We last inspected this service in January 2016 where it was rated ‘good’ overall, with one breach of the regulations because medicines were not managed safely. This inspection took place on 13 June 2018 and was unannounced. At this inspection, we found that medicines were being managed safely and that the service was now rated ‘Outstanding’.

The service is registered to provide accommodation and support with personal care for up to eight adults with mental health needs. Seven people were using the service at the time of inspection.

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.

The service was exceptionally responsive and used innovative ways to ensure that it was providing care that was tailored to meet people’s needs. Staff and management went the extra mile to include people in all aspects of their care as well as creating opportunities for them to socialise and integrate within the community. Arrangements were made to support people in maintaining relationships so that they could live as full a life as possible.

People’s hobbies and interests were championed by the service and staff made sure people were taking part in activities they were passionate about. The service was actively involved with the local community in ensuring resources and networks were utilised to benefit people who used the service, as well as in the local area.

The service was particularly skilled at helping people explore and record their wishes about care at the end of their life and plan how these wishes would be met. The service was very responsive in enabling people to have a comfortable and dignified death.

Visiting professionals spoke positively about the service and had confidence that the care provided was person centred.

The service was remarkably well led and staff felt extremely proud to work there. Staff had a strong organisational commitment to the service and felt motivated. The registered manager had a clear vision and strategy to deliver high-quality care and support and to promote a positive culture that was person-centred, inclusive and empowering.

The service was innovative and had developed a community group for people with mental health needs, to benefit people who used the service and others in the wider community.

The service was safe and people were protected from harm. Support workers were knowledgeable about safeguarding adults from abuse and what to do if they had any concerns and how to report them. Safeguarding training was given to all staff.

Risk assessments were thorough and personalised. Support workers knew what to do in an emergency situation.

Staffing levels were meeting the needs of the people who used the service and support workers demonstrated they had the relevant knowledge to support people with their care.

Recruitment practices were safe and records confirmed this.

Training for support workers was provided on a regular basis and updated when relevant. Support workers told us the quality of training was good.

Support workers demonstrated an understanding of the Mental Capacity Act (2005) and how they obtained consent on a daily basis. Consent was recorded in people's care plans.

People were supported with maintaining a balanced diet and the people who used the service chose their meals and these were provided in line with their preferences.

People were supported to have access to healthcare services and receive on-going support. Referrals to healthcare professionals were made appropriately and a multi-disciplinary approach was adopted to support people.

Positive relationships were formed between support workers and the people who used the service and staff

This inspection took place on 28 January 2016 and was announced. We last inspected this service in November 2013 and it was found to be fully compliant with all the outcomes we looked.

The service is registered to provide accommodation and support with personal care for up to eight adults with mental health issues. Seven people were using the service at the time of our inspection. The service had a registered manager in place. 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.

There was no system in place to audit or identify the amounts of medicines held at the service.

We found one breach of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

The service had appropriate safeguarding procedures in place and staff understood their responsibility with regard to safeguarding adults. Risk assessments were in place which included supporting people who exhibited behaviours that challenged the service. There were enough staff working at the service to meet people’s needs. The service had robust staff recruitment procedures in place.

Staff were well supported by regular training and supervision. The service worked within the Mental capacity Act 2005 and Deprivation of Liberty Safeguards. People were able to make choices about their daily lives. People had sufficient amounts of food and drink and were able to make choices about what they ate. The service supported people with health care appointments and sought to promote their physical and mental health wellbeing.

The service promoted a homely and family atmosphere and people told us staff were caring. Staff supported people to develop their independence and promoted their privacy.

Care plans were in place which set out how to meet people’s individual needs in a personalised manner. The service had a complaints procedure in place and people knew how to make a complaint.

People that used the service and staff told us they felt the management team was open and supportive. The service had various quality assurance systems in place, some of which included seeking the views of people that used the service.

Appropriate arrangements were in place in relation to the recording, handling, using, safe keeping and disposal of medicines. We found some unexplained gaps in entries in medicine administration records (MAR) charts but appropriate action had been taken to address this issue.

The premises was suitably designed in layout and adequately maintained. There were regular checks on the emergency lighting and fire alarm and detection system.

There were effective recruitment and selection processes in place. Staff we spoke with told us they had completed an induction for six weeks during which they worked alongside experienced staff. This demonstrated that staff had the necessary skills and experience to care for people safely.

People were made aware of the complaints process because there was a copy of the complaints procedure in each “Residents Handbook” and on the noticeboard on the living room wall. We saw that people’s complaints had been acknowledged, investigated and resolved, where possible, to their satisfaction.

We spoke to four people who use the service and two members of staff.

People told us that staff treated them with respect and said "the staff are really good." People said the support was of a high quality and met their needs, and that they were able to express their views to staff and managers. One person said "I like it here" and listed activities that they liked doing. We found that the care provided corresponded with written care plans and that risks were being assessed and managed accordingly. Staff were aware of care planning procedures and what they should do if people's care needs changed.

Staff were able to describe the different types of abuse, how they would identify it and what steps they should take to address it. People told us that they felt safe while using the service. One person said "There is no brutality or abuse here. Staff are very good."

The service had improved its method of dealing with incidents and complaints. This included documented debriefing meetings at the time of the incident and at intervals afterwards. Risk assessments were updated where there was an identified risk of repeat incidents.

The Grove had six residents at the time of our inspection. We spoke to most of them however some of them had difficulties giving us feedback on the quality of the service. The comments we received were positive regarding the meals, the staff and the service in general.

Staff told us that they enjoyed working at The Grove, they received good induction and appropriate training. They also told us that the number of staff on duty were enough to meet people’s needs.

We found that information on people’s needs and their care plans were available and were reviewed on a regular basis. People had their own room that they personalised and they were involved in various activities in the home and in the community. The manager monitored the quality of the service through a number of regular checks to ensure that the service met people’s needs as safely as possible.

People told us that they liked living at The Grove. They told us that they go out all the time and that staff helped them. We observed people accessing additional health care in the community. Staff we spoke with described the importance of creating a family environment and how they work to enable people’s independence. Staff felt able to access training and to develop their skills.