Grovelands is a residential care home for up to 60 people. The home specialises in the care of older people, including people living with dementia. The home is divided into four areas, two areas provide specialist care for people living with dementia. At the time of the inspection there were 60 people living at the home.

At the last inspection in October 2015 the service was rated Good. At this inspection the rating has improved to Outstanding.

Why the service is rated Outstanding

The registered manager led by example to make sure people were well cared for and had opportunities to express themselves and make choices about all aspects of their day to day lives. People were at the heart of everything that happened at the home and their views and suggestions were sought and acted upon.

People were valued and made to feel special by staff who went over and above their job roles to help people to realise their wishes.

People were treated as individuals and were supported to follow their interests and hobbies. Special trips and events were arranged for people to promote their well-being and enjoyment of life.

People were safe at the home because the provider had systems in place which minimised risks. People smiled when staff approached them and were happy to be helped. One person told us, “I like it because the staff are nice to you.” The provider learnt from incidents and accidents and took action to minimise further risks.

People were supported by staff who had the skills and experience to effectively meet their needs. Staff were well supported and received the training required to make sure they provided effective care and support. One person said about the staff, “They like what they do, they’re all well trained.”

People were supported to have a good diet which met their needs and wishes. One person told us, “As I’ve got older I’ve got fussier - but the cook is good to me, it’s better than my cooking and I don’t have to wash up.”

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

Staff were kind and compassionate which created a happy and relaxed atmosphere throughout the home. One person described how two members of staff had visited them when they were in hospital and said, “They made that effort to come in to see me - that’s kindness.”

Further information is in the detailed findings below

We carried out this unannounced, focused inspection on 30 March 2015 to follow up on breaches of regulation identified at previous inspections. We carried out an unannounced comprehensive inspection of this service on 27, 28 and 31October 2014 at which we found breaches of legal requirements. This was because people living in the specialist residential care part of the service were not protected from risks of infection because the environment was not clean. Staff were not monitoring people in a manner that ensured risks were managed appropriately. Medicines were not administered safely. Records did not reflect people’s care needs accurately and this put people at risk of receiving inappropriate or unsafe care. People were not protected by effective quality assurance systems.

After the comprehensive inspection we told the provider to take action to improve record keeping and quality assurance by 4 March 2015. The provider wrote and told us about improvements they would make in relation to the other breaches of regulation identified. These breaches related to safe medicines administration, how risks were managed and how people’s care consent to care was established.

This report only covers our findings in relation to these areas. You can read the report from our last inspection by selecting the “all reports” link for “Grovelands” on our website at www.cqc.org.uk

Grovelands is a purpose built service, providing accommodation and personal care for up to 60 older people. The service specialises in caring for people who have dementia. It is divided into two main parts. Residential care is provided on one side of the home and specialist residential care (SRC) is provided on the other side of the home. This provides care for people with complex dementia needs and is commissioned directly by the Somerset Partnership NHS Foundation Trust who provide a dedicated nurse to work with the provider.

The provider is required to recruit a registered manager for this type of service. There was a registered manager 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 and associated Regulations about how the service is run.

At our inspection on 30 March 2015 we found the provider had taken action to make improvements and legal requirements had been met.

People told us that they felt safe and staff were able to describe the risks people faced and how they supported them appropriately.

People received their medicines safely.

Where people did not have capacity to make decisions about their own care there was clear guidance for the staff on how they should make decisions in their best interest. Staff told us they had received training about the Mental Capacity Act 2005 and understood how to apply its principles to people’s care.

The home smelled and looked clean, there was a robust system in place to ensure this was maintained.

Records were accurate and reflected people’s needs.

The service had sought appropriate professional input to make improvements and quality assurance systems were operating effectively.

We spoke with seven people who used the service but their comments did not relate to the standards we inspected. We spoke with one visiting relative who told us that the staff met their relatives care needs well and told us about a recent incident where staff had acted promptly to address their relative needs.

The staff we spoke with were aware of some of the people's needs but not all. When activities were provided these were observed as enjoyed by the people who used the service.

The provider had taken steps to identify abuse at the home but some of the systems designed to report concerns had weaknesses. Staff did not consistently know who to report concerns to outside of the organisation.

Staff demonstrated they had the skills to meet people’s needs and had opportunities to further develop their knowledge of the care sector through training. At there were times when there were insufficient staff to meet people’s assessed needs.

The care records used by the home were not always accurate and updated as required.

People told us that they understood the care choices available to them, and could have their views taken into account in the way their care was delivered. A person told us, "If you’ve got a query you can ask.” Another person told us, "They always say do you want to.” Another person said, "We get choices for lunch and dessert."

We found that people's needs were assessed, and care was planned and delivered to meet people's needs. A person told us, "I know I have a care plan." People's care was regularly reviewed and their personal information was held securely.

People were protected from the risk of abuse and their human rights were respected and upheld. A person told us, “I have no concerns about staff or residents, they are all very nice to me.” Another person told us, “I feel safe here.”

We viewed a selection of staff records, and saw that relevant checks had been carried out when the home employed staff. Staff had opportunities to gain appropriate qualifications. A person told us, "They are looking after me O.K." Another person told us, “The staff are all lovely.”

The home had an appropriate system in place to deal with comments and complaints.

We spoke with eleven people who lived in the home. They told us that staff provided the care and support they needed. Everyone spoke very highly of the home. People said staff were very patient and kind and they listened to them.

There was a very relaxed and homely atmosphere. One person we spoke with said “It’s very nice here. There’s a real mixture of people living here. You have choices about everything. I can still do most things for myself and the staff are fine with that”. Another person said “I try to do as much as I can. It’s very important that you hang on to your independence”.

People who lived in the home told us they felt very well cared for and that staff were available when they needed them. People said staff helped them to do the things they needed help with. Comments from people included “I am very happy here. The staff help me with lots of things”, “it’s very good here. The staff are good. I have a call bell and the staff come quickly if I use it” and “this is the best place I could be”. People told us staff arranged for them to see their GP or other health care staff if they needed to.

Some people who lived at the home had varying levels of dementia. The home had developed many areas of good practice to enable staff to meet this group of people’s needs.

People told us they liked the food served in the home. Meals were discussed regularly and were always on the agenda for residents’ meetings. People had the choice of meals showed to them at each mealtime and chose where they wished to eat their meals. Most people chose to eat in the dining areas and this was encouraged by staff to prevent people from becoming isolated.

People we spoke with said they thought the home was a safe place for them to live. Comments included: “yes, it does feel like a safe place to live” and “oh yes, I do feel very safe living here”. One person told us they chose to move to this home because they did not feel safe in their own home after they had a fall. They told us “I do feel safe now as staff are always around if I need help”.

People who lived in the home said staff were available when they needed them and they understood the care and support they needed. One person said “I like the staff, they are lovely”. Another person told us “I couldn’t cope living on my own. I’m very happy here because there are staff here night and day. All of the staff are very good. They are lovely and kind”.

This inspection was unannounced and took place on 21and 23 October 2015. The last inspection of the home was carried out on 30 March 2015 following a previous inspection in October 2014 where breaches of regulations had been identified. People had not been protected against the risk of unsafe or inappropriate care and treatment arising from a lack of proper information about them because records did not contain appropriate information. People were not protected because there was not an effective system to monitor the quality of service and identify and manage risk. No concerns were identified in the follow up inspection in March 2015. The provider had taken action to make improvements and legal requirements had been me. However the ratings remained the same until sustainability of improvements were found.

Grovelands is a purpose built home providing accommodation and personal care for up to 60 people. At the time of the inspection there were 50 people living at the home. The home is divided into two main parts. Residential care is on one side and specialist residential care (SRC) is provided on the other side of the home. SRC provides care for people living with dementia.

There was a registered manager 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.

There was a homely feel to the home with staff finding time to sit and chat with people. Everyone we spoke with complimented and praised the staff who supported them. We observed people were cared for compassionately and with respect. One person told us “They [the staff] are all wonderful”.

The registered manager and deputy manager provided effective leadership and had a clear vision and purpose for the development of the home and staff team. People told us that many changes had taken place under the new management team and that they felt safe and happy living at the home. Regular resident’s and relatives’ meetings ensured people were involved in the running of the home.

People were cared for by an established, motivated and well trained staff team. Staff received regular supervisions and training that provided them with the skills and knowledge to meet people’s needs effectively. Staff worked well together and communicated well with each other. One member of staff informed us “ Staffing levels most of the time are ok, we can always talk to the manager and deputy if we are not happy, we have agency care staff to back us, but new staff are starting so that will be better”. Staff told us they enjoyed working at the home and felt supported by the registered manager and deputy manager. Staff were seen to work well as a team and showed knowledge of the people they were supporting.

Staff were very visible and attentive, noticing when those who could not verbally ask for assistance required help. They responded to people with an understanding about their likes and dislikes, they communicated gently with people, coaxing where needed. One member of staff said. “I love working here”. Another member of staff said. “We have a great manager, we all work well together”.

People’s rights were protected, Where people lacked the capacity to consent to decisions about their care and treatment, staff consulted with health and social care professionals and people who knew the person well. This helped to ensure any decisions were fully considered before being agreed to be in the person’s best interests. One member of staff said “it is about respecting choice but also helping someone who may not realise the consequence of their decisions”.

Professionals were involved where additional support was needed. One professional informed us” I am always kept informed if there are any concerns. I come in most days, my instructions are always followed straight away, and it’s a very proactive staff team”.

Care records were detailed, personalised, up to date, and accurately reflected people’s care and support needs. The care plans included information about peoples’ likes, interests and background, and provided staff with sufficient information to enable them to provide care effectively. A computer system was in place to support the recording and monitoring of care records.

People received their medicines safely. People were seen to be gently coaxed to take their medicines with explanations given on why they were taking them. People’s health needs were supported, people had access to their own GP, chiropodist and Dentist. The manager informed us that it was important that people were treated as individuals rather than having one health professional for all.

There were new systems in place that ensured the home looked homely and clean, regular spot checks were carried out by the housekeeper and registered manager to ensure standards were maintained. There was a nice atmosphere in the home, people were seen to be well cared for. One person told us” I have a nice staff member that looks after me personally. My visitors are always made welcome by all the staff, my bedroom is personal to me and people always respect my privacy by knocking and asking if they can come in, I would rather be in my own home but I can’t. So this is now my home and I don’t think I could find a better home”.

Quality assurance systems ensured the registered manager identified good practice and completed regular quality assurance checks of the home.