We inspected the service on 4 January 2019. The inspection was unannounced. The Grove 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 service accommodates twelve people and on the day of our inspection twelve people were using the service.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with acquired brain injuries using the service can live as ordinary a life as any citizen.

At our last inspection on 20 June 2016 we rated the service ‘good.’ At this inspection we found the evidence continued to support the rating of ‘good’. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. However, the rating for Well-led has deteriorated to ‘Requires Improvement’.

There was 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 registered manager had not ensured that statutory notifications were submitted to the Commission in a timely manner.

People could be assured that they would receive care in a way that maintained their safety and promoted their independence. Lessons were learnt and action taken as a result of accidents and incidents. People were supported by sufficient numbers of staff who received the support and training that they needed to work effectively in their role. People’s prescribed medicines were managed safely.

People’s needs were assessed and detailed plans of care in place, reflective of people’s preferences, to guide staff in providing care. People were supported to maintain the best possible health and were enabled to access the healthcare services they needed in a timely manner.

People could be assured that they would be treated with dignity and respect. Staff focussed on enabling people to be as independent as possible and gave people the maximum possible choice and control over their care.

There was an effective system of quality assurance in place. There was a well understood and clear person centred culture that was demonstrated by staff and the registered manager. This culture and focus on supporting people to be independent had resulted in positive outcomes for people receiving care.

Further information is in the detailed findings below.

The inspection was unannounced and took place on 20 June 2016.

The Grove is registered with the Care Quality Commission to provide accommodation and personal care for a maximum of 12 people. There were 10 people living at the home on the day of the inspection. There was a registered manager in place. 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.

People were protected from harm as staff knew how to protect them from abuse. People told us that they were supported when required and they were happy with the support they received.

People received their medicines in a way that kept them safe. Staff had received medication training and there were arrangements in place for managing people’s medication.

Staff had been recruited following the appropriate checks on their suitability to support people living in the home. Staff were available to meet people’s needs promptly and they demonstrated good knowledge about people living at the home.

People were able to tell care staff about the care and treatment they needed and day to day decisions. People were assured that all staff have been trained and understood how to look after them. All staff we spoke with felt they had the right skills and knowledge and attended regular training to ensure they kept their knowledge updated.

People were involved in choosing their meals and all staff were seen to support people to eat and drink if needed. People told us the food was good and a choice of meals was available. People were supported to access professional healthcare outside of the home, for example they had regular visits with their GP. Where appointments were needed at hospital these were supported by staff and any changes to care needs recorded and implemented.

People told us they felt staff were caring and that they knew how to look after the people who lived at the home. Staff showed us that they knew the interests, likes and dislikes of people. We saw that staff ensured that they were respectful of people’s choices and decisions.

People living at the home told us they would speak to staff and the registered manager about any concerns. The registered manager advised that as a small service any concerns were picked up and dealt with immediately.

Staff were supported to carry out their roles and responsibilities effectively, so that people received care and support in-line with their needs and wishes. The management team ensured regular checks were completed to monitor the quality of the care that people received and action had been taken where areas were identified for improvement.

On the day of inspection there were 12 people living at The Grove. We spoke with four people who used the service, one relative and four members of staff, including the deputy manager as the registered manager was on holiday. We looked at policies, processes, four care records and five staff records to gain an insight into the care provided.

We saw that there were arrangements in place to act in accordance with the wishes of people who used the service. One person we spoke with said, “They (staff) help me go where I want.”

We saw that people and their relatives were involved in decisions about the care provided. Details of their needs and interests were included in their care records. Care plans and risk assessments were in place to ensure people received the care they needed. People told us they like living at The Grove and staff were, “Really great.”

We saw that there was a rota for cleaning and people who used the service were able to help if they wished. Staff had appropriate training and showed a good knowledge of how they would prevent infection spreading if people became unwell.

There were appropriate selection and recruitment systems in place to ensure staff were suitable to work with vulnerable people. Staff we spoke with said they liked working there and there was a great team spirit.

There were no recent complaints but there was a system in place to report complaints. We saw that people were supported to make complaints if needed and that documents were available in formats to meet their needs.

During our inspection we spent time with people who used the service while they were in communal areas of the home. We spoke with one person while they were in their bedroom. We also spoke with three staff on duty including the registered manager.

We saw people who used the service engaging in some activities during the day and were told about some other activities they do outside of the home.

We found that staff on duty had a good understanding of the needs of people and that they supported them in meeting their needs. One person said of the service provided “Staff come and help”.

People who used the service indicated that they were happy and felt safe. Staff had knowledge about safeguarding procedures followed in the home. One member of staff said “We really care about them (people who use the service)”.

Many of the staff had been trained in areas relevant to the specific needs of people who used the service.

Suitable systems were in place to assess and monitor the quality of care provided and as a means to identify any improvements needed. These were primarily carried out by people working for the provider but not permanently based at the service.