We undertook an unannounced inspection of Grove Hill Care Home on 19 January 2017.

Grove Hill is a residential care home providing care and support for up to 27 people. The home is situated in Highworth near Swindon and the accommodation is arranged over three floors. The home's owner is also the registered manager. On the day of our inspection 23 people were living at the home.

At the last inspection on the 8 December 2015 we found the Mental Capacity Act (2005) (MCA) principles were not being followed in line with the MCA code of practice. This was a breach of Regulation 11 Health and Social Care Act (Regulated Activities) Regulations 2014.

We also found records were not always detailed with enough information to ensure people’s safety and well being and there was not an effective system in place to monitor the quality and safety within the service. These concerns were a breach of Regulation 17 Health and Social Care Act (Regulated Activities) Regulations 2014.

At this inspection we found the home had made significant improvements to address the areas of concern and bring the service up to the required standards.

Staff understood the Mental Capacity Act (MCA) and applied its principles in their work. The MCA protects the rights of people who may not be able to make particular decisions themselves. The registered manager was knowledgeable about the MCA and how to ensure the rights of people who lacked capacity were protected, this included people who were deprived of their liberty.

Records in relation to people who used the service were complete and accurate. The manager conducted regular audits to monitor the quality of service. Learning from these audits was used to make improvements.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission 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.

We were greeted warmly by staff at the service who seemed genuinely pleased to see us. The atmosphere was open and friendly.

People told us they were safe. Staff understood their responsibilities in relation to safeguarding. Staff had received regular training to make sure they stayed up to date with recognising and reporting safety concerns. The service had systems in place to notify the appropriate authorities where concerns were identified.

People were supported by staff that were extremely knowledgeable about people’s needs and provided support with compassion and kindness. People received high quality care that was personalised and met their needs.

Where risks to people had been identified, risk assessments were in place and action had been taken to manage the risks. Staff were aware of people’s needs and followed guidance to keep them safe. People received their medicines as prescribed.

There were sufficient staff to meet people’s needs. Staff responded promptly where people required assistance. The service had robust recruitment procedures and conducted background checks to ensure staff were suitable for their role.

The service responded to people’s changing needs. People and their families were involved in their care and how their care progressed and developed.

Staff spoke extremely positively about the support they received from the registered manager. Staff supervisions and meetings were scheduled as were annual appraisals. Staff told us the registered manager was very approachable and supportive and that there was a very good level of communication and trust within the service.

The service sought people's views and opinions. Relatives told us they were confident they would be listened to and action would be taken if they raised a concern.

People had sufficient to eat and drink. Where people required special diets, for example, pureed or fortifie

We inspected Grove Hill on the 8 December 2015. Grove Hill is a residential care home providing care and support for up to 27 people. The home is situated in Highworth near Swindon and the accommodation is arranged over three floors.

There was a registered manager in post at the service who was also the owner. A registered manager is a person who has registered with the Care Quality Commission 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.

People received their medicine when they required it. However there was not always a procedure in place for people who required PRN (as required medicines).

People were protected from the risk of harm and abuse by staff who understood their responsibilities in relation to safeguarding. Staffing levels were sufficient to meet people’s needs. People’s needs were assessed and risks associated with their needs were documented. However records did not always contain adequate detail to manage risks.

People did not always benefit from a service that understood and applied the principles of the Mental Capacity Act (MCA) 2005. MCA is the legal framework that protects people’s right to make their own decisions.

Staff felt supported and had access to regular supervision and appraisal; however there was no record of these supervisions. There was also adequate training for staff and opportunities to develop professionally.

People had access to appropriate health professionals which was clearly planned and people also received a varied and healthy diet.

Staff were described as caring by people and their relatives. People were supported to maintain friendships with people they lived with. People’s independence was supported and their privacy and dignity was respected.

People were not always involved in creating their support plans or reviewing their care. We observed people enjoying activities on the day of our inspection and were informed of arranged days each week activities were made available. However, there was not formalised structure or arrangements of day to day activity. This meant we could not be assured that each person was provided with opportunities to engage with activities that interested them. When people’s needs changed the service responded. People views were seen as important and feedback was used to improve the service.

There was a long standing management team within the service who benefited from the support of a committed and long standing staff team. This led to a clear vision within the service and a leadership that people and their relatives spoke highly of. However, there was no system in place to ensure the quality of the care people received was being monitored. There were some systems in place to monitor the safety of the service, but they were not always being effective. The absence of these systems meant that the safety and quality of the service was over dependant on the registered manager and experienced staff to be sustained and people’s safety and experience of care could be impacted in the absence of those individuals.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of the report.

People were being well cared for and were treated with respect by the staff team. There were individual care plans in place that reflected a person’s needs. The care plans were detailed and being regularly updated and reviewed.

We observed that staff responded positively to people living in the home and were patient and reassuring.

People were supported to eat sufficient food and drink and their nutritional health was correctly monitored by the home.

Staff were required to complete training on adult safeguarding and information and guidance was available and displayed on how to report concerns.

The home had a complaints procedure in place that was well advertised to relatives and the people living the home.

People who lived in the home and their relatives told us they were happy with the care and support that was provided. We were told the staff and manager treated people with respect and also responded quickly to any concerns that were raised. We saw that staff were attentive to peopless needs and interacted frequently in the communal area of the home.

People we spoke with said they were happy with the food and the menus that were provided. We saw that a relaxed and friendly atmosphere was promoted at mealtimes with people having a choice as to where they ate their meal.

We found that the home was clean and hygienic.

The home had appropriate and safe systems in place to store and administer medication. Staff were correctly trained before they carried out any administration.

The home followed the correct recruitment procedures with the required checks being completed on staff before they commenced employment.

People who live in the home told us they were well cared for and that the staff and management treated them with dignity and respect. We were told they felt safe and were able to discuss issues or concerns. People said that care staff were always friendly and polite and involved them in their care, which was completed to a high standard.

We were told that a good range of activities were organised and that people could choose whether to participate or not.

Relatives told us that the home communicated well with them and kept them informed of issues or concerns. People were satisfied with the approach of the staff and were always made to feel welcome in the home when they visited.

Staff said they were well supported by the management and that they worked well as a team. Good training was provided and people were proud of the quality of care and support that the home delivered.