We inspected this service on 31 October and 1 November 2018 and 20 December 2018. The first day of the inspection was unannounced and we commenced the inspection at 7am in the morning. The third day of the inspection visits was unannounced. This was because of some concerns that we had been informed about. The service had last been inspected in January 2017 and had received the rating of good. However, during this inspection we found that the service had deteriorated and we have now rated it as requires improvement. We found breaches of the regulations concerning people's dignity, their safe care and treatment and the governance of the home. You can see what action we told the provider to take at the back of the full version of the report.

Grove House 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. Grove House is a purpose-built care home over three floors. It is registered to provide care to up to 63 people. At the time of our inspection there were 57 people living in the home. The ground floor was for people who are elderly and who had general nursing needs and the top floor was for people with dementia. The middle or first floor had been designated for intermediate care patients who were funded by the NHS.

Grove House requires a registered manager. 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 a registered manager who had been in post for three months at the time of our inspection.

The systems and processes around medication administration require improvement as record-keeping showed that there were omissions and inconsistencies. Skin integrity checks had not been completed and referrals to the falls team had not been done. There was a lack of information about infection control.

People who lived in the home were able to receive appropriate healthcare services. Medication records were poorly recorded and lacked detail. We were concerned that people's privacy and dignity were not enabled sufficiently. Most people’s privacy and dignity were respected; however we did find that some staff entered their rooms without knocking or calling out and some people told us that clothes either got mixed up or went missing and sent to the laundry and that they sometimes had to wear other people’s clothes.

The care records in many cases were incomplete and inaccurate and did not show that the care was person centred. It was not clear from the records that people’s assessed needs and choices had been met although most people we talked with told us that they were happy with their care. We found that risk assessments lacked detail and were not up to date. However, people told us that staff treated them as individuals. Staff were clear that they knew how to care about each person and showed us how they found out about them.

We found that the quality assurance processes in the home had not identified the issues we found and were not sufficiently robust. Confidential records were not always stored securely.

Consent to care and treatment was carried out in line with legislation.

People told us that staff treated them well and with kindness and compassion. People told us that they had been asked about their views on the service. It was not clear from the records that they had had an active involvement in making decisions about their care and treatment.

People told us they felt safe and we saw that robust recruitment procedures had been followed and that there appeared to be sufficient staff on duty. There was a safeguarding policy and staff h

The inspection took place on 17 and 19 January 2017 and was unannounced on the first day. The home is a purpose-built, three-storey property in a residential area close to the town centre. There were bedrooms on all floors. There were communal areas on each floor.

The service is registered to provide accommodation and nursing or personal care for up to 63 people.

The service was divided into floors, with general nursing on the ground floor, intermediate care on the first floor and dementia care on the second floor. At the time of our inspection, there were 39 people residing as permanent residents and 22 people who were in intermediate care (IMC). IMC beds are funded by the local NHS trust and social services for periods of up to six weeks post discharge from hospital. The aim was to support people who no longer required acute hospital support and people were accommodated in the home to enable their ongoing rehabilitation and to enable people to return to their own homes safely.

This was the first inspection of the service since it had changed its legal entity, more usually known as ‘the provider’. The service provided a predominantly nursing care service, with a specialist dementia care unit as well as the IMC unit.

The service required a registered manager. 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 registered manager had been in post for two years.

There were enough qualified and experienced staff to meet people’s needs and keep them safe. Where there were shortfalls, the home used their own bank staff and their permanent staff to cover the shortfall. The required checks had been carried out when new staff were recruited. Staff were trained and knew how to report concerns about care, safeguarding adults and also knew about the homes policies, procedures and how to ‘whistle-blow’.

We found that the home was clean and well maintained and records we looked at showed that the required health and safety checks were carried out. Medicines were managed safely and records confirmed that people always received the medication prescribed by their doctor.

Where appropriate, applications had been made to the local authority for Deprivation of Liberty Safeguards. People were happy with their meals and choices were always available.

The members of staff we spoke with had good knowledge of the support needs of the people who lived at the home. The staff we met had a cheerful, pleasant and caring manner and they treated people with respect and ensured their dignity. The relatives we spoke with expressed their satisfaction with the care provided.

People were registered with local GP practices and had visits from health practitioners as needed. The care plans we looked at gave information about people’s care needs and how their needs were met.

We found that there was a friendly, open and inclusive culture in the home. Staff expressed some concerns to us which we discussed with the registered manager. The registered manager told us that they knew about these concerns and that they were being addressed. We saw evidence to support this.

People we met during our visits spoke highly of the registered manager and the staff. Staff told us that the registered manager was approachable and supportive. Some staff had some issues with certain aspects of the home, such as the hot water system. Regular quality audits were completed and these identified where improvements were needed and who should do them and by what date.