Grove House Residential Care Home

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Improvements were needed in the management of environmental risks and medicines management. Significant risks identified by external organisations in relation to fire and the management of Legionella had not been addressed in a timely way. Processes to support safe medicines practices needed to be improved to minimise the risk of harm. There were enough staff to meet people’s needs but there were some gaps in recruitment files to evidence all the required checks for safe recruitment were in place. Risk management plans for ‘short stay’ people needed to reflect more detail when significant risks had been identified. People felt safe at Grove House Residential Care Home and spoke warmly about the staff and the care they received. Relatives were positive about people’s continuity of care when they moved between services and described a problem solving approach to any concerns they shared.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives told us information was shared appropriately and felt the registered manager was approachable should they need to report any incidents involving their family member. One relative told us, “I havent had to do it (raise a concern) but I think they would be responsive. I don’t think they would take offence and they would put it right.” Another relative commented, "There seems to be a good chain of command where things are followed through, and they try to solve the problem.”

Staff understood the process for reporting any accidents and incidents. They told us learning was taken from these events and actions implemented to reduce future risk and improve staff practice. One staff member said, “Some (people) have mobility issues. We learn from those incidents and say, ‘put the buzzer over your neck so you can use it’ or, ‘use your walking aid’.” Another staff member told us if a person had a fall, “Everyone will attend, and the managers will be there. [Managers] always attend the emergency bells and we will have a discussion there and then and make a plan to take forward." Staff told us they had handover meetings at the beginning of their shift. These gave them the opportunity to share any concerns about people’s health and safety and any potential learning. The registered manager understood their responsibility to be open and honest when things had gone wrong. The provider’s nominated individual explained the learning taken and improvements implemented after our last inspection, but acknowledged actions in response to some safety concerns still remained outstanding.

People's accidents and incidents were recorded, and records indicated what action had been taken to keep people safe and to minimise the risk of future re-occurrence. The registered manager analysed accidents and incidents to ensure people had been referred to external healthcare professionals where necessary and to identify any trends or patterns that needed to be addressed. However, records indicated the same proactive response had not always been taken when service level concerns had been identified.

Relatives told us they were involved in discussions about their family members’ care when they moved to the home. One relative told us, “When [Name] moved in, they were asking questions about their needs. They keep us updated all the time.” Another relative spoke positively about the continuity of care when their family member moved between services. They told us staff arranged transport for their family member to attend hospital for any planned appointments. If there was an emergency admission to hospital, staff would let them know when the ambulance was leaving the service so they could be at the hospital when it arrived.

Staff told us they carried out checks of people to monitor their health and safety, particularly when they had been discharged from another care provider. For example, one member of night staff was aware a person had been in hospital and had returned to the home. They explained they had read the person's records to understand any new support needs they had.

Healthcare professionals did not share any concerns about the timeliness of referrals. One healthcare professional told us staff accompanied them when they went to see people to ensure information was shared. They told us, "The staff are always so polite, they come with us, especially when we are going to see new patients."

When people were admitted to hospital, information was shared about people’s medicines, their health conditions and their wishes in respect of advance care planning. However, the provider did not have a formal process to share important information about people’s risks in areas such as eating, drinking, communication and their mobility. This presented a risk of people being provided with unsafe care due to a lack of shared information.

People told us they felt safe and were complimentary of the staff and registered manager. One person told us, “They look after me well, staff are very kind.” This person told us if they didn’t feel safe, they would, “Ask to see the one in charge.” They went on to say, “I would have to be very upset though,” and told us they had not been upset since they had moved to Grove House. Relatives told us they were confident their family members were safe and would feel comfortable in raising any concerns. One relative told us “The staff and manager are nice, they are all lovely, you can ask them anything.” Another relative said, "They (staff) speak nicely to [Name], they have time for them and time for me. It is nice to have someone you can trust. I go every day and haven't seen anything untoward.”

Staff understood how to recognise potential abuse and knew their responsibilities to report concerns to help keep people safe. Staff told us they completed safeguarding training, so they knew about protecting people and upholding their rights. Staff explained how changes in people's behaviour or demeanour might alert them to potential abuse or discrimination. One staff member told us they would be alert, "If it is somebody who is very outgoing and they become withdrawn or don’t want to engage anymore. I know the signs to look out for, sleeping more, being depressed. It is quite easy to notice when something is wrong." Another staff member told us, "I go by their body language. We get to know the residents pretty well so I would be able to tell from their body language if something was wrong." Staff recognised neglect was a form of abuse and said they would report any issues of poor practice to their managers. One staff member told us, “Sometimes we notice different things which we report to the manager who deals with it.”

Staff approached and spoke to people in a kind and considerate way. We saw a staff member sitting and talking with people in the lounge. People were laughing out loud showing they felt relaxed and comfortable in the staff member’s presence.

Staff had access to online safeguarding training which they completed regularly to ensure they provided safe and appropriate care to people. Accessible information ensured staff had regular reminders about the safeguarding process. Accidents and incidents were reviewed to ensure any safeguarding issues were identified and referred to the local authority safeguarding team and CQC. Staff worked in line with the Mental Capacity Act 2005 (MCA) and when people were identified as potentially being deprived of their liberty, applications were made to the authorising body as required. Nobody had any conditions on their DoLS at the time of our assessment. Records indicated previous conditions had been met as required by the legislation.

Where possible, people were involved in discussions about any risks associated with their care and treatment. One person told us they had been involved in discussions about their mobility aids which had resulted in a new walking frame being provided. We saw how this enabled them to be independent with walking around the home. One relative told us about their family member’s risk of losing weight linked to an illness. They told us how staff had managed this risk and how the person had put on weight since being at the home. Another relative told us how their family member's risks and anxieties around eating were managed well. They told us, "They always keep a close eye on what [Name] is eating and drinking and soften the food. [Name] is a bit scared, so they go out of their way to support them. They put their food on a smaller plate, so it is not so daunting.”

Staff told us they involved people in decisions about their care. One staff member said, “We try and get consent from them. We have residents who do not have capacity but most of them can consent.” Where people had behaviours due to anxiety, staff were aware of this and knew to give people time. One staff member said, “If they say no, I am not ready, we ask them when they want us to support them. They may say come back in 20 minutes and we go back.” Another staff member told us about one person’s health condition that required close monitoring. However, one person was diabetic which meant they needed to be monitored for any symptoms of concern associated with this health condition. Two staff we spoke with were not aware the person was diabetic. Both staff said they had received training in diabetes care.

Our observations showed staff supported people to manage risks safely. For example, people were supported with equipment while staff walked alongside them. People who required pressure relieving equipment to prevent the risk of skin damage had this in place, and staff ensured walking aids were kept within people's reach.

We looked at three people's care plans and found the level of detail about risks varied. In one care plan there was good information for staff about the person’s risks. In another care plan the information was not so detailed, for example, the person had diabetes but there was no care plan to inform staff how to limit the risks associated with diabetes. This person was also at very high risk of skin damage and required support with their continence care needs. There was no continence care plan to inform staff about the level of support required or the continence products the person needed to mitigate associated risks. The registered manager said this was because the person was at the home on a short stay basis, and for these people there was only limited information in care records. The registered manager agreed additional details would benefit those living at the home for short periods of time, and that these care plans would be reviewed. Records were not always completed accurately or clearly to demonstrate safe practice and enable effective monitoring to take place. Two people who had lost weight were to have high calorie snacks to help increase their calorie intake. There were limited entries on the charts to evidence these people had been offered or had eaten the high calorie snacks in accordance with their care plan. Another person had a catheter, but records did not evidence care was being provided in accordance with the care plan.

People and their relatives did not express any concerns in relation to the environment. However, at the time of our assessment, the lift was not working which was having an impact on some people socialising with others. One person showed disappointment they were not able to have lunch with other people because they were restricted to the first floor. The bathroom on the first floor was out of order. One person told us, "There are no baths. When I was at home I loved a bath. There is a little shower here. I can only have one once a week here. I am used to having one once a day and I do like a bath. But it doesn’t bother me too much. It is what it is at my age." Lift access between the floors was restored shortly after our assessment visit.

Staff told us they completed fire drills every 3 to 4 months to ensure they knew what to do in the event of a fire emergency. A maintenance person employed by the home told us they completed regular checks of the environment to ensure it was safe. This included checks of hot water to make sure the temperature was not too hot to scald, fire doors, window restrictors and equipment. They told us pressure mattresses were checked to make sure they were operating correctly, and mattresses were not ripped. They said arrangements were in place for any equipment needing repair to be reported to an outside provider if required. Staff told us they reported any concerns in the environment to the maintenance person and recorded them in a communication book. One staff member told us improvements were being made to the environment including the kitchen and communal areas.

During our visit most people were based downstairs in the home due to the lift not being operational and awaiting checks. People on the first floor who were unable to access the ground floor were able to use a temporary lounge and dining area that had been set up. On the first floor the bathroom was not in use and was being used as a storage area. The only shower room in the home was based on the ground floor which meant there were limited facilities for people to use. Checks of equipment identified no concerns. For example, all walking frames had fully intact rubber ferrules to ensure people were not placed at additional risk of falling. However, equipment was seen stored in the ground floor shower room, in people's bedrooms and other areas around the home. Where equipment was stored in bedrooms, this meant people had very limited space to move around creating a potential risk of falls or injury.

Processes to ensure the safety of the environment were not effective. External organisations had completed a legionella risk assessment in May 2022 and a fire risk assessment in September 2023. At the time of our visit some risks identified as being significant had still not been addressed which left people at potential risk of serious harm. There was a lack of processes in place to evidence risks were being addressed within specific timescales. Environmental risk assessments were generic and did not reflect the specific risks presented by the environment at Grove House. People had personal emergency evacuation plans that guided staff how to support people in the event of an emergency. Planned checks of equipment people used ensured it was in good working order and safe. The provider's contingency plan for emergency situations had recently been used and proved effective.

People and relatives gave mixed views as to whether there were enough staff available. Comments included: "Yes enough staff, they have been checking on me regularly” and, "I have only got to press this button, and someone will come. They come quickly. If I do have to wait, they will pop in and say they will be 10 minutes. That’s fine by me." However other people said, "I think they could do with more staff. We don’t expect staff to drop what they are doing and come but it can be a bit slow. I have never been waiting too long for things I really need but they will come and say 'I will be with you in a minute' which is then a long time. If it was something urgent, they would come quick, I can't say they are slow with that, but you just know they could do with a few more" and "I don’t really feel like I am waiting but sometimes it feels like there isn’t many about." Comments from relatives included: “There is never enough staff for these people. You can always find some but there is never enough”, “[Name] rings her bell and they are there more or less straightaway. Probably at the weekends there doesn’t seem so many” and, “There is always somebody around. They all know [Name] and talk to me about them and raise any concerns.” People did not raise any concerns about staff knowledge or understanding of their needs.

Staff said there were enough of them on duty to meet people's needs safely and effectively and spend time with them. One staff member said, “We try to make sure people are at the centre of care. We manage but of course it could be better.” Another staff member said, “Here, because it is a smaller home, everyone knows each other really well and you have more time to spend with people. Even if it is sitting in their bedroom watching television with them." Staff did not raise any concerns about the training and said they felt confident in their roles and had opportunities to discuss their work with managers and senior staff. One staff member told us, “I did my last supervision about 2 weeks ago. This is something we do regularly with the manager, and we get feedback on what we could improve upon."

Staff were visible across the home and were seen going into bedrooms to support people when needed. Staff interactions with people were not rushed, staff took the time to support people how they wished. When one person required emergency support, staff with the appropriate skills responded quickly.

People’s needs were assessed to identify the number of staff to provide safe and effective care. Rotas showed identified staffing levels were maintained across the home. Records demonstrated staff completed regular training to update their skills and knowledge to help support people safely. The provider had a process to support the recruitment of staff with the appropriate values, skills and experience. However, we found this needed to be more robust. Although the registered manager assured us all checks had been carried out, there were some gaps in recruitment files to evidence all the required documentation for safe recruitment was in place. When new staff started shadowing shifts before their Disclosure and Barring Service check had been received, there was no risk assessment to support this practice.

People told us they had no concerns regarding the cleanliness of the home. Comments included, “Staff come in and clean. They come in every day to do something. They wear gloves and after they have finished, they put them in the bin”, “The cleanliness is fine for me” and, “The home is clean. They clean my room. No problems with cleanliness.”

Staff told us they completed infection prevention and control training and were aware of what they needed to do if there was an infection outbreak in the home. Domestic staff told us they worked together to ensure cleaning and laundry across the home was completed. They described good practice in collecting and managing soiled laundry to prevent any cross infection.

Most areas of the home were clean but there were some areas where rooms were over filled with equipment which meant effective cleaning had not been completed. In one room a tabletop was filled with personal items making it difficult to clean. In some areas of the home there was bare wood or wood chipped door frames, and we also saw an unpainted or sealed door. Bare wood areas or wood chipped areas are difficult to clean which meant infection prevention and control may be compromised. Staff were seen to wear appropriate Personal Protective Equipment (PPE) for tasks they completed.

The provider had an infection prevention and control policy which outlined the provider’s expectations regarding safe infection control processes. However, cleaning schedules did not evidence daily, and weekly cleaning tasks were being completed. Infection control audits had not been carried out and checks the registered manager told us they regularly completed had not been recorded.

People told us they got their medicines when they needed them. One person told us how staff had responded to their pain by giving them regular pain relief and another person explained how they had requested a medicine to help them sleep. People confirmed staff stayed with them to ensure they had taken their medicines as prescribed. We saw staff safely administering medicines to a person in their room. Staff entered their room carrying the medicine pot and a glass of water on a tray. The person was handed the medicines and chose to take them with the water provided. The staff member ensured the medicine was swallowed before assisting the person further. One relative told us their family member had once had an adverse reaction to a prescribed medicine and staff, "Were on top of that.”

Staff told us they had received sufficient training and there were safe medicine practices within the home. One staff member told us, “Medicines training was face to face and we had some online. I watched the team leader and then she watched me. I would say we have good medicines practices here.” The deputy manager explained a variety of checks were completed to ensure people received their medicines safely and told us staff went through robust training procedures and competency checks.

Records demonstrated people received their prescribed medicines. However, the processes to support safe medicine practices needed to be improved to minimise the risk of harm. For example, when people were given ‘as required’ medicines to support their emotional well-being, the medicine administration record (MAR) did not evidence a clear rationale for why this had been administered. Staff had not completed records to ensure these medicines had been given as a last resort or to show whether these medicines had been effective to enable a robust review by clinicians. Some medicines with short expiry dates once opened did not have their dates of opening recorded. This is important to ensure medicines in use remain effective. Medicines records were not clear where people’s prescribed creams should be applied. One person’s cream had been applied for 16 days although the prescribing instructions stated it should only be applied for 5 days. This increased the risk of an adverse reaction. These were similar issues to those identified at our last inspection visit.