We inspected The Grove and The Courtyard on 4 and 9 December 2014. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.
The Grove and The Courtyard is a purpose built care home providing care for different client groups across four separate units. The Lodge accommodates a maximum number of 14 people living with a dementia and who have nursing needs. The Cleveland unit can accommodate a maximum number of 14 people with mental health conditions. Courtyard unit on the ground floor can accommodate 12 people and Courtyard unit on the first floor can accommodate 15 people with mental health conditions. Accommodation is provided over two floors and includes communal lounge and dining areas. Externally there are garden areas and a car park.
The home had a manager who started working at the service in July 2014. The manager was in the process of completing their application to apply to be 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.
People told us they felt safe in the service and we saw there were systems and processes in place to protect people from the risk of harm. Checks of the building and maintenance systems were undertaken to ensure health and safety. However the service had been without a handyman for a number of weeks and as such some safety checks such as testing water temperatures and monthly fire instruction with staff had not been undertaken as often as required during this time.
We found that people were encouraged and supported to take responsible risks. People were encouraged and enabled to take control of their lives.
We found people were cared for by sufficient numbers of suitably qualified, skilled and experienced staff. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.
Systems were in place for the management of medicines so that people received their medicines safely. However we had some concerns in relation to the medicines storage room on Courtyard (first). This room was used as an office and also a hairdressing room. People’s mental health conditions meant that people and their medicines required reviewing on a regular basis at different times during the month. This made the reordering process of medicines difficult for staff as they had to remember to reorder medication for different people at different times during the monthly cycle. This increased the risk of people running out of their medication supply.
Staff told us that they felt well supported, however formal supervision was not taking place as often as it should be. We saw that most mandatory training for staff was up to date.
There were positive interactions between people and staff. We saw that staff were kind and respectful. Staff were aware of how to respect people’s privacy and dignity. However we saw that some improvement could be made. On occasions when providing care and support staff did not always tell people what they were doing particularly in relation to moving and handling. This could compromise welfare and safety. People told us that they were able to make their own choices and decisions and that staff respected these.
The manager and staff had been trained and had a good knowledge of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The manager understood when an application should be made, and how to submit one. This meant that people were safeguarded and their human rights respected.
People told us they were provided with a choice of healthy food and drinks which helped to ensure that their nutritional needs were met. People told us that they liked the food provided. However we felt that some improvements could be made to the meal time experience of those people living with a dementia.
People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff or relatives to hospital appointments.
People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. The care plans contained a good level of information and set out how each person should be supported to ensure their needs were met. We found that some risk assessments were insufficiently detailed. They did not contain individual person specific actions to reduce or prevent the highlighted risk. This meant that safety actions to keep people safe were not documented and people could come to harm.
We saw that people were involved in a range of activities. We saw that staff engaged and interacted positively with people. We saw that people were encouraged and supported to take part in activities. However activities for those people living with a dementia were limited. This meant that some people were provided with limited stimulus during the day.
Appropriate systems were in place for the management of complaints. People and relatives told us that the manager was approachable. People we spoke with did not raise any complaints or concerns about the service.
In general there were effective systems in place to monitor and improve the quality of the service provided; however the manager had not undertaken infection control audits. Staff told us that the service had an open, inclusive and positive culture.
We inspected The Grove and The Courtyard on 4 and 9 December 2014. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.
The Grove and The Courtyard is a purpose built care home providing care for different client groups across four separate units. The Lodge accommodates a maximum number of 14 people living with a dementia and who have nursing needs. The Cleveland unit can accommodate a maximum number of 14 people with mental health conditions. Courtyard unit on the ground floor can accommodate 12 people and Courtyard unit on the first floor can accommodate 15 people with mental health conditions. Accommodation is provided over two floors and includes communal lounge and dining areas. Externally there are garden areas and a car park.
The home had a manager who started working at the service in July 2014. The manager was in the process of completing their application to apply to be 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.
People told us they felt safe in the service and we saw there were systems and processes in place to protect people from the risk of harm. Checks of the building and maintenance systems were undertaken to ensure health and safety. However the service had been without a handyman for a number of weeks and as such some safety checks such as testing water temperatures and monthly fire instruction with staff had not been undertaken as often as required during this time.
We found that people were encouraged and supported to take responsible risks. People were encouraged and enabled to take control of their lives.
We found people were cared for by sufficient numbers of suitably qualified, skilled and experienced staff. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.
Systems were in place for the management of medicines so that people received their medicines safely. However we had some concerns in relation to the medicines storage room on Courtyard (first). This room was used as an office and also a hairdressing room. People’s mental health conditions meant that people and their medicines required reviewing on a regular basis at different times during the month. This made the reordering process of medicines difficult for staff as they had to remember to reorder medication for different people at different times during the monthly cycle. This increased the risk of people running out of their medication supply.
Staff told us that they felt well supported, however formal supervision was not taking place as often as it should be. We saw that most mandatory training for staff was up to date.
There were positive interactions between people and staff. We saw that staff were kind and respectful. Staff were aware of how to respect people’s privacy and dignity. However we saw that some improvement could be made. On occasions when providing care and support staff did not always tell people what they were doing particularly in relation to moving and handling. This could compromise welfare and safety. People told us that they were able to make their own choices and decisions and that staff respected these.
The manager and staff had been trained and had a good knowledge of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The manager understood when an application should be made, and how to submit one. This meant that people were safeguarded and their human rights respected.
People told us they were provided with a choice of healthy food and drinks which helped to ensure that their nutritional needs were met. People told us that they liked the food provided. However we felt that some improvements could be made to the meal time experience of those people living with a dementia.
People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff or relatives to hospital appointments.
People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. The care plans contained a good level of information and set out how each person should be supported to ensure their needs were met. We found that some risk assessments were insufficiently detailed. They did not contain individual person specific actions to reduce or prevent the highlighted risk. This meant that safety actions to keep people safe were not documented and people could come to harm.
We saw that people were involved in a range of activities. We saw that staff engaged and interacted positively with people. We saw that people were encouraged and supported to take part in activities. However activities for those people living with a dementia were limited. This meant that some people were provided with limited stimulus during the day.
Appropriate systems were in place for the management of complaints. People and relatives told us that the manager was approachable. People we spoke with did not raise any complaints or concerns about the service.
In general there were effective systems in place to monitor and improve the quality of the service provided; however the manager had not undertaken infection control audits. Staff told us that the service had an open, inclusive and positive culture.