We carried out an unannounced comprehensive inspection of this service in January 2018. Breaches of legal requirements were found. After the comprehensive inspection the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches found.

We undertook this focussed inspection to check the provider had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Grovewood House on our website at www.cqc.org.uk.

The inspection took place on the 24 and 25 October 2018 and we inspected the service against two of the five questions we ask about services: Is the service safe? and Is the service well led?

At this inspection, we found the provider had not fully addressed the issues from the last inspection and they continued to be in breach of regulation 12, safe care and treatment with a further breach being found in relation to good governance, regulation 17.

No risks, concerns or significant improvement were identified in the remaining key questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these key questions were included in calculating the overall rating in this inspection

Grovewood House at one time was the local vicarage and is set in a rural location on the edge of a small village in Northumberland. It accommodates up to 28 people over two floors. At the time of the inspection, 23 people lived at the service.

Grovewood House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single packages under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection in relation to the key questions, ‘safe and well led’

There was a registered manager in place. A registered manager is a person who has registered with the 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 time of the inspection there were some issues with the provider registration which were being dealt with separately by the CQC.

Although people and staff felt that the service provided safe care, we found a number of issues which needed to be addressed.

The management of medicines was inadequate and required improvement. For example, regarding administration, storage and recording.

Although we found the service was clean and tidy and people also deemed the service was clean, we found issues with infection control in connection with the use of aprons and gloves in the kitchen areas.

Record keeping needed further improvements. Some care plans, risk assessments and other monitoring records, were either out of date or not in place at all.

Accidents and incidents were not always fully recorded and reported to the correct authorities, including the local safeguarding team and the CQC.

Staff did not always follow safe moving and handling procedures, by failing to place the brakes on a wheelchair during transfer of a person. We have made a recommendation about this.

Fire safety procedures were in the process of being updated, including staff training and monitoring within the home. The local fire authority will be returning to the service in November to ensure they are fully completed.

Audits and checks had not identified all the concerns we had during the inspection. The service had the continued support from a quality assurance organisation. However, from the last two reports provided by this organisation, it appeared that advice given had not always been followed in a ti

This inspection took place on 31 January 2018 and was unannounced. This meant that the provider and staff did not know we would be visiting. We carried out further announced visits to the home on 6 and 8 February 2018 to complete the inspection.

Grovewood House is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Grovewood House provides care to up to 28 older people. There were 26 people using the service at the time of the inspection.

The provider was a husband and wife partnership. Their two daughters and son were involved in the management of the service. One of their daughters was the registered manager of the care home and their son was the registered manager of a home care service run by the provider but registered separately to the care home. He supported with the management of the care home on a daily basis. A registered manager is a person who has registered with the 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.

At our previous inspection in May 2017, we found four breaches of the Health and Social Care Act 2008. These related to safe care and treatment, premises and equipment, and good governance. The provider had also failed to notify us of all incidents the provider was legally obliged to inform us of. We rated the service as inadequate and placed the service in 'special measures.' This meant the service was kept under continuous review.

Following the inspection, the provider formulated an action plan and sent us regular updates in response to the breaches and concerns we had identified. We carried out this inspection to check whether the provider had complied with the imposed conditions and had met the breaches which were identified at our last inspection.

Since the last inspection a visiting manager had been brought in from a care home advisory service to assist the provider to review the management systems in the service and support improvements.

The provider had met three of the four breaches, however the breach in safe care and treatment continued as medicines were not always managed safely.

Medicines were stored in locked cupboard in an office adjacent to the kitchen. Staff frequently used this as a thoroughfare to a back door which was unlocked during the inspection. Staff did not always supervise people taking their medicines and left them unattended to take later. Assessments had not been made to determine that the people concerned were able to self administer medicines.

The safety of the premises and equipment had improved and contracts were in place for the regular servicing of equipment. Routine checks of the premises and equipment were carried out.

The home was clean and tidy during the inspection and staff were seen to follow infection control procedures.

There were suitable numbers of staff on duty and safe recruitment procedures were followed.

New risk assessment tools had been introduced to assess risks such as falls and nutritional risks, and these were being used at the time of the inspection.

New care documentation and procedures had been introduced relating to the application of the Mental Capacity Act (MCA) and Deprivation of liberty safeguards (DoLS). There were discrepancies in a small number of records and we have made a recommendation to monitor the quality and accuracy of these records until the new processes are fully embedded in practice.

A training matrix was available which recorded staff training completed and due. Training had been planned in order of priority and all staff were enrolled with the NHS Learning and Development Unit and the Care Certificate. The Care Certific

The inspection took place on the 9 May 2017 and was unannounced. This meant the provider and staff did not know we would be visiting. We carried out a further two announced visits to the home on the 10 and 12 May 2017 to complete the inspection.

At our last inspection on 9 March 2016, we found two breaches of the Health and Social Care Act 2008. These related to safe care and treatment and good governance. We rated the service as requires improvement.

At this inspection we found that action had not been taken to improve in all areas and we identified further shortfalls in relation to other areas of the service.

Grovewood House is a family run care home and opened over 20 years ago. It was originally built in 1863 as a Vicarage. It accommodates up to 28 older people, some of whom are living with dementia. There were 25 people living at the home at the time of the inspection.

The provider was a husband and wife partnership. Their two daughters and son were involved in the management of the service. One of their daughters was the registered manager of the care home and their son was the registered manager of the home care service. A registered manager is a person who has registered with the 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.

The home care service however, was no longer being carried on at the care home and was registered separately. The provider had not applied to remove the homecare regulated activity from the care home’s registration. Both registered managers told us that this would be addressed. Regulated activities are services which are delivered by the provider.

We identified serious shortfalls and omissions in relation to checks and tests of the premises and equipment to demonstrate their safety. Risk assessments were not always specific or accurate.

One person had sustained an unobserved injury. Records relating to this accident were not detailed. In addition, there was no recorded investigation into the events leading up to or following the injury to identify if action needed to be taken to mitigate any risks.

The adaptation, design and decoration of the home did not fully meet the needs of people with a dementia related condition. In addition, the environment did not fully promote people’s privacy, dignity and independence.

On the first day of our inspection, we had concerns with the storage of certain medicines. This was addressed by the second day of our inspection. Not all staff on night duty had completed medicines training. Staff would contact the registered manager of the home care service if medicines needed to be administered overnight. This issue had not been risk assessed.

Records did not always evidence that safe recruitment procedures were followed.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The authorisation procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS).

We found shortfalls regarding the maintenance of records relating to the MCA. DoLS assessments had not been updated following the Supreme Court judgement in March 2014. This meant there was a risk that DoLS assessments did not accurately assess whether people’s plan of care amounted to a deprivation of liberty to ensure people were not be

Grovewood House is registered to provide two services; a care home and a home care service.

The inspection took place on 9 and 17 March 2016. The care home inspection was unannounced. This meant that the provider and staff did not know that we would be visiting. The inspection of the homecare service was announced and we gave the provider 48 hours' notice to ensure that a member of staff would be available at the office to facilitate our inspection and organise visits to people’s homes.

We last inspected the service in November 2015 where we found that they were meeting all the regulations we inspected.

Grovewood House is a former vicarage. It was built in 1863 to house the vicar whose church is adjacent to the care home. There were 23 people living in the care home at the time of the inspection some of whom were living with dementia. The homecare service provided three hundred hours of care per week.

The provider is a husband and wife partnership. The home is managed by the provider’s family. There were two registered managers. One oversaw the homecare service and the other the care home. 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 have written our report under the headings Care Home and Homecare to ensure that our specific findings for both services are clear.

Care Home

People told us that they felt safe. There were safeguarding policies and procedures in place. Staff were knowledgeable about what action they would take if abuse was suspected. We spoke with a local authority safeguarding officer who told us that there were no organisational safeguarding concerns with the service.

We found some concerns with the premises. On our first visit to the service, some of the windows were not fitted with window restrictors to prevent any accidents and incidents. When we carried out our second visit to the service, these had been fitted. We checked equipment at the service and noticed that the bed rails did not meet best practice guidelines . The registered manager told us that this would be addressed immediately.

We found that the premises were clean and there were no offensive odours in any of the areas we checked.

There was a safe system in place for the receipt, storage, administration and disposal of medicines. People told us that staff supported them with their medicines. One person said, “Yes, they’re very good, they never forget.”

People told us there were enough staff to meet their needs. On the day of the inspection, we saw that people’s needs were met by the number of staff on the day of the inspection. There was a training programme in place. We observed however, that staff did not always follow safe moving and handling procedures. We discussed this with the manager who said that she would source refresher training in this area. In addition, staff on night duty had not completed medicines training. The registered manager of the home care service was called if anyone required their medicines overnight.

Staff told us that they were a small supportive team. All staff told us that they felt well supported by the management team. Regular supervision sessions were carried out and an annual appraisal held.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’ it also ensures unlawful restrictions are not placed on people in care homes and hospitals.” The manager had submitted DoLS applications to the local authority to autho

We spoke to four people and two relatives during our visit to Grovewood. People told us they were satisfied with the care and support they received from staff. One person told us, “I am happy with the service here. The staff are all very kind and I like them. If you need anything you just ask them and they do it. The food is good and I like my room.” A relative told us, “There is excellent care here. We have been very satisfied with it. They rang me one night at 11pm to tell me Y had an accident. They wanted to make sure I knew about it. I feel reassured by the staff here.”

We found people’s care and treatment was delivered in line with their individual care plan.

We concluded people were provided with adequate nutrition and hydration.

We found people were protected from the risk of infection because appropriate guidance had been followed.

There were enough qualified, skilled and experienced staff to meet people’s needs.

Staff records and other records relevant to the management of the service were accurate and fit for purpose.

We spoke with the manager and two members of staff about the management of medicines. We saw there had been new cupboards fitted to provide adequate space for storage of medicines held. Individual records reflected the amount of medicines held and there were regular checks carried out by a senior member of staff. Creams and topical medicines were labelled and stored separately from other medicines. Ordering and disposal of medicines was clearly recorded. Controlled drugs were securely stored.

We spoke with four people who lived at the home to find out their views on the care provided at the home. One person who lived there said, “I am very settled here and I like the staff. I am comfortable and my room is nice. The staff are very kind and they know what help I need. Another person told us “I like the food and my room is very comfortable. I have been here for about six months and I find the staff kind and helpful. Everything is fine here and although I miss my home I know that I could not continue to live on my own. I feel safer here.”

Another person told us “The food is good and I am able to make choices about my routines like when I get up and when I go to bed. The staff come when I ring my bell and I get the help I need. If I am not happy about anything I could speak to any of the staff or the manager, but I have never had to.”

We spoke to seven people, however many people could not offer direct comments about the care they received due to their needs. People said they were comfortable and staff were kind. The two people who were able to communicate their views said they were consulted about their care and support. They said that they were able to make decisions about their routines.

One person told us, “I like to get up at 7 am. I used to go to bed at 10 pm at home, but most people are in bed by 10, so I go to bed then and read. I can get up and go to bed when I like.”

We did not ask people about the arrangements for infection control at Grovewood House.

People said that they were very happy with the care and support provided by the staff. They said that staff were there when they needed them and that they were always cheerful and kind. One person said that she felt very happy living at Grovewood and it was warm, comfortable and safe. She said staff always spoke nicely to everyone and that her privacy was respected. She also said that staff knew what she needed help with and were there when she needed them.

People said that the staff were good at their jobs and they thought that they had the training they needed. They said that the food was good and that there was always a choice at mealtimes. People told us that they were very happy with their rooms.

We considered all the evidence we gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

Below is a summary of what we found –

Is the service caring?

People told us they were generally happy with the care they received; both in the residential part of the service and from the domiciliary care service. People living at the home told us, “The care is very good. I’ve no complaints at all” and “I am very happy here; very satisfied with it. It is easy going and the food is nice.” People using the domiciliary service said, “They are absolutely wonderful; every one of them. They really are okay; I’ve not a bad word to say about anything”; “I am very happy indeed. There is not a single thing I would want them to improve on”

People living at the home looked clean and were dressed appropriately. We saw that care workers were attentive to people’s needs and understood about the care they needed to deliver. We saw that care plans reflected people’s needs and were reviewed to take account of changes in people needs.

Is the service responsive?

We saw that people’s needs were appropriately assessed and where necessary advice taken from other professionals, such as general practitioners and physiotherapists. We spent time observing care being delivered at the home and saw that people did not have to wait for help and that they were supported with their care.

We saw that where people had fallen or had suffered an injury, because of an accident, then checks had been made by staff and, where necessary advice taken from the person’s general practitioner or by them attending hospital.

People who used the domiciliary service told us they were happy with the support offered and that it helped them meet their current needs. One person told us, “They are the most helpful group of ladies I have ever clapped eyes on. They do all sorts of little bits of jobs that make quite a difference.”

Is the service safe?

We found that fire safety procedures were now fully in place and were being followed. There were regular checks on system and equipment and fire frills to ensure that people could be safely moved or evacuated in the event of a fire.

We saw that checks on electrical systems and equipment and on water systems had been undertaken and were also being monitored. There was a system in place to ensure that maintenance was carried out at the home.

Previous safeguarding issues had now been addressed. Staff were able to tell us about potential safeguarding issues and how they would report them if they were concerned. People we spoke with told us they felt safe with the staff who delivered care.

Changes had been made to staff rotas to improve the number of staff available at certain times during the night. This meant that extra staff were available to deliver safe care.

Laundry bins had been relocated so that soiled or wet clothing was no longer left in area open to people or the public.

The provider told us they were currently working with the local safeguarding adults team to ensure anyone who should be subject to the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 had been properly assessed and the proper legal process completed.

Is the service effective?

Relatives we spoke with told us, “Mum was in another home but this is far better. She is better now than when she lived at home” and “Things are a lot different here, there is a huge difference in the last few weeks. It is all on the ball now.”

Staff understood about people’s care and we saw care detailed in people’s care plans being delivered in the home. People using the domiciliary care service told us that staff helped them to achieve tasks that they needed to do to remain in their own homes.

Is the service well led?

In this report the names of two registered managers appear. This is because both individuals are registered with us for separate regulated activities at the home.

We found that staff had regular supervision and that a range of issues were discussed. Staff meetings were now taking place and issue highlighted in the previous inspection report had been considered.

We found that regular checks, such as safety checks, legionella checks, fire drills and audits on medication were taking place. The manager had conducted an overall audit of the home and the environment to consider risks or issues that required addressing. She told us a regular checking system was being considered.

New care plan audits had been introduced to review people's care on a monthly basis and check that care plans were up to date.

Relatives we spoke with told us, “The manager is always available to have a chat and tells us about anything going on” and “We get questionnaires to fill in and get reports about what is going on.”

Staff and people who used the domiciliary service said that there were regular spot checks and that the manager would also come and work alongside the care workers to ensure everything was alright. People we spoke with told us, “I speak to (the manager) frequently and he comes and checks everything is okay”; “(The manager) pops out to discuss things and check that everything is okay” and “(The manager) comes fairly regularly to check that everything is alright; which it is. I’ve also been asked to fill in a questionnaire and send it back in the post.”