The Grove is a residential home for 30 people, some of whom live with dementia. At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.

People’s experience of using this service:

• People felt safe and were protected from avoidable harm. Staff understood how to keep people safe and how to report any concerns they may have.

• Staff knew about the risks associated with people’s care and understood how to minimise risks to them. Further information was available in care plans for staff to refer to.

• Staff supported people to take their medicines and how to store them safely.

•Staff understood how to prevent the spread of infection.

• People received care from a consistent team of staff who understood their needs well.

• People’s needs were assessed to ensure they could be met by the service.

• Staff were recruited safely and processes were in place to check the background of potential staff.

• Staff received training and guidance.

• People made their own decisions about their care and were supported by staff who understood the principles of the Mental Capacity Act 2005.

• People were offered choices in the meals and drinks they were offered.

• Staff respected people’s rights to privacy and dignity and promoted their independence.

• People received information about the service in a way that was appropriate to their needs.

• People were involved in planning their care.

• Care plans contained the information and guidance staff needed to support people.

• Systems were in place to manage and respond to any complaints or concerns raised.

• The provider had systems for reviewing how the home was managed by the registered manager. This included reviewing systems for updating people’s care.

At this inspection we found the service met the characteristics of a “Good” rating in all areas.

Rating at last inspection: At our last comprehensive inspection of this service in April 2016, we rated the service as 'Good'.

Why we inspected: This was a planned inspection based on the date and the rating of the previous inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 11 February 2016 and was unannounced.

The Grove Residential Home provides care and accommodation for up to 30 older people. There were 29 people living at the home at the time of our inspection, of whom a number of people lived with dementia. Out of 29 people, a person was in hospital and four people were at the home receiving a ‘hospital to home’ service. This is a contract held between the provider and NHS which facilitates up to five people staying at the home. This is usually for a period of up to eight weeks for rehabilitation following discharge from hospital prior to returning to their own homes.

A registered manager was 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.

Staff were available at the times people needed them and had received training so that people’s care and support needs were met. This included training about dementia care. Staff understood their responsibility to safeguard people from harm. Where risks associated with people’s health and wellbeing had been identified, there were plans to manage those risks. Risk assessments ensured people could continue to enjoy activities as safely as possible and maintain their independence as able.

People were involved in decisions about their care and told us they received support in the ways they preferred. People told us staff encouraged them to pursue their hobbies and interests. People were supported to maintain relationships with people important to them and visitors were welcomed at the home. People and their relatives told us that staff were caring and that people were afforded privacy and treated with dignity and respect.

People received a nutritious diet, had a choice of food, and were encouraged to have enough to drink. People were referred to external healthcare professionals to ensure their health and wellbeing was maintained. Medicines were managed so that people received their medication as prescribed.

Staff understood the principles of the Mental Capacity Act (MCA), and care workers gained people’s consent before they provided personal care. People told us they were encouraged to make choices about their daily lives.

There were processes to monitor the quality and safety of the service provided and to understand the experiences of people who lived at the home. This was through regular communication with people and staff, surveys, checks on care workers to make sure they worked in line with policies and procedures and a programme of other checks and audits.

Arrangements were in place so that actions were taken following concerns raised, for the benefit of people who lived at the home. Systems were in place to drive continuous improvement at the home for the benefit of the people who lived there.

The evidence we collected helped us 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 the records we looked at and what people using the service and staff told us.

If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

There were procedures in place to safeguard people from abuse. Staff understood their role in safeguarding the people they supported. The staff and manager had a good understanding of whistle blowing policy. This meant people were kept safe. We saw people were cared for in an environment that was safe and clean. There were enough staff on duty to meet the needs of people who lived at the home.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We saw that proper policies and procedures were in place. The manager had an understanding of these safeguards which make ensures people’s rights and choices.

Is the service effective?

We saw that people were treated with dignity and care. Care plans were linked to people’s individual needs, for example, in relation to nutrition and mobility. Staff had a good understanding of people’s care and support needs and knew them well. The service worked well with other agencies and services to make sure people received their care safely and effectively. A visiting social worker told us, “The staff here are always available, there are very detailed updates and I get the information I need. They are very prompt and we work well together.”

Is the service caring?

We found the care and support was delivered with dignity and respect which meant that the care was very person centred. All staff were aware of peoples choices, preferences and support needs. We saw the staff and manager were patient and gave encouragement when supporting people. All the staff we spoke with expressed compassion and kindness towards the people they supported. A visiting professional told us, “The interactions between staff and people are very positive and warm, staff genuinely seem to care.”

Is the service responsive?

We saw people were treated with respect when they changed their minds and the service was responsive to people’s needs. For example, at lunchtime when people changed their minds about their meal and requested different food, this was given. We spoke with the manager who told us she involved other professionals in people’s care when their needs changed. This was so their care could continue to be provided safely and appropriately. Staff were aware that people’s needs varied throughout the day and responded accordingly. A visiting professional told us, “They are so timely, I get a prompt response.”

Is the service well-led?

The manager was aware of her responsibilities in meeting the essential standards of quality and safety. Staff told us they were clear about their roles and responsibilities. One member of staff told us, “The managers are very good, we are forever doing training, and I feel skilled to do my job.” There was a clear structure of supervision responsibilities within the staff team. Staff felt supported to do a good job.

We visited The Grove Residential Home to check action had been taken to address areas of non compliance with medication management. These were identified at our inspection on 2 July 2013.

During our inspection visit we found that sufficient improvements had been made to ensure the safe and appropriate management of medicines.

During our visit we spoke with eight people who lived in the home and two visitors. People and visitors we spoke with told us they were satisfied with the care provided. Comments included: “Very good.” “I like it here.” “It’s wonderful care for physical needs. X is happy and contented here.” We saw that people looked well cared for.

People told us they liked the meals. Comments included: “The food is very good.” “It’s fairly reasonable.” We saw some social activities had been provided although there were none taking place on the day of our visit.

We found there were some improvements needed in relation to medicine management. This included how medicines were stored and monitored to maintain their effectiveness and safety.

Staff we spoke with had a good knowledge of the needs of people they were caring for. People were positive about the staff caring for them. They told us: “Very nice, they are very gentle, I like them.” “Very good.” “The staff do what they can.”

People we spoke with did not have any complaints about the service but told us they would feel at ease to raise any concerns with staff. Systems were in place to investigate complaints received.

During our last visit to this service we found that care records were not sufficiently detailed to protect people from the risks associated with unsafe care and treatment.

During this visit we selected three care files at random to review to see if improvements to records had been made. We found that they all contained detailed information about the person’s care needs. We saw there were clear instructions to staff on how to manage these. Care records were all dated and dates of when they had been reviewed had also been recorded.

We did not speak with people directly about their records. We did ask a visitor if they had been involved in contributing to their relative’s records. They told us: “They talked to us about everything. They kept us up-to-date, they always phoned us.”

We carried out this visit to review improvements following our last inspection to the home. We found improvements had been made in relation to the management of nutrition. We also found there had been some minor improvements to people’s care records.

People told us they were happy with the food being provided. On the day of our visit we saw that the main meal looked appetising. Comments included: “I really enjoy the food but never put on any weight.” “The food is lovely, I have not had a bad meal it’s very good.”

Staff had a good awareness of those people who were losing weight. We saw that staff were taking actions to ensure those people at risk of poor nutritional health were being supported with their meals and drinks.

We looked at the care records for three people with health conditions that could impact on their nutritional health. We did not find that sufficient improvements had been made to the care records to ensure staff delivered consistent and appropriate care.

We spoke with four people living at The Grove and three visitors. People told us: “I am quite happy, I am more independent than some. I wanted to come here, my son and daughter went round all the homes. It’s more homely than some.” “I like it here, I am quite happy to stay here.” “Staff are very good, well I think they are.” Visitors told us: “I can’t fault anything.” “This place is run very professionally, there are a lot of young carers who are very switched on.”

We saw that people looked well cared for and we observed that people’s privacy and dignity was maintained. Staff were friendly and respectful towards people and people told us they would feel comfortable to speak with staff about any concerns.

People told us they could choose how to spend their day and we saw some people sitting in lounge areas watching the television and others in their rooms. Some people felt more could be done to meet their social care needs. Comments included: “We do handicrafts painting and all sorts of things.” “They do have a table up and do party things and making cards, I think it’s for those whose minds are not so good, they don’t force me to.” “It can be boring, there are so many things I would love to do.”

We observed people enjoying their meals and we saw that there were sufficient choices made available. People told us they liked the meals. Comments included: “Very good, there is a lot of home cooking.” “It is excellent, I can never say I go hungry….” “The food is reasonable.”

We found that improvements were needed to care records. Records of health conditions and risks associated with these conditions were not sufficiently detailed. Records relating to people falling and the risks associated with these were also not sufficient. People could be placed at risk of harm if records are not clear about their care, treatment and risks and how these need to be managed.

We saw that people had an opportunity to voice their opinions about the care and services being provided within annual satisfaction surveys and bi-monthly ‘resident’ meetings. Many positive comments were seen about the home including: “Good, friendly and well run.” “Welcoming and homely.”

We visited the home on 18 April and 4 May 2011. We spoke to four people who lived at the home. We spoke to four relatives about the care given in the home. We spoke to health professionals who visit the home. Some people living at the home have communication difficulties. This limited the amount of discussion we could have with them. All the people we spoke to were happy with their care.