Grove House Residential Care Home

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• 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 service did not have a consistently effective quality assurance system which meant shortfalls in service provision and breaches of regulations had not been identified. Processes were not robust enough to drive and sustain improvement in all areas of service delivery. Despite these issues, staff spoke of an inclusive environment where equality and diversity were promoted, and leaders were visible and supportive. Staff and relatives were able to share their views and felt listened to.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The registered manager described how they had developed new values for Grove House Residential Care Home based on 'family and home' and explained, "I want the home to feel happy and vibrant and that everyone knows everyone.” Staff spoke of an inclusive and supportive working environment which motivated them to carry out their role. They described a staff team who enjoyed working together and communicated well. One staff member told us, "We are just like a little family. Our relationships are different with all the residents, but they are all positive and the teamwork is good here." Another staff member told us, "We work really well together. We are a happy bunch, and we are happy for the residents as well."

The provider's values were displayed in the office and discussed during the recruitment process. Staff had regular supervision to review their practice and discuss any personal development needs. Staff also had staff meetings where they could share their views and opinions about the service. The registered manager told us they aimed to increase the frequency of these meetings as they did not always happen as often as they would like. The registered manager had recently carried out a survey to enable people and staff to share their views about the service and these were being collated at the time of our assessment. However, further work needed to be done to ensure a listening culture focused on learning and improvement.

Staff told us leaders were visible and gave them support and guidance as well as demonstrating a caring attitude towards them. One staff member told us, "I get on well with them (managers). If you don’t feel comfortable at work it can affect your mental health. If you can't speak to your manager about little things, what would happen if something big should happen?" Another staff member told us, "I think the management here are really good and a really good support. [Registered manager] has built my confidence." Another staff member told us, “[Registered manager] is good, I have confidence in her. If I need something she will tell me, ‘Don’t worry, I will see what I can do’.” Staff also spoke positively of the provider. One member of night staff stated, “They are good. We don’t normally see them but if we call them, they will come in any time.” Another said, “[Provider] is very approachable, and I can message them.” The registered manager told us they valued the empathy and understanding demonstrated by the provider during personally and professionally challenging times.

The registered manager demonstrated great commitment to the delivery of compassionate person-centred care at Grove House Residential Care Home and supporting staff to work well and effectively together. However, the registered manager and the provider’s nominated individual acknowledged they needed to develop their skills and understanding in relation to the implementation of robust quality assurance processes to identify issues and drive improvement within the home in line with the regulations.

Staff told us they felt listened to and managers responded to any concerns they raised. One staff member told us they were able to approach the registered manager or provider at any time. Another told us they were able to contact managers out of hours if needed. Staff told us managers were visible and regularly asked them if they had any concerns or wished to raise any issues. One staff member told us, "We have got quite an open relationship with the manager, we can go to her about anything. They do ask every day if everyone is okay and whether we have any concerns." Another staff member told us they felt confident any issues would be addressed by the registered manager, but also felt able to speak to the provider’s nominated individual if they had any issues. They explained, "I know I could go to [nominated individual] and say this isn't right or I am not happy with this, and I know she would discuss it with the manager, and something would be sorted."

Staff had received training in safeguarding to they understood their responsibility to speak up on behalf of people if needed. Staff were given opportunities through handover to raise any concerns or issues they needed to share. A whistleblowing policy was in place and accessible for staff. This gave them information of who they could contact if they felt their concerns were not being taken seriously or resolved by the management team.

Staff spoke of an inclusive environment where equality and diversity were promoted. Staff told us they had never witnessed discrimination and gave examples of how people's care had been adapted to promote their cultural preferences. One staff member told us how management were supportive of their needs, whether these be at work or in their personal life. The registered manager told us there was flexibility in working patterns to support the personal needs and caring responsibilities of staff.

There were processes to support staff in their understanding of equality and diversity. Staff training records showed staff had or were scheduled to complete this training. Rotas were flexible to support the religious and cultural beliefs and caring responsibilities within the staff team.

The registered manager and nominated individual both acknowledged there were gaps in skill sets that needed to be addressed to ensure quality assurance processes were effective at identifying issues and driving improvement. The nominated individual recognised the registered manager needed support and had recruited an external consultant to review their quality assurance processes. They had also appointed an external provider to review their service level risk assessments and provide further training and guidance to managers and staff with delegated responsibilities for monitoring risk within the home. These were very recent appointments at the time of our visit, so the impact was yet to be assessed.

The service did not have a consistently effective quality assurance system which meant shortfalls in service provision had not been identified. For example, medicines audits had not identified and addressed shortfalls in medicines practices. The registered manager conducted a daily 'walk around' of the service which they explained was used to observe staff practice and to check the environment. However, these checks were not formally recorded so it was not clear whether the issues we found during our assessment had been identified by the registered manager prior to our visit. Care plan reviews had not identified some gaps in risk management plans and that records were not always completed accurately to enable effective monitoring to take place. Where issues had been identified by external contractors, they had not been addressed in a timely way. A lack of action plans meant there was no timeline for completion and no priority for when things would be addressed. The provider visited the home regularly and carried out checks as part of the quality assurance procedures, but these were not recorded to provide an audit trail of actions.

Relatives told us they were able to share their views and felt listened to. One relative told us when they contacted the home, staff took time to give them updates about their family member which helped them to feel reassured. Another relative told us they had daily contact with the service to check on their family member's wellbeing. Other comments included, "They all know [Name] and talk to me about them and raise any concerns” and, "The office door is always open. They are very approachable.” We asked relatives if they attended meetings or had completed any quality questionnaires. One relative told us, “I don’t know about resident meetings, but we have done questionnaires in the past." When asked if there was anything they felt needed to change, they responded, “No, they do a brilliant job.” People told us they would be happy to talk to the registered manager if they needed to.

Staff described positive relationships with local healthcare professionals to support people's ongoing healthcare needs. They also recognised the importance of involving people's relatives in supporting people's care to promote positive outcomes. The registered manager and nominated individual told us they were liaising regularly with external partners to address issues and drive forward improvements in the home and recognised the benefit of scrutiny and guidance from other organisations.

Healthcare professionals who visited the home told us managers and staff were welcoming and supportive of their visits. Commissioners confirmed that the provider regularly engaged in local meetings and took advantage of training opportunities to improve practice in the home. Whilst there were ongoing issues identified by external organisations, these organisations confirmed the provider was engaging with them and had begun to take action in response.

Records demonstrated people had been referred to other healthcare professionals as required. For example, the GP, district nurse and occupational therapist. The provider had engaged external agencies to carry out checks and audits but had not developed action plans to address issues identified. This meant it was not clear which actions had been addressed and what remained outstanding.

The registered manager and nominated individual described some improvements that had been made following our last inspection. For example, improvements to the environment of the home and the implementation of a refurbishment plan. However, they both acknowledged that processes to identify risk and develop the quality of care to improve people’s experience of living at the home had not always been effective. The registered manager assured us action would be taken and described their plans to create staff champions to enhance their roles and develop their skills and interests. Staff told us their views on improving the service were listened to with one staff member explaining, “The manager is available to staff and if anyone has anything to say, they can. We talk about things and any changes we need to make and how we can improve.”

Following our last inspection in January 2023, we expected improvements would have been made and the provider to be compliant with all regulations. However, we found repeated breaches of the same two regulations and the rating of the service remains requires improvement in safe and well-led. Processes were not robust enough to drive and sustain improvement in all areas of service delivery. Where external audits of the service had evidenced potential non-compliance, the provider had failed to take actions to address and reduce the risks to people. This included implementing identified actions from the fire risk assessment and legionella risk assessment which remained outstanding.