Archived: Oliver House

Oliver House is a residential care and nursing home providing personal and nursing care to 25 people aged 65 and over at the time of the inspection. Some people were living with dementia. The service can support up to 26 people. Care is provided on two floors, with bedrooms on each floor and communal areas on the ground floor.

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

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 protected from avoidable by staff who understood their responsibility to safeguard people. People’s risks had been identified and assessments were undertaken to ensure they received the level of support they required. Staff provided people with their prescribed medicines safely.

There were a sufficient number of suitable recruited staff to meet people’s needs in a timely manner. Staff had access to training and support to improve their knowledge of care and enhance their skills. People were provided with a choice of nutritious food and plentiful drinks. Staff supported people to retain their independence and when support was required it was provided in a kind and reassuring manner.

People enjoyed the company of staff who respected their privacy and promoted their dignity. People were able to maintain their important relationships with relatives and friends who were welcomed into the home and included in social events.

People were protected from social isolation. There was an active and diverse range of activities offered to people both in and outside of the home. There were strong links with the community.

People received the care they preferred because staff asked them and their relatives about their likes and dislikes. Care was reviewed regularly to ensure it was still relevant for people. People told us they were happy with their care and would speak with the registered manager or staff if they wanted to discuss a concern or complaint.

There was a registered manager in post who people and staff respected and found approachable. Quality monitoring processes were in place. When improvements were required these were implemented in a timely manner.

People, staff and external healthcare professionals were supported to share their views of the service through satisfaction surveys.

Rating at last inspection

The last rating for this service was Good (15 May 2017)

Why we inspected

This was a planned inspection based on the previous rating.

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

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.

There was a registered manager in post. 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.

The provider determined the staffing levels on the number of people living in the home and the level of support they required, however this was based on physical needs and not always included peoples emotional needs. . Staff had received training in a range of areas to support their role and further training had been planned to enhance their learning. People who used the service were safe and staff understood their role in ensuring people were protected from abuse or poor practice.

The provider and registered manager understood their responsibilities when people lacked capacity. We saw best interest decisions and assessments had been completed in line with guidance. Where people were being restricted of their liberty in their best interests, the appropriate authorisations had been applied for.

Everyone we spoke with felt that there had been improvements to the home and these had enhanced people’s experience of care. We saw that people were responded to in a kind and friendly manner and staff respected their decisions. Risk assessments were in place to ensure people’s safety was maintained and people’s independence was encouraged.

Medicines were managed safely and in accordance with good practice. People received food and drink that met their nutritional needs and had been encouraged to make choices in future menus. Staff made referrals to healthcare professionals in a timely manner to maintain people’s health and wellbeing.

Staff were caring in their approach and they created a warm homely environment which people told us they liked and enjoyed. People felt confident they could raise any concerns with the provider and manager. There were processes in place for people to express their views and opinions about the home. The provider and registered manager had systems in place to monitor and improve the quality of the service.

At the last comprehensive inspection this provider was placed into special measures by CQC. This inspection found that there was enough improvement to take the provider out of special measures. CQC is now considering the appropriate regulatory response to resolve the problems we found.

There was a registered manager in post. 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.

The provider had developed some auditing processes; however they had not been used to reflect the wider needs of the quality of the service or in driving improvements. Support for the management staff had not been provided or checks completed to ensure that the training the staff had received was understood and implemented.

People had not been consulted on the service and encouraged to be part of any improvements to the service or their environment. Staffing levels had improved, but there were some areas of the day when there were not enough staff to respond to people’s needs. People’s dignity was not always considered. Daily activities were not always provided to support people’s interests or hobbies.

Staff understood what constituted abuse or poor practice. There were systems and processes in place to protect people from the risk of harm. Medicines were managed safely and in accordance with good practice. Risks to people’s health and wellbeing were assessed. Where risks had been identified the provider had taken action to remove or minimise the risks. Changes to people’s health were responded to by referring them to healthcare professionals in a timely manner.

Where people lacked capacity to make decisions for themselves, there was an assessment to consider what decisions had been made in the person’s best interest. Staff received training to meet the needs of people living in the home and this was ongoing. People received food and drink that met their nutritional needs and when identified any risks through the monitoring of their health needs they were referred to other healthcare professionals to maintain their health and wellbeing.

Staff were caring in their approach, and offered support with aspects of people’s needs. People told us the staff respected people’s privacy and they were encouraged to maintain relationships with family and friends. The care records provided details of people’s preferences to how they wished to receive their care and about their life.

Staff told us they felt supported and they received regular supervision, which enabled them to identified areas of development or support. People and relatives felt confident they could raise any concerns with the registered manager and that they would be addressed.

We found 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.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask. This is a summary of what we found:

Is the service safe?

People told us that they felt safe living at Oliver House and that they were treated well. One person told us, 'I feel safe; I couldn't be on my own, I am lucky to have somewhere like this.'

Visiting relatives told us that they felt that their relative was cared for and were kept safe from harm. One relative explained, 'I know she is safe [their relative] and if there is anything wrong they will always report back to me.'

We talked to the care workers on duty during our visit. This was to determine whether there were enough care workers on duty to meet the needs of those in their care and to keep them safe. The care workers told us that they thought that the numbers were about right, but on some days it was definitely busier than on others. The people who used the service told us that they felt that there were enough staff on duty to meet their needs.

We looked at the records belonging to five of the people who used the service. Records kept to monitor how much food and fluid people had consumed during each day were not up to date. This meant that the provider could not demonstrate that people were protected from the risk of malnutrition or dehydration.

The care plan belonging to a person who required the use of a wheelchair stated, 'ensure foot plates are used'. On our arrival at the service we saw this person being assisted from the lounge area without the footplates being used. This meant that the person had been placed at risk of serious injury.

Care workers spoken with knew the actions to take should they suspect that someone was being abused and the registered manager and nurse in charge were aware of their responsibilities in keeping people safe. One care worker told us, 'I would report to the nurse in charge and also management.'

Is the service effective?

People told us that they were satisfied with the care and support they received. One person explained, 'They look after us very well.' Another person told us, 'I am quite happy here thank you.'

Relatives told us that they were happy with the care and support their relative received. One relative explained, 'She has come on in leaps and bounds, I am happy because she is happy.'

Care plans provided care workers with information about people's care and support needs, though these were not always accurate or had not been followed. This meant that people were at risk of not receiving the care and support they needed.

The provider cooperated with other health and social care professionals to deliver a coordinated approach to people's health and care needs. This included obtaining support from the local speech and language team, doctors and tissue viability nurses.

Is the service caring?

We observed staff going about their work. They treated the people they were supporting in a kind and respectful way and, although staff availability was at times limited, provided them with the time that they needed in order to carry out a task. This included assisting people with their meals and assisting them to use the bathroom.

A new activities leader had recently joined the staff team and we observed them spending time with the people who used the service both in groups and providing personal one to one time. This provided the people who used the service with a more stimulating and interesting environment in which to live.

The people who used the service told us that they were treated with respect and we observed staff knocking on doors and calling people by their preferred name. One person told us, 'The place is marvellous and the staff are very respectful.'

Is the service responsive?

Relevant professionals had been involved in people's care. Records showed that visits had been arranged when necessary. These included visits from their doctor, their dentist, the local speech and language team and the tissue viability nursing team. This ensured that people who used the service received the care and treatment they required.

A complaints procedure was in place and a copy of this was displayed. This provided people with the information they needed, should they wish to make a complaint about the service they received.

Is the service well-led?

Staff had a good understanding of the ethos of the home. They felt supported by the management team and they explained that they were able to talk to them, if they had a concern of any kind. One care worker told us, 'The management is very approachable, you can talk to them and they would deal with it.'

A monitoring system was in place but the effectiveness of this was questioned because of the shortfalls that were identified during our visit. Care records had not always been reviewed or kept up to date. This meant that the people who used the service were at risk of having their health care needs and their safety, compromised.

Staff meetings had been held. These provided the staff team with the opportunity to have a say on how the service was run. A meeting for the people who used the service, their relatives and their advocates had also been arranged for 29 September this year. This meant that they would be provided with an opportunity to have a say about the overall service being provided.

Most people said that they liked the meals. Appropriate records were kept to ensure that people were offered a choice of foods, and received sufficient diet and fluids.

Essential communications and records were in place to ensure that people received appropriate care and treatment. Arrangements were also in place to ensure that people's medicines were handled properly.

A new manager was appointed at the end of January 2014. She had introduced various changes to ensure that the service was well managed. Further systems had been put in place to monitor the quality of the service and to manage risks relating to people's welfare and safety.

People who were able to express their views said they were generally happy with the care they received. They also said that they liked the staff that supported them.

Two relatives told us they were generally satisfied with the care their family member received, and felt involved in decisions about their care and treatment.

There was more to do to occupy people's day as appropriate social activities were being provided.

An extra carer was provided from the teatime and early evening period, as this was when people required more support.

Aspects of the recording of people's medicines did not ensure that all medicines were managed appropriately, and that people received them at the times they needed them.

This inspection showed that there had been some improvements since our last visit in June 2013. However, effective communications and concise care records were not in place, to meet people's individual needs and ensure their welfare and safety.

Effective systems were also not in place to monitor all aspects of the quality of the service, and to identify and manage all risks relating to people's welfare and safety. This did not ensure that the service was well managed.

Some people had limited communication. People able to express their views said they were happy with the care they received, and felt that their needs were being met. They also said that they liked the staff that supported them.

Relatives told us they were generally happy with the care their family member received. One relative said 'the staff are excellent; they provide personal care and treat people with respect''. Another relative told us 'the staff are lovely; they really care and can't do enough for people''.

People generally experienced care and support that met their needs, although priority needs to be given to establishing appropriate social activities to meet their needs.

Comments regarding the food were mixed. People were supported to have sufficient to eat and drink but they were not always offered a suitable choice of food, which reflected their preferences and needs.

People's medicines were handled safely and they received them at the times they needed them, although aspects of the recording of medicines did not ensure they were managed appropriately.

Procedures were in place for managing complaints about the service. People said that they felt listened to, and able to raise concerns if they were unhappy with the service.

Effective systems were not in place to monitor the quality of the service to identify and manage all risks relating to people's welfare and safety.

At our visit of 18 December 2012, although the people we spoke to had limited verbal communication they were all able to indicate that they liked living at Oliver House.

During this visit we found the provider had put systems in place to minimise the risk to people's safety. The provider had installed thermostatic valve controls on people's bedroom sinks to regulate the hot water temperature. The provider had disabled the deadlocks on people's bedroom doors.

We found care plans had been signed by the staff member completing them.

We found people's privacy, dignity and independence were respected. Relatives of people who use the service told us they were fully involved in discussions about their needs and care of their family member.

We found there was a good level of communication and contact between staff and people using the service. Care and daily routines were centred around people's individual needs and preferences. A relative told us the 'staff are impressive.' Although care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare, we found some important risk assessments had not been completed.

We found there were effective systems in place to reduce the risk and spread of infection.

We found that there were enough appropriately trained, skilled and experienced staff to meet people's needs. We saw that staff had received relevant training for their job. We found staff were supported in their work and were confident that they were able to provide the care required.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained. We found the provider had clear and effective systems in place relating to record keeping.