We inspected Overslade House on 04 January 2018 and then returned on16 February 2018. Both days were unannounced. We returned because we were made aware of a serious incident which took place after our first inspection day and currently remains under investigation. Overslade House is divided into three separate units over two floors, and provides personal and nursing care for up to 89 older people, including people living with dementia and physical disabilities. There were 80 people living at the home when we inspected the service.
A requirement of the service’s registration is that they 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 and the associated Regulations about how the service is run. There was a registered manager in post at the time of our inspection visit. We refer to the registered manager as the manager in the body of this report.
We last inspected this service in January 2016 when we rated Safe as ‘Requires Improvement’ because we found staffing numbers required improvement, with an overall rating of Good. At this inspection we found whilst improvements had been made to staffing levels, there is a lack of clarity about what happened with regard to the serious incident at the home, and we have therefore continued to rate Safe as Requires Improvement.
Since our previous inspection in January 2016 we have reviewed and refined our assessment framework, which was published in October 2017. Under the new framework certain key areas have moved, such as support for people when behaviour challenges, which has moved from Effective to Safe. Therefore, for this inspection, we have inspected all key questions under the new framework, and also reviewed the previous key questions to make sure all areas were inspected to validate the ratings.
We found risk management plans were established to ensure the environment and premises were managed safely, and environmental risks to people were minimised. In addition, we found people had individual risk assessments completed and staff were instructed on how to minimise risk to people’s health and wellbeing.
Most people told us there were enough staff at the home to provide them with safe care. We saw there were enough staff during our inspection visit to ensure people were cared for safely. However, three people told us they sometimes had to wait for assistance to go to the toilet, or for personal care, at busy times. The manager assured us staffing levels were worked out to ensure people received safe care. Although there were busy times of day, there were sufficient staff to meet people’s needs. Quality assurance procedures were in place to monitor staffing levels remained safe.
All necessary checks had been completed before new staff started work at the home to make sure, as far as was possible, they were safe to work with the people who lived there. People were supported by a staff team that knew them well, as the manager did not employ temporary staff.
Staff received training and had their practice observed to ensure they had the necessary skills to support people. Staff treated people with respect and dignity, and supported people to maintain their privacy and independence.
People had been consulted about their wishes at the end of their life. Plans showed people’s wishes about who they wanted to be with them, and the medical interventions they had agreed to. People and their relatives told us the care they received at this difficult time was excellent.
People received their medicines as prescribed to maintain their health and wellbeing. People were supported to access healthcare from a range of professionals inside and outside the home, and received support with their nutritional needs which assisted them to maintain their health.
The provider, manager and staff understood their responsibilities under the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure people were looked after in a way that did not inappropriately restrict their freedom. The manager had made applications to the local authority where people’s freedom was restricted, in accordance with DoLS and the MCA requirements. Decisions were made in people’s ‘best interests’ where they could not make decisions for themselves.
People were supported to take part in social activities and pursue their interests and hobbies. People made choices about who visited them at the home, which helped people maintain personal relationships that were important to them.
People knew how to make a complaint if they needed to. Complaints received were investigated and analysed so the provider could learn from them. People who used the service and their relatives were given the opportunity to share their views about how the service was run; action was taken in response.
Quality monitoring procedures identified areas where the service needed to make improvements. Where issues had been identified in checks and audits, the manager took action to address them to continuously improve the quality of care people received.