We carried out a comprehensive inspection on 10 and 11 October 2018, a breach of the legal requirements was found. This was because the arrangements in place for the administration and management of medicines at the service were not robust. Staff who transcribed medicines on to Medicine Administration Records (MAR) were not following the service’s policy. Such entries on to the MAR were not always witnessed and signed by another member of staff to help reduce the risk of any errors. The system for monitoring people who self-administered their own medicines was not always effective. Some creams and liquids had not been dated when opened. Staff were not following manufacturers guidance when applying pain relieving patches. Medicine audits carried out had not identified concerns found at inspection. The guidance provided in care plans did not always match with the care and support people required, or that care staff were providing. Records purported to demonstrate that care plans had been reviewed regularly, but we found that where people's needs had changed their care records had not been updated to reflect these changes. Risks in relation to people's daily lives were identified. Some risk assessments had indicated further risk management was required, such as fall risk assessments. Falls risk assessments were not part of the new care plan format. This meant the opportunity to reduce the risk of falls, whilst helping people to be as independent as possible, may have been missed. We took enforcement action against the provider due to the repeated nature of the concerns. The service was rated overall Requires Improvement at that time.

After the comprehensive inspection the registered provider wrote to us to say what they would do to meet the legal requirements in relation to the breaches. As a result, we undertook a focused inspection on the 29 January 2019 to check they had followed their plan and to confirm they now met legal requirements.

We checked on if the service was Safe and Responsive. This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Grove on our website at www.cqc.org.uk. The Grove has been rated overall Requires Improvement for a third time due to the repeated breach of the regulations found at this inspection. We will review The Grove again at our next scheduled comprehensive inspection.

The Grove is a care home which offers care and support for up to 38 predominantly older people. At the time of the inspection there were 34 people living at the service. Some of these people were living with dementia. The service occupies a detached house over three floors with a lift for access.

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had identified the minimum numbers of staff required to meet people’s needs and these were being met. The registered manager had added one additional member of staff to the day shift to allow for staff to have more time to meet people’s needs. One person told us, "Its a lot better now they got over a staff shortage."

Robust systems were now in place for the management and administration of medicines. The medicines audit template had been reviewed and the audits were now effectively identifying if any error occurred. Handwritten entries on medicine records were all signed by two people according to their policy. People who self-administered their medicines were regularly assessed and monitored. The storage of medicines in people’s rooms was now secure. Pain relieving patches were applied in accordance with manufacturers guidance and this helped reduce the risk of unnecessary side effects. Creams and liquids were dated when opened.

Falls and nutritional risk assessments h

The Grove is a care home which offers care and support for up to 38 predominantly older people. At the time of the inspection there were 34 people living at the service. Some of these people were living with dementia. The service occupies a detached house over three floors with passenger lifts to support access to upper floors.

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.

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 and associated Regulations about how the service is run. The service is required to have a registered manager and at the time of the inspection there was a registered manager in post.

This unannounced comprehensive inspection took place on 11 and 12 October 2018. The last inspection took place on 14 and 15 November 2017 when the service was not meeting the legal requirements. The service was rated as Requires Improvement at that time. There were concerns with the quality of the records held at The Grove. Staff did not always record the care provided and care plans did not always provide staff with the direction and guidance to meet people’s needs. There was no regular auditing of the records completed by staff relating to the care and support provided to some people. Information relating to the evacuation needs of people living at the service in the event of a fire was not up to date. Records held relating to the stock of medicines held at The Grove, that required stricter controls, were not accurate. There were no audits being carried out of medicine administration and management which would have identified the concerns found.

Following the November 2017 inspection the registered manager sent in an action plan to state what action they were taking to address the concerns identified. This inspection was carried out to assess what improvement had been made to address these issues at The Grove. However, we have again identified a number of similar failings at this inspection and the service has again been rated as Requires Improvement.

Improvements were identified at this inspection. The registered manager had taken action regarding the staffing levels at specific times of the day, the quality of the records completed by staff and the monitoring of pressure relieving mattresses to ensure they were always set correctly for the person using it. The Personal Emergency Evacuation Plans (PEEPS) had been reviewed for each person, staff had received regular supervision and training was up to date.

However, some concerns identified in November 2017 remained a concern at this inspection. Medicine audits commenced since the last inspection were not robust. People received their medicines as prescribed. However, the system for monitoring people who self administered their own medicines was not always effective. Some creams and liquids had not been dated when opened. Staff were not following manufacturers guidance when applying pain relieving patches.

Care plans were in the process of changing to a new format. They were well organised and contained information to direct and guide staff. However, the guidance provided did not always match with the care and support people required, or that care staff were providing. This was a repeated concern from the last inspection. Records purported to demonstrate that care plans had been reviewed regularly, but we found that where people's needs had changed their care records had not been updated to reflect these changes.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what peopl

This unannounced comprehensive inspection took place on the 14 and 15 November 2017. The last focused inspection took place on the 13 October 2015. The service was meeting the requirements of the regulations at that time.

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. The Grove is a care home which offers care and support for up to 38 predominantly older people. At the time of the inspection there were 31 people living at the service. Some of these people were living with dementia. The service is based in a detached house over three floors. There were two passenger lifts to support access to the upper floors.

The Grove was in the process of moving to a new electronic care plan system. All care plan information had been moved on to the electronic system at the time of this inspection. Staff and management had been provided with training in the use of this equipment. Paper based files were still in use during this transitional period. This was to ensure all information was available to staff. Some information on the electronic system was not yet entirely accurate and did not always give staff the correct direction and guidance needed to meet people’s needs. We reviewed the paper files in these instances. Staff did not always record the care provided accurately and appropriately.

The paper copies of care plans showed people, and where appropriate their relatives, signed to agree to the content of their care plans. The registered manager assured us that paper copies of care plans would continue to be provided for people to see and sign in agreement with the contents.

The hand held electronic devices for staff to input specific care provided, at the time it was delivered, into the electronic care planning system were not yet available due to a lack of wi-fi at the service. This was in the process of being addressed. Staff were recording the monitoring of people’s specific care needs on paper at the time of this inspection. For example, re-positioning and skin checks. These records were held in people’s bedrooms. There was no regular auditing of the records completed by staff relating to the care and support provided to some people. One person’s records contained regular gaps for up to six hours over the afternoon/early evening period for several days. There were inconsistent recording methods used by staff, which made it difficult to establish the current condition of a person. Staff were not always completing skin monitoring records correctly.

The information file available to the fire service containing the evacuation needs of people living at the service in the event of a fire was not up to date.

Whilst the administration and storage of medicines was safe, the records held relating to the stock of medicines held at The Grove, that required stricter controls, were not accurate. There were no audits being carried out of medicine administration and management which would have identified the concerns found at this inspection.

Risks in relation to people’s daily lives were identified, assessed and planned to minimise the risk of harm whilst helping people to be as independent as possible.

Staff were supported by a system of induction training, supervision and appraisals. The registered manager was in the process of creating a record to provide them with an overview of when staff required supervision and appraisals.

People were supported by staff who knew how to recognise abuse and how to respond to concerns. The service held appropriate policies to support staff with current guidance. Training was provided to all staff with regular updates provided. The registered manager had a record which provided them with an overview of staff training needs.

People were positive about the care and support they provided. They told us, “They (staff) are

When we carried out a comprehensive inspection of The Grove on 13 October 2015. A breach of the legal requirements was found. This was because the service did not have effective training made available to staff. This included, training which required regular updates. For example, Moving and Positioning, First Aid and Infection control as well as fire training. Where staff required the skills to identify and respond to mental capacity issues they had not always received the necessary training.

Members of the management team did not understand the most recent criteria in respect of assessing people who might be deprived of their liberty. Staff had not been provided with annual appraisals which provided an overview of performance and learning.

Following the comprehensive inspection the registered provider wrote to us to say what they would do to meet the legal requirements in relation to the breach. As a result we undertook a focused inspection on the 20 February 2017 to check they had followed their plan and to confirm they now met legal requirements.

This report only covers our findings in relation to the question ‘is the service effective?’ You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Grove on our website at www.cqc.org.uk

The Grove provides accommodation and personal care for up to 38 people. There were thirty three people using the service at the time of this inspection. The service is situated in its own extensive grounds, on the outskirts of Charlestown and close to the town of St Austell. The Grove is required to have a registered manager and there was one 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 had taken action to improve training. The registered manager had increased the access to training for all levels of staff working at the service. Updates had taken place for moving and positioning, first aid and infection control. In addition training had taken place for safeguarding, mental capacity act (MCA) and dementia care. A training matrix had been developed and this document allowed managers to monitor the when it was due for updating. The registered manager had taken steps to carry out annual appraisals for all staff. Records showed it looked at all areas of performance and future development.

The management team and staff understood the principles of the Mental Capacity Act and what their responsibilities were for assessment and referral where restrictions were necessary for a person’s safety and well-being. Staff had undertaken training in this area and could clearly understand what restrictions meant and how they would be referred.

At this focused inspection we found the registered provider had taken effective action to meet the requirements of the regulations and the breach had been met.

This unannounced comprehensive inspection took place on 13 October 2015.

The last inspection took place on 2 December 2013. The service was meeting the regulations at that time.

The Grove is a care home which offers care and support for up to 38 predominantly older people. At the time of the inspection there were 32 people living at the service. The service also provided support to people who stayed for short periods of respite.

The service had 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 registered manager was not present at this inspection. The deputy manager and the operations manager were present.

The service used a detached house which provided accommodation over two floors. We walked around the service, bedrooms were comfortable and personalised to reflect people’s individual tastes. People were treated with kindness, compassion and respect. People were relaxed and happy being supported by staff at The Grove.

We looked at how medicines were managed and administered. We found it was possible to establish if people had received their medicines as prescribed. Regular medicines audits were consistently identified if errors occurred.

The service had identified the minimum numbers of staff required to meet people’s needs and these were being met.

Staff were supported by a system of induction when they started to work for the service. Supervision was provided on a regular basis and staff found this supportive and helpful. The service was not carrying out annual appraisals. Staff were not always supported to access necessary training on a regular basis. More specialised training specific to the needs of people using the service was not always being provided.

Staff meetings were held regularly. These allowed staff to air any concerns or suggestions they had regarding the running of the service.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate and drank to help ensure they stayed healthy.

Care plans contained a large amount of information, much of which was historic and did not need to be held in the current care plan file. However, the care records were well organised and contained accurate and up to date information. Care planning was reviewed regularly and people’s changing needs recorded. Where appropriate, relatives were included in the reviews. There was evidence people were asked to sign in agreement with the contents of their care records.

Activities were provided both in and outside the service. The activity programme was varied and people were able to go out for coffee and visit garden centres. The Grove had their own vehicle which staff used to support people to access the local community and personal appointments. The service had links with the local community who regularly visited, such as a volunteer who bought their dog in weekly for people to enjoy.

The registered manager was supported by a deputy manager, operations manager and a stable staff team of motivated care and ancillary staff.

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

During our inspection we spoke with the staff, management and three people who lived at the home. We also walked around the home and were invited into people’s bedrooms. The staff we spoke with demonstrated a sound knowledge of the care needs of the people who lived at the home. Staff told us they “love” working at the home and it was “friendly”. People who lived at the home told us the care was “very good” and one person told us “I have no complaints”.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were protected from the risk of infection because appropriate guidance had been followed.

People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

We carried out a planned inspection of The Grove on 23 July 2012. During the course of our inspection we talked with seven people who lived at The Grove. We also spoke with the registered manager, the deputy manager, the operations manager, and four members of staff. Following the inspection we spoke to one relative.

We also obtained feedback from a nurse practitioner who had been recently working alongside the registered manager and staff to review their care planning documentation.

At the time of our inspection there were thirty three people living at The Grove. People told us “I love it here, they are very kind”, “they are very very good and certainly obliging”, “it’s very well run”, “I like it, it’s near the sea” and “it’s a wonderful place, I am very happy here”.

People also told us “the care is very very good”, “it’s clean and the food is reasonably good”, “it’s a lovely place” and “I don’t have to say, may I go, I just go!”.

Everyone who lived at The Grove told us that they were treated with dignity and respect and if they had a complaint to make, they would feel confident about complaining to staff, the registered manager, someone in the office or to their family.

Staff comments included, “X is a very good manager”, “the manager has made us all equals, the manager has encouraged that”,” I love it”, “if I had any concerns about the running of the establishment, I would report it right away”, “the manager says her door is always open”, “the support is always there”, “management are always available at the end of the phone”, “its rewarding because you see the difference you are making to peoples lives” and “it’s a lovely atmosphere to work in, I really do enjoy it”.

We spoke to a nurse practitioner, she told us that the home was "very transparent" and the staff were "incredibly keen to listen to advice".

During our inspection we looked at seven outcomes of the Health and Social Care Act 2008. We found that the provider was compliant in six areas and non compliant in one area inspected.

In the one area of non compliance, we found that people’s needs were assessed however, care and treatment was not always planned and delivered in line with their individual care plan.