This inspection took place on 8 and 9 May 2018 and was unannounced. There were no concerns at the last inspection of December 2015. The Grove provides accommodation and personal care for up to 36 people and supports those who have a dementia. At the time of our visit there were 33 people living at the service. 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.

At our last inspection, we rated the service Good. At this inspection, we found evidence continued to support this rating and in addition, we found the service had improved to outstanding in some areas.

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.

We were introduced to people throughout our visits and they welcomed us. People were relaxed, comfortable and confident in their home. Staff involved in this inspection demonstrated a genuine passion for the roles they performed and their individual responsibilities. Visions and plans for the future were understood and shared across the staff team. They embraced new initiatives with the support of the provider, registered manager, deputy and colleagues. They continued to look at the needs of people who used the service and ways to improve these so staff felt able to make positive changes.

People experienced a lifestyle that met their individual expectations, capacity and preferences. There was a strong sense of empowering people wherever possible and providing facilities where independence would be encouraged and celebrated. People’s health, well-being and safety were paramount. The registered manager listened to people and staff to ensure there were enough staff on duty to meet people's needs. They demonstrated their responsibilities in recognising changing circumstances within the service and used a risk based approach to help ensure the staffing levels and skill mix was effective.

Staff had the knowledge and skills they needed to carry out their roles effectively. They enjoyed attending training sessions and sharing what they had learnt with colleagues. There was an emphasis on teamwork and unison amongst the staff at all levels. People were supported to enjoy a healthy, nutritious, balanced diet whilst promoting and respecting choice. The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). For people who were assessed as not having capacity, records showed that their advocates or families and healthcare professionals were involved in making decisions.

Staff had an excellent awareness of individuals' needs and treated people in a warm and respectful manner. They were knowledgeable about people's lives before they started using the service. People received appropriate care and support because there were effective systems in place to assess, plan, implement, monitor and evaluate people's needs. People and family were involved throughout these processes. This ensured their needs were clearly identified and the support they received was meaningful and personalised. Regular monitoring and reviews meant that referrals had been made to appropriate health and social care professionals and where necessary care and support had been changed to accurately reflect people's needs.

People and relative feedback was a vital part of the quality assurance system either through annual surveys, ‘residents’ meetings, complaints or reviews. People, relatives and staff were listened to and action was taken to make improvements whe

We carried out an unannounced focused inspection of this service because we had received some information of concern. We have only looked at the areas of Safe as the concerns sat within these areas.

This report only covers our findings in relation to this specific area. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘The Grove Residential Home’ on our website at www.cqc.org.uk.

The Grove Residential Home is registered to provide residential and nursing care for up to 36 people living with dementia (maximum 35 as one shared room used by a single person). At the time of our inspection there were 34 people in residence.

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 and has the legal responsibility for meeting the requirements of the law; as does the provider.

People were safe. Staff received safeguarding adults training and were knowledgeable about safeguarding issues. They knew what to do if concerns were raised and who to report the concerns to. Any incidents that occur within the service were reported to the safeguarding team at South Gloucestershire Council. However one that had happened in November 2016 was not reported. The service had put measures in place to ensure all incidents were discussed with, or referred to the safeguarding team and improvements had been implemented by the registered manager to prevent this happening again.

Any risks to people’s health and welfare were assessed and well managed in order to reduce or eliminate the risk. The service had taken the appropriate steps to reduce or eliminate the risk of people falling. If however people did fall, the reasons why were analysed and action taken to prevent a reoccurrence. The service had a pro-active approach to falls management but recognised that sometimes people fell.

Where people had been assessed as at risk of malnutrition, the service had measures in place to monitor their body weights and recorded food and fluid intake were required. The service liaised with the GP and would involve other healthcare professionals as necessary.

The service had measures in place to ensure the premises were safe and people were not placed at risk. As a result of an injury sustained by one person, the provider had subsequently taken action to remove the risk. The provider had reviewed the whole home to ensure the risk was not present in other places, as well as to eliminate the risk. There was a programme of weekly and monthly checks in place to check the safety of the home.

The staffing numbers on duty each shift were calculated to enable each person’s care and support needs to be met.

We visited The Grove in response to information we received from an anonymous whistle-blower. They raised concerns and alleged that ‘management were giving staff a list of people to get up in the morning’. They told us that night staff were getting people up from 4am and that by 5.30am ‘most residents were up and dressed’.

As a result of this inspection we found that people expressed their views and were involved in making decisions about their care including the time they got up and dressed. People were supported in maintaining their independence and their diversity, human rights and choices were respected.

People were supported by their families, staff and significant health and social care professionals. This was to help them chose how they wished to be cared for and provide guidance on what would be considered in their best interests for those decisions that they couldn’t make.

We did not find evidence to support the allegations we received.

The manager and deputy were available throughout the day and both were very knowledgeable about the people in their care, the policies, procedures and systems in place to ensure the continued smooth running of the home.

Because we were looking at recruitment during the inspection we were asked if we would like to attend interviews for new staff that had been arranged that day. We observed one interview which provided us with a good insight about how the home wanted to ensure they employed suitable people.

We spent time in various parts of the home including all communal areas so that we could observe the direct care, attention and support that people who lived at the home received.

There was a constant interaction between staff and people in the home. People were relaxed, happy and comfortable in each other's company.

We spoke with one person who visited the home every week to supply a service to the people living there. They told us that “Staff were dedicated and wanted the best for people in their care” and that they were “kind and considerate. It was evident through observation and in discussions that they enjoyed working in the home and supporting people.

There were people that had a diagnosis of dementia which meant that they were sometimes confused about the questions we asked them. There were people that had capacity and they were able to express their views. We also spoke with two relatives.

During the first part of our visit the atmosphere was calm relaxed and happy. People were using all parts of the home freely. The manager explained that they wanted people to feel free to wander and to feel empowered, balancing the risks against people’s choice and quality of life.

In the afternoon a musical entertainer visited the home. We watched some of the performance to see if people were enjoying the activity. Everyone was singing, clapping, tapping their feet and some got up and started dancing in the middle of the room.

We watched staff interact with people throughout our visit. Staff were patient and kind, offering reassurance when some people became restless or anxious. It was evident throughout the inspection that the manager, deputy and staff had people’s best interests at the centre of their care.

One family told us about how their relative had settled in to the home and ‘seemed happy’ and ‘well cared for’. Some people with dementia came up to us and held our hand; they were leading us and showing us around their home. They told us they were happy.

This inspection took place on 29 September and 1 October 2015 and was unannounced. The previous inspections of The Grove Residential Home were in November 2013 and March 2014. There were no breaches of the legal requirements at those times.

The Grove Residential Home is a care home for up to 36 predominately older people who are living with dementia. One bedroom that is registered to accommodate two people however was only used by one person. At the time of our inspection there were 34 permanent people in residence and one person who had been admitted for a short stay (a respite stay).

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.

People were safe. Staff received safeguarding adults training and were knowledgeable about safeguarding issues. They knew what to do if concerns were raised and who to report the concerns to. Any risks to people’s health and welfare were well managed. Pre-employment checks were robust and ensured that unsuitable workers could not be employed to work in the service. The management of medicines was in line with good and safe practice.

The staffing numbers on duty each shift were calculated to enable each person’s care and support needs to be met. Staff were well trained to enable them to carry out their roles and responsibilities. New staff had an induction training programme to complete and there was a programme of refresher training for the rest of the staff. There was a collective aim within the staff team to provide a high quality service. Care staff were encouraged to complete nationally recognised qualifications in health and social care.

People were supported to make their own choices and decisions where possible. Staff understood the need for consent and what to do where people lacked the capacity to make decisions. We found the home to be meeting the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People were provided with sufficient food and drink. There was a real commitment by the catering staff and the care team to ensure that people enjoyed their food and received the nutrients and vitamins they needed to maintain good health. Arrangements were made for people to see their GP and other healthcare professionals as and when they needed to do so.

People received a service that was caring and met their individual care and support needs. They said they were well looked after and this was also confirmed by relatives we spoke with. The staff team had good friendly relationships with the people they were looking after. People were able to participate in a range of different activities, both in-house and in the local community. People were supported to be as independent as possible.

Care records were kept for each person and provided detailed information about how the person wanted to be looked after and how their care was to be delivered. People were involved in decisions about their care as much as possible and their families were also consulted. People were encouraged to raise any concerns they may have.

A range of measures were in place to audit and monitor the quality and safety of the service. Action plans were developed where improvements and changes were required. These measures ensured that any improvement actions were followed up and implemented. The registered manager demonstrated a real commitment to improvement and had also engaged the whole staff team to ‘strive towards excellence’.