Olivemede

Olivemede is residential care home providing accommodation and personal care to up to 33 people. The service provides support to older people, some of whom were living with dementia, people with a physical disability and people with a sensory impairment. Olivemede accommodates up to 33 people in one adapted building. Each person’s accommodation included en-suite facilities with shared communal shower, dining and lounge areas. At the time of our inspection there were 29 people using the service.

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

Not all staff adhered to good infection prevention and control practices. Fire safety was compromised due to the storage of materials under a fire escape stairwell and not all medicines records were accurate. Risks to people were identified, but these were not always safely managed. Although no one had come to harm, there was a potential risk of harm.

Although the service had a registered manager, the provider notified us on the 22 September 2022 they had left the service and no longer worked there. A new manager had been in post since but had not applied to be a registered manager. This manager left without notice on the 24 April 2023. We had no records of a manger being registered at the service since September 2022

Staff had regular medicines administration training and had their competency assessed to do this safely. However, not all staff recorded the quantity administered where there was a prescription for one or two doses. This meant it was not possible to establish patterns for as and when medication. Staff supported people with their medicines in a way that respected their independence and achieved positive health outcomes.

The service was clean and suitably equipped to meet people's support needs. 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.

Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and knew how to do this.. The service had enough safely recruited staff who were appropriately skilled and knew people's needs to help keep them safe.

Staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate. Staff respected people's wishes, needs and rights and valued and acted upon people's views. This helped people have a say in how the service was run.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

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.

Rating at last inspection

The last rating for this service was good, published on 5 January 2022 .

Why we inspected

The inspection was prompted in part due to concerns received about medicines administration, staffing, risks to people's safety, restrictions on people's liberty and management of the service. A decision was made for us to inspect and examine those risks. We looked at the safe and well-led questions. 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 good to requires improvement based on the findings of this inspection.

We have identified breaches in relation to safe care and treatment and governance 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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Olivemede is registered to provide accommodation and personal care for up to 33 older people including those living with dementia, physical disability or sensory impairment. There were 32 people living at the home when we visited.

Accommodation is provided in a purpose built two storey building. All bedrooms were for single occupancy with ensuite facilities. There were communal areas, including lounge areas, two dining rooms and a garden that could be accessed from both floors.

People's experience of using this service and what we found.

Not all management of people’s medicines was effective in ensuring risks were identified or managed and records lacked detail and were not kept up to date.

Sufficient staff, with the right skills, supported people to be safe. Staff used their knowledge of safeguarding systems well. Staff were recruited safely. Lessons were learned when things went wrong and a learning culture for staff was in place.

People's assessed needs were met by staff whose training and support had given them the required skills. The provider worked well with others involved in people's care.

People ate and drank enough. Staff enabled people to access health care and support services. 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 support this practice.

People's care was person centred and staff enabled them to take part in pastimes, hobbies and activities they were interested in. People's complaints were responded to in line with the provider's policies and to the person's satisfaction. Trained staff and procedures were in place to support people with end of life care and in a dignified way.

The registered manager understood their responsibilities and notified the Care Quality Commission (CQC) when needed. Staff received stable and consistent support and leadership for their role. People, relatives and staff had a say in how the service was run. The provided worked well with others to provide people with joined up care.

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 03 January 2020) and there were two breaches of Regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

Why we inspected

This was a focused inspection was carried out to follow up on action we told the provider to take at the last 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 COVID-19 and other infection outbreaks effectively.

You can read the report from our latest comprehensive inspection, by selecting the 'all reports' link for Olivemede on our website at www.cqc.org.uk

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

The service was only receiving essential visitors at the time of our inspection. Any person entering the building had their temperature taken, completed a health questionnaire and wore full personal protective equipment (PPE) including a face visor.

The service had a dedicated visiting area divided by a glass window and door. Although visits had been paused at the time of our inspection, the registered manager had a system in place so that relatives and friends could book appointments to visit when visits resume.

People were supported by staff in full PPE. This is in addition to isolating people in a separate area and is referred to as barrier nursing. This process is to protect both staff and people living in the service from spreading infection.

The registered manager told us that they had changed systems within the service to reduce the spread of infection. Staff entered through a side entrance immediately into a staff only area where they changed into clean uniform. Kitchen staff also entered the building via a separate entrance.

People who had tested positive for COVID-19, or those who were symptomatic and awaiting test results were supported to move to a bedroom within an isolated COVID-19 zoned corridor. People remained in these bedrooms for 14 days, or until 48hrs after they were symptom free.

The building was clean and free from clutter. During our inspection we observed staff cleaning communal areas. The registered manager told us that frequently touched areas were cleaned more often. Maintenance staff also followed a schedule to support staff to clean communal areas and soft furnishings.

Additional risk measures had been put into place, for example cutlery and crockery used by people with a positive diagnosis were used solely by those people in the COVID-19 zoned area. Laundry used by people with a positive diagnosis were double bagged in orange clinical waste bins and kept in a closed laundry basket for 72 hours before being transported to the onsite laundry room.

The registered manager told us that they were working collaboratively with the GP from the local surgery. The GP had been allocated to the service as a clinical lead, and they were well supported as a result.

Olivemede is registered to provide accommodation and personal care for up to 33 older people including those living with dementia. There were 31 people living at the home when we visited.

Accommodation is provided over two floors. All bedrooms were for single occupancy with some having en-suite facilities. There were communal areas, including lounge areas, two dining rooms and a garden that could be accessed from both floors.

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

Risk assessments were not always updated when peoples need changed Behaviours that challenged were not appropriately managed and there was a lack of clear guidance for staff on how to manage the situation appropriately to meet the person’s needs.

Infection control was not managed appropriately. The registered manager did not have an overview of how the cleaning was being managed. Areas of the home required were not clean and required attention.

There were not enough staff to support people in a way that met their social and emotional needs. Staff were responsible for activities but were not always able to provide this due to responding to people’s other needs. Staff received regular training, supervisions and had support with staff meetings.

Medicines were given in a safe way. However appropriate recording on medicine administration records were not completed as required. There were not systems in place that ensured lessons were learned.

Care plans were not reviewed as regularly as required or to update and reflect people’s changing needs.

The home design and décor were not dementia friendly. Better signage was needed to support people with orientation. Staff were seen to be very caring in the way they supported people with medicines, food, and moving with hoists. However, there were times where people were left unattended due to staff availability.

Audits completed two days before the inspection for infection control did not reflect what we found. The registered manager or provider did not have an overview of the service. There was no evidence to show concerns we found had been identified.

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 provided with good day to day support with such areas as, medicines management and meals.

Staff were kind, caring and promoted people’s independence. Staff understood the importance of respecting people’s independence. People were given the opportunity to express their views. People were supported to understand information and make complaints if required.

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 good (published 13 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches at this inspection in relation to updating risk assessments, infection control and good governance. Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the previous inspection on 12 October 2016 the service was rated as requiring improvement. At this inspection we found that improvements had been made and sustained and the service is rated as ‘Good’.

At the time of this inspection there was a registered manager. However they had left on 3 June 2017 and were no longer in post. The home was being managed by a manager from the provider’s other service. The manager was in the process of adding Olivemede to their registration. 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.

Risk assessments were in place to ensure that people could be safely supported at all times. Staff were knowledgeable about the procedures to ensure that people were protected from harm and would have no hesitation in reporting any concerns. People’s medicines were administered and managed safely as prescribed.

A sufficient number of suitably qualified and skilled staff were employed at the home. The provider’s recruitment process ensured that only staff, which had been deemed suitable to work with people at the home. Only those staff who were deemed suitable were employed following the completion of satisfactory recruitment checks.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. 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. DoLS applications had been submitted to, and in two cases authorised by, the relevant local authorities.

Staff respected and maintained people’s privacy at all times. People were provided with care and support as required and people only had to wait for a few minutes before having their care needs met. This meant that people’s care needs were met in a timely manner.

People’s assessed care and support needs were planned and met by staff who had a good understanding of how and when to provide people’s care. Staff encouraged and supported people to be as independent as possible. People had care records which provided staff with the level of detail required to help meet people’s assessed needs and to provide care for people which they could benefit from.

People were supported to access a range of healthcare professionals including a GP, dietician community nurse or chiropodist. These also included support to enable people to attend hospital and outpatient appointments

People were provided with a varied menu and had a range of meals and healthy options to choose from. There was a sufficient quantity of food and drinks and snacks made available to people. This included nutritional support for those people who required a pureed soft food or low sugar/fibre diet.

People received care from staff in a kind, compassionate and sensitive way. People were able to take part in a wide range of hobbies and pastimes including puzzles, chair exercises, trips out as well as being able to spend time on their own where this was their preference. This helped prevent the risk of people becoming socially isolated.

A complaints procedure was available in the home for people and their relatives to use and all staff were aware of how to support access to this. People were supported to raise concerns or complaints and any resulting actions were acted upon promptly and effectively. This reduced the potential for any recurrence.

There was an open and honest culture within the home and people were able to talk and raise any issues with the staff. The registered manager had, prior to their departure maintained and sustained improvements that had been required. People were provided with a variety of ways that they could comment on the quality of their care. This included regular contact with the provider, manager, deputy manager, staff and taking part in residents’ meetings.

An effective quality assurance and audit system was in place to seek the views of people, relatives, staff as well as visiting healthcare professionals. This helped identify any area that would benefit from improvement. Where improvements had been suggested, these had been implemented promptly and to the satisfaction of people, staff or healthcare professional.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements.

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

Olivemede provides accommodation and personal care for up to 33 older people including those living with dementia. Accommodation is located over two floors. There were 26 people living in the home when we inspected.

At the time of this inspection there was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run.

At our focused inspection on 12 October 2016, we found that the provider had followed their plan which they had told us would be completed by 30 April 2016, and legal requirements had been met.

People’s risks were assessed and measures were in place to minimise the risk of harm occurring

Records showed that notifications had been submitted to the CQC in a timely manner.

This unannounced inspection took place on 22 March 2016.

The service had a registered manager. However, they had left their post in March 2016. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Staff were knowledgeable about identifying and reporting any incident of harm should this ever occur. People were cared for and looked after by enough staff to support them with their individual needs. However, not all incidents had been reported to the CQC, and without delay. This limited the response external organisations could take if this was then required.

Satisfactory pre-employment checks were completed on staff before they were employed and allowed to work with people who used the service.

People were supported to take their medicines as prescribed and medicines were safely managed. Not all staff had been regularly assessed as being competent to safely administer people’s prescribed medicines. This put people at risk of not being safely administered their medicines. An effective induction process was in place to support new staff.

Risk assessments to help safely support people with risks to their health were in place and these were kept under review according to each person’s needs. However, we found that there were no risk assessments in place to safely support people in the event of an emergency. This put people at risk especially people those who relied on two members of staff to help them to mobilise.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The registered manager and staff were knowledgeable about when an assessment of people’s mental capacity was required. Appropriate applications had been made by the provider to lawfully deprive of their liberty. People using the service who currently met the criteria to be lawfully deprived of their liberty had applications and authorisations in place. However, not all staff had an understanding of the MCA and how a DoLS would be determined. This meant that there was a risk that people could be provided with care that was not in line with the relevant codes of practice.

People had sufficient quantities of their preferred food and drink choices including various snacks during the day. This included the provision and choice of appropriate diets for those people at an increased risk of malnutrition, dehydration or weight loss. However, there were missed opportunities for people to be as independent as they could have been at mealtimes.

People were supported to access a range of health care services and their individual health needs were met.

People were cared for and supported with their needs by kind and attentive staff. People were given as much opportunity as possible to be involved in planning and reviewing their care needs. People’s privacy and dignity was respected by staff.

Information was made available for people or their relatives who may have needed access to independent advocacy. People were given various opportunities to help identify and make key changes or suggestions about any aspects of their care. However, the investigation into their concerns, suggestions and complaints did not ensure that the potential for recurrence was minimised.

A range of audit and quality assurance procedures were in place. However, these were not always as effective as they should have been. The provider had not always notified the CQC about important events that, by law, they are required to do so.

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.

Care records we reviewed indicated to us that people who used the service had the right level of information to make a decision about their care and support and that staff respected these decisions

People we spoke with had positive comments about the standard of support and care they received. One person told us that they were, "More than content.' Another person told us that, 'I am perfectly happy here. They (staff) do everything they can to make you happy.'

Staff had access to care records which contained information and guidance for staff to ensure that they provided people with safe, appropriate, individual care and support.

When reviewing medication administration records (MAR) charts, we saw documented evidence of accurate medication administration by staff.

There was an effective system in place for people to raise a concern or make a complaint if they wished to do so.

People's care records and health care appointments were regularly reviewed to ensure that people's care was up-to-date and where any changes in a person's health were observed, staff knew how to address these with the appropriate health care professional.

The care home followed Department of Health guidelines on hygiene and infection control. We saw evidence of clean paper towels, hand wash gels and hand washing procedures provided throughout the home.

Prior to staff commencing employment at the home the provider ensured that appropriate identity and Criminal Records Bureau checks were completed.

The provider used various means to obtain people's views on the quality of care provided by the service and used the information to make improvements whenever possible.