Owlett Hall

Owlett Hall is a residential care home providing personal care and accommodation to up 56 people over 3 units. The service provides support to older people and people with dementia. At the time of our

inspection there were 46 people using the service.

People’s experience of using this service and what we found

Risks to people had been appropriately managed and these were regularly reviewed when the level of risk changed. Accident and incident records were completed and monitored to reduce the likelihood of reoccurrence. The provider had appropriate safeguarding systems in place. People received their medicines safely and as prescribed.

People's care records reflected choices and decisions they made around their care. Staff knew people’s needs well. Staff knew how to promote people’s independence. Relatives felt staff engaged well with their loved ones. People’s dignity and privacy was respected. People’s care was regularly reviewed.

People's communication needs had been assessed and information was included in care plans. Relatives were positive about the activities people were doing at the service. The service offered a varied choice of activities.

The provider had a clear complaints procedure in place. People and relatives said they could raise concerns with the unit manager or the registered manager. We observed positive interactions with staff and people during our inspection. Effective quality assurance processes had been implemented and as these were being completed, actions were identified and addressed in a timely manner. Relatives and staff spoke positively about the registered manager.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 16 November 2022) and there were breaches of regulations. The provider completed an action plan after the last inspection to show what they would do, and by when, to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Owlett Hall on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Owlett Hall is a care home that can accommodate up to 57 people who require support with nursing or personal care needs, some of whom are living with dementia. At the time of our first visit, 44 people were living at the service. On our second visit, there were 46 people living at the home.

People’s experience of using this service and what we found

People and relatives shared mixed feedback about the quality of the care provided. During this inspection, we were not assured the service provided was always safe and we found widespread shortfalls in the way the service was managed.

The provider failed to implement processes to effectively monitor the quality of the service and to identify the issues found during our inspection. There was a lack of sustained improvement. During this inspection, we continued to identify some of the same issues found at the previous inspections, and we found new concerns in relation to safety of people. Records were not always complete or contemporaneous.

During our first inspection visit, we found people did not always have their call bell in reach to call staff, if required. We found concerns in relation to fire safety and environmental risks were identified. The recording and management of some risks associated to people’s care needed improvement. Equipment to manage skin integrity concerns was not always set at the correct setting and records did not always evidence people were receiving regular checks or supported with thickened drinks safely.

Most areas of medicine management had improved since our last inspection, however, during this inspection, we found medication and thickeners were not always stored safely. This was actioned immediately by the management.

We received mixed feedback about staff’s approach and their responsiveness to people’s needs. We made a recommendation for the provider to review this area. Records showed some activities were happening at the home, however, these were not frequent, particularly for people who were nursed in bed. We made a recommendation for the provider to review and implement good practice in relation to activities.

Staff had been trained to meet the needs of people. Staff told us they felt well supported by the registered manager and records of supervisions confirmed this.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The registered manager collaborated with this inspection, was receptive to the inspection findings and acted on the issues found or told us the action they would take to address the issues identified.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was required improvement (published 19 January 2022)

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of medication and risks to people’s care. This inspection examined those risks.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Owlett Hall is a purposed built nursing home providing personal and nursing care for up to 57 people aged 65 and over. Accommodation is provided across three floors, a residential floor, a general nursing floor and a nursing dementia floor. The service also provides ‘discharge to assess’ beds, which aim to free up hospital beds, by providing a place where people can be discharged to whilst their longer term care needs are determined, and a package of care put in place. At the time of inspection 49 people were living at the home.

People’s experience of using this service and what we found

We found improvements were required with the management of medicines, along with contemporaneous record keeping and the audit and governance process. People’s medicines were not always managed safely. The provider’s audit and governance process had not identified all the issues we found during inspection, for example with medicines. Action taken where issues had been identified through auditing was not always clear and improvements made had not always been sustained.

People told us they felt safe living at Owlett Hall. Risk assessments and care plans provided staff with information to enable them to care for people in line with their wishes and keep them safe. Staff knew how to identify and report safeguarding concerns, with training provided and refreshed. Accidents and incidents had been documented and reviewed to identify trends and help prevent reoccurrence. Enough staff were deployed to keep people safe, although a high use of agency staff had been needed due to staff shortage and absences linked with the COVID-19 pandemic. The necessary employment checks had been completed, to ensure staff were suitable to work with vulnerable people.

People, relative and staff’s views were captured via meetings and questionnaires, with newsletters sent out to relatives each month to keep them informed on what was happening within the home. People, relatives and staff spoke positively about how the home was managed. Staff told us they enjoyed working at the home and felt supported in their roles.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 28 June 2021). The service has been rated requires improvement or inadequate at the last five inspections.

Why we inspected

We carried out a focused inspection of this service in May 2021 when breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do to improve safety and governance within the service.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. The report only covers our findings in relation to the key questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Owlett Hall on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified breaches in relation to the management of medicines, contemporaneous record keeping and the audit and governance process at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Owlett Hall is a nursing home providing personal and nursing care to 49 people aged 65 and over at the time of the inspection. The service can support up to 57 people. Accommodation is provided across three floors, a residential floor, a general nursing floor and a nursing dementia floor. The service also provides ‘Discharge to assess beds’ a scheme whereby people are discharged from hospital, often at short notice into this setting to await further assessment of their care needs. This aims to free up hospital beds within the acute sector.

People’s experience of using this service and what we found

Overall people and relatives provided positive feedback about the home and management. However, staff were not always effectively deployed on the Oak unit. The Oak unit provides nursing care for people living with dementia. This meant people’s care needs were not always met in a timely way. There was also a lack of organisation and leadership on the unit. These issues were a barrier to the service providing good quality dementia care. We found better organisation and care on the other units. Safe recruitment procedures were in place.

Arrangements were in place for relatives to visit the home, supported by appropriate risk management measures. However, some improvements were needed to infection control practices. We noted appropriate precautions were not always taken when people were isolating. Some areas of the home needed to be cleaner.

Overall risks to people’s health and safety were assessed and managed and people told us they felt safe in the home. Equipment and the premises were appropriately maintained. Appropriate action was taken to investigate safeguarding issues and incidents. We saw evidence of learning from incidents and adverse events. Overall, medicines were managed safely.

Staff morale was variable, and a number of staff said they felt people were not receiving high quality care as there were not enough staff or the service was not appropriately organised. Systems to assess, monitor and improve the service were not sufficiently robust as the service continued to be in breach of regulation. Whilst this was the case, a number of the issues we identified were known to the registered manager and a plan was in place to address them. Plans were in place to improve governance and leadership particularly on the Oak unit where the majority of issues were identified. We saw recent improvements had been made to the service including enhanced monitoring of nursing clinical skills and upskilling them in areas where there had previously been concerns about the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 4 February 2020). The service remains rated requires improvement. This service has been rated requires improvement or inadequate for the last five consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 19 November 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safety and governance within the service.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. We had also received some concerns about staffing levels and staff morale. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements and cover the concerns we had received prior to the inspection.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained as requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Owlett Hall on our website at www.cqc.org.uk.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to staffing deployment, infection control and good governance at this inspection. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Owlett Hall is a ‘care home’ providing personal and nursing care to 40 people aged 65 and over at the time of the inspection. The service can support up to 57 people. Owlett Hall accommodates people across three floors, each of which has separate adapted facilities. One floor provides residential care, another floor provides care for people living with dementia and the third floor provides nursing care.

People's experience of using the service

Medicines were not managed safely, and the provider continued to be in breach of Regulation 12. Risk assessments were detailed and provided clear guidance for staff to minimise risks. The provider identified trends and themes relating to risk and actions were taken to prevent accidents and incidents. Lessons were learnt from incidents and discussed in meetings with staff. Staffing levels were sufficient and people said there were enough staff to meet their needs. The provider had recruited new staff and embedded new ways of working to promote a positive culture within the home.

People's needs were assessed prior to their admission to the home. The provider had made improvements to the environment since our last inspection. For example, access to outdoor space had been much improved. People were supported with their nutritional needs and care plans were in place for people with specific needs. Some people’s fluid and food intake were monitored to ensure weights remained stable. One person had been supported to lose weight in preparation for surgery. The home proactively engaged with health professionals when needed and actions were taken to address people’s health conditions.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were well cared for by staff and provided positive feedback. One person said, “People are so friendly. I love it here, they are all so nice and we have a laugh.” We observed positive engagement between staff and people living in the home. People were involved in making decisions about their care and we found people’s dignity was well maintained. Staff treated people kindly and respected their wishes.

Care plans were person centred and included specific guidance for staff to meet people’s individualised needs. People were supported with end of life care and made to feel comfortable during this time. Care records were easily accessible to staff as they carried hand held tablets or phones to access the electronic records and input their daily care tasks. People remained in contact with their family and activities were available to prevent isolation. Complaints were responded to in a timely manner and actions taken to address concerns raised.

The provider had not made enough improvement in recording information, as records were not always up to date or accurate. The provider continued to be in breach of regulation 17, however improvements had been made following the last inspection. Relatives told us improvements the new manager had implemented including the recruitment of new staff to reduce agency use. New electronic care plans had been imbedded and included personalised details to support people with their care. Flash meetings had been introduced to ensure effective communication between staff. Quality assurance systems were in place to monitor the service and ensure risks were managed. Audits were carried out and where these had identified improvements were required, appropriate action had been taken. People and their relatives felt the home was well managed and that they were listened to. The manager continuously engaged with people, relatives and staff to seek feedback and improve care within the home.

We found two continued breaches. Medicines were not always managed safely in line with best practice and records were not always up to date or accurate.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Inadequate (published 6 June 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made to address most of the breaches from the last inspection.

This service has been in Special Measures since June 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Why we inspected: This inspection was prompted by concerns we received. At the time of the inspection we were aware of incidents being investigated by the local safeguarding team.

People’s experience of using this service: People were not always safe and did not receive support when they needed it. There were not enough staff to meet people's needs. Staff were not able to respond to people’s call bells promptly. Risks to individuals were not assessed and appropriately managed which placed people at risk of harm. Some people did not receive their medicines as prescribed. Lessons were not learned when things went wrong. Systems in place to ensure safeguarding incidents were reported appropriately were not robust.

People’s nutritional needs were not always met and the dining experience was not positive for people. Staff contacted health professionals when required, however this was not always timely. Staff did not always receive an induction, or complete appropriate training to ensure they had the skills they required for their roles. Staff did not consistently receive supervision and appraisal of their performance. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Some caring and kind interactions were observed during the inspection. However, some people told us they did not feel comfortable with staff. People had care plans regarding their support needs. These care plans lacked important information and were not always kept up to date when changes occurred. There was limited guidance for staff on how to deliver care in a person-centred way. The provider had a procedure for investigating complaints, but this was not always followed in practice.

The service was not well-led. The governance of the service was poor and the provider's quality management systems were not effective. They had not identified areas where the service needed to improve.

After the inspection, we requested an urgent action plan from the provider to tell us how they would address the concerns we found. They responded with a plan which gave timescales for the completion of work to improve the service.

We identified seven breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 and one breach of Regulation 18 of the CQC (Registration) regulations 2009.

Details of the action we have asked the provider to take can be found at the end of this report.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: At the last inspection the service was rated Requires Improvement (report published 15 January 2019).

Enforcement: Please see the 'Action we have told the provider to take' section at the back of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up: We will continue to monitor the service closely and discuss ongoing concerns with the local authority, clinical commissioning group and safeguarding team.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, it will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We carried out an unannounced comprehensive inspection of this service on 6 June 2018. After that inspection we received concerns in relation to the safety of people living in the home and concerns about the leadership of the service. As a result, we undertook a focused inspection looking at safe and well led to look into those concerns. This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Owlett Hall on our website at www.cqc.org.uk.

Owlett Hall is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Owlett Hall is registered to provide accommodation for up to 50 people who require nursing or personal care. The home is on three levels with lift access and has a garden area and car parking to the front of the building. At the time of this inspection, 46 people were using the service and all were receiving nursing care.

The service had a registered manager in post. 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.

We found shortfalls in the recording relating to medicines. Poor documentation meant we were unable to determine if all medicines had been given. We also found some medicines which had not been stored and monitored correctly but this was addressed promptly by the manager.

We found a lack of completed and accurate records to show when care had been given. Medicines administration records were not always completed, nutritional charts to document people’s food intake had not always been recorded and some audits were not effective in identifying issues. This meant some issues had not been identified through the monitoring systems within the service so that they could be addressed to prevent re occurrence.

Staffing levels were sufficient. However, improvements were required to ensure the deployment of staff around the home was effective so people's needs could be met at all times. We have made a recommendation about the deployment of staff.

People told us they felt safe living at Owlett Hall. Staff were aware of how to keep people safe from possible harm or abuse. Safeguarding concerns had been investigated and actions taken to prevent future risks.

Most risk assessments were carried out and regularly updated to reflect people’s needs. However, we found one risk assessment which had not been followed. The registered manager had ensured the person’s needs were being met during the inspection. Accidents and incidents were managed effectively and actions taken to prevent future risk.

The home was clean, spacious and suitable for the people who used the service. Health and safety checks were carried out on the premises to ensure people’s safety.

Following the last inspection, the manager had implemented changes to drive improvement within the home. This included training some senior staff to become unit managers to develop their leadership skills and to provider further oversight for each unit.

Annual surveys were carried out to gather people’s views. We also found surveys had been sent to people, relatives and staff when concerns were raised. The regional manager said this was to ensure any concerns were resolved.

People, relatives, staff and health professionals all told us the registered manager was approachable and they felt confident to raise any concerns.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, namely Regulation 17 (Good governance). You can see what action we told the provider to take at the back of the full version of this report.

Owlett Hall is purpose built and provides both residential and nursing care for a maximum number of 57 older people. The home is set over three floors, and each room has an ensuite shower room. It has car parking and outside space for people to use. The home has lifts to every floor and is fully accessible. On the first day of our inspection, there were 41 people using the service. On the second day there were 43 people.

Owlett Hall is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

There was a registered manager in post. 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.

We received mixed views from people who used the service, relatives and staff about staffing levels and how staff were organised. Some said staff were available in sufficient numbers to meet people's needs and to keep them safe whilst others said they did not always feel there were enough staff and this led to people waiting for their care needs to be met. The registered manager said they would review the deployment and organisation of staff to ensure there were sufficient staff at the times they were needed.

People told us they felt safe. Staff understood how to keep people safe and told us any potential risks were identified and managed. Risk assessments contained enough detail to enable staff to keep people safe from harm. Risk assessments were reviewed regularly, and any changes were incorporated into people's care plans. Some documentation to support risk management plans was not completed consistently. The registered manager addressed this at the time of our inspection.

Safeguarding procedures and policies were in place. Staff and the registered manager were aware of their responsibilities to identify and report any allegations of abuse to the local authority. There was a robust recruitment process to ensure people were protected and cared for by suitable staff. Incidents and accidents were being documented and analysed for patterns and trends to reduce the risk of their re-occurrence.

Staff felt well supported and received appropriate training. Staff said they enjoyed working for the service. They were well motivated and committed to providing a service that was personalised to each individual.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People’s care records clearly identified where people had capacity to make decisions about their care and support. Staff understood people needed to consent to their care and were confident they supported people to make their own decisions. The service operated within the principles of the Mental Capacity Act 2005.

People received assistance with meals and healthcare when required. This supported people to maintain their health and well-being. People engaged in activities which were meaningful and that they enjoyed.

People we spoke with told us they were happy with the care they received and were complimentary about the staff who supported them. We observed positive interactions between people who used the service and the staff. Staff demonstrated that they knew people well.

We saw people were supported by staff who were kind and caring. It was evident that positive relationships had been built between people and staff. Staff treated people with dignity and respect. People were fully involved in planning their care and support. Care plans were comprehensive to make sure staff had all the information required to support people as they wished.

People told us they knew how to raise concerns and when they had raised any issues, they were dealt with quickly and appropriately. Systems in place showed any complaints made were fully investigated and treated as learning to enable the service to improve.

The registered manager and the provider monitored and reviewed the quality of care through effective audits and reviews of the service. This demonstrated a commitment to continuous improvement of the service. People, their relatives and staff all spoke highly about the way the service was managed.

All of the staff, relatives and people who used the service spoke positively about the registered manager. Our conversations with the registered manger showed they were clearly passionate about providing good support and outcomes for people.

Owlett Hall is registered to accommodate up to 57 older people and provides residential and respite care, and intermediate care for people following hospital stays. The service did not have a registered manager at this inspection or the previous inspection in June 2016. An application to register a manager had been received in May 2016, however, this was terminated in December 2016 because the manager ended their employment at Owlett Hall. Another manager commenced at the beginning of February 2017; they told us they were submitting an application to register. 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.

At this inspection we found the registered provider did not always take appropriate action to keep people safe because they did not carry out appropriate checks before employing workers. There were enough staff employed to keep people safe. Deployment of staff was being further developed to make sure people’s needs were met in a timely way at all times. Risks to people were assessed and managed, and checks were carried out to make sure the premises and equipment were safe.

We have made a recommendation about installing a new call bell system. Medicines were managed safely.

Staff we spoke with said they felt supported in their role and received training to help them understand how to do their job well, however, we saw systems for ensuring staff received regular supervision needed further development. The manager was introducing new supervision arrangements although this was not operational at the time of the inspection. Training records showed staff sometimes completed a lot of training in one day so the manager was going to monitor this closely and introduce a better system for checking staff knowledge. The provider had improved arrangements for making decisions in line with the requirements of the Mental Capacity Act 2005; people were encouraged to make decisions and when they required assistance they received support. People had good meal experiences and enjoyed the food. Systems were in place that ensured people accessed appropriate healthcare services.

People told us they received a good standard of care and felt respected. They also said their independence was promoted. People who used the service looked well cared for; their personal appearance was well maintained, for example, people’s hair was brushed, and their clothing and glasses were clean. Staff knew people and their needs well, and treated people with respect and dignity. When we looked around the service we saw there was information available to help keep people informed about their rights and what to expect when they experienced care at Owlett Hall.

People who used the service and their relatives told us they felt involved in planning their care. Care plans identified how to support people with washing and dressing, rights and consents, medication, continence and communication. People were encouraged to engage in different group and individual activity sessions. The manager held a weekly surgery to encourage and promote feedback. A procedure was in place to respond to concerns and complaints although this had not always been appropriately implemented. Several written compliments had been received.

During the inspection we received very positive feedback about the manager and were told they were making definite improvements to the service. Regular meetings were held, and in the last few weeks the frequency of meetings had increased which ensured communication within the service was effective. The provider had improved quality management systems but some were only in the very early stages so we could not review their effectiveness over a prolonged period of time.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. You can see the action we have told the provider to take at the end of this report.

Owlett Hall provides nursing and personal care for a maximum of 57 people. Care is provided in three units. One unit offers a rehabilitation service in conjunction with the NHS; the other two units provide mainly long term care but also offer some short term and respite care. The management team told us there were 54 people using the service when we inspected.

At the time of the inspection, the service did not have a registered manager. 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. A manager was appointed in February 2016 and had applied to be registered.

People who used the service, visiting relatives and staff told us there was not enough staff to meet people’s needs. We observed sometimes there were no staff around and people did not receive care in a timely way. There was a lack of equipment that also caused delays in providing care. People could not have a bath because there were no working facilities.

Staff did not receive appropriate training and support although the manager had introduced more training opportunities recently. Staff did not understand what they must do to comply with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, and did not act within the law. The provider did not have effective recruitment and selection procedures in place so appropriate checks were not carried out before staff started working at the service.

People were complimentary about the staff who supported them and told us they received appropriate care. There was a lack of consistency in how people’s care was assessed, planned and delivered. There was not always enough information to guide staff on people’s care and support. Some people had risks associated with their health and well-being but they did not always get appropriate support to make sure they were safe. People’s care records showed they had accessed a range of health professionals but this did not include dental and chiropody services.

Information to help keep people informed was displayed; dignity, infection control and safeguarding were promoted. People were made aware about how they could make formal complaints.

People enjoyed the food and were offered a choice of meals. Drinks and snacks were offered to people throughout the day. Some people were offered a limited range of activities provided at the home and enjoyed the company of those they lived with.

There was a very mixed response about the overall management and leadership. Some felt the service was well managed others felt it was not. The provider’s systems to monitor and assess the quality of service provision were not effective. Actions that had been identified to improve the service were not always implemented. This were disorganised and it was difficult locating some information. The manager was introducing systems to help improve the quality and safety of the service; these were not embedded but improvements in some areas were evident.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. You can see the action we have told the provider to take at the end of this report.

We found staff treated people with dignity and respect and involved people in their care.

We found the provider carried out an assessment of people's needs so care could be planned and delivered appropriately.

The premises were suitably designed, laid out and maintained which ensured the safety and welfare of people who used the service.

We found there were enough staff to meet people's needs. We saw the provider had committed to increase staffing levels further to ensure more personalised support.

A robust complaints system was in place which ensured people's comments and complaints were appropriately investigated and responded to.

The care plans we looked at were detailed and up to date. They were regularly reviewed, and people and their families were involved in planning their care. One relative told us 'We have been very involved. They have worked with us to look at alternative approaches and options for support that works for my relative'. People were happy living in the service and felt that the care they received was individualised to their needs.

We looked at all areas of the home and found it to be clean and hygienic. The staff were trained in infection control and were following the related procedures. Staff received regular opportunities to develop their skills and felt the manager was approachable and supportive.

The service carried out regular audits and regularly asked for feedback about the service. Records were up to date and stored appropriately.