Archived: Olton Grange Residential Home

A requirement of the provider's registration is that they have a registered manager. A registered manager is a person who had registered with the Care Quality Commission to manager the service. Like registered provider's 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 the time of our inspection a registered manager had not been in post for over 12 months. The manager who was responsible for running the home was in the process of applying for registration.

The home was last inspected on 21 July 2016 when we found the provider was not meeting the required standards. We identified two breaches in the legal requirements and regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

These breaches were in relation to the safe care and treatment people received and the leadership of the service. Care and treatment was not provided in a safe way. Risks were not assessed and action had not been taken to reduce risks. Systems and processes were not established or effective. The quality and safety of the service was not assessed or monitored. Accurate records of people and their care and treatment were not maintained.

The provider sent us an action plan outlining how they would improve. During this inspection we checked whether the improvements had been made. We found some improvements had been made but action had not been sufficient in response to the breaches in regulation.

New audits and checks to monitor the quality and safety of the home had been implemented. However health and checks of the building safety were not effective. Also, the provider’s fire risk assessment was out of date and was not fit for purpose. This meant the provider could not always demonstrate how they ensured people and the staff would be kept as safe as possible.

At our previous inspection, we were told meetings where people who lived at the home could discuss any issues or concerns would commence. At this visit, they still had not taken place.

The provider had received a Provider information Return (PIR) as part of this inspection process but this had not been completed and returned to us as requested.

Some improvements had been made to manage the risks associated with people’s care. Risk assessments and management plans identified potential risks to people's health and wellbeing. However, information for staff to follow to reduce risks was not always recorded.

At our previous inspection people were not involved in reviewing their care and their care records had not been regularly reviewed. Reviews had commenced but had not identified when people's risk assessments did not contain sufficient information. However all of the people we spoke with told us they were involved in their care reviews and received their care and support in the way they preferred which met their needs.

Incident and accident records were completed. Since our previous inspection the manager had implemented a system to analyse the records and we saw action had been taken to reduce the likelihood of the incidents happening again.

Relatives confirmed they had opportunities to be involved in people’s care and people were encouraged to maintain relationships important to them.

People told us they felt safe living at Olton Grange. Procedures were in place to protect them from harm and staff had received safeguarding training. Staff were confident to challenge poor practice and share concerns with their manager.

Sufficient and experienced staff were on duty to meet people's needs. Most staff told us they had received an induction when they started working at the home. The provider's recruitment procedures minimised, as far as possible, the risks to people safety.

Since our previous inspection medicine audits had commenced to check they were given safely and effectively. Improvements had also been made to the way medicines were stored. People received their medicines when they needed them but staff had not consistently recorded when they had administered people’s prescribed creams.

People provided positive feedback about the food and dining experiences at the home. Staff demonstrated good knowledge of people's nutritional needs. People were supported to manage their health conditions and had access to health professionals when required.

Managers and staff understood the principles of the Mental Capacity Act 2005 (MCA) and the Depravation of Liberty Safeguards (DoLS). Consent to care was sought in line with legislation. People were supported to make choices and decisions about their everyday routines. This meant the rights of people were protected.

Staff were caring and knew the people who lived at Olton Grange well. We saw they quickly responded to people’s requests for assistance. People's right to privacy was respected and their dignity was maintained by staff who supported them to be as independent as possible.

People spoke positively about the social activities available to occupy their time. People and their relatives knew how to make a complaint and felt comfortable doing so. No complaints had been received in the last 12 months.

The manager spoke positively about the support they received to be effective in their role. People and their relatives were happy with how the home was run. Staff told us they enjoyed working at the home and spoke positively about the manager.

Some staff had not had their work performance monitored for over 12 months. Staff confirmed they had some the opportunities to attend and contribute to team meetings to share ideas and drive forward improvements.

Annual quality questionnaires were sent out to gather people's views on the service they received. The provider had an improvement action plan in place to improve the décor in the home to make the home a nicer place for people to live.

The manager told us which notifications they were required to send to us so we were able to monitor any changes or issues within the home.

We found two breaches of the Health and social care Act 2008 (Regulated activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The service was last inspected on 23 February 2015 when we found some improvements were required in relation to how risks were managed. At this visit we found the improvements had not been made and further improvements were required in other areas.

Olton Grange Residential Home provides care for up to 25 older people in Solihull. At the time of our inspection there were 20 people living at the home. Some people were living with dementia.

A registered manager was not in post. The previous registered manager had left following a period of absence which began in October 2015. 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 new deputy manager had been in post for four weeks and was the acting manager at the time of our visit.

We could not be sure people who used the service were safe. Risks to people’s safety were identified by staff, however ways to manage and reduce these risks were not always documented to ensure a consistent and effective approach was taken.

Care records contained limited information for staff to help them provide personalised care, however some information was conflicting or missing about people and how they wanted to receive their care.

People knew how to complain, however we were unsure if complaints were recorded or responded to, to people’s satisfaction, as we were unable to see these records during our visit.

Staff had mixed views about the management of the home following recent changes, however felt positive that a new deputy manager was now in post.

There were limited processes to monitor the quality and safety of service provided to ensure staff were following policies and procedures. However, plans were in place for the deputy manager to start completing these following our visit.

There were enough staff to care for the people they supported and checks were carried out prior to staff starting work to ensure their suitability to work with people who used the service. Staff received an induction into the organisation, and they completed training to support them in meeting people’s needs effectively.

Staff had a good understanding of what constituted abuse and knew what actions to take if they had any concerns.

There were formal opportunities for staff to feedback any issues or concerns at one to one and team meetings.

People and relatives told us staff were caring and had the right skills and experience to provide the care required. People were supported with dignity and respect and people were given a choice in relation to how they spent their time. Staff encouraged people to be independent.

People received medicines from staff who were trained and medicines were administered safely. For medicine taken ‘as required’ (PRN), guidelines were not recorded to tell staff when people needed this.

Staff understood the principles of the Mental Capacity Act (2005) and how to support people with decision making, which included arranging further support when this was required.

People had enough to eat and drink during the day, were offered choices, and enjoyed the meals provided. Special dietary needs were catered food.

People were assisted to manage their health needs, with referrals to other health professionals where this was required. However, outcomes of these visits were not always documented or agreed actions followed up.

Some people had enough to do to keep them occupied and staff tailored activities to people’s individual interests. There were limited activities arranged for people living with dementia.

People were given the opportunity to feedback about the service they received through surveys. Meetings for people and relatives had lapsed, however plans were in place for these to start again.

Checks of the environment were undertaken and staff knew the correct procedures to take in an emergency.

We had received the required notifications to enable us to monitor the service.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Below is a summary of what we found. The summary describes what people told us, what we observed, the records we looked at and what staff told us. We used the evidence we collected during our inspection to answer five questions. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe. One person told us, "I feel safe here." Safeguarding procedures were in place and staff understood their role in safeguarding the people they supported. Staff were aware of the provider's whistleblowing policy.

We found people were not always included in the planning of their care and that risks to people's health and wellbeing had not been assessed and planned for.

At our previous two inspections we found systems were not in place to ensure people were protected against the risks associated with the administration of medicines. At this visit we found medicines management had improved, but it was still not sufficiently robust to ensure medicines were always administered safely to people.

We found the provider did not have a robust recruitment procedure in place to ensure staff were of good character and had the necessary skills and experience.

Systems were not in place to make sure that the manager and staff learned from events such as accidents and incidents, complaints and checks made on the service. This increased the risk to people.

We found care records were not stored securely. Record keeping generally in the home was poor. This included insufficient detail in people's care records to keep them safe.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We found no applications had been made to the local authority because the provider had not yet assessed people's capacity to consent to remaining in the home.

Is the service effective?

People were not always included in the planning of their care. We found that care plans and risk assessments were not current and lacked sufficient detail. This meant people were not receiving effective care that met their needs.

Is the service caring?

People were supported by kind and caring staff. We saw staff were patient with people. One person told us, "The staff are very kind." We saw staff encouraged people to maintain their independence and treated them with respect.

People's preferences, interests and diverse needs had not always been recorded.

Is the service responsive?

People were given the opportunity to plan and engage in a range of different activities each day.

People were not always asked their views about the service. The registered manager could not provide evidence that comments people made were acted on.

Is the service well led?

The provider had some risk management systems in place. We found the provider did not check that risks were managed effectively.

The provider sought the views of relatives but not people who lived at the home or staff.

We found record keeping was poor in relation to people's care, staff information and other records required to ensure the safe and effective management of the home.

People we spoke with were complimentary about the service and the staff who provided care and support. Comments included:

'This is a most happy home. They are so caring and nothing is too much trouble.'

'I love it here.'

'Brilliant. A most happy and wonderful place.'

People looked well cared for. We saw staff supported people with kindness and compassion. Staff we spoke with were aware of people health conditions and how to manage them to keep people safe and well. Appropriate and timely referrals to outside health professionals had been carried out when a need had been identified. A visitor said, 'Staff are good together. It starts at the top and it goes down.'

At our last inspection we identified concerns in the management of medication within the home. At this visit we found that medication management was still not sufficiently robust to ensure medicines were always administered safely to people.

During this inspection we found care records were not sufficiently detailed and improvements were needed to ensure care was always provided consistently.

People spoke positively about their experience of living at Olton Grange. One person told us, "I have not been here long but I love it. It is wonderful." Another said, "There is nothing I can grumble about." During our visit we saw staff supporting people in a kindly, respectful manner.

We looked at a sample of care plans. Some care plans were not sufficiently detailed to ensure staff delivered care that met people's needs and managed any identified risks.

We checked how medication was managed. We were not satisfied there were always arrangements in place to safely manage people's medicines.

Staff told us and records showed they received regular training. Staff said that support from the manager was very good.

The complaints procedure was available in the "welcome pack" people were given when they moved into the home. One person told us, "I've never been unhappy about anything."