6 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 were reflected in the systems and processes used by the service. However, we found aspects of the service did not always uphold these values.

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 10 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 basic information about end of life care and funeral plans, this information had not been reviewed or updated for many years.

Support plans were person centred and contained details about people’s individual needs and preferences. However, they would have benefitted from a full review to ensure they remained up to date.

Audits and provider quality monitoring visits had taken place but had not identified some issues found at this inspection.

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 mostly supported to have choice and to make decisions and staff mostly supported them to be as independent as possible; the policies and systems in the service supported this practice.

Staff received an induction process and on-going trai

This inspection took place on 21 December 2015 and was unannounced. When we last inspected the home in June 2014 we found that the provider was meeting the legal requirements in the areas that we looked at.

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

Currently, the home does not have 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 home was being run by a Senior Support Worker as the acting manager, who was supported by a registered manager of two neighbouring homes and the provider’s Area Manager.

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 planning the weekly menu and were given a choice of nutritious food and drink throughout the day. People were encouraged to maintain their interests and hobbies. They were supported effectively and encouraged to develop and maintain their independence. They assisted with the running of the home. 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 and able to demonstrate the impact training had on the delivery of support to people. 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.

We consider all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we ask;

•Is the service safe?

•Is the service effective?

•Is the service caring?

•Is the service responsive?

•Is the service well led?

This is a summary of what we found.

Is the service safe?

People’s care plans reflected their individual needs. Two care plans we looked at had risk assessments that included: how to care for people who had epilepsy, how people were assisted to move, people’s nutrition and skin care, and how people were safeguarded. Staff we spoke with were aware of people’s needs. We observed good care and interaction from staff.

During our inspection we found the outside of the building and spaces to be well maintained. The garden was spacious and had adequate seated areas. We also found that the interior of the home was well maintained. The provider has taken steps to provide care in an environment that was suitably designed and adequately maintained to meet the people’s needs.

Is the service effective?

People’s needs were being met by staff that had received the relevant training for their role. This enabled them to support people appropriately. We spoke to staff that were able to demonstrate that they understood people's needs. We spoke with two family members, one said, "I am very pleased with the home, we are involved with [Name] care needs and were involved with their care plan. The staffs are very good and always welcoming and [Name] is very happy there". Another family member said, "Best home [Name] has ever been in. They are very happy here and the staff are very approachable”.

Is the service caring?

People were supported by kind, attentive staff. During our observations we saw that people's diversity, values and human rights were respected. During our visit people were observed being spoken with and supported by staff in a respectful way.

We observed good interaction between staff members and people who used the service. Staff we spoke with told us they encouraged people’s independence

Is the service responsive?

People needs had been assessed and each person had a key worker. The key worker would be involved with their personal care plan. Care plans included people’s preferences and diverse needs. People who used the service had been asked to complete questionnaires to seek their views. People had access to activities and were supported out in the community. We spoke with family members and staff, they were aware of the services complaints policy.

Is the service well led?

The service had provided people who lived at the home and staff with surveys to obtain feedback. This meant people’s views were actively sought. There were regular staff meetings.

The care plans we looked at included the appropriate information and risk assessments to ensure that people’s need were met. These were reviewed on an annual basis, due to people were active and in good health. The care plans are updated when people’s needs changed. There were daily diary notes kept for people who used the service, this recorded their personal care and their daily activities. We saw audits which reviewed medication and infection control. An internal audit had been carried out in May 2014 this highlighted areas for improvement and an action plan has been implemented to be completed by Aug 2014.

When we visited The Grove -6 on 17 June 2013, we observed that people were offered support which ensured their individual needs were met. Staff were friendly in their approach to people and engaged confidently with them, respecting their dignity and communicating effectively with people.

We observed that people were happy and relaxed in the home environment and noted the atmosphere was calm and homely. We saw that people receiving support were relaxed in the company of staff. This was evident in their gestures and expressions which showed them to be at ease.

We reviewed four people's care records and saw that they included comprehensive information to show how people should be supported and cared for.

We spoke with two staff about their knowledge of safeguarding processes and they were able to demonstrate how they would report concerns to relevant people if this was required.

We reviewed the training records for the home and observed that staff training was up to date which ensured that staff had the appropriate skills and knowledge to provide care for the people they supported.

We observed the quality assurance processes within the home and noted that there were appropriate systems in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

During our visit on 4 December 2012, we spoke with five out of the six people living at The Grove 6, and also four members of staff.

People who lived in the home had limited communication abilities and most were not able to verbally tell us about their experiences. As such, we used a number of different methods to help us understand this. People used various methods, including body language and Makaton to communicate with staff. One person was able to tell us they were happy living in the home and said “staff are good”. Two other people, using their own methods of communication, were able to express they were happy living in the home.

We observed a friendly, relaxed environment, with staff interacting well with people. People were offered choices related to the care and support they received, and staff respected the decisions they made.

During the course of our visit, several people were engaged in activities, including attendance at the lifelong learning centre managed locally by the provider.

People told us about the activities and holidays that they had taken part in. We observed positive communication between staff and people living in the home.