Grove Lodge is a residential care home for up to 22 older people with dementia and mental health needs. The building offers accommodation over two floors with lift access to each floor. People have access to communal lounge and dining areas, an accessible garden and outside space. There were 16 people living at the home at the time of inspection.

Grove Lodge 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.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were protected from the risks of abuse because staff understood the potential signs and how to report concerns. There were sufficient numbers of safely recruited staff available to meet people’s needs and staff knew people well and understood the risks they faced and how to manage these. Accidents and incidents were reported, recorded and learning shared with staff. People received their medication safely and these were recorded accurately.

Pre-admission assessments were undertaken before people moved to the home and included information about physical, religious, emotional and mental health needs to ensure that these could be effectively met. There were assessments of capacity and decisions made in people’s best interests where required. Meals were prepared fresh at the home, this was a change since the last inspection in response to feedback from people. Feedback about this change was positive and people had choices about what they ate and drank. Staff received support through supervision and had access to relevant training opportunities to provide them with the correct skills and knowledge for their role.

People were supported by staff who were kind and compassionate in their approach. We observed the use of gentle, tactile contact and staff communicating with people in ways which were meaningful for them. People were offered choices about how they spent their time and were supported with respect by staff who protected people’s dignity and promoted their independence. Visitors were welcomed whenever they wished to visit and were encouraged to feedback through informal discussions, resident and relative meetings and surveys.

People’s care records showed that their support was reviewed at least monthly and was therefore responsive to changing needs. People were supported by staff to engage in a range of social opportunities which included some group activities, one to one time with staff and a range of visits from external providers. People and relatives were aware about how to raise concerns if needed and felt that these would be listened and responded to. End of life care was person centred and planned with people to ensure that wishes and preferences were understood and respected.

Feedback from people, relatives and staff was that Grove Lodge was well managed. Everyone spoke positively about the registered manager who used an open door approach and was approachable and responsive. Staff were clear about their roles and responsibilities within the service and communicated well to ensure that they were responsive to people’s needs. Feedback was gathered and used to drive changes at the home and audits were used to identify any gaps or trends to continually improve the service people received.

The inspection took place on 18 and 19 May and was unannounced.

Grove Lodge is a residential care home outside Dorchester which provides support for up to 22 people. They had seven vacancies at the time of our inspection. The home is a large 1930’s building with rooms arranged over two floors and around a central lounge and dining area. The home has 16 single rooms and three double rooms. All bedrooms have a call bell in situ and some are en-suite. There is a large central staircase and a passenger lift to access the first floor bedrooms. People are able to access communal areas at the front of the home and there is a veranda which is partly accessible to the rear. Some ground floor rooms have direct access via a few steps to the rear veranda.

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.

When we last inspected the service in September 2014 we had concerns about the care and welfare of people who used services, the safety and suitability of the premises, cleanliness and infection control, how workers were being supported, how the service was respecting and involving people who use services, how the service assessed and monitored the quality of service provision and records. We asked the provider to take action about these concerns and they sent us a plan detailing that they would have addressed them all by December 2014. At this inspection we found that improvements had been made in all areas.

People were supported safely at the service. They told us that they felt safe with staff supporting them. We observed staff supporting people safely and responding to call bells promptly.

Staff were aware of how to keep people safe and able to explain how they would identify signs of possible abuse and report these. We saw evidence that staff had received safeguarding training and that safeguarding information was displayed on the boards in the main training room for staff.

We saw that peoples records had person centred risk assessments which were individual to people’s needs. Staff were aware of peoples risks and their role in reducing these. Staff had access to appropriate equipment to support people to move safely and this was monitored and maintained regularly.

People knew the staff who supported them and staffing levels were sufficient. The registered manager told us that the staffing was set when they had started in post and they used feedback and observation to determine appropriate staffing levels.

Medication was stored safely and given as prescribed. MAR records were accurate and we saw that staff had received medicine training and that this was updated annually. Medicine audits were completed by the registered manager and lead senior monthly.

Staff were knowledgeable about the people they were supporting and received relevant training for their role. Supervision was regular and face to face with the registered manager or lead senior carer. Staff received annual appraisals and were also observed regularly by the registered manager.

Staff received regular training in a range of different areas including manual handling, first aid, fire safety and mental capacity. Training was delivered by a mixture of face to face training from external providers and in house workbooks. People and relatives felt that staff had sufficient skills to support them.

We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty were being met. We saw that the service had completed comprehensive assessments for people under MCA.

People had mixed views about the food at the service. The registered manager explained that

At the time of our inspection there were five people living at the service.

We spoke to people that use the service and carried out observations throughout the day which showed us that people were being treated with dignity and respect and people's independence was encouraged. People we spoke with told us they felt very well cared for and that they were involved in making decisions about their care and treatment.

Discussions with staff, people who use the service and observations showed us that people were able to make their own choices about what support they received and activities they took part in. People told us that staff were very good at their jobs and very professional.

Staff that we spoke with felt very valued and supported and said that supervision and training provided was great and that they were able to improve their work as a result of this. Staff records that we looked at confirmed this. We saw staff training records this showed us that staff were qualified and competent to look after people.

During our visit we saw that people's records were accurate and stored securely in locked filing cabinets within the home.

We saw that people were provided with a healthy and nutritious diet. People said that they had a lot of choices and that food was great.

There was only one person living at the home. We did not consult with this person during the inspection as they had complex needs and were unable to tell us about their experiences.

Our observations of staff working with this person were that they were empathetic and professional.

The staff we spoke with told us that they felt supported by the manager.

There were unsafe recruitment practices that may have put people at risk of harm. The staffing records available were inaccurate when accessible.

Grove Lodge had reopened in May 2012 after being closed by the owner for just over a year. At the time of our visit there was one person living permanently at the home, three other people attending for respite on a “When required” basis, some of these people also coming to the home for day care.

We spoke with two people living at the home. One person told us they were “happy living at the home” and that they were involved with the day to day running of it. They told us that they were involved in planning the menu and often went to the shops to purchase food for the week escorted by staff.

We observed staff working with two people. The people appeared confident and relaxed in their company.

A single inspector carried out this inspection. We considered our inspection findings to answer questions we always ask; is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led? Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People told us they felt safe and appeared relaxed overall. We found that there were areas relating to the premises and infection control which needed some improvement, for example, the outside area to the rear of the home was not safe to walk on and some of the equipment was not clean. Individual risk assessments were not always kept up to date. We have asked the provider to address these concerns.

Is the service effective?

The care plans were not updated and we observed areas where the delivery of care needed improvement. Some care had not been assessed properly, for example one person did not get the support they needed with their daily routine. . Records overall needed improvement. For example, although staff kept consistent daily records of care for each person and handover records, this was not used to update care plans. People or their representatives had not been involved in their care plan. Most people were able to make decisions about their care and treatment however their views were not always sought and recorded. People could not be confident that staff were well trained to meet their needs. There were gaps in training and support for staff. This was being addressed by the manager.

Is the service caring?

We spoke to nine people, most of whom told us they were happy with their care. However some people told us they felt the service did not always meet their needs or that it could be difficult to get their views heard by staff. We observed that staff responded promptly to requests for help however that they told us they were not t always guided about how to communicate with people or provide appropriate assistance. For example we saw one person with mental health needs who staff did not know how to communicate effectively with and that there was no guidance in the care plan about this. One member of staff told us about someone with complex moving and handling needs that they felt the guidance and support they received was inadequate.

Is the service responsive?

We found that staff did spend time with people, talking however there was a lack of planned meaningful activity for people. The home was situated in a rural position, with no dedicated vehicle for transport of people to activities. We saw that while some people were occupied, either because they had visitors, most people were physically inactive for large parts of the day. For some people they lacked meaningful personalised interactions. For example two people were observed over three days to have no planned activity. One person we observed had not meaningful activity over several weeks. The home was aware of this and plans were in progress to appoint an activity coordinator to meet people’s social and welfare needs for this area.

The home worked with social workers and nurses to help plan people care however had not always sought specialist advice where needed. However when the needs of one person we observed were pointed out, prompt action was taken.

Is the service well led?

A new manager was appointed recently immediately following the departure of the registered manager for the service. They told us they were developing an improvement plan in relation to a number of areas including premises, staff and care plans. The senior manager told us they would be supported to carry these out. We saw that some works in the building were in progress and that some care plans had been updated. There was a lack of established methods for checking and monitoring quality in the home and poor record keeping meant that risks were not always well managed and plans for improvements were not yet well developed.