Grove Hill Care Home

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

In this key question we looked at 5 quality statements. Safeguarding incidents were not always managed appropriately, and people did not always have clear and effective risk management plans in place. The environment was not always safe. Staffing levels did not support the delivery of safe and effective care. We identified breaches of regulation relating to safeguarding people from abuse and safe care and treatment.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

One person told us they did not feel safe living at the service due to other people going into their room at night. One relative told us they had witnessed physical restraint by a member of staff. However, other people and relatives we spoke with did not have any safeguarding concerns and that they felt safe within the service.

Staff were able to tell us about different types of abuse and could explain the procedure for raising safeguarding concerns. However, staff and leaders did not demonstrate a good understanding of the legislative requirements for using restrictive practices which put people at risk of abuse.

We observed incidents through the service’s closed-circuit television (CCTV) footage which demonstrated inappropriate and unsafe use of restrictive practice. For example, we saw one staff member physically preventing a person from standing up, and another incident where a staff member had used incorrect moving and handling techniques to assist a person to stand. However, we did not observe any safeguarding concerns during our onsite visits.

Systems were not always effective in managing safeguarding incidents and did not follow current legislation. Systems had not identified themes in omissions of care or practices by staff that were potential abuse. For example, there had been various incidents which involved unlawful restrictive practices, and these had not been identified by the service, so these continued to happen. Additionally, staff had not received any training in restrictive practices.

One relative told us they had concerns about poor care records and the transfer of information to external health professionals to enable them to meet people’s needs. They told us; “I spoke to the paramedics who arrived to tend to my [relative] and they informed me that there was practically nothing written in her Care Folder. This is unacceptable!” However, other relatives we spoke with did not have any concerns about how risks to their relatives’ safety and wellbeing were managed and felt their relative had appropriate equipment to help them reduce risks.

Staff felt people’s risks were well managed however staff and leaders were not always consistently aware of people’s risks. For example, one staff member told us they had recently removed a light from a person's room, as the light appeared to increase seizure activity, however the manager was not aware of this and it was unclear how this decision was made.

In response to our requests for assurance about how the service was managing risks related to epilepsy, during our second onsite visit, we noted the service had implemented the use of a camera monitor for a person with epilepsy. However, during our follow up site visits, we noted this camera was frequently left unattended or was located in communal areas without effective monitoring in place and without regards to this person’s privacy.

People did not always have clear, accurate or up to date risk assessments in place. For example, one person’s level of staffing support had changed, and risk assessments had not been updated to reflect this. Another person had a history of seizures and was being cared for in bed. This person did not have a clear or personalised risk assessment in place for epilepsy and leaders and staff were not consistently aware of this person’s seizure presentation. We raised this with leaders who updated the person’s risk assessment and arranged an appointment with an epilepsy specialist.

One relative told us: “My [relative] has been requesting now for over 6 weeks for her bedside table to be replaced as it is broken and dangerous. I was there 2 weeks ago, and the broken bedside table was still there.” The relative went on to tell us: “When we have asked them to repair the bedside table, they said they would have to put [relative] upstairs and “we don’t go up there as frequently”, which was a bit intimidating.” However, other relatives we spoke with felt the environment was safe and had no concerns.

The manager told us they did not feel it would be fair to the person to remove a lamp with a cable from their room, despite them being at risk of self-harm and suicide by ligature, but they had not considered any safer alternatives for this person. Staff told us they had recently received additional training regarding fire evacuations, and that they felt confident in following fire evacuation procedures.

During one site visit we observed unsecured chemicals in a communal bathroom, which was not in line with legislation and posed a risk to people living at the service. We raised this with the provider, and we observed no additional concerns relating to the storage of chemicals during our follow-up site visits. We observed ligature points in the room of a person at risk of self-harm and suicide by ligature which had not been considered, such as a lamp cable. However, other people in the service had equipment in place to support their independence and safety.

We saw evidence to demonstrate equipment was checked regularly, and various health and safety checks were in place. Fire checks were in place including a fire risk assessment; however, we received information from the fire & rescue service regarding their own assessment of the service and the provider had a number of actions to undertake including having a fire risk assessment completed by a competent person which they were working through. The provider's own fire safety checks had not identified the issues raised by the fire service.

One person told us activities did not happen regularly and said they were not able to go out as much as they would like. We received mixed feedback from relatives about staffing levels. Some relatives told us they felt staffing levels met people’s needs. One relative told us: “I think the staffing levels are good. My [relative] never lacks for attention.” However, another relative told us: “Over the last 6 months it has changed. There is no consistency of staff in attendance when we visit.” Another relative told us “[Staffing levels] could be better managed. When I visit in the morning [staff] are doing the medicine round. If someone requires assistance the medicine dispatcher has to stop and assist with the physical caring. Saying that though when I visited today there was plenty of staff around.”

One staff member felt staffing levels were ‘inadequate’. Staff told us “Staffing levels could be improved, particularly during the day shift. At this moment of time, 4 health care assistants are allocated. One [staff member] doing the medication, 1 supporting the person in-charge, and the other 2 are left to assist and help residents, make beds and other required tasks that are left to do.” Another staff member told us; “I feel the workload is too much for 2 people on the floor at times.” Leaders told us they worked out safe staffing levels using a dependency tool, which was completed monthly and changed accordingly dependant on people’s needs. Leaders went on to tell us they had “Put in extra staff on weekend mornings and were trialling this, as some staff felt they didn’t have the support on a weekend morning.”

We observed that people did not always receive their funded 1-1 hours. During a site visit we observed the 1:1 allocated staff member of a person at risk of self-harm and suicide leaving the person without support for a fifty-minute period, including leaving the room to support other people. We observed staff were not always present to respond to people’s needs or requests. For example, we observed one person asking when they can have a shower repeatedly, but no staff were present to respond to this person.

There was not an effective process in place to calculate the number of staff required to meet people’s needs. Although the provider used a staffing dependency tool they had failed to recognise the individual needs people living at the service had at night, which meant staffing levels were not always appropriate. Staff recruitment processes had not always been carried out safely, for example, we found some staff had gaps in their employment history which had not been explored by leaders. This increased the risk of unsafe recruitment.

People told us they felt the service was clean.

Staff told us they completed infection control training. The manager told us infection control audits took place monthly.

During our first onsite visit we observed a pile of dirty laundry in a communal bathroom sink which was not in a water-soluble bag, as their policy stated should be. We observed one light switch which was not able to be cleaned effectively due to it being a string pull-cord, we raised this with the manager who told us they would replace this. There was a strong smell of urine in one person’s bedroom, however we were told by leaders there were plans for this to be replaced imminently with new flooring. However, other areas of the service were observed to be clean and odour-free.

Infection prevention and control audits took place monthly, although these had not identified the concerns found during this assessment, such as by identifying equipment which could not be cleaned effectively. However, infection control practices within food safety were managed well.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.