Archived: Overstone Retirement Home

Updated 6 December 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 is 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 was a comprehensive inspection and was carried out to check that improvements had been made by the provider to meet legal requirements, following the findings of our last inspection and subsequent enforcement action that we took.

This inspection took place on the 18 October 2016 and was unannounced. The inspection was carried out by one inspector and an inspection manager.

Prior to our inspection we reviewed all of the information that the provider had sent us since our last inspection to evidence the steps they had taken to achieve compliance with those regulations previously breached. This included evidence submitted to the Commission, in the form of reports and statements. We also contacted the local authority safeguarding and contracts and commissioning teams, to obtain their feedback about the service. We used the information that they supplied to inform the planning of this inspection.

During our inspection we spoke with the registered provider, senior care worker, five members of staff, six people in receipt of care from the service and one visiting healthcare professional. We also reviewed a range of records related to the management of the service including five staff training, recruitment and supervision records and other quality assurance and maintenance documentation.

Updated 6 December 2016

This inspection took place on the 18 October 2016 and was unannounced. Overstone Retirement Home is a residential care home based in Hexham, Northumberland, which provides care and personal support for up to 15 older persons, some of whom are living with dementia.

The requirements of the provider's registration currently do not require a registered manager to be in post. However, the provider told us they had changed their legal entity to that of a limited company, and as such they planned to amend their registration with the Commission imminently, which would require the appointment of 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. We will monitor that the relevant applications are made to alter the provider's legal entity and we will ensure that this matter is addressed promptly.

We carried out this inspection to check whether improvements had been made since our last inspection in July 2016 at which multiple breaches of Regulations 12, 13, 17 and 20a of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 were identified. In response to our findings at that time, we took enforcement action against the provider. At this inspection we found that improvements had been made but some minor shortfalls remained. The provider had achieved compliance with all five of the regulations that were previously breached, but a new breach was identified.

People told us they felt safe and they had no concerns about how they were treated. They described staff as kind and caring and said they felt completely "at home". Previous failings with the management of safeguarding incidents and medicines had been addressed. Staff had been retrained since our last visit to the home and the provider was clear on their personal responsibility to report and progress matters of a safeguarding nature.

Improvements in how safely medicines were handled had been made and effective auditing of medicines processes and procedures had been undertaken.

Environmental risks had been addressed and window restrictors had been fitted throughout the home to help people remain safe. Water temperature checks had been undertaken to ensure they remained within safe limits to prevent the development of legionella bacteria in the water supplies within the home. General health and safety checks had been reviewed by an external company and personal emergency evacuation plans (PEEPs) were in place. Emergency planning had been considered and a file containing information for staff to refer to was being developed.

Accidents and incidents were managed well and people received the attention and support they needed to remain safe.

Staffing levels were consistently maintained. Staff training was carried out in key areas, such as medicines management and safeguarding, and also in areas specific to the needs of the people supported by the service, such as nutrition awareness. Staff supervisions were carried out and a new annual appraisal system had been introduced and had commenced.

People said that staff met their needs. The healthcare professional we spoke with reflected that any requests they received for support or input into people's care, were both proportionate and appropriate. People were supported to maintain their general health and wellbeing and attend appointments, for example, with their dentist and opticians. When people were ill, records evidenced that GP's were called.

CQC monitors the application of the Mental Capacity Act (2005) and deprivation of liberty. Applications to deprive people of their liberty lawfully had been made to prevent them from coming to any harm where they lacked capacity. The provider and senior care worker advised us that no best interests decision making had taken place in the service since our last visit in July 2016. They told us they routinely assessed people's capacity when their care commenced and on an on-going basis, and they would include people's families in decisions where relevant, and appropriately record any decisions made.

People were supported to eat and drink in sufficient amounts to remain healthy and although no person was being monitored for their food and fluid intake, tools were in place to facilitate this should it be necessary. People spoke highly of the quality and variety of home cooked food that they were served.

Staff and people enjoyed good relationships with each other. We observed staff treated people with respect and people told us that their dignity was maintained at all times. People were encouraged to be as independent as possible and they told us they made their own choices. Several people accessed the community on their own, or with friends and family. People pursued activities of their choosing. There were limited activities within the home but they were in line with people's needs. A large selection of films, games and books were available. People told us they enjoyed regular film nights put on by the provider.

Care records were person-centred and provided staff with information about people's dependencies, needs and the risks they faced in their daily lives. Care records were regularly reviewed. The care people received was individualised and specific to their needs. People and their relatives told us they had not had any reason to complain about the service and records reflected no complaints had been made. People told us they had choices about how they lived their lives and they were supported to be independent by staff.

Governance systems had been reviewed and staff meetings introduced which staff said they appreciated and found useful. Auditing was in place but in some areas such as infection control and health and safety, further developments were needed. The provider had also not identified through their own quality assurance systems the shortfalls that we identified with recruitment procedures. We have made a recommendation about this which states, "We recommend the provider continues to develop their quality assurance and governance systems and processes further, to ensure that any shortfalls or issues are identified and addressed promptly and that improvements within the service are sustained".

Recruitment processes were in place but we found shortfalls existed. Previous employment histories had not always been explored, the content and results of interviews were not recorded and the results of verification checks, such as references and Disclosure and Barring Service checks (DBS checks), had not always been received before staff started working for the service.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, namely Regulation 19, Fit and proper persons employed. You can see what action we told the provider to take at the back of the full version of the report.