Archived: Little Oldway

Updated 1 September 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 26 and 27 July 2016. The first day was unannounced.

One Adult Social Care inspector carried out the inspection.

Before the inspection we gathered and reviewed information we hold about the registered provider. This included information from previous inspections and notifications (about events and incidents in the home) sent to us by the provider.

Not everyone living at Little Oldway was able to tell us about their experiences. Therefore we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us.

During the inspection we met or spoke with all 30 people using the service. We spoke with 7 care and ancillary staff, the registered manager, care manager and provider. We also spoke with one health care professional and three visitors. Following the inspection we received emails from two social care professionals and the local authority’s quality support team.

We looked at a number of records including four people’s care records, the provider’s quality assurance system, accident and incident reports, three staff files, records relating to medicine administration, complaints and staffing rotas.

Updated 1 September 2016

This inspection took place on 26 and 27 July and the first day was unannounced. The service was last inspected on 7 April 2014 when it met the requirements that were inspected.

Little Oldway is registered to provide accommodation and personal care for up to 35 older people. Many of the people living at the home were living with dementia. The home is not able to deliver nursing care. This is provided by the district nursing service if required. On the day of inspection there were 30 people living at the service

A registered manager was employed at the service. They were also registered to manage another care service owned by the same provider and situated nearby. They were supported in their role at Little Oldway by a care manager, who was in day to day control of the service. 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 were sufficient staff on duty to meet people’s care needs. During the inspection we saw people’s needs being met in a timely way and call bells were answered quickly.

People received individualised personal care and support delivered in the way they wished and as identified in their care plans. People’s care plans contained all the information staff needed to be able to care for the person in the manner they wished. Care plans were reviewed regularly and updated as people’s needs and wishes changed.

Staff confirmed they received sufficient training to ensure they provided people with effective care and support. There was a comprehensive staff training programme in place and a system that indicated when updates were needed. Training included caring for people living with dementia, first aid and moving and transferring.

Not everyone living at Little Oldway was able to tell us about their experiences. Therefore we spent some time in the main lounge and used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us. We saw good interactions between staff and people living at the service. However, we also saw missed opportunities for staff to interact with people. A number of staff walked through the dining room on several occasions without speaking with people at all. Small interactions when staff walk around the service could encourage conversations and help keep people occupied.

People’s privacy and dignity was respected and all personal care was provided in private. People’s needs were met by kind and caring staff. People told us “All staff are wonderful, can’t name one better than the other”. Visitors told us “Overwhelming feeling (at Little Oldway) is the kindness and caring”. Following the inspection we received an email from a visiting professional. They wrote ‘I have always been very impressed by the care provision. [Care manager] puts her heart and soul into the care that is provided and is very conscious that her staff do the same’.

Risks to people’s health and welfare were well managed. Risks in relation to nutrition, falls, pressure area care and moving and transferring were assessed and plans put in place to minimise the risks. For example, pressure relieving equipment was used when needed. People’s medicines were stored and managed safely. However, handwritten entries to Medicine Administration Record (MAR) charts were not checked to ensure what was prescribed was what was written on the MAR charts. People were supported to maintain a healthy balanced diet and people told us there was a good choice of food. People were supported to maintain good health and had received regular visits from healthcare professionals.

People and their relatives were supported to be involved in planning and reviewing their care. At each care plan review people and their relatives were asked for their views. Relatives told us that they could visit at any time and were always made welcome. They also said that staff always kept them informed of any changes in their relative’s welfare.

Staff knew how to protect people from the risks of abuse. They had received training and knew who to contact if they had any suspicions people were at risk of abuse. Robust recruitment procedures were in place. These helped minimise the risks of employing anyone who was unsuitable to work with vulnerable people.

People’s human rights were upheld because staff displayed a good understanding of the principles of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). However, some forms relating to the MCA needed to be completed more fully in order to meet the guidelines set out in the Mental Capacity Act Code of Practice. Improvements were also needed to the way best interest decisions were made.

Some improvements had been made to the environment to make it more suitable for people living with dementia. Each person’s bedroom door was personalised with their name and a photograph of them. There were regular activities available for people to participate in. These included singing, bingo quizzes and outside entertainers.

The care manager was very open and approachable and staff spoke positively about them. People were confident that if they raised concerns they would be dealt with. One staff member told us the care manager was “willing to try anything and discuss anything”. One visiting professional wrote following the inspection ‘[Care manager] has taken many clients of mine and some have been incredibly challenging but she has always persevered. I particularly like the way that the families are always included in the care planning and consulted’.

There were effective quality assurance systems in place to monitor care and plan on-going improvements. Monthly audits were undertaken including medicines, care plans and accidents and incidents. We saw that where issues had been identified action was taken to rectify the matters. For example, flooring was being replaced where it had become a trip hazard. Records were well maintained.

We have made recommendations in relation to updating knowledge of the MCA and making improvements to the environment.