Archived: Grove House Residential Dementia Care Home

Updated 19 June 2019

The inspection: We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection team: This inspection was carried out by two inspectors, an assistant inspector, a pharmacy specialist advisor, and an “expert by experience”. An "expert by experience" is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type: Grove House Residential Dementia Care Home provides accommodation and personal care for people with dementia.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection: This was a comprehensive inspection, which took place on 23 & 25 April 2019 and was unannounced.

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What we did: Before the inspection, we reviewed information we had about the provider, including notifications of any safeguarding concerns or other incidents affecting the safety and wellbeing of people. We also contacted two social care professionals and obtained feedback from them.

Inspection site visits took place on the 23 & 25 April 2019. It included speaking to the registered manager, one of the registered partners and four other staff. We reviewed four people's care records, which included care plans and risk assessments. We also looked at four staff files checking staff recruitment, training and supervision records. We looked at records relating to the management of the service which included various policies, medicine charts, procedures, maintenance files and audits.

Updated 19 June 2019

About the service: Grove House Residential Dementia Care Home provides accommodation and personal care for a maximum of five adults who may have dementia care needs. At the time of this inspection, there were four people using the service.

People’s experience of using this service:

The quality of care had deteriorated since the last inspection. People's welfare and safety had been placed at risk due to a lack of staff, vigilance and effective management of the service.

During our last inspection on 6 June 2018 we found the provider was in breach of Regulation 17 of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. The registered provider did not always operate effective systems to assess, monitor and the improve the quality of service provided to people who used the service. At this inspection we found the provider still did not make significant improvements. Deficiencies were not promptly identified and rectified.

During our last inspection on 6 June 2018 we found the provider was in breach of Regulation 12 HSCA RA Regulations 2014 Safe care and treatment. The registered person did not ensure the safe and proper management of medicines. At this inspection we found the provider continued to have deficiencies in the safe and proper management of medicines.

During our last inspection on 6 June 2018 we found the provider was in breach Regulation 18 HSCA RA Regulations 2014 Staffing. Staff did not receive appropriate support, training and professional development to enable them to carry out the duties. At this inspection we found the provider had ensured that staff were provided with support and training.

People who used the service had dementia and three of them did not provide us with their view regarding the quality of the care provided. One person stated that they were not fully satisfied with the services provided. Feedback from two of the three relatives indicated that they were not fully satisfied with some aspects of the care provided.

Arrangements were in place to help ensure people were protected from the risk of abuse. Staff had received training on how to safeguard people.

Risk assessments had been documented. Risk assessments covered areas such as the environment, physical health and personal care. We however noted that there was a lack of documented information about control measures and action required to reduce certain potential risks such as those associated with behaviour which challenged the service and danger posed by the steep stairs. The registered manager told us that they were aware of how to manage behaviour which challenged the service and they would prepare a risk assessment for the steep stairs.

The home had a procedure to ensure that people received their prescribed medicines. Staff had received medicines administration training. Our pharmacist specialist advisor however, noted a number of errors associated with the administration of medicines and these included errors in the administration of a controlled drug and inadequate recording. We found a breach of regulation in respect of this.

Most staff had been carefully recruited. However, one staff member did not have documented evidence of their right to work in this country. The registered manager stated that this person had permission to work in this country but their documents were with the Home Office. We found a breach of regulation in respect of these deficiencies.

The home had inadequate staffing levels. This meant that people’s care needs and certain duties such as care documentation and ensuring the cleanliness of the home may not always be attended to. We found a breach of regulation in respect of this.

The premises were not well maintained, and we noted several deficiencies. These included fire safety deficiencies identified by us and the fire authorities. The garden was overgrown, and this meant that people were not able to use it. There was no current safety inspection certificate for the electrical wiring. We found a breach of regulation in respect of this.

We noted that there were health and safety risks on the premises. This included a trailing wire in the decking area and a window without a restrictor. There was no recorded evidence that staff had checked the hot water temperatures prior to people being given showers. There was no gate at the top of a steep flight of stairs. These placed people at risk of harm. We found a breach of regulation in respect of this.

The premises had not been kept clean. There were unpleasant odours in the home on the first day of inspection. This was rectified on the second day of inspection.

We are not confident that people’s healthcare needs were met. Appointments had been made for healthcare professionals to attend to people. However, one person’s care plan had not been updated following the appointment. Another person did not attend an appointment in 2018 and no reasons were recorded.

Fresh fruits and vegetables were available, and meals were freshly prepared. However, we observed that people were not always asked about their preferences. There was documented evidence that one person was provided with a meal that was not appropriate for them.

There were arrangements for supporting staff and providing them with essential training. Supervision and a yearly appraisal of their performance had been carried out.

Staff had been provided with training and understood their obligations regarding the Mental Capacity Act 2005 (MCA). They knew that people should be supported to have choice and control of their lives in the least restrictive way possible. Staff gained people's agreement before providing them with assistance with personal care and other activities.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored and the reasons why they are being restricted is regularly reviewed to make sure it is still in the person's best interests. We noted that there had been some deficiencies related to DoLS. This was being addressed by the home.

Staff respected people’s privacy and feedback received indicated that people had been treated with respect. Some staff had a caring approach towards people whilst others did not. People’s enjoyment of their environment was not always taken into consideration as the home had an unpleasant odour at times. Three dogs belonging to the registered manager were barking loudly in the decking area during the morning on both days of inspection.

Staff had an awareness of ensuring equality and valuing diversity. People were not subject to any discrimination on account of their religious, cultural or other individual characteristic. We however, noted that one person’s religious dietary needs were not always met.

There was a lack of consultation with people and their relatives. We noted that there was no record of minutes of meetings with either people or their relatives. Relatives we spoke with stated that there was little consultation with them regarding the needs of people and they were not always aware of people’s progress.

People did not always receive personalised care and support that met their individual needs and choices. There was a lack of social and therapeutic activities. Although there was a record of some activities people had engaged in. Since the beginning of the year, no evaluations or reviews of care had been carried out to ensure the care plans met people’s changing needs. Some care plans lacked detail and had not been updated to provide information for staff on how to support people. We found a breach of regulation in respect of these deficiencies.

There was a formal complaints procedure in place which was available to people. No complaints had been documented. The registered manager stated that none were received although a relative stated that they had made a complaint last year. We have made a recommendation to ensure that complaints made are recorded and followed up.

The home had a management structure in place with the registered manager and a team of care workers. The registered manager however, informed us that she would soon be resigning from her post and one of the partners would be applying to become the registered manager.

The registered manager monitored the quality of some aspects of the service. However, our findings indicated that the checks and audits were not sufficiently effective to identify and promptly rectify deficiencies in the service. The standard of care documentation and records was inadequate. One recruitment record related to permission to work in this country was not provided. A care record of a person had details of another person in it. This may place people at risk of harm and not receiving a good quality service. We found a breach of regulation in respect of this.

The standard of cleanliness was poor and maintenance issues had not been picked up and rectified until they were identified by us. There continues to be repeated breaches in the administration of medicines. We also noted that the service this section had been rated as requires improvement in the last two inspection reports.

The registered manager and one of the partners informed us after the inspection that they intended to close the home temporarily so that improvements can be made to the premises and the staffing arrangements.

We found six breaches of the Health and Social Care Act 2018 (Regulated Activities) Regulations 2014

Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s regi