This inspection site visit took place on 5 April 2018 and was unannounced.

Grove House 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.

The home accommodates 29 people in one adapted building across two floors. On the day of our visit 20 older people lived at the home. The home is located in Coventry in the West Midlands.

We last inspected Grove House in March 2017 and gave the home an overall rating of 'Requires Improvement'. There was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Safeguarding service users from abuse and improper treatment. This was because where people lacked capacity and had their liberty restricted, referrals had not been made to the local authority to ensure their restriction was lawful; and concerns about abuse had also not always been referred to the safeguarding team. We asked the provider to send us a report, to tell us how improvements were going to be made to the service.

At this inspection on 5 April 2018 we checked to see if the actions identified by the provider had been taken and if they were effective. We found sufficient action had been taken in response to the breaches in the Regulation. However, we also identified a number of areas where standards had not been maintained. This is the second time the home has been rated as requires improvement.

The service had 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 provider had not ensured people’s medicines were always managed and administered safely and in line with their procedure.

Staffing levels meant staff were not always available to respond to people’s requests for assistance, were task focused and there were often times when there was no staff presence in communal areas of the home.

Procedures were in place to ensure risk associated with people’s care, the premises and equipment, and emergencies were assessed. However, some risk assessments contained conflicting information. People’s care records were personalised and regularly reviewed. However, information documented in care records, and the inclusion of people and relatives in care reviews was not always clear.

Inductions for new staff did not reflect nationally recognised guidance. Staff completed training, including on-going training, though staff had mixed views about the quality of the training provided. Staff received regular management support through individual and team meetings.

The provider’s systems to check monitor and improve the quality and safety of the service provided were not always effective. People and relatives were satisfied with the service provided and the way the home was managed. The provider used feedback from people and relatives to make improvements to the service.

People told us they felt safe living at Grove House. The management team and staff understood how to protect people from abuse and their responsibilities to raise any concerns. Staff recruitment systems reduced the risk of recruiting unsafe staff. People told us they were provided with some opportunities to take part in activities they enjoyed.

People, relatives and professional visitors said care staff were kind, caring and professional. People enjoyed their meals and the range of food available.

The management team had an understanding of the Mental Capacity Act (MCA) and their responsibilities under the Act. Restrictions on people’s liberty, where needed, were approved by the local authority. However, some people’s conse

We carried out this inspection on 2 March 2017 and it was unannounced.

Grove House provides care for up to 29 older people in Coventry. At the time of our inspection there were 23 people living at the service. Some people stayed at the service on a short term basis for rehabilitation, following discharge from hospital. Some people were living with dementia.

A registered manager was in post and had been for two years. 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.

At our previous visit in February 2015 the service was rated as good overall. However, the service was rated as requires improvement in ‘effective,’ as mental capacity assessments had not always been completed for people who lacked capacity to make decisions. Also, people were not always referred to health professionals in a timely way.

At this visit we found that mental capacity assessments had been completed, however people had not been referred to the local authority for the appropriate assessments when their liberty may have been restricted. Staff understood the principles of the Mental Capacity Act (2005) and how to support people with decision making. Consent was obtained before staff supported people with their care.

Staff had an understanding of what constituted abuse and knew what actions to take if they had any concerns. However, we found referrals had not always been made to the local authority safeguarding team, when there were concerns about potential abuse.

People were assisted to manage their health needs, with referrals to other health professionals where this was required. However, we identified referrals for some people continued to not be made in a timely way.

People received their medicines from staff who were trained to do so, and this meant their medicines were administered correctly. For medicines taken ‘as required’ (PRN), guidance was not always recorded to tell staff when people needed this. Medicines were not always stored correctly.

People told us they felt safe. Risks to people’s safety were identified by staff and ways to manage and reduce these risks were documented to ensure a consistent and effective approach was taken.

Care records were up to date and contained information for staff to help them provide personalised care.

There were enough staff to care for the people they supported. Checks were carried out prior to staff starting work to ensure their suitability to work with people who used the service. Staff received an induction into the organisation, and they completed training to support them in meeting people’s needs effectively.

People and relatives told us staff were caring and had the right skills and experience to provide the care people required. People were respected and supported to maintain their dignity. Staff encouraged people to be independent.

People had enough to eat and drink during the day, were offered some choices, and enjoyed the meals provided. Special dietary needs were catered for.

Some people had enough to do to keep them occupied and there were some social events arranged which people and their families enjoyed.

There were some processes to monitor the quality and safety of service provided to ensure staff were following the provider’s policies and procedures.

People were given the opportunity to feedback about the service they received through surveys. Meetings for people and relatives were held.

People knew how to complain and told us they did not have any complaints. The registered manager was aware that complaints should be recorded and responded to in a timely way.

People, visitors and staff had positive views about the management of the service. Staff felt managers were approacha

We carried out this inspection on 7 May 2015. The inspection was unannounced.

Grove House is registered for a maximum of 29 people offering accommodation for people who require nursing or personal care. At the time of our inspection there were 19 people living at the home.

A requirement of the service’s registration is that they 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. At the time of our inspection a registered manager was in post.

At our last inspection in September 2014 the home was found to be compliant in all areas we inspected.

People and relatives consistently told us care provided at Grove House was good and there were enough staff to support them with their care needs.

People’s health and social care needs were reviewed regularly with appropriate referrals made to other professionals, however sometimes there was a delay in referrals being made. Risk assessments were completed but at times did not reflect changes to their needs.

Staff knew about safeguarding people and what to do if they suspected abuse. Medicines were stored securely and systems ensured people received their medicine as prescribed.

Checks were carried out prior to staff starting work at the home to ensure their suitability for employment. Staff received training to do their jobs effectively and were encouraged to continue to develop their skills in health and social care.

Staff had some understanding around the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLs) following training. However, when there were concerns about people’s capacity to make decisions, assessments were not always completed to comply with the legal requirements.

People told us they liked living at the home. We saw there was a variety of food available and snacks and drinks could be accessed when people required them. People with special dietary needs were catered for, and relatives could enjoy a meal with their family member if they wished to.

People told us they enjoyed the activities available at the home and there were group and individual activities arranged. Staff were caring, and we saw examples of this during our visit. People were treated as individuals with their preferences and choices catered for where possible. Staff showed dignity and respect when providing care and all the people we spoke with were positive about staff.

Everyone we spoke with was positive about the management team and the running of the home. The registered manager knew the people that lived there well. We saw good systems that made sure that overall people received a good quality service. People knew how to complain if they wished to and complaints were actioned quickly and thoroughly.

One inspector and an expert by experience (a person who has experienced providing care for an older person) visited Grove House to follow up concerns we identified at a previous inspection on 24 February 2014. We completed this inspection to check whether the necessary changes had been made to make sure people received care from a service which was safe, caring, effective, responsive and well led.

We spoke with the newly appointed manager, four staff, six people who lived at the home and three relatives. We also spent time sitting with people in the lounge and dining room observing the care they received. We looked at the records of three people who lived at the home.

Below is a summary of what we found. If you want to see the evidence supporting our summary please read our full report.

At our last inspection in February 2014 we found the service in breach of the Health and Social Care Act regulations 2008 relating to respecting and involving people who use services, consent to care and treatment, care and welfare of people, supporting workers and records.

Is the service safe?

Records showed people had consented to their care and treatment. People's mental capacity had been assessed to determine their cognitive abilities to make decisions for themselves. We found staff had received training to help them understand the Mental Capacity Act, and the Deprivation of Liberty Safeguards (DoLS). This meant the provider was now compliant with the regulation relating to consent to treatment.

Is the service effective?

We saw by looking at records, observing and talking with staff that staff had received sufficient training and support to provide them with the skills and knowledge required to provide safe and effective care. Staff were confident the new manager was making effective changes to the home and improving the care provided to people. This meant the provider was now compliant with the regulation relating to supporting workers.

Is the service caring?

At this visit we found work had been undertaken by management and staff to ensure staff understood and responded to people's individual needs. We saw people had been given information to help them know their rights, and there were now some activities available to people on a daily basis. We observed staff respected people's privacy and provided support to people to maintain their dignity. This meant the provider was now compliant with the regulation relating to respecting and involving people who use the service.

Is the service responsive?

Care records gave clear and up to date information about the care needs of each individual. Staff we spoke with worked to the updated care plans. The concerns raised at our last visit regarding individual people had been addressed. This meant the provider was now compliant with the regulation relating to care and welfare and records.

Is the service well-led?

The provider sent us a plan setting out the actions they were taking to improve the service after our last inspection. We saw they had completed the actions they set out to do. The new manager had worked well with an external consultancy agency and with the local authority contracts monitoring team to improve the service.

During our previous inspection to this service on 15 October 2013, we found the provider was not meeting the required standards. We set compliance actions that let the provider know they needed to improve.

When we carried out our follow up inspection on 24 February 2014 we found additional improvements were required.

We found people continued not to be fully involved in their care. People told us they went along with the routines of the home because they didn’t want to pressure staff. We found staff were not always knowledgeable about the health conditions that people had. We also found staff training was not up-to-date to enable them to meet people’s needs safely and effectively.

Care plans had been updated following our last visit but there were key elements of information about people’s care that was either missing or not accurate.

People who lived at Grove House Residential Home were positive about the staff and the home. They told us: “I am happy here.” “They are very good and kind to me.” “I love it here.”

On the day of our visit there were 24 people living in the home. We spoke with seven people and also spent a period of time observing those people unable to speak with us. This was so we could determine what it was like for people living in the home.

We found most people we spoke with were happy with the care and services provided and had no concerns. We found some people did not feel involved in their care and had limited choices. We saw there was limited information about people’s ability to make decisions and consent to care. People we spoke with about their care told us:

“I think it is terrific.”

“It’s quite good really.”

“You are not asked what time you want to get up. They switch the light on and say come on here’s a cup of tea. They can be very strict at times.”

People confirmed they were given their medicines when they expected them and we found medicines were being managed appropriately.

We saw staff were caring and supportive towards people. People were positive in their comments of the staff. They told us:

“They are quite good really. I have got to give them that, some are better than others.”

“They work very hard. They are excellent at bathing.”

We found some of the care records we looked at were not sufficiently detailed or accurate.

We visited the home unannounced and met with people who lived there, staff, the manager and visitors to the home. There were 23 people living at the home on the day we visited. We spoke with five relatives of people at the home, as well as with twelve of the people themselves. People were very positive about the home. We had no negative comments. “Very happy with care” and “Staff are excellent” were two typical comments we had from relatives.

We spoke with staff, all of whom had worked at the home for several years. The longest serving staff member had been there over thirty years. The newest employee we spoke with was the manager, who had worked at the home for around eighteen months.

The home was clean and free from unpleasant odours. All floors were carpeted and kept clean and fresh throughout. We saw staff being attentive to people, reassuring and explaining things to them wherever necessary. Staff were able to take time to talk to people and give assistance when needed.

The home was ‘homely’ in feel and had a choice of three lounges. People were free to associate in communal areas or spend time in their own rooms. A lot of people liked to spend time in their own rooms. Most preferred their doors to be open so they did not feel isolated. People commented on the home’s responsiveness. “We only have to mention something, and it’s sorted” was one typical comment.