This inspection took place on the 12 and 13 March 2018. The inspection was unannounced on the first day with the registered provider aware we intended to visit on the second day.We previously carried out an unannounced comprehensive inspection of this service on 21 April and 9 June 2017. Breaches of legal requirements were found in relation to Regulations 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. As a result of this rating, the service was placed into special measures. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safety, effectiveness, caring, responsiveness and well led to at least good
At this inspection we identified that the required improvements had been made.
While no breaches were identified at this visit, we have rated the location as requiring improvement overall. This is because the registered provider needs to demonstrate a period of sustained good practice.
Overdene House 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.
Overdene House is situated within a residential area of Winsford, Cheshire. On the first floor nursing care for older people is provided. On the ground floor residential and respite care is provided for older people as well as adults with physical disabilities. There were 45 people residing in the home on the day of the inspection.
There was a registered manager. This 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. The registered manager had come to work at Overdene House since our last inspection.
Our last inspection identified that people were not being provided with a safe service. People were not being supported to take their medication as prescribed. We had found that prescription pain relief had not been re-ordered in a timely manner which meant that people did not receive pain relief for more than a week. Medication audits were not effective as the actual stock of medication did not tally with stock recorded on audits. This had meant that the registered provider could not be sure that people had received their medication as required.
This visit found that the registered provider had introduced a more regular and robust audit of medications. Systems of re-ordering medicines had been improved. As a result, people who used the service were appropriately provided with their prescribed medication.
Our last inspection also identified that effective action had not been taken following serious incidents. For example one person had managed to leave the building placing them at risk. The premises had not been secured following this incident. Other risks at that time involved people given food that presented a choking hazard to them despite dietary advice and an incident involving a person falling down the side of their bed. In these instances, no subsequent action had been taken to prevent reoccurrence.
This visit found that the premises were secure and that no further incidents had occurred. There was evidence that the registered provider had made arrangements to prevent adverse incidents occurring. This had been achieved by prompt action being taken to ensure that any incidents were investigated and analysed to prevent future re-occurrence. In addition to this, information for both kitchen and care staff was robust meaning that people could not be at risk of choking if given inappropriate food.
At our previous inspection we identified that the registered provider did not have effective systems in place to identify and assess the risks to the health and safety of people who used the service. On this inspection we found that improvements had been made, however, a longer term of consistent good practice is required to achieve a rating of good for this key question. We will review the rating for this domain at our next inspection.
This visit found that accidents were analysed to determine any patterns or reoccurrence. A more robust process was in place with management meetings held to analyse the type of accident that had occurred and how it could prevented in future. This also extended to any incidents within the service. Information was also available to both kitchen and care staff in respect of how meals should be presented. We found that information about what form meals would take, for example, soft or pureed were known by all relevant parties. This minimised the risk of people being provided with inappropriate food and the risk of choking.
Staff had a good understanding of abuse, the types of abuse that could occur and how any concerns could be reported. They also told us that they had received safeguarding training and this was confirmed through training records.
Staff understood the principle of whistleblowing where concerns about care practice could be raised. This included the external agencies that concerns could be raised with.
Each person had a personal evacuation plan (known as PEEPS). These provided staff with considerations they had to take to safely support people if they needed to be evacuated in the event of an emergency such as an outbreak of fire.
Appropriate checks had been completed with regards to equipment and other aspects of the environment to ensure they were safe and in working order. These included hoist checks and checks to fire detection and firefighting equipment.
The premises were clean and hygienic. The registered provider employed domestic staff to ensure that infection was controlled and these staff were observed using personal protective equipment as part of their role.
At the time of the inspection visit we observed enough staff to meet people's needs. Staff rotas indicated that there were sufficient staff to meet people’s needs. Staff recruitment was robust with appropriate checks made to ensure that people were suitable for their role.
Our last visit found that the process for introducing new staff into their role through induction had not always been completed. This visit found that the induction process was more robust. Training required by staff as part of their induction had been completed enabling staff to have the knowledge to perform their role. As a result people were effectively supported.
Staff received the training they needed to perform their role. Regular supervision was provided for staff so that they could develop their own care practice. Staff held regular meetings with the registered manager.
The registered provider operated within the principles of the Mental Capacity Act (MCA). Staff had received training in this and were conversant with the principles of the act and how this impacted on people in their daily lives.
Food was prepared hygienically and provided a wide choice of meals to people who used the service. Those who required assistance in eating were appropriately supported by staff.
The registered provider recorded ongoing health issues for each person. Where consultations with health professionals were required, these were facilitated by the staff team.
Further breaches in regulations were identified at our last inspection relating to confidentiality. We had found that office doors were open and that information relating to people’s personal details and personal care were on display. This undermined the security of those records being kept. This visit found that there was robust practice in maintaining confidentiality. Office doors were locked when not in use and when they were occupied; information was only available to the member of staff who was using it. This had been reinforced during staff meetings and we observed offices being locked once they had been vacated.
Staff spent time sitting with people and chatting to them. Staff interactions were positive and genuine. The privacy of people was taken into account with staff knocking on bedroom doors before entering and ensuring that doors were closed when receiving personal care.
Our last visit found that there was not an effective activities programme in place. This had resulted in people not receiving appropriate stimulation or being able to pursue chosen interests. The activities programme had improved with regular activities both within the building and in the wider community being held.
Care plans outlined personal preferences and routines of individuals. This meant that people received a more person centred approach to their support. Our last visit noted that care plan reviews had not been effective. This had been apparent in the lack of action following specific incidents. This visit found that the response to incidents was now more robust and as a result, care plan reviews were more effective. The registered manager had put processes in place whereby incidents were discussed with a plan of action put into place to prevent further re-occurrence.
A robust complaints procedure was in place. This enabled people to raise concerns about the service. These were appropriately investigated and responded to.
Our last visit found that the service was not well led. This conclusion was made given that audits from representatives of the registered provider were not robust and that the registered provider had failed to inform us, as required by law, of incidents that adversely affected the wellbeing of people who used the service.
This visit found that adverse incidents were now reported to CQC when necessary. A representative of the registered provider now visited the service regularly and commented on progress within the service.