This inspection was carried out over three days on the 5, 6 and 8 December 2016. Our visit on 5 December 2016 was unannounced.At the last inspection on 11 March 2015 we rated the service as requires improvement. At that inspection we identified three regulatory breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014, which related to medication administration, staff training and good governance.
This inspection was to check improvements had been made and to review the ratings.
Grove Lodge Care Home is registered to provide accommodation for 19 adults who require help with personal care and support with their daily lives. At the time of our inspection there were 19 people living at the home.
The home is located on the outskirts of Stockport and is close to local amenities and services.
There are eleven single occupancy rooms, three with en-suite facilities and four bedrooms with shared occupancy. The three bedrooms on the first floor of the home cannot be accessed by people with limited mobility because a passenger lift was not available.
The home had a manager registered with the Care Quality Commission (CQC), who was present throughout the three days of inspection. A registered manager is a person who has registered with CQC 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.
During this inspection, we found improvements had been made and we observed staff giving positive and caring support to people. However, we also identified some areas where improvements were still required. The registered manager and the deputy manager were responsive to our feedback and had started to take actions to make some of the required changes during our inspection.
During this inspection, we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
We found that people living on the ground floor only had access to one domestic bath, which we were told was only used by one person and one shower on the ground floor for up to 16 people. In addition we were told that at peak times of water usage for example in the morning, the water in the shower and the sinks in people’s bedrooms could run cold. However two new boilers were to be fitted the first week in January 2017 which would resolve the issues.
From looking at the training record and speaking with staff, we found improvements had been made to ensure staff received further training to carry out their role more effectively. However, we found there were still some gaps in staff training. For example, although the service user guide stated they provided care for people with past or present mental health problems such as schizophrenia, bi-polar, depression, anxiety and dementia we saw that staff had not received training in some of these mental health conditions.
We saw that medicines were managed safely and staff had received the appropriate medicines awareness training and competency assessment before they were allowed to administer medication.
Staff spoken with understood the need to obtain verbal consent from people using the service before a care task was undertaken and staff were seen to obtain consent prior to providing care or support.
The audit systems developed required implementation to fully assess and monitor the quality of the service provision and promote service improvement.
People were supported by a caring staff team and staff, with the exception of one staff member, and relatives of people living at Grove Lodge told us they thought there were sufficient staff to safely meet people’s needs. However, we found there was not a systematic approach to determine the number of staff and range of skills required to meet the needs of the people who used the service. This meant the registered provider could not be sure that the staffing levels and skill mix of staff were sufficient to meet the assessed needs of people living at Grove Lodge Care Home. We made a recommendation that they implement the use of a staffing tool. A staffing tool recommends appropriate staffing levels based on people’s health needs and dependency.
People received person-centred care and we saw privacy and dignity was respected. However from the care records we examined we saw that some parts of the plans of care were vague and did not include details of exactly what assistance the person required to meet their assessed care need. Due to this we recommended that the service considers reviewing people’s plans of care to ensure where possible they are developed in partnership with the service user and are designed to meet the specific individual needs and personal preferences of the person living at Grove Lodge Care Home.
Whilst there were no formal checks of cleanliness or internal infection control audits in place, we saw that the home was clean and well maintained and we saw staff had access to personal protective equipment (PPE) to help reduce the risk of cross infection.
We saw appropriate safety checks were undertaken. For example portable appliance testing, emergency lighting, fire safety cheeks had all been undertaken.
We saw people had a personal emergency evacuation plan (PEEP’s) in place. These plans detailed the level of support the person would require in an emergency situation in order to safety evacuate the home.
Environmental risk assessments had not been undertaken and there was no clear system for documenting maintenance work required and evidenced that the work had been undertaken. A system to record maintenance requests and evidence once the work had been completed was implemented during the course of the inspection.
The service had good recruitment processes to ensure only suitable staff were employed to work with vulnerable people.
Since the last inspection staff supervision sessions had been implemented to enable them to carry out the duties they are employed to perform. The registered manager told us it was now their intention to implement an appraisal for all staff early in the New Year.
Staff understood how to recognise and report abuse which helped make sure people were protected.
People had access to healthcare services and we saw specialist advice was sought in a timely manner. For example from the speech and language therapist, district nurse, dentist, optician and chiropodist and people were supported to attend hospital appointments as required.
Attention was paid to people’s nutrition and hydration needs; however we received mixed reviews from people who used the service in relation to the food provided.
The visitors we spoke with told us they were happy with the care their relatives received at Grove Lodge care Home.
From our observations of staff interactions and conversations with people, we saw staff had good relationships with the people they were caring for. The atmosphere felt relaxed and homely.
There was a complaints notice on the back of people’s bedroom doors and in the service user guide, which people were given on admission to the home. There was a clear recording system for complaints and concerns raised and any action taken.