Grove House Home for Older People

Updated 24 June 2021

The inspection

We carried out this focused inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection, we looked at the infection control measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by one inspector.

Service and service type

Grove House Home for Older People is is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with CQC; the manager was also the owner. This means they are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service, including information from the provider about important events that had taken place at the service, which they are required to send us. We considered feedback from the local authority including the safeguarding team.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all this information to plan our inspection.

During the inspection

We observed how staff provided support for people to help us better understand their experiences of the care they received. We spoke with four people living in the home, four members of staff, a housekeeper, an operations manager and area co-ordinator for cleaning services, a senior operations manager and the registered manager.

We reviewed a range of records. This included two people’s care records and risk assessments, two medication records and one staff member’s recruitment records. A variety of records relating to the management of the service were also reviewed. We walked around the service to observe the environment; we did not look at all areas.

After the inspection

We continued to seek clarification from the provider to confirm evidence found. We looked at and considered the provider’s action plan sent to us after the inspection.

Updated 24 June 2021

Grove House Home for Older People is registered to provide accommodation and personal care for up to 47 people. The home is set in its own grounds and accommodation is provided across two floors. The home is divided into four areas known as Willow Court, Elm Court, Cedar Court and Oak Court. There were 31 people living in the home at the time of the inspection.

People’s experience of using this service and what we found

The provider's systems failed to identify that care and treatment was not always provided in a safe way. Audits and checks were not effective in identifying risks to people’s health and safety. Staff practice was not always effectively monitored.

Whilst people told us they were happy living in the home, care and treatment was not consistently provided in a safe way. We found two people’s support documentation, including their risk assessments had not been updated to provide staff with current guidance about their care. One person had experienced two falls in the home which had resulted in significant injuries and a substantial change in their needs. However, these events did not prompt a review of their support plan or risk assessments. As a result, staff were carrying out complex care activities and a specialist healthcare task with no guidance or oversight. This placed the person at high risk of unsafe and inconsistent care. Two people required support for positional changes, however, most of their daily care monitoring charts were not completed and it was unclear what checks and positional changes had taken place. There was no evidence to demonstrate the management team had checked the charts to ensure appropriate care was provided.

Whilst staff had access to training and appropriate policies and procedures, there was a delay in reporting a safeguarding issue to the local authority. Medicines were not always managed appropriately, there were no protocols seen to guide staff in the administration of ‘as necessary’ medicines and at the time of the inspection, staff told us they were applying an external cream which had been brought into the home by the district nursing team. There were no details or instructions about the application of the cream on the person’s medication administration record.

The home had a satisfactory level of cleanliness. Although the provider had appropriate arrangements for routine maintenance and repairs and some areas had been refurbished, the wallpaper was badly scuffed in many bedrooms making it difficult to clean walls. At the time of the inspection, remedial work recommended on the electrical safety check in 2018 had not been carried out. Following the inspection, the provider confirmed immediate safety issues had been addressed at the time and a planned and coordinated electrical update would be carried out in June 2021.

There were sufficient staff on duty and the provider had suitable arrangements for the recruitment of new staff. However, three staff spoken with were unsettled and they felt communication with the management team could be improved. The provider had considered the staff morale and had recently carried out a staff survey.

The provider had failed to notify the commission without delay of two incidents where people had incurred serious injuries. This matter will be considered separately from the inspection process.

We asked the provider for details and evidence of their checks and audits of the service over the last six months. This information was provided after the inspection. Whilst the information received demonstrates the provider had carried out checks and audits, our findings showed people remained at risk from inconsistent and unsafe care.

The provider had appropriate arrangements for the management of people’s finances. All records checked were complete and up to date.

Following the inspection, we received an action plan from the provider which set out their response to the inspection findings. We will check improvements to the service on our next visit to the home.

Rating at last inspection

The last rating for this service was good (published 17 March 2019).

We also carried out an unrated targeted inspection to look at the infection prevention and control measures in place (published in 8 April 2021).

Why we inspected

We received concerns related to the management of medicines and finances and the management of the home. As a result, we undertook a focused inspection to review the key questions of safe and well-led. We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have found evidence the provider needs to make improvement. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Grove House Home for Older People on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

During this inspection, we have identified breaches in relation to Regulation 12 – Safe care and treatment and Regulation 17 – Good governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request a further action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.