Grove Lodge Care Home is registered to provide accommodation for 19 adults who require help with personal care and support with their daily lives. The statement of purpose for the home states that they provide services for people who may be living with dementia and/or mental health disorders. At the time of our inspection there were 18 people living at the home.

The home is located on the outskirts of Stockport and is close to local amenities and services.

Grove Lodge has eleven single occupancy rooms, three with en-suite facilities and four bedrooms with shared occupancy. The three bedrooms on the first floor of the building could not be accessed by people with limited mobility because there was no passenger lift.

There was a registered manager in post. 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. The manager was registered in July 2016.

We inspected Grove Lodge Care home on 20 June 2018.

The service was last inspected in December 2016, and rated Requires Improvement. There were three breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014, relating to safety at the service and how it was governed. Following the inspection the provider sent us an action plan which stated the breaches would be addressed. At this inspection we found significant improvements in all areas.

At this inspection we found that the service had fitted two new boilers which meant people had unlimited access to hot water. People told us that they could have a shower whenever they wished and the facilities suited their needs.

We found that systems to monitor the safety and quality of the service had been put in place and sustained over a period to ensure compliance with the regulations.

Staff had undergone training to ensure they had the knowledge and skills to support people safely. This included training specific to the needs of the people living at Grove Lodge.

Staff knew how to protect vulnerable people and had safeguarding policies and procedures to guide them, which included the contact details of the local authority to report to.

Recruitment procedures were robust and ensured new staff should be safe to work with vulnerable adults. The service had developed a staffing dependency tool to ensure there were sufficient staff to meet people’s needs.

Person-centred care plans were in place that reflected the needs of the people living at Grove Lodge and included a range of individual risk assessments developed to keep people safe.

Environmental risk assessments were carried out regularly to ensure safe service provision and maintenance work was carried out and recorded. Grove Lodge was clean and well maintained.

Staff were sufficiently supervised and had their performance reviewed by managers regularly.

People had access to a range of activities which was suitable to their age, gender, ethnicity and beliefs.

There was a relevant complaints procedure. There had not been any formal complaints since the last inspection.

The service liaised well with other organisations to help meet people’s health and social care needs.

Medicines were safely administered by staff who had received appropriate training. The service had recently introduced an electronic medicines management system which enabled the management team to have clear oversight of how staff administered medicines and helped easily identify medicines errors.

Systems were in place to ensure that all medicines were stored correctly and dispensed by staff trained to provide medicines safely, and where health needs were identified we saw staff followed advice given by professionals to make sure people received the care they needed.

This inspection was carried out over three days on the 5, 6 and 8 December 2016. Our visit on 5 December 2016 was unannounced.

At the last inspection on 11 March 2015 we rated the service as requires improvement. At that inspection we identified three regulatory breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014, which related to medication administration, staff training and good governance.

This inspection was to check improvements had been made and to review the ratings.

Grove Lodge Care Home is registered to provide accommodation for 19 adults who require help with personal care and support with their daily lives. At the time of our inspection there were 19 people living at the home.

The home is located on the outskirts of Stockport and is close to local amenities and services.

There are eleven single occupancy rooms, three with en-suite facilities and four bedrooms with shared occupancy. The three bedrooms on the first floor of the home cannot be accessed by people with limited mobility because a passenger lift was not available.

The home had a manager registered with the Care Quality Commission (CQC), who was present throughout the three days of inspection. A registered manager is a person who has registered with 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 and associated regulations about how the service is run.

During this inspection, we found improvements had been made and we observed staff giving positive and caring support to people. However, we also identified some areas where improvements were still required. The registered manager and the deputy manager were responsive to our feedback and had started to take actions to make some of the required changes during our inspection.

During this inspection, we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that people living on the ground floor only had access to one domestic bath, which we were told was only used by one person and one shower on the ground floor for up to 16 people. In addition we were told that at peak times of water usage for example in the morning, the water in the shower and the sinks in people’s bedrooms could run cold. However two new boilers were to be fitted the first week in January 2017 which would resolve the issues.

From looking at the training record and speaking with staff, we found improvements had been made to ensure staff received further training to carry out their role more effectively. However, we found there were still some gaps in staff training. For example, although the service user guide stated they provided care for people with past or present mental health problems such as schizophrenia, bi-polar, depression, anxiety and dementia we saw that staff had not received training in some of these mental health conditions.

We saw that medicines were managed safely and staff had received the appropriate medicines awareness training and competency assessment before they were allowed to administer medication.

Staff spoken with understood the need to obtain verbal consent from people using the service before a care task was undertaken and staff were seen to obtain consent prior to providing care or support.

The audit systems developed required implementation to fully assess and monitor the quality of the service provision and promote service improvement.

People were supported by a caring staff team and staff, with the exception of one staff member, and relatives of people living at Grove Lodge told us they thought there were sufficient staff to safely meet people’s needs. However, we found there was not a systematic approach to determine the number of staff and range of skills required to meet the needs of the people who used the service. This meant the registered provider

This inspection took place on the 11th and 13th March 2015. The visit on the first day was unannounced. We inspected this home in April 2013 when some non-compliance was identified in connection with some records. We revisited the home in November 2013 and found that all the issues had been addressed satisfactorily.

Grove Lodge Care Home is registered to provide accommodation for 18 adults who require help with personal care and support with their daily lives. Some bedrooms had shared occupancy. Some bedrooms could only be accessed by people without significant mobility difficulties as they were up a flight of stairs with no lift. At the time of this visit there were 18 people living in the home with ages ranging from 44 to over 90.

It is a condition of registration that Grove Lodge has a registered manager. At the time of this visit there was no registered manager in post. The previous manager was off work from August 2014 and resigned in January 2015.

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 provider is currently in breach of the condition attached to their registration requiring them to have a registered manager for this home.

People told us they felt safe living at the home. Staff had received training in connection with safeguarding adults. They were aware of their responsibility to be vigilant with regard to identifying and reporting any concerns about poor practice.

The building was well maintained, with no obvious safety hazards.

The homes procedures in connection with the administration of medication were not being rigorously followed. This meant that the home could not account for all the medication prescribed to people who used the service.

Observation of staff and people who used the service indicated that interactions were calm, relaxed and respectful. Staff were experienced by people who used the service, and their colleagues, as competent. Staff were neither asked nor expected to undertake tasks they could not do competently.

Specific one to one supervision sessions for staff were infrequent. However, staff told us there was easy access to support and advice from their colleagues and senior staff if they needed it.

It was not evident that all applications for a Deprivation of Liberty Safeguards authority (under the Mental Capacity Act 2005) which may have been required had been made.

People who used the service had good access to support from health care professionals in the community.

The provision of food was good. Although a planned alternative menu was not provided, an alternative meal was prepared if someone did not want the one offered. Staff understood people’s likes and dislikes.

Staff were experienced by people who used the service as caring, friendly and approachable. Similarly visitors told us that they were welcomed by friendly staff who made Grove Lodge feel homely.

People who used the service and their visitors were confident that they could complain about the service if necessary and that they would be listened to.

Written care plans were sometimes inconsistent in the guidance they provided to staff about how to meet the needs of individuals. Other process in the home and effective communication within the staff team helped to mitigate potential problems caused by these anomalies. Not all decisions in connection with people’s health and wellbeing had an effective record of why the decision had been made.

The home had not benefited from a full time dedicated manager for the six months preceding this inspection. The acting manager had remained the registered manager for a different care home during this period. Several administrative and quality monitoring duties had not been implemented as rigorously as necessary. These tasks are necessary as without them it is not possible for the service to provide evidence of the consistent and sustained provision of care and support to maximise the wellbeing of people who use the service.

During our previous inspection on 15 April 2013, we had some concerns that appropriate records were not being kept by the service in relation to the care plans for people. Following that inspection the service had given us an action plan to show us the improvements they were going to make.

During this inspection we looked at a sample of three care plans. We saw that significant improvements had been made and people’s care plans contained sufficient, up to date, accurate information to meet their needs.

During this visit we spoke with six people who lived at the home. People we spoke with told us that they were happy and had no complaints. Some of the comments we received were: “We have a good crowd here and we all get on ok,” “Its very easy going here and we can do what we want,” “We sometimes need a little bit of help but we can pretty much do what we want” and “I am feeling very well today.”

During our observations on the day of this visit we saw that people looked relaxed and content. People were seen to be freely moving around the home and chatting to each other in a friendly manner. We saw staff providing care and support to people in a kind and caring way. We observed good interactions between the staff and people living in the home.

During this visit we did have some concerns about the lack of detail in people’s plans of care. This means that people’s safety and well being may not always be protected

We spoke with some of the people living at Grove Lodge Care Home and some of the staff who worked there. We were told that people were happy to be living or working at the home.

Some of the comments included:

“You couldn’t find a better place than here, the staff, the rooms, everything is first class.”

“I feel very well today.”

“The food is always very nice.”

“I am very happy here and wouldn’t like to live anywhere else.”

“You can’t fault it here.”

“I absolutely feel safe.”

“If you have any problems you only have to mention it and its put right.”

Some of the staff told us:

“Privacy and dignity is always respected.”

“We always encourage people to have choice.”

“This is the best care home I have ever worked in.”

“The care here is excellent.”

“There is a very homely environment and the residents feel like our extended family.”

“The food is very good, people always get a choice if they don’t like what is on the menu.”

"We are a friendly, happy home, its like home from home."

“We do activities twice a day as well as regular parties, day trips out, external entertainers every week and we always get outside when the weather is warm.”

As part of this review process we contacted Stockport Commissioners and Stockport Local Involvement Networks (LINks). LINKs are groups of individual members of the public and local voluntary/community groups who work together to improve health and social care services. They gather the views of local people and use them to influence how health and social care is commissioned and delivered. No concerns were raised.

During our inspection we spoke with people who used the service, relatives, social and healthcare professionals.

One relative told us their family member received the “best care possible”. They also said, “I don’t need to see care plans, all I have to do is talk to staff and they tell me what’s happening”. Another relative said they could no longer care for their family member at home and that they “are happy in here”.

During our inspection we looked at care files for three of the people who lived in Grove Lodge. There is a new care planning format in place within the home. We did not see evidence to show the person and/or relatives were involved in planning their care or that the contents of their plans were discussed with them.

The manager told us there were policies and procedures in place to safeguard people who used the service from harm or possible abuse.

Staff received training and were able to access NVQ courses. They also received support from the senior staff .

There were no systems in place to monitor key care practices within the home.

Personal records for people who used the service were not kept secure and confidential