The Grove is a residential care home for 32 people who have physical disabilities. The home is a period building over two floors. A newer extension provided ensuite facilities and communal areas. At the time of our inspection there were 30 people living within the home.

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.

The people who lived at The Grove had a wide variety of needs and health conditions and complex physical disabilities. Some people required more significant support than others and most were wheelchair users. The people who lived in The Grove were provided with high quality, safe, caring, person centred support which was responsive to their needs. People received personalised support and there was a clear understanding of seeing each person as an individual, with their own social needs.

Staff received training in all areas relating to people's individual health needs and holistic

activities. Staff also received support from external healthcare professionals on how to best care for people. People were encouraged to socialise and pursue their interests and hobbies.

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.

People were involved in all aspects of their care and were supported by staff to communicate their wishes, likes, dislikes and decisions. People were supported through the use of verbal communication, pictorial forms and electronic aids.

People were protected from risks relating to their physical and mental health and possible abuse. Risks to people had been assessed and had taken action to seek guidance and minimise identified risks. Staff knew how to recognise possible signs of abuse.

Staff and volunteers treated people with respect and kindness. There was a warm and pleasant atmosphere at the home where people and staff shared jokes and laughter. Staff knew people and their preferences well. People were supported to have enough to eat and drink in ways that met their needs and preferences. Meal times were social events and people were supported individually to ensure their specific needs around food and drink were met.

Staff supported people to take their medicines safely and staffs' knowledge relating to the administration of medicines was regularly checked. Staff told us they felt comfortable raising

concerns.

There were systems in place to assess, monitor and improve the quality and safety of the care and support being delivered.

Further information is in the detailed findings below

The inspection took place on 15 and 17 March 2016 and was unannounced.

The Grove provides residential and nursing care for younger adults with physical disabilities. Accommodation is over two floors and 25 of the 32 rooms have en-suite facilities. Rooms are spacious and fully accessible. Communal areas include a number of lounges, dining rooms and those dedicated to leisure activities such as a therapy room and IT room. At the time of our inspection, 30 people were living at The Grove.

There was a manager in place who had been appointed in November 2015. At the time of the inspection, the manager had submitted an application to the Care Quality Commission (CQC) to become a registered manager; their application was being processed. 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.

People received care and support from staff that had received training to meet their individual needs. Staff had received comprehensive inductions that allowed them time to get to know the people they supported. Staff had been recruited following appropriate checks that showed they were safe to work in health and social care.

There were enough staff to meet people’s individual needs and they worked in a way that contributed to the smooth running of the service. Staff worked well together and supported each other. Good teamwork was evident and people had confidence in the staff that supported them.

People were complimentary about the staff that supported them. They told us they were friendly, kind and supportive. They told us staff knew them well and had time to talk with them. The relatives of people who used the service told us ‘nothing was too much trouble’ for the staff in caring for their family members.

The people who used the service told us they felt respected, valued and listened to. They had choice in their day to day living and their independence was promoted. Confidentiality and privacy was adhered to.

People were protected from the risk of abuse as staff understood their responsibilities to raise any concerns they may have. They could identify potential signs of abuse and they knew how and where to report these. We know from the information we hold about this service that concerns had been reported appropriately in the past.

The service had identified and managed the risks to the people who used the service, staff and visitors. These had been reviewed regularly to ensure people were protected from the risk of harm. Medicines had been managed and administered appropriately although some records were not entirely legible. The manager told us they would address this swiftly.

The Care Quality Commission (CQC) is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. The service had worked within the principles of the MCA and made appropriate applications for consideration of depriving some people of their liberty. Where the service had made best interests decisions for people they supported, this had been done legally and involved the appropriate people. These decisions had been recorded.

The people who used the service, and their relatives, told us they had been involved in the planning of their care and support. We saw that people’s needs had been identified and, in most cases, comprehensively recorded to ensure they received the right support. Care plans were person-centred and focused on the individual including what was required in order to achieve positive outcomes. Personal details were recorded to aid staff in getting to know people better and in order for them to develop important relationships with the people they supported.

The service ensured people had opportunities to engage in their interests and hobbies. People told us their leisure and social needs were met. With the he

A single adult social care inspector carried out this inspection to follow up concerns identified during our previous inspection of 04 and 07 April 2014. One of the key questions we ask ourselves during an inspection is whether the service is effective. At the April 2014 inspection we identified that whilst improvements had been made to ensure that staff received supervision and appraisal, there were still significant gaps. This meant that the service was not operating effectively because people were not cared for by staff that had received appropriate supervision or appraisal. The provider’s policies for managing staff development were not being adhered to and the manager’s action plan had not been fully implemented.

Is it effective?

This inspection established that significant improvements had been made. We were satisfied that the manager’s action plan had been fully implemented. Systems were in place to ensure that staff received the appropriate support within the timescale required by the provider’s policies. Consequently, the service was effective in ensuring that people were cared for by staff who received suitable and timely support and development from the service’s management team.

You can see our judgement on the front page of this report.

People commented about staff and their care. One person said, "They do what I need. They are very good." Another person told us that they felt staff supported them as they would wish. Relatives expressed no concerns about the way people they visited were supported and felt that the care was "...good." We observed that people needing assistance during the day were given this. However, we found that records did not always support that effective care was delivered in the way their care plans said was needed.

People were offered drinks regularly on what was a hot day. One person said, "They come round regularly with drinks or you can ask for one." They told us that the meals were good and they enjoyed their food. We noted that a menu displaying options for lunch and tea on the day of our visit was displayed in a dining area. People receiving nutrition and fluids via tubes were given this to ensure they were properly nourished and hydrated.

Although the provider had taken steps to identify the possibility of abuse, we were concerned that allegations were not always responded to appropriately.

Checks upon staff for their suitability to work with vulnerable people were made and recruitment processes helped contribute to people's safety. However, staff did not always receive supervision and appraisal as expected, to discuss their work and any development needs and to show that they were effectively led.

People able to speak with us and relatives, told us who they would speak to if they had any concerns about the standard of care they received. They said they felt confident that any such concerns would be addressed.

People told us they were happy in the home. One added, "I wouldn't still be here if it wasn't alright." Another told us that the manager was always there and was, "The top one you can go to, to say things."

We were told that the staff always gave people choices and explained what they were going to do. One person said, "No one forces us to do things. They ask us and that's what it's all about."

Three visitors told us they were very happy with the standard of care, describing The Grove as a 'friendly, lovely place'. One told us, "The staff are very good. I can't fault them."

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

This is a summary of what we found-

Is the service safe?

People told us they felt safe and were well treated by staff. They told us that staff always spoke to them respectfully. Staff had received extra information about how to safeguard the people they supported and the importance of reporting any concerns promptly to the local safeguarding team.

Systems were in place to make sure that managers and staff learnt from events such as accidents, incidents and complaints. This reduced the risks to people and helped the service to improve.

The home had proper policies and procedures in relation to the Mental Capacity Act 2005 and how to support people to make decisions about their care. Where staff thought people could not understand information and make informed decisions, appropriate processes were followed to assess their capacity and ensure decisions made were in people’s best interests.

Is the service effective?

There was a residents' committee at the home, which met regularly and could help represent the views of people living there.

People’s health and care needs were assessed with them, and they were involved in developing their plans of care. One person told us, “They’ve just been round to talk to people about their care plans.” Specialist dietary, mobility and equipment needs were identified in care plans where required.

Staff received training to help them understand and meet people’s needs appropriately. They were able to tell us clearly about people’s needs and how they were supported.

Is the service caring?

People told us they felt that staff were kind. One person said, “I have no complaints about staff. I’m very happy with the way I’ve been treated.” Another told us, “Staff ask before they do things.”

Comments from relatives about the service included, “I think the people who look after this home are lovely, lovely people.” They went on to say that they did not worry about leaving their relative in the home because the person was in “…such kind hands.” Another commented that, “Nothing is too much trouble.”

People using the service, their relatives, friends and staff had the opportunity to complete a survey so that the manager could see if anything needed to improve.

Is the service responsive?

People were able to join a range of activities in and outside the service regularly if they wanted to. The home had adapted transport so that people could get out and about in the area. One person told us who they had a shopping trip booked because they needed new clothes. People told us about the activities they got involved in, including quizzes and learning how to use the computer.

One person told us how the service had responded when their needs changed. They said, "I need more help now and I get it."

People knew how to raise concerns if they were unhappy. One person said, “Mostly people can raise concerns for themselves. They don’t always do it through the residents’ committee. People are listened to.” People commented about the residents’ committee and felt that the service responded to their suggestions. They said, “Some suggestions are taken up quickly. Some take a bit longer.”

Is the service well-led?

The service had a quality assurance system. They were participating in the Commissioning for Quality and Innovation process under the NHS, to return information about things that may indicate poor or good care so they could be sure of their standards.

Staff had a clear understanding of their roles and responsibilities and of the needs of people living in the home. This helped to ensure that people received a good quality service at all times. Staff would benefit from improved support from more senior staff, through supervision and appraisal so that they could develop further in their roles. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to supervising and appraising members of staff.

If you wish to see the evidence supporting our summary please read the full report.