Grove Park

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

The overall rating for this key question is requires improvement. This service was not always well-led. There had been a number of management team changes since our previous assessment. There remain shortfalls in clinical oversight and governance processes to ensure people received care and treatment that met their assessed needs. We identified the provider had not always notified CQC of all allegations of abuse. There were shortfalls in some peoples care which had not always been identified and when this had occurred there was insufficient action taken to ensure service users received timely support to meet their needs. The provider had failed to ensure staff reported incidents of potential harm to managers or the local authority and there was a lack of monitoring to identify trends to improve the safety and quality of the service. Oversight systems and processes in some instances had failed to identify shortfalls in staff practice or consider risk mitigation measures. This was a continued breach of Regulation relating to governance. Processes to address closed culture concerns identified at last assessment had been implemented, however, some people and staff told us they continued to not always feel free to speak up.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Systems and processes to protect people from the risk of abuse and harm failed to operate effectively. The service did not always reflect a culture that empowered people to achieve good outcomes and be equal partners in their care. People were dependent on staff for their safety needs and failure to identify altercations between people as reportable incidents and subsequent failure to monitor those events, increased the risk of continuing harm. Where concerns had been identified and had followed the incident process there were some improvements. The management team had experienced a number of changes following our previous assessment. The provider had reviewed and implemented systems designed to assess and monitor the day to day culture of the service and improve the level of engagement. Some people and their families told us there were continued communication challenges. One relative said, “[The provider] has recently started doing relatives meetings and sending out the minutes. I have tried to speak to the manager about things, but they are difficult to get hold of”. These reviewed systems had not had opportunity to be fully embedded and there were continued challenges with communication and engagement. The manager told us how they were working on improvements in these areas.

Following our previous assessment the provider was required to regularly report to CQC on actions they were taking to address shortfalls in service provision. Following our feedback the provider had recognised the need for improvement and reviewed the quality of audit systems in order to comply with conditions. Staff provided mixed feedback about the openness of senior leaders. Grove Park had experienced a number of leadership changes, and it was apparent some staff lacked confidence in leader skills and ability to manage the service effectively. The manager had recognised there were challenges to be worked through and told us, “When I first started, most staff would hide from me, and everybody would make themselves busy to avoid interaction. If they had to come here, they would stand by the door and be weary to come in. Now they come and sit down, they are respected and valued.”

At our previous assessment, the provider, former registered manager and some staff shared concerns regarding how staff had not felt safe to speak up. At this assessment some staff continued to express concern and told us they would not always feel comfortable to speak up. The provider had taken action to implement a Freedom to Speak up process which included specific staff acting as Freedom to Speak up Officers (FTSO). We asked for evidence of how this worked in practice and the provider did not supply information relating to the nursing unit. Whilst this is in the process of being embedded it meant there were continued concerns with how this impacted the quality of the service people received. Systems designed to gather feedback from people and staff had been reviewed and had started to identify and manage concerns about the culture of the service. The manager had recognised the need to improve the promotion of a positive culture at Grove Park.

Processes in place were now effectively monitoring the experience of staff. Staff were able to share concerns in various ways. Policies, procedures and quality assurance processes were considering specific cultural challenges and working to address the negative experiences of some staff. Most staff told us they enjoyed working at Grove Park. The workforce at the service was diverse and staff had a range of backgrounds, skills and experiences. The management team was supportive of oversees workers to work towards achieving their nursing qualifications and other social care qualifications. Whilst some staff told us they had not always felt included and informed in discussions, most acknowledged the improvements following the appointment of the manager. A staff member told us, “[The manager] is more on board with everything, much more approachable than [previous manager], with them we can give our concerns there and then and she will go to the residents and have a look with her own eyes. She is present in every handover and keeps an eye on every resident”.

The provider did not have effective auditing processes in place to ensure they were continually monitoring the risks to the health, safety and welfare of people. The provider had reviewed their processes following our previous assessment and new systems were in the process of being embedded. However, some concerns remained. Current systems had failed to identify shortfalls in staff practice or compliance risks. IPC audits were in place, however, did not ensure staff were clear on precautions to take in the event of a suspected outbreak of infection. The providers “Compliance Tracker” had not effectively managed regulatory risk. For example, the provider did not always complete their regulatory responsibilities and duty of care by notifying CQC of certain events. Statutory notifications to CQC had not always been submitted, some of these were under the previous manager, the provider’s systems had not identified these omissions. There were some improvements to the auditing and governance process. For example, medicine systems were now operating effectively, and staff were able to demonstrate how the systems had improved the support people received. Staff were able to evidence a reduction in the use of PRN medicines to manage a person’s behaviours. There was evidence of learning from incidents, reflective practice records had identified service improvements and staff told us they had opportunities to feedback.

Some people and relatives told us there could be delays with accessing support from external health professionals. Following links being made with partners, people told us staff and leaders collaborated with health professionals and supported them with appointments. The manager told us about how they engaged with professionals to support good outcomes for people. They gave an example of working to improve the environment for people living with dementia and how they were working with partners on this. Health professionals who work regularly with Grove Park noted improvements in the communication. Recent changes to the care management system had supported this improvement as records of work and communication with partners was now accessible and supported collaborative working.

The provider continued to not have effective quality monitoring systems in place to monitor staff practice that would have identified the need to ensure staff practice was in line with their training. We spoke with staff and whilst there had been an increase in training provision, there was limited evidence of how the provider assured themselves staff were following this training. For example, staff were in the process of completing Positive Behaviour Support (PBS) training designed to identify strategies and improve staff skills when supporting people who might be distressed. Some records relating to care were about compliance and non- compliance which suggested this approach was not always followed by staff. Following our feedback the manager spoke of their plans to support staff to improve their understanding and gain confidence. They had recognised the need to support continuous learning and improvement. Processes designed to be opportunities for staff to learn and be heard had increased and lessons were now being identified and shared. For example, a recent staff meeting had including consideration of moving and handling training and how it had supported staff learning and improvement. Staff spoke of training they had completed including for dementia and how they supported people when they appeared confused or distressed.