Grove Hill Care Home

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

In this key question we assessed 5 quality statements. Leaders did not have effective governance systems in place, and audits had not identified the shortfalls found during this assessment. We identified a breach of the legal regulation in relation to good governance.

This service scored 39 (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 Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Most staff spoke positively about the leaders within the service. Staff described the manager as “Lovely, supportive and understanding”, and “has a way of accommodating everybody.” However, we received one piece of feedback by email which described the manager as not always being approachable, but there was no evidence this had been raised to the manager.

Although leaders had completed relevant training and qualifications, they did not always understand and follow national best practice guidelines or legislation and did not always understand how to meet the CQC regulations, such as submitting notifications to the Commission and following the Mental Capacity Act 2005. Leaders were also not always alert to and proactively addressing examples of a poor culture that affected the quality of people’s support, such as restrictive practices and care which compromised people’s dignity.

Staff felt there was a positive culture and that any concerns raised would be acted upon. One staff member told us: “We have a speak up culture, for instance a [person] made an allegation the other day, we checked the cameras. Anything the residents say is taken seriously and fully investigated.” Another staff member told us they received supervision regularly and were able to share new ideas.

There were not always processes in place for people to give feedback about their care on a regular basis or in a person-centred way. We were informed resident meetings had happened in the past but were not a regular occurrence. There was no evidence of the service exploring alternative options for people to give feedback who chose not to attend meetings. We requested the policy around supporting staff to speak up during our assessment, however this was not provided. We were told there was a suggestion box in place which had not been utilised by staff.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The manager told us about the various audits and checks which took place within the service, which included observations of staff practice.

Although audits took place, these were not always effective in identifying the shortfalls found during this assessment. For example, audits of care plans and risk assessments took place monthly, but we identified various care plans and risk assessments which contained incorrect or historical information which had not been identified in the service’s own audits. Additionally, the manager told us staff files were audited every 6 months but there were various gaps in staff employment history which had not been identified or addressed. Notifications were not always sent to CQC where appropriate, and the manager was not always knowledgeable about when these notifications were sent. For example, we were not notified of an incident which involved the police until we prompted the service to do so. Leaders’ quality assurance systems had not identified that staffing levels did not meet people’s needs at night. The service had not always followed their policies and procedures in relation to disciplinary processes, and leaders failed to identify, monitor and improve the culture within the service.

People did not always achieve good outcomes as the service was not always jointly working with external agencies in a timely or effective way. For example, one relative told us “[Person] has been weeks now without hearing aids. I said we might as well pay as they won’t take him to hospital. They have said [the manager] has now done a referral. Not being able to hear makes [person’s] Alzheimer’s worse. Another person had an epilepsy care plan which had not been supported by health professionals. This meant there was a risk that staff would not know how to respond in the event of a seizure, which put the person at risk of harm.

Leaders told us they worked with external health professionals, such as the district nurse team and the mental health team. A staff member told us “We all work with the mental health team, they are there to support us.”

The local authority safeguarding team told us, following a recent safeguarding incident, that “basic safeguarding principles weren’t applied, I didn’t feel [the manager] took it seriously what happened that night [the night of an incident where police were called].” They went on to tell us: “They are not efficient, far from it, it’s been so difficult to get everything together”. The fire service also provided us with some feedback after completing a fire service audit and finding the service’s risk assessment to be insufficient, telling us: “When challenged [the nominated individual] maintained his assertion that he was competent to assess the risks and have lead responsibility for fire safety. He felt confident to challenge some of our findings with his own rationale.” However, the mental health service we spoke with told us: “I think [the manager] and the care home have worked well with us as a team. They have asked for and followed guidance where appropriate. In my opinion, sometimes the team have done a little bit too much for [person], for example feeding [person], when she is able to do this herself. However, when I have pointed this out, they have responded quickly to feedback and adjusted their approach. I don't have any safeguarding concerns.”

The service had implemented guidelines from the mental health service around the support of one person living at the service. However, the service did not always work effectively with other external services to ensure people received safe and effective care. For example, at the time of our assessment, one person had an epilepsy protocol which contained limited information, was not personalised, and had not been written or reviewed by a healthcare professional at the time of our site visit, however, the provider did address this. The local authority safeguarding team told us leaders were not proactive in sending information to the team.

Staff told us all concerns were listened to and there was an open-door policy in relation to learning and identifying improvement. One staff member told us “We can speak to the manager about anything.” However, another staff member told us they felt leaders were not approachable. The manager told us they learned from audits as there are actions following audits, however we found these were not always effective as these had not identified the concerns found during our assessment of the service.

The manager encouraged reflection following some incidents in some meetings, however, some concerns such as restrictive practices had not been identified and therefore learning and improvement did not always take place. There was not always recorded evidence in team meetings or staff supervision records of leaders encouraging staff to speak up with ideas for innovation or improvement. Additionally, leaders failed to recognise the concerns we identified relating to the culture of the service, therefore this could not be monitored or improved.