet people’s needs, their wishes and preferences.

People were provided with the equipment they had been assessed as needing to meet their needs. For example, pressure relieving mattresses. These were correctly set for the person using them.

There were activities provided for people. The activity co-ordinator planned both morning and afternoon activities in groups and on a one to one basis. People were supported to access the local area.

People felt cared for by staff. Staff spoke about people with affection and empathy. Staff respected people’s diverse characteristics and were clear that each person’s individual needs were their priority. People told us they felt listened to and their privacy and dignity were respected.

Robust audits were regularly carried out to monitor the service provided. Actions from these audits were being acted upon to further improve the service.

Complaints were recorded, and responses were seen. The manager recorded all issues raised and showed us that all were resolved at the time of this inspection.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately.

People, staff, relatives and healthcare professionals told us the service was well led. Everyone we spoke with were positive about the new manager and the impact they, and the head of care have had on the service provided at The Grove.

People were given various opportunities to provide feedback about the service. The manager and senior staff had developed positive relationships with local organisations, which helped ensure people had their needs met promptly. Staff told us they enjoyed working at the service and that the team worked well together.

Visiting healthcare professionals told us, “This is one of the better homes in the area. We have no concerns about the care here,” “Staff call us when necessary and are vigilant about any changes in people’s needs” and “I have seen great improvement in a person’s ankle, they [Staff] have followed my instructions well and it has improved greatly" and "It is good here, always staff around, they are knowledgeable and friendly."

Rating at last inspection and update:

At the last inspection the service was rated as requires improvement (report published 15 February 2019) We issued a requirement notice. This focused inspection was carried out to review enforcement action taken following the previous comprehensive inspection (report published 7 November 2018) The inspection was again rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

We met with the provider following the last report being published to discuss how they would make changes to ensure they improve their rating to at least good. The provider agreed to send us regular updates on an action plan they produced, to show what they had done 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 scheduled inspection to review the action taken by the provider following our previous inspection.

Follow up: We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

After the comprehensive inspection the registered provider wrote to us to say what they would do to meet the legal requirements in relation to the breaches. As a result, we undertook a focused inspection on the 29 January 2019 to check they had followed their plan and to confirm they now met legal requirements.

We checked on if the service was Safe and Responsive. This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Grove on our website at www.cqc.org.uk. The Grove has been rated overall Requires Improvement for a third time due to the repeated breach of the regulations found at this inspection. We will review The Grove again at our next scheduled comprehensive inspection.

The Grove is a care home which offers care and support for up to 38 predominantly older people. At the time of the inspection there were 34 people living at the service. Some of these people were living with dementia. The service occupies a detached house over three floors with a lift for access.

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.

The service had identified the minimum numbers of staff required to meet people’s needs and these were being met. The registered manager had added one additional member of staff to the day shift to allow for staff to have more time to meet people’s needs. One person told us, "Its a lot better now they got over a staff shortage."

Robust systems were now in place for the management and administration of medicines. The medicines audit template had been reviewed and the audits were now effectively identifying if any error occurred. Handwritten entries on medicine records were all signed by two people according to their policy. People who self-administered their medicines were regularly assessed and monitored. The storage of medicines in people’s rooms was now secure. Pain relieving patches were applied in accordance with manufacturers guidance and this helped reduce the risk of unnecessary side effects. Creams and liquids were dated when opened.

Falls and nutritional risk assessments had been reviewed and updated appropriately.

The care plans were very large and contained a great deal of historical information which could be confusing and meant it was not always easy to find current accurate information. As we had identified in past inspections there were still discrepancies in what some care plans stated and the care and support staff were providing. At the time of the inspection, we asked the provider to take immediate action to update two care plans to ensure guidance was clear and accurate for staff to follow.

This was a continued breach of Regulation 17 the Health and Social Care Act 2008 (Regulated Activities) 2014 remained. You can see the action we have told the provider to take at the end of this report.

People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

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 and associated Regulations about how the service is run. The service is required to have a registered manager and at the time of the inspection there was a registered manager in post.

This unannounced comprehensive inspection took place on 11 and 12 October 2018. The last inspection took place on 14 and 15 November 2017 when the service was not meeting the legal requirements. The service was rated as Requires Improvement at that time. There were concerns with the quality of the records held at The Grove. Staff did not always record the care provided and care plans did not always provide staff with the direction and guidance to meet people’s needs. There was no regular auditing of the records completed by staff relating to the care and support provided to some people. Information relating to the evacuation needs of people living at the service in the event of a fire was not up to date. Records held relating to the stock of medicines held at The Grove, that required stricter controls, were not accurate. There were no audits being carried out of medicine administration and management which would have identified the concerns found.

Following the November 2017 inspection the registered manager sent in an action plan to state what action they were taking to address the concerns identified. This inspection was carried out to assess what improvement had been made to address these issues at The Grove. However, we have again identified a number of similar failings at this inspection and the service has again been rated as Requires Improvement.

Improvements were identified at this inspection. The registered manager had taken action regarding the staffing levels at specific times of the day, the quality of the records completed by staff and the monitoring of pressure relieving mattresses to ensure they were always set correctly for the person using it. The Personal Emergency Evacuation Plans (PEEPS) had been reviewed for each person, staff had received regular supervision and training was up to date.

However, some concerns identified in November 2017 remained a concern at this inspection. Medicine audits commenced since the last inspection were not robust. People received their medicines as prescribed. However, the system for monitoring people who self administered their own medicines was not always effective. Some creams and liquids had not been dated when opened. Staff were not following manufacturers guidance when applying pain relieving patches.

Care plans were in the process of changing to a new format. They were well organised and contained information to direct and guide staff. However, the guidance provided did not always match with the care and support people required, or that care staff were providing. This was a repeated concern from the last inspection. Records purported to demonstrate that care plans had been reviewed regularly, but we found that where people's needs had changed their care records had not been updated to reflect these changes.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy. However, such monitoring charts were not being robustly monitored to ensure people had the amount of food and drink they required. This was a repeated concern from the last inspection.

Quality assurance systems in place to monitor the standards of the care provided were not always robust. Audits carried out were not always robust. Concerns from the last inspection remained.

Risks in relation to people’s daily lives were identified. Some risk assessments had indicated further risk management was required, such as fall risk assessments. Falls risk assessments were not part of the new care plan format. This meant the opportunity to reduce the risk of falls, whilst helping people to be as independent as possible, may have been missed.

People who lived at The Grove were invited to meetings to put forward any ideas and views they may have. However, we saw that many of the suggestions made at the meetings in March and June 2018 had not been taken forward. Such as a questionnaire being circulated for people’s views on activities and food had not taken place. This is because the activity co-ordinator had been taken from their role to join the management team in the office. A new activity co-ordinator, who had not done this work before, had begun just before this inspection. People were supported to go out with staff, to attend appointments, have coffee or visit local attractions. However, plans to access a minibus to take groups of people out in to the local area had not taken place.

At the November 2017 inspection we identified that people's bedrooms displayed a number and a small name plate displaying their name in small print. This was not easy to read for people with poor sight and did not help people with dementia to find and recognise their own room independently. We found this concern had not been addressed at this inspection. Some people did not have their name on their bedroom doors.

We spent time in the communal areas of the service. Staff were kind and respectful in their approach. They knew people well and had an understanding of their needs and preferences. People were treated with kindness, compassion and respect. People told us, “I am very happy here, we are all spoilt” and “I have no worries at all here.” One relative told us, “My mother is very happy at The Grove, so I am happy, there is a lovely atmosphere there and it is always clean and fresh.” The service was comfortable and appeared clean with no odours. People’s bedrooms were personalised to reflect their individual tastes.

The premises were well maintained. There were people living at The Grove who were living with some early dementia and who may require additional support with recognising their surroundings. The service had clear pictorial signage to help people recognise bathrooms and toilets. The premises were regularly checked and maintained by the provider. Equipment and services used at The Grove were regularly checked by competent people to ensure they were safe to use.

The service had identified the minimum numbers of staff required to meet people’s needs and these were being met. The service had staff vacancies at the time of this inspection. The vacancies were being covered by regular use of agency staff until the posts could be recruited to.

Technology was used to help improve the delivery of effective care. Staff carried pagers so that they knew when people had called for assistance.

Staff were supported by a system of induction training, supervision and appraisals.

People were supported by staff who knew how to recognise abuse and how to respond to concerns. The service held appropriate policies to support staff with current guidance. Mandatory training was provided to all staff with regular updates provided. The registered manager had a record which provided them with an overview of staff training needs.

People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. The principles of the Deprivation of Liberty Safeguards were understood and applied correctly.

The registered manager was supported by the provider and a team of motivated and happy staff. The staff team felt valued and morale was good. Staff told us, “The manager is very supportive and we can approach her at any time” and “They (the management team) have been very good to me, when I have had a few problems.”

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The Grove is a care home which offers care and support for up to 38 predominantly older people. At the time of the inspection there were 31 people living at the service. Some of these people were living with dementia. The service is based in a detached house over three floors. There were two passenger lifts to support access to the upper floors.

The Grove was in the process of moving to a new electronic care plan system. All care plan information had been moved on to the electronic system at the time of this inspection. Staff and management had been provided with training in the use of this equipment. Paper based files were still in use during this transitional period. This was to ensure all information was available to staff. Some information on the electronic system was not yet entirely accurate and did not always give staff the correct direction and guidance needed to meet people’s needs. We reviewed the paper files in these instances. Staff did not always record the care provided accurately and appropriately.

The paper copies of care plans showed people, and where appropriate their relatives, signed to agree to the content of their care plans. The registered manager assured us that paper copies of care plans would continue to be provided for people to see and sign in agreement with the contents.

The hand held electronic devices for staff to input specific care provided, at the time it was delivered, into the electronic care planning system were not yet available due to a lack of wi-fi at the service. This was in the process of being addressed. Staff were recording the monitoring of people’s specific care needs on paper at the time of this inspection. For example, re-positioning and skin checks. These records were held in people’s bedrooms. There was no regular auditing of the records completed by staff relating to the care and support provided to some people. One person’s records contained regular gaps for up to six hours over the afternoon/early evening period for several days. There were inconsistent recording methods used by staff, which made it difficult to establish the current condition of a person. Staff were not always completing skin monitoring records correctly.

The information file available to the fire service containing the evacuation needs of people living at the service in the event of a fire was not up to date.

Whilst the administration and storage of medicines was safe, the records held relating to the stock of medicines held at The Grove, that required stricter controls, were not accurate. There were no audits being carried out of medicine administration and management which would have identified the concerns found at this inspection.

Risks in relation to people’s daily lives were identified, assessed and planned to minimise the risk of harm whilst helping people to be as independent as possible.

Staff were supported by a system of induction training, supervision and appraisals. The registered manager was in the process of creating a record to provide them with an overview of when staff required supervision and appraisals.

People were supported by staff who knew how to recognise abuse and how to respond to concerns. The service held appropriate policies to support staff with current guidance. Training was provided to all staff with regular updates provided. The registered manager had a record which provided them with an overview of staff training needs.

People were positive about the care and support they provided. They told us, “They (staff) are brilliant, very kind” and “I am very happy here everyone is nice and kind and the food is good.”

Staff meetings were held regularly. These allowed staff to air any concerns or suggestions they had regarding the running of the service. The service had identified the minimum numbers of staff required to meet people’s needs and these were being met. Call bell response times were being monitored by the management team. However, people told us staff were rushed at certain periods of the day.

People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005 (MCA). The principles of the Deprivation of Liberty Safeguards (DoLS) were understood but not always applied correctly. Capacity assessments had not always been carried out before DoLS applications were made, or bed rails and pressure mats put in use.The service had applied for some people to be assessed for an authorised restrictive care plan. There were no DoLS authorisations in place at the time of this inspection. People told us, “I can go out as I please” and “I am able to get up and go to my room when I want.”

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy, although these records were not always completed by staff for each meal, or checked to ensure people had sufficient food and drink. People told us the food was good.

The service was warm, comfortable and appeared clean with no unpleasant odours. The service was well maintained by two maintenance people who completed any faults in a timely manner. Bedrooms were personalised to reflect people’s individual tastes. People were treated with kindness, compassion and respect.

Some people living at The Grove were living with dementia and were independently mobile around the service. However, the service did not have clear pictorial signage to help people who need additional support recognising areas of the building such as the toilet and shower rooms. This was addressed at the time of the inspection. The registered manager confirmed that additional signage had been ordered to support people to be as independent as possible within the service.

People had access to activities. An activity co-ordinator was in post who arranged regular events for people. These included, household tasks such as folding napkins for the dining room, folding laundry, music and singing, visiting entertainments, animals visiting, manicures and shopping trips in the local area. People were supported to go outside in the service car to attend appointments, have coffee or visit local attractions.

The registered manager was supported by the provider through regular visits. There was a deputy manager and senior care staff who supported a team of motivated and committed staff. Staff were happy working at The Grove and told us they found the registered manager had brought about many positive improvements to the service since they were in post. Staff told us they could approach the manager at any time and were confident they would be listened to and their concerns would be addressed.

There was a breach of the Health and Social Care Act 2008 (Regulated Activities) 2014 regulations. You can see the action we have told the provider to take at the end of this report.

Members of the management team did not understand the most recent criteria in respect of assessing people who might be deprived of their liberty. Staff had not been provided with annual appraisals which provided an overview of performance and learning.

Following the comprehensive inspection the registered provider wrote to us to say what they would do to meet the legal requirements in relation to the breach. As a result we undertook a focused inspection on the 20 February 2017 to check they had followed their plan and to confirm they now met legal requirements.

This report only covers our findings in relation to the question ‘is the service effective?’ You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Grove on our website at www.cqc.org.uk

The Grove provides accommodation and personal care for up to 38 people. There were thirty three people using the service at the time of this inspection. The service is situated in its own extensive grounds, on the outskirts of Charlestown and close to the town of St Austell. The Grove is required to have a registered manager and there was one 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 service had taken action to improve training. The registered manager had increased the access to training for all levels of staff working at the service. Updates had taken place for moving and positioning, first aid and infection control. In addition training had taken place for safeguarding, mental capacity act (MCA) and dementia care. A training matrix had been developed and this document allowed managers to monitor the when it was due for updating. The registered manager had taken steps to carry out annual appraisals for all staff. Records showed it looked at all areas of performance and future development.

The management team and staff understood the principles of the Mental Capacity Act and what their responsibilities were for assessment and referral where restrictions were necessary for a person’s safety and well-being. Staff had undertaken training in this area and could clearly understand what restrictions meant and how they would be referred.

At this focused inspection we found the registered provider had taken effective action to meet the requirements of the regulations and the breach had been met.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were protected from the risk of infection because appropriate guidance had been followed.

People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.