Grove Lodge Care Home

Grove Lodge Care Home is registered to provide accommodation for up to 19 people who require support with personal care. At the time of our inspection there were 15 people living at the home. Grove Lodge Care Home has 11 single occupancy room and 4 large rooms which could be shared.

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

Risks were assessed but timely action had not always been taken in response to environmental issues identified. The registered manager told us these would be quickly addressed following the inspection. Staff were suitably recruited and there was enough staff who knew people well to provide the support people needed. People were supported to take their medicines as they needed, and people felt safe.

People’s needs were assessed and reviewed regularly. People received the support they needed to eat and drink well, and staff supported them to access any health care services they may need. The environment had been adapted to meet people’s needs. Staff accessed a variety of training and told us they felt well supported in their role. Work was ongoing to ensure staff were fully compliant with all mandatory training. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported by a consistent staff team who knew them well. People told us staff were kind and caring and staff spoked with affection about the people they supported. People were encouraged to make decisions for themselves, their dignity and privacy was respected, choice and independence were promoted.

People were receiving personalised care and told us they had freedom of choice. People’s communication needs were assessed and supported. People were supported to go out and engage in activities and interests as much as possible. People felt able to raise concerns if they had any and were confident these would be quickly addressed.

The management team were visible within the home and people knew who they were. Staff felt well supported by the management team and people spoke highly of the service and how this was run. People, relatives and staff were encouraged to share their views and ideas in a variety of forums and the management team were committed to continually improving the home. The registered manager and deputy were responsive to feedback and took action when needed.

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

Rating at last inspection and update

The last rating for this service was good (published 09 July 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Recommendations

We have made a recommendation in relation to the management of risk

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The home is located on the outskirts of Stockport and is close to local amenities and services.

Grove Lodge has eleven single occupancy rooms, three with en-suite facilities and four bedrooms with shared occupancy. The three bedrooms on the first floor of the building could not be accessed by people with limited mobility because there was no passenger lift.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. The manager was registered in July 2016.

We inspected Grove Lodge Care home on 20 June 2018.

The service was last inspected in December 2016, and rated Requires Improvement. There were three breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014, relating to safety at the service and how it was governed. Following the inspection the provider sent us an action plan which stated the breaches would be addressed. At this inspection we found significant improvements in all areas.

At this inspection we found that the service had fitted two new boilers which meant people had unlimited access to hot water. People told us that they could have a shower whenever they wished and the facilities suited their needs.

We found that systems to monitor the safety and quality of the service had been put in place and sustained over a period to ensure compliance with the regulations.

Staff had undergone training to ensure they had the knowledge and skills to support people safely. This included training specific to the needs of the people living at Grove Lodge.

Staff knew how to protect vulnerable people and had safeguarding policies and procedures to guide them, which included the contact details of the local authority to report to.

Recruitment procedures were robust and ensured new staff should be safe to work with vulnerable adults. The service had developed a staffing dependency tool to ensure there were sufficient staff to meet people’s needs.

Person-centred care plans were in place that reflected the needs of the people living at Grove Lodge and included a range of individual risk assessments developed to keep people safe.

Environmental risk assessments were carried out regularly to ensure safe service provision and maintenance work was carried out and recorded. Grove Lodge was clean and well maintained.

Staff were sufficiently supervised and had their performance reviewed by managers regularly.

People had access to a range of activities which was suitable to their age, gender, ethnicity and beliefs.

There was a relevant complaints procedure. There had not been any formal complaints since the last inspection.

The service liaised well with other organisations to help meet people’s health and social care needs.

Medicines were safely administered by staff who had received appropriate training. The service had recently introduced an electronic medicines management system which enabled the management team to have clear oversight of how staff administered medicines and helped easily identify medicines errors.

Systems were in place to ensure that all medicines were stored correctly and dispensed by staff trained to provide medicines safely, and where health needs were identified we saw staff followed advice given by professionals to make sure people received the care they needed.

At the last inspection on 11 March 2015 we rated the service as requires improvement. At that inspection we identified three regulatory breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014, which related to medication administration, staff training and good governance.

This inspection was to check improvements had been made and to review the ratings.

Grove Lodge Care Home is registered to provide accommodation for 19 adults who require help with personal care and support with their daily lives. At the time of our inspection there were 19 people living at the home.

The home is located on the outskirts of Stockport and is close to local amenities and services.

There are eleven single occupancy rooms, three with en-suite facilities and four bedrooms with shared occupancy. The three bedrooms on the first floor of the home cannot be accessed by people with limited mobility because a passenger lift was not available.

The home had a manager registered with the Care Quality Commission (CQC), who was present throughout the three days of inspection. A registered manager is a person who has registered with CQC 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 and associated regulations about how the service is run.

During this inspection, we found improvements had been made and we observed staff giving positive and caring support to people. However, we also identified some areas where improvements were still required. The registered manager and the deputy manager were responsive to our feedback and had started to take actions to make some of the required changes during our inspection.

During this inspection, we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that people living on the ground floor only had access to one domestic bath, which we were told was only used by one person and one shower on the ground floor for up to 16 people. In addition we were told that at peak times of water usage for example in the morning, the water in the shower and the sinks in people’s bedrooms could run cold. However two new boilers were to be fitted the first week in January 2017 which would resolve the issues.

From looking at the training record and speaking with staff, we found improvements had been made to ensure staff received further training to carry out their role more effectively. However, we found there were still some gaps in staff training. For example, although the service user guide stated they provided care for people with past or present mental health problems such as schizophrenia, bi-polar, depression, anxiety and dementia we saw that staff had not received training in some of these mental health conditions.

We saw that medicines were managed safely and staff had received the appropriate medicines awareness training and competency assessment before they were allowed to administer medication.

Staff spoken with understood the need to obtain verbal consent from people using the service before a care task was undertaken and staff were seen to obtain consent prior to providing care or support.

The audit systems developed required implementation to fully assess and monitor the quality of the service provision and promote service improvement.

People were supported by a caring staff team and staff, with the exception of one staff member, and relatives of people living at Grove Lodge told us they thought there were sufficient staff to safely meet people’s needs. However, we found there was not a systematic approach to determine the number of staff and range of skills required to meet the needs of the people who used the service. This meant the registered provider could not be sure that the staffing levels and skill mix of staff were sufficient to meet the assessed needs of people living at Grove Lodge Care Home. We made a recommendation that they implement the use of a staffing tool. A staffing tool recommends appropriate staffing levels based on people’s health needs and dependency.

People received person-centred care and we saw privacy and dignity was respected. However from the care records we examined we saw that some parts of the plans of care were vague and did not include details of exactly what assistance the person required to meet their assessed care need. Due to this we recommended that the service considers reviewing people’s plans of care to ensure where possible they are developed in partnership with the service user and are designed to meet the specific individual needs and personal preferences of the person living at Grove Lodge Care Home.

Whilst there were no formal checks of cleanliness or internal infection control audits in place, we saw that the home was clean and well maintained and we saw staff had access to personal protective equipment (PPE) to help reduce the risk of cross infection.

We saw appropriate safety checks were undertaken. For example portable appliance testing, emergency lighting, fire safety cheeks had all been undertaken.

We saw people had a personal emergency evacuation plan (PEEP’s) in place. These plans detailed the level of support the person would require in an emergency situation in order to safety evacuate the home.

Environmental risk assessments had not been undertaken and there was no clear system for documenting maintenance work required and evidenced that the work had been undertaken. A system to record maintenance requests and evidence once the work had been completed was implemented during the course of the inspection.

The service had good recruitment processes to ensure only suitable staff were employed to work with vulnerable people.

Since the last inspection staff supervision sessions had been implemented to enable them to carry out the duties they are employed to perform. The registered manager told us it was now their intention to implement an appraisal for all staff early in the New Year.

Staff understood how to recognise and report abuse which helped make sure people were protected.

People had access to healthcare services and we saw specialist advice was sought in a timely manner. For example from the speech and language therapist, district nurse, dentist, optician and chiropodist and people were supported to attend hospital appointments as required.

Attention was paid to people’s nutrition and hydration needs; however we received mixed reviews from people who used the service in relation to the food provided.

The visitors we spoke with told us they were happy with the care their relatives received at Grove Lodge care Home.

From our observations of staff interactions and conversations with people, we saw staff had good relationships with the people they were caring for. The atmosphere felt relaxed and homely.

There was a complaints notice on the back of people’s bedroom doors and in the service user guide, which people were given on admission to the home. There was a clear recording system for complaints and concerns raised and any action taken.

During this inspection we looked at a sample of three care plans. We saw that significant improvements had been made and people's care plans contained sufficient, up to date, accurate information to meet their needs.

During our observations on the day of this visit we saw that people looked relaxed and content. People were seen to be freely moving around the home and chatting to each other in a friendly manner. We saw staff providing care and support to people in a kind and caring way. We observed good interactions between the staff and people living in the home.

During this visit we did have some concerns about the lack of detail in people's plans of care. This means that people's safety and well being may not always be protected

One relative told us their family member received the 'best care possible'. They also said, 'I don't need to see care plans, all I have to do is talk to staff and they tell me what's happening'. Another relative said they could no longer care for their family member at home and that they 'are happy in here'.

During our inspection we looked at care files for three of the people who lived in Grove Lodge. There is a new care planning format in place within the home. We did not see evidence to show the person and/or relatives were involved in planning their care or that the contents of their plans were discussed with them.

The manager told us there were policies and procedures in place to safeguard people who used the service from harm or possible abuse.

Staff received training and were able to access NVQ courses. They also received support from the senior staff .

There were no systems in place to monitor key care practices within the home.

Personal records for people who used the service were not kept secure and confidential