We inspected Grove House on 5 December 2018. The service is a ‘care home’. 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.

Grove House is registered to provide personal care and accommodation for up to 31 adults, including people living with dementia. On the day of our inspection there were 25 people using the service.

The service was last inspected on 28 April and 02 May 2017. The service was rated ‘Requires Improvement’. There was no clear management structure in place and staff did not always receive the training necessary to meet people’s needs. We also found people, particularly those living with dementia, experienced inconsistent levels of support to maintain interests and meaningful activities.

During this inspection we checked to see whether improvements had been made, we found improvements had been made and this contributed to the service receiving a rating of ‘Good’ in all the key areas.

Since our last inspection there had been a change in the management of the service and a new registered manager had been appointed and registered since June 2018. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Improvements had been made to the training staff had received. This had developed staff’s understanding on providing care to people living with dementia. This also included improved understanding, in how to provide and engage people living with dementia in social activities, occupation and stimulation. The systems that monitored quality and safety had been improved upon with plans for further development. The service was continually driving forward improvements and an action plan was in place.

Staff were aware of their responsibilities to protect people from abuse and avoidable harm, they had received safeguarding training and had policies and procedures to support their practice. Accidents and incidents were reviewed and action was taken to reduce further reoccurrence. This included reviewing how risks were managed and advice and guidance was sought from extremal healthcare professionals when required. Risks associated with people’s individual needs, including the environment were assessed and planned for, and regularly reviewed.

The environment and equipment was found to be clean and staff followed best practice guidance, in the prevention and control of infections.

People were supported by sufficient numbers of staff that were deployed appropriately, to meet their individual needs. The provider had robust safe staff recruitment procedures to ensure as far as possible, staff employed were safe to provide care and treatment.

People received their prescribed medicines safely and best practice guidance was followed. This included staff receiving ongoing training and competency assessments, in the management of medicines.

Staff received an induction and ongoing training and support to ensure their knowledge, skills and competency were safe and effective. Staff were knowledgeable about people’s health conditions and worked effectively with external healthcare professionals to support people’s needs. Systems were in place to share information about people’s health conditions with other healthcare professionals, to ensure people’s ongoing needs were known and understood.

People received a choice of meals and drinks and were assisted to eat and drink where required and their independence was encouraged and supported.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible;

Grove House is registered to provide personal care for up to 25 adults, which may include some people living with dementia. This inspection was carried out over two days and was unannounced on the first day. It took place on 28 April and 02 May 2017. At the time of our inspection there were 22 people living there.

There was a registered manager at this service. 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.

During our inspection visit we observed that staff were friendly and approachable. When possible, they spent time sitting with people to offer them comfort or stimulation. We observed staff delivering care which met people’s individual care needs and which supported them in a respectful and appropriate way.

Accidents and incidents were investigated and plans put in place to reduce risk. All people had a risk assessment to ensure staff understood the risk to them and what to do to mitigate this risk.

There were training and processes in place to keep people safe and staff followed these. People’s physical and mental health was generally promoted. However staff were not trained to meet the special needs of people such as people living with dementia. Medicines were administered and recorded as prescribed.

We saw staff ensured people were comfortable. We saw people were supported in a relaxed and unhurried manner. However some people had to wait longer than they wanted to for assistance with eating. Staff were caring and communicated well with people. People were offered choices at meal times and some were seen to enjoy their food. However lunch was a solitary event. Attempts had not been made to make this a social occasion.

Staff focused on people they were caring for rather that the task they were carrying out. Staff spoke in a positive manner about the people they cared for and had taken the time to get to know people’s preferences and wishes. Staff had a good understanding of people’s needs and this was demonstrated in their responses to people and recognition of when people required additional support. However, none of the staff we spoke with knew people’s history.

People’s privacy was respected. People had their independence promoted. Where possible they were offered choice on how they wanted their care delivered and were given choices throughout the day.

People were supported to maintain relationships with family and friends. Visitors were welcomed at any time. Records we looked at were personalised and had included decisions people had made about their care including their likes, dislikes and personal preferences.

There were very few activities for people to partake in. We saw they were left un-stimulated through the days of our visit.

People, relatives and staff spoke well of the registered manager and felt the home was starting to be well-led.

Most staff were aware of their roles and responsibilities for people’s care. The provider and registered manager had systems in place to review the service and to ensure the service responded to the on-going needs of people.

Staff’s moral was generally good. However they found the management structure confusing and often received conflicting directions from the management team that was not always in people’s best interests.

There were 25 people living in the home at the time of our visit. We spoke with people to gain their views about the care received but some people had memory loss or dementia and were not able to verbalise their views clearly.

During our visit we observed that the interaction between staff and people was caring and friendly. The residents were observed smiling at staff and appeared at ease.

People we spoke with told us they felt safe living at the home. One person told us that staff were “Marvellous and I am not afraid to go to any of them.” Another person told us they were “Quite satisfied and felt safe” at the home.

There were suitable arrangements in place to ensure that people were consulted and involved in making decisions about their care. Where people could not make decisions there were systems in place to ensure decisions were being made in people’s best interests.

We saw that care plans were sufficiently detailed to ensure staff were aware of people’s needs. The care plans were personal and described people’s preferences.

People received their medicines regularly and there was accurate recording of medication stocks. However medicines were not always stored or handled appropriately.

Staff told us that they were frequently busy but told us people’s care needs came first. We saw that there were systems in place to maintain regular staffing levels. Our observations at our visit indicate that staffing levels are sufficient to meet people’s needs.

We spoke with three staff and four people who received care. People told us they were well cared for. One person told us staff were good and helpful. We observed staff quietly prompting people to eat where there were concerns about their lack of appetite.

Where care plans were in place we found these were well detailed, personalised and described people’s choices and wishes. We found however that for some aspects of care, particularly where people had the capacity to present in a challenging manner there were not clear plans in place to ensure people received safe and appropriate care.

We found that staff were aware of safeguarding adult procedures, but incidents were not always being reported or investigated in a prompt manner.

The provider had effective recruitment and selection processes in place. We found people were supported by suitably qualified, skilled and experienced staff.

There were systems in place to handle complaints and people told us they would feel confident about raising concerns. There was some information made available to people about how to complain, but this was not up to date.

Some of the people in the home were not able to communicate with us about their experience of the home. Others could speak to us and our assessment of the home takes into account what people told us and what we observed.

We observed people with different meals demonstrating that choices were offered to people. Specialist plates and cutlery were used to enable people to eat independently. People seemed to enjoy the lunch offered.

People knew the names of staff and the manager and said they would tell them if they had any worries. Some comments from the surveys completed by people in the home indicated that people did know how to raise concerns with quotes such as “the occasional concern has been promptly and sensitively dealt with”, I wouldn’t make a complaint, I am very happy”.

Some people did speak to us about their care and spontaneously told us they were well looked after in the home. We observed people to be clean and smartly dressed and peoples’ individual styles were evident in their choice of clothing. One person told us that “staff ask me what help I need”

One relative told us that there was “always staff around” when they visited the home and they seemed like they “really care about the people in the home.

This was an unannounced inspection that took place on 30 October and 04 November 2015.

Grove House is a care home with accommodation for up to 31 older adults, some of whom may have dementia. At the time of the inspection there were 29 people living in the home.

Our last inspection of 24 June and 17 July 2014 found the provider was not meeting two regulations. These were in relation to the administrations of medicines the management of staff in relation to bullying allegations. At this inspection we found that the actions we required had been met.

The home did not have 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 and associated Regulations about how the service is run.

People and their relatives thought a good service was provided, they enjoyed living at the home and there was enough staff to meet their needs. The staff team were friendly and caring.

Record keeping was sometimes out of date. These included care plans and risk assessments. The lack of up to date information could cause a risk to people. The acting manager was aware of this and had an action plan in place to update records to ensure they reflected people’s needs and wishes. Medicines were stored and administered appropriately.

Staff were aware of how to keep people safe and how to proceed if they had concerns about people’s safety. However they were not always aware of their duty of care under the Mental Capacity Act.

People who used the service had access to community based health professionals, as required. People were protected from nutrition and hydration associated risks with balanced diets. They said that the quality of the food was good and it was the type of food they liked.

There were thorough staff recruitment processes in place that records showed were followed. Most staff were knowledgeable about the people using the service and their likes, dislikes, wishes and needs.

Staff did not have all the appropriate skills and training to offer person centred care. Staff

said they were well supported by the management team who were approachable and easy to talk to. People and their relatives said they felt comfortable talking with the management team, who were responsive to their views and encouraged feedback from people.

People were not supported to pursue their hobbies and interests and some people told us they were bored. The home had activity staff, however they were not managed effectively and this meant that some people who could not make their needs met were left without stimulation. Some people told us they were bored.

The service lacked a clear management structure and staff struggled to identify who they would contact in an emergency if the acting manager was not available.