This inspection took place on 5 and 6 November 2018 and was unannounced on the first day.

At the last inspection in October 2017, the service was rated Requires Improvement and the provider was in breach of four regulations. These related to standards of hygiene and the management of medicines in the key question safe, staff training and support in the key question effective, person-centred records in the key question responsive, and governance in the well-led key question. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when, to improve these key questions to at least Good. We checked to see that the action plan had been completed and found progress had been made to meet compliance with the breaches, but further improvements in some areas were required. We have rated the service Requires Improvement again.

The Grove Care Home accommodates up to 52 older people, many of whom are living with dementia. People who use the service are accommodated in single rooms which have en-suite toilet facilities. Some rooms have a small kitchen so people can make themselves drinks and snacks. At the time of this inspection there were 44 people using the service.

The Grove Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a new registered manager in post, who registered with CQC in September 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found there had been improvements with the overall management of the service and also regarding governance from the senior management team. Staff confirmed management and communication had improved, they felt more supported and could raise concerns.

The systems to assess, monitor and improve the quality of the service provided had been effective in driving the necessary improvements in relation to standards of hygiene. The home was cleaner and fresher. The registered manager had completed additional medicine audits and improvements had been made with the management of medicines, although we found shortfalls with the records to support administration of topical medicines. Improvements had been made with the quality of person-centred information in people’s care plans and the completion of supplementary monitoring records, although some care plans had not been updated to reflect changes in people’s needs. These issues around recording had been identified by the senior management team and plans were in place to address them.

We received mixed feedback about staffing levels. Some people told us they had to wait for care and support. Observations showed there was enough staff on duty to support people safely. There was a visible staff presence at all times; although routines were busy, staff responded promptly to requests for assistance. Staff turnover was high and continued shortfalls were covered by agency, home and bank staff. We have made a recommendation that the provider reviews staff retention strategies.

Safe recruitment procedures were in place to ensure people employed to work at the home were safe working with vulnerable people.

Staff knew how to safeguard people from the risk of harm and abuse. There were safeguarding procedures to guide staff who had completed training. Staff knew how report concerns and the registered manager was aware of their responsibilities in referring issues to the local authority safeguarding team.

People had individual risk assessments completed which provided in

The Grove Care Home is registered with the Care Quality Commission (CQC) to provide care and accommodation for a maximum of 52 older people, some of whom may be living with dementia. Accommodation is provided over two floors and all rooms have en-suite toilet facilities; some rooms have a small kitchen so people can make themselves drinks and snacks. At the time of this inspection, there were 44 people using the service.

We undertook this unannounced inspection on the 24 and 26 October 2017. We last inspected the service on 1 and 2 December 2016 and found the provider was meeting the fundamental standards of relevant regulations. At that time, we rated The Grove Care Home as ‘Good’ overall and ‘Good’ in four out of the five key questions; we rated the well-led key question ‘Requires Improvement’ to ensure the improvements found during that inspection were sustained over time. We carried out this inspection in response to recent complaints and concerns that local commissioners had raised following their visit. During our inspection on 24 and 26 October, we identified shortfalls throughout the service and breaches of regulations.

The service had 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.

The provider's systems to assess, monitor and improve the quality of the service provided had not been effective in identifying and addressing all the issues highlighted during our inspection or consistently driving improvements in line with their own action plans. This lack of robust quality monitoring meant there was inconsistency in how well the service was managed and led. Following the inspection, we were given assurance that additional resources and senior management support were provided to the registered manager to address the improvements needed at the service.

There were shortfalls in the administration and recording of some people’s medicines. We also found one person’s medicines had been out of stock for a period of time. There was limited guidance for staff around the use of ‘as needed’ medicines, to ensure consistent administration.

We found shortfalls with the standards of hygiene in areas of the home. There was a strong stale odour in the lounge and we also found items of furniture and equipment which were damaged and could not be cleaned effectively.

The training, supervision and support provided to staff were inconsistent and did not ensure they were confident and competent in their role.

We saw people had assessments of their needs prior to admission to the service and staff completed risk assessments and care plans. Whilst some of these were person-centred and tailored to people’s individual needs, others lacked important information. This meant staff may not have full and up to date information about people’s needs.

We found some people’s risk assessments had not been completed or updated if their needs had changed. We found gaps in the risk management of some areas of the environment. Staff had not always followed the provider’s incident reporting procedures and the registered manager completed three notifications retrospectively.

Some redecoration had taken place but we also observed areas of the service were looking tired and in need of refreshing. Improvements could be made with providing a more dementia-friendly environment. Although there was no renewal programme in place, the registered manager gave assurances that the home was scheduled for refurbishment early in 2018.

Staff had knowledge of safeguarding procedures and were aware of their responsibilities for reporting any concerns. The local safeguarding team had directed the registered manager to complete investigations into four c

The Grove is registered with the Care Quality Commission (CQC) to provide care and accommodation for a maximum of 52 older people, some of whom may be living with dementia. People who use the service are accommodated in single rooms which have en-suite toilet facilities; some rooms have a small kitchen so people can make themselves drinks and snacks. At the time of this inspection there were 45 people using the service.

This inspection took place over two days on 1 and 2 December 2016 and was unannounced. At the previous inspection in July 2015, we found the registered provider was in breach of regulations relating to staffing and the operation of governance systems and auditing processes, and the availability of accurate and detailed records. The overall rating for the service was, “Requires improvement”. Following the inspection in July 2015 we received an action plan from the registered provider detailing how improvements would be made.

At this inspection we found improvements had been made and that registered provider had taken appropriate action to address the above breaches of regulation. We have changed the rating in the safe, effective, caring and responsive domains that were previously rated as Requires Improvement to Good. We have not changed the rating in the well-led domain, because we need to ensure the service is able to develop and sustain the improvements that have been made.

A new manager was in post and they had applied to be the registered manager. A registered manager is a person who has registered with the CQC 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. Service’s without a registered manager cannot be rated higher than requires improvement in the well led domain.

Improvements had been made in relation to the availability of staff and there was evidence of an on-going process of recruitment for staff to ensure there were suitable numbers of them available to meet people’s needs. The registered provider had ensured staff were provided with a programme of on-going training to ensure they were able to effectively carry out their roles, although further work was required to ensure a programme was available of regular supervision for them all to be clear about their roles. The governance systems for the service had been developed to enable the quality of the provision to be effectively monitored, which included a programme of audits and analysis of incidents and accidents, to enable trends or patterns to be identified.

Recruitment checks were appropriately followed to ensure care staff were safe to work with people who used the service. Dependency levels of people were monitored and we were told about plans to deploy additional staff at busy times to ensure people’s needs were promoted at all times. Safeguarding training had been provided to enable care staff to recognise and report potential signs of abuse and ensure they were familiar with their responsibilities for raising concerns. Care staff told us said they were supported and listened to by the manager and were confident they would take appropriate action when required.

Care staff had received training on the Mental Capacity Act 2005 to ensure they knew how to promote people’s human rights and ensure their freedom was not restricted. Systems were in place to make sure decisions made on people’s behalf were carried out in their best interests.

We observed care staff demonstrated compassion for people’s needs and treated them with kindness and consideration. People were supported to make choices about their lives and provided with a range of wholesome meals. People’s health and nutritional needs were monitored with involvement from health care professionals when this was required.

People were supported to make informed decisions about their l

This inspection took place over two days on 28 and 29 July 2015 and was unannounced. This was the first inspection of the service since it was registered under a new provider in September 2014.

The Grove is registered with the Care Quality Commission [CQC] to provide care and accommodation for a maximum of 49 older people, some of whom may be living with dementia.

People are accommodated in single rooms which have en-suite toilet facilities, some rooms have a small kitchen so people can make themselves drinks and snacks.

There was a registered manager in post at the 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.

We found the registered provider was in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to Staffing and Good Governance.

There were not always enough staff available to meet people’s needs which meant staff were potentially not always able to deliver safe care to people who used the service.

Staff had not received appropriate professional supervision and appraisals of their skills, which meant they may not be able to effectively carry out their roles safely.

Whilst quality systems were in place to monitor the service, these had failed to ensure the service was safe, effective, responsive or well led. People had not always been protected from the risk of receiving inappropriate care and treatment, because complete and contemporaneous records had not always maintained.

Staff were recruited safely and had received training about the protection of vulnerable adults. This ensured staff knew how to recognise and report the potential abuse of people who used the service.

People told us they were cared for by staff who were kind and caring and who respected their individual preferences whilst delivering their support.

We observed people were provided with a variety of activities to enable them to have opportunities for social stimulation and interaction which enhanced their wellbeing.

People received their medicines as prescribed.

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