This inspection took place on the 22 and 26 January 2018. The first day of the inspection was unannounced which meant the home were not expecting us on the date of the inspection.

Our last inspection of the home was carried out in December 2016. At that inspection we rated the service as ‘Requires Improvement’ overall and also for each domain. At the last inspection we found the home to be in breach of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to regulation 11, Need for consent, two breaches of regulation 12, Safe care and treatment and regulation 17, Good governance. At this inspection we found the home had met all the previous breaches of regulations and had improved the overall rating from ‘Requires Improvement’ to ‘Good’, as well as for each of the five domains.

Grove House Home for Older People (Grove House) is registered to provide accommodation and personal care for up to 47 older people. The home is located close to higher Adlington and is set in its own grounds. Accommodation is provided in 46 single bedrooms, five of which have en-suite facilities. The home has four distinct areas known as Cedar Court, Elm Court, Oak Court and Willow Court. With the exception of Willow Court all other areas provide support and care for people living with dementia. At the time of the inspection there were 41 people living in the home.

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

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

There was a manager in place at the time of our inspection, who was in the process of applying to the Care Quality Commission (CQC) to be the registered manager of Grove House Home for Older People. During the compilation of this report the manager was successful in becoming registered. 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.

The service had systems in place to record safeguarding concerns, accidents and incidents and took necessary action, as was required. Staff had received safeguarding training and they understood their responsibilities to report unsafe care or abusive practices.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

Staff had been recruited safely, appropriately trained and supported. They had skills, knowledge and experience required to support people with their personal and social care needs.

Medication procedures we observed protected people from unsafe management of their medicines. People received their medicines as prescribed and when needed and appropriate records had been completed.

Staffing levels were seen to be sufficient to meet the assessed needs of the people at the home. Staffing had been an issue prior to the new home manager coming into post but we saw evidence to show that these issues had been resolved and that agency use was now limited.

We looked around the building and found it had been maintained, was clean and hygienic and a safe place for people to live.

The design of the building and facilities provided were dated, but these were in the process of being modernised. We saw some redecoration had already begun to take place and people were involved in choosing colour sch

We carried out an inspection of Grove House Home for Older People on 12 and 14 December 2016. The first day was unannounced.

Grove House Home for Older People is registered to provide accommodation and personal care for up to 46 older people. The home is located close to higher Adlington and is set in its own grounds. Accommodation is provided in 46 single bedrooms, five of which have an ensuite. The home has four distinct areas known as Cedar Court, Elm Court, Oak Court and Willow Court. With the exception of Willow Court all other areas provided support and care for people living with dementia. At the time of the inspection there were 38 people accommodated in the home.

The home had a manager who had begun the application process for registration with the Commission. 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.

At the last inspection on 8 July 2014, the service was found to be meeting the regulations applicable at that time.

During this inspection, we found there was a breach of four regulations relating to failures in medicines management, the assessment of risks, providing care without consent from a relevant person and maintaining accurate and up to date records. You can see what action we told the provider to take at the back of the full version of the report. We also a made a recommendation in respect to enabling people to participate in the support planning process.

People told us they felt safe and staff treated them well. Safeguarding adults’ procedures were in place and staff understood how to safeguard people from abuse. We were aware a safeguarding investigation was on-going at the time of our visit and were concerned to note that although the social worker had asked on three occasions for some documentation this had not been provided.

Whilst some risks had been assessed and documented, we found a risk assessment had not been carried out to manage the risks associated with one person’s behaviour and there was no risk assessment to assess a person’s potential of developing pressure ulcers and no management plan following deterioration in their skin integrity.

There were shortfalls in the management of medicines especially in relation to prescribed creams. There were significant gaps in the records used for the application of creams, which meant it was difficult to determine if the creams were being used correctly. We checked the audits carried out and noted the shortfalls had not been picked up, which meant no action had been taken.

We noted staff were crushing one person’s medicines and giving it to them without their knowledge. However, there was no documentation in place to support this practice in line with the Mental Capacity Act 2005.

Staff told us they had received appropriate training, however, not all staff had received a supervision session and none of the staff had received an appraisal of their work performance. Four members of staff expressed concerns about the staffing levels in the home. We checked the staff rota and were assured by the manager that two staff were allocated to work in each area of the home.

We observed staff acted in a courteous, professional and safe manner when supporting people and all people spoken with told us the staff were caring and helpful. People also confirmed they enjoyed the food provided in the home and had access to healthcare services as necessary.

All people had an individual care plan, however, we found some people’s plans had not been reviewed and updated in line with changing needs.

An activity co-ordinator had recently been employed in the home and they were in the process of developing an activity programme. However, there were poor arrangements p

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

We carried out an unannounced inspection. Prior to the visit we spoke with 11 health professionals that had visited the home. During our inspection we spoke with nine people who used the service, seven relatives, three care staff, one activities co-ordinator and the registered manager.

Grove House home for Older People provides accommodation for care without nursing for up to 46 people who are living with a dementia, older people and people with a physical disability. On the day of our inspection there were 43 people living in the home. There were four units in the home. The registered manager told us the units were referred to as courts. Three of the courts cared for people living with a dementia.

There was a registered manager in place for the home and had been in place since May 2012. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

We received complimentary feedback about the service, staff and the registered manager from people using services, family and visiting professionals. We observed positive interactions between staff and people using services. Staff were seen to be speaking kindly to people, offering them choices and time to make decisions.

People who used the service and their family told us they felt safe and well cared for in the home. We saw evidence of training provided to staff in the protection of vulnerable adults. Staff we spoke with were able to tell us appropriate procedures to take if they suspected abuse was taking place and they were aware of the whistleblowing policy for the home.

We saw evidence of completed Deprivation of Liberty Applications in place for one person who used the service. Most staff were able to tell us about the Deprivation of Liberty Safeguards [DoLS] however, one of the staff members we spoke with could not provide us with the assurance that they understood DoLS for people living in the home. The Mental Capacity Act [MCA] and DoLS provide legal safeguards for people who may be unable to make decisions about their care.

We found people who used the service received care that was relevant to their needs. This was because care files had been reviewed and updated regularly. Staff told us they referred to peoples care plans to provide them with the information they needed to care for people safely and effectively.

There was evidence of staff training and the home had plans in place for staff training over the coming months. Staffing levels were monitored regularly to ensure appropriate staffing numbers were in place to care to for the needs of people living in the home. New approaches to recruitment had been introduced which included the involvement of people who used the service.

Staff attended team meetings and confirmed they were able to take an active part in these. Effective systems for monitoring the quality of service provision were in place and we were shown examples of actions taken such as complaints investigations and audits of care files.

Activities were an important part of everyday life in the home. The registered manager encouraged activities on a one to one basis as well as group activities. Examples given were all people who used the service attended a village fete the weekend prior to our inspection and one person had shown an interest in attending painting classes, this had been organised in the local community by the home.

At the time of our inspection there were 42 people living at Grove House Home for Older People. We spoke to a number of residents, relatives and visiting professional who visited on the day as well as staff working at the home. People who lived at the home were positive about their experiences and the comments received reflected this. One person living at the home stated, "All the staff are fabulous, all of them. They tell me what they are doing and knock on my door before they come in. I don't think I really get asked what I want to do but I'm happy as I am, I love it here".

People's needs were assessed and care and support was planned and delivered in line with their individual care needs. From speaking to staff it was clear that they were able to act appropriately in the event of an emergency such as a fire or a medical issue.

Equipment used in the home was stored correctly and well maintained. Staff knew how to use the equipment and confirmed that there was always enough equipment in place to meet the needs of the people in the home.

The provider had an effective system in place to identify, assess and manage risks to the health and safety of people using the service and others.

People were satisfied with the service provided, one person told us, “It is a very nice home, I have no worries about anything” and another person said, “I feel at home, the staff are lovely”. People told us their rights to privacy, dignity and independence were upheld and respected.

People’s care was planned and delivered in accordance with their needs. People had detailed individual care plans which were supported by a series of risk assessments. We saw evidence that people had discussed their care plans with staff and they had signed the plans wherever possible to indicate their agreement.

People had mixed views about the food provided. Since our last inspection a new menu had been introduced. All people spoken with said they enjoyed their meal on the day of our visit and confirmed they were always offered a choice.

We found staff had received training on safeguarding vulnerable adults and had access to appropriate policies and procedures. Staff had an understanding of the safeguarding processes and knew how to raise an alert.

There were suitable arrangements in place to record the administration of medication, however, we found cream charts had not been fully completed and it was therefore unclear if staff had consistently assisted people with their prescribed creams.

People told us they were happy with the premises and in particular their bedrooms. Suitable arrangements were in place for general maintenance and repair.

People made complimentary comments about the staff team and staff were observed to have a respectful and sensitive approach to meeting people’s needs.

We found there were established systems to monitor the quality and operation of the service. We saw evidence to demonstrate that people were regularly consulted about their opinion of the service and their comments were used to shape future developments in the home.

People told us they were happy with the care provided in the home, one person said, “Everyone is very nice and we are looked after well”. People confirmed their rights to privacy and dignity were respected and they were involved in the planning and review of their care plans. However, the two care plans we looked at during the visit had not been updated in line with people’s current needs and one plan lacked detail.

People living in the home shared a good relationship with the staff and people were encouraged to participate in conversation and discussions. However, some people told us that although they were listened to they were not confident action would be taken. There was no evidence a residents’ meeting had been held on Willow unit and satisfaction questionnaires had not been distributed. Following the inspection the manager confirmed a meeting had been held with the people on this unit in order to discuss and resolve their concerns.