4 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.

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.

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

There was a registered manager in post. 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 had detailed risk assessments in place to enable them, in most instances, to be as independent as possible whilst also remaining safe. However, there was insufficient evidence that, where restrictive measures had been in place for a long time, the continuing need for this was fully assessed.

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 for several years in some instances. Although they had been reviewed and amended by hand regularly, the reviews were not always robust..

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.

Some of the people who lived at the service were unable to tell us about their experiences in detail, so we observed the support they received and their interactions with staff to help us understand.

People 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 policies and systems in the service supported this practice.

Staff received a

This inspection took place on 22 December 2015 and was unannounced. When we last inspected the home in April 2013 we found that the provider was meeting the legal requirements in the areas that we looked at.

4 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 independence. They were supported effectively and encouraged to maintain their interests and hobbies. 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 4 on 3 April 2013, we saw that people were happy and at ease, living in a calm, homely and relaxed atmosphere. The seven people who lived at this home had various levels of verbal communication. We therefore used different methods to help us understand people’s experiences, and observed the interactions between people and the staff they were supported by.

The six people we observed clearly communicated through their body language they were satisfied with the care and support they received. We observed that people were offered support that ensured their individual needs were met and independence encouraged. Staff were friendly and respectful in their approach to people and interacted confidently with them, respecting the individual's dignity and knowing how to communicate effectively with them.

We noted people were involved in planning their care and making decisions about their support and how they spent their time. Some people were going to the learning resource centre at the time of our visit, and others were involved in personal development activities. One person confirmed the different activities and entertainment they participated in and showed us through their gestures that they enjoyed this.

During our visit on 4 December 2012, we spoke with four out of the seven people living at The Grove -4, and also the three staff members on duty.

We were told by staff that whilst most people who lived in the home were not able to verbally tell us about their experiences, some people were able to understand more than they could tell us, and could communicate some words. We therefore used different methods to help us understand people’s experiences, and observed the interactions between staff and the people they supported.

During our visit, some people returned from various activities, including attendance at the learning resource centre: we were told people visited this throughout the week. We saw an activities board displayed for the week with a section for each resident. Staff told us this was mainly for their reference, so they knew that people were doing something and not “just sitting around getting bored.”

We observed staff interacting well with people and most people looked happy in the home environment. However, prior to our inspection, we had received information about one person’s behaviour impacting on two other residents. We saw such an incident occur during our inspection and noted that the people receiving the behaviour did not look happy or relaxed in that environment. The care plan for the person responsible for the behaviour had been amended to reflect the requirement for additional support, but not the care plans for those who experienced it.

During our visit on 07 November 2011 we observed staff supporting people in a kind and respectful manner.