2 The Grove is a care home for up to seven people with learning disabilities and/or autistic spectrum conditions. People in care homes receive accommodation and nursing or personal care as a single package 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. At the time of our inspection seven people were living at the home.

We checked to see if the care service had been developed and designed in line with the values that underpin ‘Registering the Right Support’ and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service should be able to live as ordinary a life as any citizen. The provider’s values were strongly connected to these principles, which was reflected in the systems and processes used by the service. However, we found that the service did not always uphold these values in practice.

This unannounced inspection took place between 1 October 2018 and 16 November 2018.

At our last inspection we rated the service as ‘good’. At this inspection we rated the service as ‘requires improvement’. This was because we found some areas of the service needed work to ensure the service provided consistently good quality support to people.

There was a registered manager in post although they had little involvement in the day to day running of the service. 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.

Although people had detailed risk assessments in place to enable them to be as independent as possible whilst also remaining safe, staff did not always follow this guidance.

Although staff were kind and caring in their approach towards people, there were occasions when people were left without staff contact for long periods of time.

There was information available to people about how to make a complaint, and information for staff on how to understand how people communicated this. However, this information was not used effectively to identify and act on complaints made by people who used the service.

Although people’s support plans included information about end of life care and funeral plans, this information had not been reviewed or updated for many years.

Support plans and risk assessments had not been rewritten since 2015, and any changes that had been necessary since had been added by hand. This led to records having many crossed out sections and added information, which made it difficult to find current guidance.

Audits and provider quality monitoring visits had taken place but issues found at the inspection had not been identified and acted on quickly to make improvements to the service.

People who were able to speak with us told us they felt safe. Those who were not able to tell us were clearly comfortable in the presence of staff. Staff had received training to enable them to recognise signs of abuse and they felt confident in how to report these types of concerns.

There were sufficient numbers of skilled staff on duty to support people to have their needs met safely. Effective recruitment processes were in place to ensure only suitable staff were employed

Medicines were managed safely and administered as prescribed and in a way that met people’s individual preferences. The service was clean and people were protected from the risk of infection.

Staff understood and worked in line with the principles of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards. People were supported to have choice and to make decisions and staff supported them to be as independent as possible; the polici

This inspection took place on 01 December 2015 and was unannounced. When we last inspected the home in June 2013 we found that the provider was meeting the legal requirements in the areas that we looked at.

2 The Grove provides accommodation and support for up to seven people who have a learning disability or physical disability. At the time of this inspection there were seven people living at the home.

The home has 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.

People were safe and the provider had effective systems in place to protect them from harm. Medicines were administered safely and people were supported to access other healthcare professionals to maintain their health and well-being. People were involved in the choice of food they were offered and given a choice of nutritious food and drink throughout the day. They were assisted to eat their meals where this was required. People were encouraged to maintain their interests and hobbies. They were supported effectively and encouraged to develop and maintain their independence. They were aware of the provider’s complaints system and information about this and other aspects of the service was available in an easy read format. People were encouraged to contribute to the development of the service.

Staff were well trained. They understood and complied with the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards. They were caring and respected people’s privacy and dignity. Staff were encouraged to contribute to the development of the service and understood the provider’s visions and values.

There was an effective quality assurance system in place.

When we visited The Grove- 2 on 17 June 2013, we used different methods to help us understand the experiences of people using the service. We observed people were offered support at a level that supported their independence and ensured their specific needs were appropriately met.

The atmosphere within the home was calm and relaxed and we saw that people were happy in the company of staff and engaged in activities of their choice. Staff were attentive to the needs of the people they supported which meant that people's needs were met in a timely manner.

The staff on duty were polite and respectful in their approach to people and engaged with them on a meaningful level. They supported them in planning their care needs and making decisions about how they spent their time. One person told us, "I am going to drama today which I really enjoy. It is fun."

We observed from the care records and discussions we had with staff, that although activities were scheduled for people, there was a need to be flexible. This was to allow for people to make alternative choices, if they did not wish to participate in the planned activity. Staff told us it was people's right to live their life as they wished to and that they tried to encourage and support this.

We reviewed three people's care records and saw they included comprehensive information to show how people should be supported and cared for. One person said, "I like staff here. They look after me well."

During our visit to The Grove – 2 on 4 December 2012 we spoke with two out of the six people who lived in the home. We also spoke with the three members of staff on duty.

Due to the complex needs of people who lived in the home, most were not able to tell us about their experiences, so we used different methods to help us understand this. One person was able to talk with us and they told us they were “very happy” and that they “felt safe” with the care and support provided by staff. One other person whose communication abilities were limited was able to express they were happy through the use of body language and facial expression.

The home had a relaxed atmosphere and people were supported by staff in a respectful manner. We noted the lounge area in the home was very small for the number of people living there, particularly with two people using specialised wheelchairs. We were told by staff and the manager that a larger living / conservatory area was in the process of being developed, to increase the amount of useable space for people living in the home. It was anticipated this would be built at the start of the New Year.

The people that we met during our visit on 05 July 2011 did not use words to communicate, so we spent some time observing the support being provided to them.

We noted that the staff were attentive, and understood the needs of the people that they were supporting.