The Grove is a residential care home for up to 19 older people including those with dementia and/or sensory impairment. The home is a detached listed property, set in extensive grounds. Accommodation is provided on several floors in 13 single rooms and three shared rooms.

People in care homes receive accommodation and nursing or personal care as a 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.

At our last inspection, on 1 June 2016 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.

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Processes were in place to keep people safe. Risks to their health and safety were assessed and reviewed regularly and actions were taken to reduce these risks. Incidents were reported, investigated, and action to prevent recurrence, were identified. People were protected as far as possible, from abuse and the registered manager was aware of the reporting requirements. There were sufficient numbers of staff with the right qualifications, skills and experience to provide a high standard of care. Medicines were managed safely.

The premises and equipment were maintained to ensure people’s safety and the required safety checks were completed regularly. Arrangements were in place to maintain good standards of hygiene and cleanliness and people were protected by procedures to prevent and control infection.

People continued to receive an effective service. Staff had access to best practice guidance and this was utilised to plan people’s individual care. Staff received the training and support they required to meet people’s individual needs. People were provided with a healthy and nutritious diet and were provided with the support they needed to eat and drink sufficiently. Staff worked well with external health care professionals and people were supported to access health services when required. 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 place supported this practice.

Staff were caring and compassionate towards the people they cared for and we observed a relaxed, friendly atmosphere within the home. Feedback from people using the service and their relatives was extremely positive about the attitude, attentiveness and responsiveness of staff. People described the home as “A home from home.” They emphasised the personal service, the friendly atmosphere, and the support they received from staff. People felt involved and listened to.

People continued to receive care that was responsive to their individual needs. Staff had a detailed knowledge of the people they cared for and they responded effectively to their needs and wishes. People were treated equally, without discrimination and information was accessible. People were encouraged to maintain their relationships and contacts outside the home. A wide range of activities were provided, based on people’s interests and wishes.

The registered manager provided good leadership and support to staff. The views of staff, people using the service and relatives were actively sought and listened to. Quality audits were in place to enable continuous improvement in the quality of the service provided. Representatives of the provider visited the service regularly and provided the opportunity for staff and people using the service to provide feedback. They completed quality monitoring audits.

Further information is in the detailed findings below.

This inspection was unannounced and was carried out on 31 March 2016.

The Grove Residential Care Home is registered to provide accommodation and personal care for up to 19 older people. The home is a detached listed property set in extensive grounds. The home offers personal accommodation in 13 single rooms and 3 shared rooms.

There was a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (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.

People were safe living in the home and staff understood how to respond to any concerns that may arise so that people were kept safe from harm. People’s medicines were managed safely and they had been helped to avoid the risk of accidents by staff who had received training to help them do this.

There were enough staff on duty who had been trained to support people in ways they wanted to be supported. People were supported to receive the healthcare they needed and they were helped to eat and drink enough to promote good health.

People’s rights were protected and they were supported to make their own decisions wherever possible. Appropriate arrangements were in place to support people who could not do so. CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered

necessary to restrict their freedom in some way, usually to protect themselves. At the time of the inspection no-one using the service had any legal restrictions placed upon freedom.

People were treated with kindness and respect. Their right to privacy within the home was upheld and staff respected their confidential information.

People received all of the care and support they wanted and needed and they had been consulted about how their care should be provided. They were supported to engage in a range of activities and interests. There was a system in place for people to make a complaint if they needed to and they felt comfortable to raise any issues they had.

Quality assurance systems were in place to ensure any shortfalls in the provision of care and services for people could be identified and improvements made. Systems were also in place to ensure staff had appropriate support to help them carry out their roles effectively.

When we visited this service on 04 April 2014 we found that the service was not compliant with regulation 20 of the Health and Social Care Act 2008 - Records. This was because the provider had not ensured that records were securely stored. We found this had a minor impact on people who used the service.

Following this inspection we asked the provider for an action plan telling us how they would achieve compliance with the regulation. However the provider did not send us one.

During this inspection we found that improvement had been made with the safe storage of records. However, other areas of concern were identified with the care and welfare of people who used the service.

At the time of our inspection the home was without a registered manager. We spoke with the provider who told us the acting manager had submitted their application for registration to become a registered manager. We observed that they had arrangements in place to provide leadership and support in the interim period.

When we visited The Grove there were 14 people living at the home. We spoke with six people and observed how others were cared for. This was because some people had problems with their memory and could not tell us their experiences of the care they received. We also spoke with the provider, the manager, two staff members and a relative.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service and staff told us.

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

Is the service safe?

People we spoke with told us they felt safe living at the home. One person said “Yes they [staff] make sure we’re very safe. They watch me when I’m walking in case I fall, they set the fire alarm off as well to make sure we know what to do.”

We saw that there was a policy and procedure that described what safeguards needed to be observed if someone needed to have part of their freedom limited. Documents and records showed that no one was having their freedom restricted at the time of our inspection.

Staff we spoke with understood how to keep people safe. They knew how to identify if abuse had or was likely to happen. They knew how to report any issues or concerns to social services or the police.

Some people needed extra help to relieve pressure on parts of their body. We saw staff carried out this support regularly and completed charts to show they had done so.

People we spoke with told us they could get medical attention whenever they needed it. One person said, “I only have to mention it to the staff and they get the doctor or nurse to see me.”

There was a plan in place to deal with foreseeable emergencies such as interruptions to the supply of electricity, water and gas. The arrangements set out in the plan included providing alternative accommodation if it became necessary.

We saw the provider had a system to record when anything in the home needed repairing or replacing. The records showed what actions had been taken to address the issues highlighted.

We found that people’s personal records were not always fully secured and staff did not use a private space to share information about people’s needs at shift change times. This meant that people’s confidentiality was not fully protected. We have asked the provider to address these issues.

Is the service effective?

Staff demonstrated a clear understanding of people’s needs and preferences. They carried out care tasks, such as moving people, in a safe way and in line with current guidance. We also saw that a housekeeper was involved in fire safety testing when we arrived at the home for our visit.

Some people needed extra help to relieve pressure on parts of their body. We saw staff carried out this support regularly and completed charts to show they had done so.

People we spoke with told us they could get medical attention whenever they needed it. One person said, “I only have to mention it to the staff and they get the doctor or nurse to see me.”

Training records showed staff had all been trained in fire safety and moving and handling. We also saw training had been booked throughout 2014. Subjects included health and safety, record keeping, first aid, and medication.

We saw there were policies and guidance available to make sure people’s rights to make decisions were upheld. Care records showed how people were supported if they did not have the capacity to make decisions for themselves, in line with current guidance.

The provider had produced a guide to their service for people who lived at the home and those who may wish to live there. The guide told people what arrangements there were for things like keeping pets, shopping, laundry and medical care. The guide also told people about their rights, how the provider monitored the quality of the service provided and how to make a complaint.

Is the service caring?

All of the people we spoke with told us they were happy living at the home. One person said, “It’s lovely here, lovely staff to have a chat with.” Another person said, “I get everything I need here, I just came back from hospital and I was so happy to be home.”

Staff spoke respectfully with people and asked for permission before they carried out any care tasks.

People told us they had a choice of food and the quality was always good. We saw staff assisted people where necessary with eating. Assistance was unhurried and personalised and staff gave their full attention to people they were with.

Is the service responsive?

When people asked for assistance staff responded promptly and care was carried out in private areas.

People we spoke with said they knew how to make a complaint if they needed to. A visitor also told us they knew how to make a complaint and they were confident the provider would deal with any issues in the right way.

A complaints policy was available for people and their visitors. Records showed that no complaints had been received by the home since our last visit.

Is the service well-led?

Staff told us they were well supported by the manager and the provider and had a good package of training. They said they were encouraged to express their views at staff meetings, share their knowledge with others and talk about better ways to do things in the home.

The provider had an effective system to regularly assess and monitor the quality of service that people receive. This included audits of topics such as medication, fire safety and infection control.

People we spoke with said staff and the provider always asked for their opinions about things that happened in the home. One person said, “They [staff] come round with questions on a paper that we can fill in, they listen to what we have to say here.” Records showed people were also able to express their views and opinions at meetings which were regularly held in the home.

On this inspection we saw new care plans had been introduced for each resident. We found the care files addressed individual need and were person centred. There was evidence that care was planned in partnership with people and also other professionals such as district nurses.

We saw where people were on special medication such as antibiotics they had a care plan to guide staff on the safe administration.

Staff told us they thought there was enough staff to keep people safe. One staff member said, “If someone is off sick, we always managed to cover it with another staff member.”

People told us the staff knew how to look after them. One person said, “They are kind and caring, I can’t grumble.”

Staff told us they attended team meetings and were given a say on all aspects of home life. They told us the owners were approachable. One carer said, “They treat you as an equal, rather than above you. They are visible leaders.”

All the people we spoke with said they were happy living in the home.

People spoke appreciatively about their experience of the service. Comments included, “They look after you well here” and “I do like it here, I am very satisfied with all aspects of the care I receive.”

We found the planning and recording of care did not always reflect people's needs and this put their health, safety and welfare at risk. However relatives and health care professionals we spoke with were complimentary about the care. One relative told us, “They are quick to contact the GP if there are any concerns and always let us know.” A health professional told us they visited the service most days and were very satisfied with the standards of care for their patients.

We looked at menus and meals provided for people. People we spoke with told us the food was very good and they had plenty of choice.

We looked around the premises and found people who used the service were protected against the risks of unsafe or unsuitable premises because of adequate maintenance. People spoken with told us they liked their home. They said it was comfortable and homely.

Records and discussions showed staff had received more training, which enabled them to be skilled and confident when supporting people. We found sufficient numbers of staff were provided to care for people. We found staff recruitment procedures were generally followed but not all the checks were in place before staff worked in the home. People spoke positively about the staff who worked at the home.

We spoke with five people who lived at the home and three visitors. Their comments indicated people received the care and support they needed and they were happy with how staff delivered care. When we asked one visitor about the care their relative had received they said, "The care is very good, staff are marvellous.” Another person told us, "Very satisfied with everything."

The people we spoke with said staff were supportive and kind, and we received only positive comments about how they delivered care. One person commented, "The staff are very nice and always very helpful." Another person told us, "Lovely group of staff, always very willing and kind."

People we spoke with told us that they felt safe living in the home. Comments included, "Yes I feel safe here, and they look after us very well."

People we spoke with confirmed they were able to give their opinions on how the service was run. Comments included, "Yes we have residents meetings, I usually go to them. We talk about a range of things including meals, activities and anything else we want to discuss.” Another person told us, “Very good home, I’ve no problems, best decision I made to move here.”

We inspected The Grove Residential Care Home on 9 and 10 December 2014. The inspection was unannounced.

At the last inspection on 29 July 2014, we asked the provider to take action to make improvements to the way they assessed and planned care for people, and this action has been completed.

The Grove Residential Care Home provides care for up to 19 older people, some of whom may experience needs related to memory loss. The home has 13 single rooms and three shared rooms and 13 people were living in the home during the inspection.

There was no registered manager in post at the time of the inspection. A registered manager had not been in post since 31 July 2013. The provider had submitted an application to the Care Quality Commission (CQC) in order to register as the manager. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are registered persons who have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 (MCA)Deprivation of Liberty Safeguards (DoLS) and to report on what we find. Staff had been trained and understood how to apply the principles of the MCA, although records were not always completed correctly. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of the inspection no-one who used the service had their freedom restricted.

We undertook a Short Observation Framework for Inspection (SOFI) at coffee time in the main lounge and in the dining room at lunchtime. SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

People told us they felt safe living in the home and they were treated with respect and dignity. They said they were supported to enjoy activities and interests of their choice and were able to say how they wanted to be cared for. Staff understood how to identify, report and manage any concerns they identified.

People received support to access appropriate healthcare services when they needed to and their medicines were managed safely. They were provided with a variety of foods and drinks. Nutritional planning took account of their needs and preferences.

Staff were appropriately recruited to ensure they were suitable to work with vulnerable people. They were knowledgeable and received training about how to meet people’s needs. They delivered care that was planned to meet people’s needs and took account of their choices, decisions and preferences.

People said they felt able to raise concerns and knew how to make a complaint if they needed to. They felt staff listened to their concerns and took action to resolve any issues.

We identified some areas of care and support which required improvement such as fire safety arrangements, completion of care records and quality assurance processes. The provider was aware of these issues and had taken steps to address them.