Archived: Little Oldway

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.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found. The summary is based on our observations during the inspection, speaking with three people using the service, six staff supporting them, speaking with a visiting healthcare professional, and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. During our inspection we spent 35 minutes observing people in the dining room. We noted the interactions were good and showed staff respected people at the home. People told us they felt safe at the home. Safeguarding procedures were robust and staff understood how to safeguard the people they supported. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager told us they had not needed to submit any applications. Proper policies and procedures were in place and the manager had liaised with the local DoLS team. The manager and senior staff had been trained to understand when an application should be made, and how to submit one. Recruitment practice was safe and thorough. Staff recruitment files showed us that the service had undertaken appropriate checks. Equipment such as hoists, lifts, fire alarm systems, and heating systems were well maintained and serviced regularly therefore not putting people at unnecessary risk.

Is the service effective?

People who lived in the home told us they were happy with the care they received. Comments included 'It's lovely' and 'they look after me'. We spoke with staff who were able to tell us how they met people's care needs. We observed the care provided and spoke with the people who lived in the home. This gave us evidence that staff knew people well. People's health and care needs were assessed. Where people were not able to make certain choices and decisions we found evidence that relatives and representatives had been involved in the care planning process. Regular care plan reviews were carried out to ensure they reflected people's current needs.

Is the service caring?

People were supported by kind and attentive staff. We observed that staff were patient and went at the person's pace when assisting them with their mobility, food, and medication. We spoke with a visiting healthcare professional who gave us a recent example of one person's care at the home and described this as 'brilliant'.

Is the service responsive?

People's needs had been assessed before they moved into the home. The manager visited people and carried out an assessment to ensure the service was able to meet their needs. The service employed an activities person and people had access to activities that were important to them. We saw the complaints procedure was available on the noticeboard in the corridor. Several people told us they felt able to speak to the manager or staff if they were unhappy about something. They felt confident that the service would deal with any matters to their satisfaction.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. We spoke with a visiting healthcare professional who told us the manager and staff at the home contacted them if they had concerns and followed their advice and instructions.

Staff told us they were clear about their roles and responsibilities. Staff told us they had regular meetings with the manager. Staff commented 'the manager is very supportive, they listen to us' and 'you can approach the manager with any problems, and they sort it'. This helped to ensure that people received a good quality service at all times.

We found that improvements had been made. We saw the home had improved the systems for assessing and reducing risks to people who lived in, worked at or visited the home. We saw people were being asked their views about the services and comments made were being acted upon.

The home had employed a consultant and had taken advice from health and social care professionals on ways to improve the services provided. We saw these had been implemented, and included changes to the care plans, and provision of a more dementia friendly environment and garden.

We saw the home had undertaken assessments of their strengths and weaknesses and had plans in place to improve further. For example we saw that staff were undertaking a specialist course over the next six months in the care of people with dementia.

We found that the warning notice had been complied with.

We found that improvements had been made to the ways in which people were involved in their care and the care planning. We found the home had changed the care plans to better reflect the needs of people with dementia living there. We saw that people were receiving appropriate physical care from staff at the home and community services. A relative told us "I feel my relative gets the support they need, definitely. We have confidence that (the care manager) keeps on top of things. We can talk to her if we need anything."

We saw that the provider had taken steps following the last inspection to improve the cleanliness and infection control at the home. They had also undertaken work to improve the safety of the environment by fitting new windows, protecting older windows and increasing the adaptations to support people with dementia.

We saw people enjoying an activity session, and we observed care being delivered, which was supportive and in line with the care records. People we spoke with told us they were happy with the services and care the home provided.

However, we found that the registered person still did not have an effective system in place to assess and monitor the quality of the services or manage risks to the health, welfare and safety of people living at the home. This was outstanding from the previous inspection.

People living at the home and their relatives told us the staff were kind and met their needs. They said 'The staff here are the best they've had yet', ' The staff are lovely...it's lovely to be here'they all work together as a team' and 'The care of people is generally very good'.

However on the inspection we identified concerns with the way people were enabled to make choices in relation to their care, care assessments, and care planning and delivery, particularly in relation to the needs of people with dementia. We found that the premises were not well adapted to meet the needs of people with dementia and that activities were not tailored to meet and engage individual's interests.

We also identified concerns in relation to infection control, risk assessments, the safety of the premises, and the way in which the provider assessed the quality of the services provided. We found that the home had not made improvements following the last inspection for all the areas identified at that time. However we were told that improvements were being planned for the accommodation.

We found that staff were being well trained and supported to do their job. Staff told us they enjoyed working at the home and worked well as a team.