We carried out a review of the data available to us about Overleat Residential Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Overleat Residential Care Home, you can give feedback on this service.
Overleat Residential Care Home (known as Overleat) is a residential care home in Kingsbridge providing care to a maximum of 13 older people some of whom may be living with dementia.
People’s experience of using the service
People using the service benefitted from caring staff. People and their relatives told us they were treated with kindness, compassion and respect.
People were placed at the heart of the service and involved in decisions as far as possible. People and staff told us they were listened to and care was individualised.
People’s care was provided safely. The staff team were consistent, staff knew people well and staff supported people to move safely around the service. People’s risks were known and managed well, promoting independence as far as possible. People were protected from discrimination because staff knew how to safeguard people.
People lived in a service which had a positive culture and was led by a dedicated manager. Overleat had good relationships with local healthcare professionals supporting people’s care.
Rating at last inspection:
At the last inspection the service was rated as Requires Improvement (The last report was published 16 April 2018). At this inspection the overall rating had improved.
Why we inspected:
This was a planned inspection to look at improvements the service had made following the previous rating. At this inspection we found improvements had been made. People’s risks relating to their health needs and the environment were known and care planned. People’s human rights were protected because the provider followed the laws in place to protect people. People’s views were taken into account. People who wished to be active were supported with social activities. The leadership at the service had improved their monitoring of the service to ensure the quality and safety of people.
Follow up:
We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned based on the rating. If we receive any concerns we may bring our inspection forward.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
The team inspected Overleat against three of the five questions we ask about services: is the service safe, is the service effective, is the service well led? This is because we had received some concerns relating to these questions and we identified some concerns during our inspection. No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.
Overleat Residential Care Home, referred to in this report as Overleat, is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Overleat is registered to accommodate up to 13 people in one adapted building. Nursing care is not provided by staff at Overleat. This is provided by the community nursing service. At the time of this inspection in February and March 2018 there were 12 people living in the home.
The home had 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.
People living in Overleat were not always safe. Although we saw a number of good examples of risks to people being managed, we also identified instances where risks had been identified but management plans had not been put in place to protect people. For example, where one person had been identified as being at risk due to their having diabetes, staff had not been provided with any information relating to their acceptable blood sugar ranges, how to identify when the person’s sugars may be too low or too high or what action to take. We also found a lack of management plans in relation to risks posed by people’s behaviours.
We found people were at risk with regards to their environment. During our inspection we found a steep staircase unsecured on two occasions which could have posed a risk to the person whose bedroom was at the top of the stairs and who was mobile. We also found a radiator in the lounge which did not have a protective guard around it and could have placed people at risk of burns.
Although staff had received training in safeguarding adults and had access to relevant information, we found people were not always safeguarded from abuse. This was due to an allegation not having been properly investigated and recorded in line with the home’s safeguarding policy and best practice.
The five principles of the MCA include that all individuals are presumed to have capacity; an action taken on behalf of a person must be in their best interests and regard must be had as to whether an act or decision is the least restrictive of a person's rights and freedoms. These principles had not always been followed with regards to people who may lack capacity to make certain decisions. For instance, the registered manager had applied for some people to have their liberties restricted under the Deprivation of Liberty Safeguards without first conducting an assessment to ensure those people were unable to make the decisions for themselves.
Staff did not receive regular supervision, appraisal or access to staff meetings. Staff views were not regularly sought in order to improve the service. People’s views and relatives’ views were not sought in ways that met their communication needs and therefore the registered manager was unaware of a number of issues people shared with us during our inspection.
The systems and processes in place to monitor the safety and quality of care had not been effective in identifying the concerns we found during this inspection.
We found people’s social needs were not always being met as they did not have access to sufficient activities to meet their individual needs.
People spoke highly of the food served at Overleat and we observed people being supported to eat their meals in a caring and compassionate way.
There were sufficient staff to meet people’s needs and during our inspection we observed staff responding to call bells quickly and meeting people’s needs in an unhurried and pleasant manner.
We found the home operated safe medicine management practices and had thorough recruitment practices which ensured, as far as possible, that suitable staff were employed.
The provider and the registered manager were very receptive to our feedback and following the inspection they worked hard towards implementing improvements. They took a number of actions to improve the service and have sought further advice.
We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to people not always being protected from harm, people’s rights under the MCA not being protected, people’s care not always meeting their needs, staff not being supported and ineffective quality assurance processes. You can see what action we told the provider to take at the back of the full version of the report.
Overleat is registered to provide accommodation with care and support for up to 13 older people. On the day of the inspection there were 10 people living there. Nursing care is not provided by staff at Overleat. This is provided by the community nursing service.
A registered manager was employed by the service. 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 robust staff recruitment process had not been followed for one member of staff. However, the registered manager and provider rectified this immediately. Systems were in place to support staff and ensure they received the training and support they needed to do their job effectively. We saw, and people told us they had built positive relationships with staff. People’s privacy and dignity was respected, and their independence was encouraged as far as people were able. This included supporting people to eat, move and take part in activities as independently as possible.
People were supported by kind and caring staff and we received many positive comments from people and their visitors. One person said “They are all very sweet here, very kind, couldn’t say anything bad about them.” Another person told us they were “Perfectly happy, well looked after and spoilt.” Comments from relatives included “Very caring”, “Staff are very good and very patient”, “They [staff] are excellent”, “The things they [staff] do for mum go above and beyond” and “Staff are marvellous, 10 out of 10”. People were supported by suitable numbers of well trained and skilled staff.
People received safe care in an environment that was regularly reviewed and any actions needed were addressed. For example, the lighting in the lounge had been renewed. Risks to people’s health and well-being were assessed and minimised. Risks assessed included mobility, moving and transferring, nutrition, and pressure area care. These were regularly updated and specialists, such as dieticians contacted when needed. People received their medicines safely, although record keeping needed improvement.
People were protected from the risks of abuse because staff understood how to identify and report any concerns they may have. Systems were in place for the management of complaints and concerns. While we were told no-one had ever had to make a complaint they were confident it would be addressed if they did.
People‘s rights regarding capacity to make decisions and consent were understood and supported by staff. Throughout the inspection we heard people being offered choices. People and their relatives were supported to take part in planning their care if they wished. We saw people received person- centred care as detailed in their care plans. A variety of activities were on offer and we saw people enjoying a word game. One person told us how staff supported them to follow their interest in gardening by planting flower pots.
People received a well-balanced and nutritious diet with special dietary needs catered for. Meals were home cooked and people told us how much they enjoyed their food. Where one person was at risk of poor nutrition staff had taken advice from a dietician to support them to gain weight.
The service was being well managed and run. The registered manager and provider had put in place systems and audits to ensure good standards were maintained. The registered manager was working towards a management qualification and regularly updated their practice and knowledge. The registered manager and provider conducted a monthly audit of the environment and the care provided. People and their relatives were regularly asked for their views about the service. Staff told us they felt well supported by the registered manager and one told us “She’s the best we have had in a long time.” One relative told us “She [registered manager] is an angel”.
Records were well maintained, and appropriate notifications had been made to the Care Quality Commission as required by law.
We have made a recommendation in relation to the service’s recruitment policy.
This unannounced inspection took place on 14 and 15 March 2016 when there were 12 people living at the home. The service was last inspected 4 August 2015 when it was rated as ‘Requires improvement’. This was because we found there was no robust recruitment procedure in place, there was no system to assess the quality of care provided, there were not always enough staff on duty and people did not receive personalised care. At this inspection in March 2016 we found that improvements had been made in all areas. However, some improvements still needed to be made.
There has been no manager registered at the service since December 2014. 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. It is a condition of the registration of the service that a manager is registered. We were told that the acting manager who had been at the home at our last visit had left before they had registered. At this inspection in March 2016 a new manager had been appointed and the provider told us they planned to register that person as manager. Since the inspection an application to register the manager has been received by CQC.
There were effective quality assurance systems in place to monitor care. However, not enough time had passed for some of these changes to be fully embedded into practice and recent improvements needed to be sustained.
Opportunities for social interaction had increased but improvements needed to be made with regard to the provision of activities. Staff told us they had time to spend with people on an individual basis as well as playing word games and puzzles in a group. During the inspection we saw and heard staff chatting to people while looking at books.
People’s needs were met in a safe and timely way as there were enough staff available. One person told us “Staff are very helpful, if you want something, just ring the bell and they don’t take long to come”. Staff told us and records confirmed that they had received training that helped them meet people’s needs. Training had included food hygiene, safeguarding adults, moving and transferring and infection prevention and control. Staff had also received more specific training relating to people’s needs. For example, pressure area care, prevention of falls and dementia awareness.
People told us staff were kind and caring. One person said “Staff are terrific – this is a happy place with lots of laughter”. Staff ensured people’s privacy and dignity was respected and all personal care was provided in private. Staff ensured people received care and support that was responsive to their needs. One person told us that staff always gave them the care they needed and always asked if they were doing the right thing. They told us the staff were “Very good and sweet”.
People’s care plans contained details of how their needs were to be met. People and their relatives could be involved in making decisions about care provided by staff, if they chose. One person told us they had been involved in planning and reviewing their care. Some care plans contained signatures of the person’s representative indicating they were happy with the care provided.
People’s human rights were upheld because staff displayed a good understanding of the principles of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards (DoLS). People were offered choices in all aspects of their lives.
Staff ensured people’s health care needs were addressed and there were effective systems in place to manage people's medicines. People were supported to maintain a healthy balanced diet. People told us they enjoyed the food and there was always an alternative if they did not want what was on the menu. One person told us the food was very good “especially the selection of vegetables – all nicely cooked”.
Thorough recruitment procedures ensured the risks of employing unsuitable staff were minimised. People were protected from the risks of abuse as staff knew how to recognise and report abuse.
People told us the acting manager was supportive, open and approachable. Staff and people living at the home praised the acting manager for the support they gave and the changes they had made. One staff member said the acting manager was “Very approachable and on the side of everyone. I would trust them with anything”. Another staff member said things had changed for the better and “[acting manager] has done a lot in the few months they have been here”.
Records were well maintained and people’s personal care records recorded the care provided. All records we asked for were kept securely but easily accessible.
We have made recommendations in relation to monitoring staffing levels and the provision of meaningful activities.
Overleat Residential Care Home is registered to provide accommodation for persons who require nursing or personal care for up to 13 older people who are living with dementia. People living at the home were in the early stages of dementia. Nursing care is not provided by the home, the local community nursing team provide this service.
This unannounced inspection took place on 4 August 2015 when there were nine people living at the home. The service was last inspected in July 2013 and was meeting the requirements at that time.
There was no manager registered at the service. 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. The manager who had been registered at the home had last worked there in October 2014. A manager was employed and worked until 31 July 2015. They did not register with the CQC. A new manager had been appointed but had not yet applied to be registered.
Prior to this inspection we received concerns that staff were working at the home without satisfactory criminal records checks having been received. We found that staff were working at the home who had not had the required recruitment checks completed. We were also told that one member of staff had been heard shouting at people living at the home. Staff from the local authority visited the home prior to this inspection to look into the concerns about people being shouted at. They found no evidence to support the allegation that people were being shouted at, but did have concerns about staffing levels and the care records. We discussed the issue of staff shouting at people with the manager who had previously worked as care staff. They told us they had never had any concerns about other care staff and no-one living at the home had ever reported any concerns to them. Following our inspection staff from the local authority’s quality team began working with the new manager to address the issues identified.
There were no effective quality monitoring systems in place. No audits had been undertaken in relation to medicines or accidents. Records relating to people’s care were not well organised or reviewed appropriately. A number of records were not accurate or kept up-to-date. This included care plans and risk assessments. People had not been involved in developing the service and had not been asked for their opinions on the quality of care provided.
Staffing levels were not sufficient to meet people’s needs at all times and staff recruitment systems were not robust. There was no system to identify when staff training updates would be required. We discussed these matters with the registered provider and the manager. The registered provider told us they had “taken their eye off the ball” and had thought the previous manager was addressing the issues.
People were not protected in the event of an emergency. Information on how to safely evacuate people from the building was not available. Information relating to the maintenance of the fire protection system was not available. It was not possible to check if the system had been correctly maintained or any routine checks carried out. Following this inspection we asked the fire service to visit the service and give their advice. The registered provider has since told us the fire service had visited and made some recommendations, which the registered provider was addressing.
Records in relation to risk assessment and management were incomplete. For example, one person who had been recently admitted had limited mobility and independently used a wheelchair. No risk assessments had been completed in relation to moving and transferring, pressure area care or independently accessing the community. However, the person told us staff were aware of their needs in relation to pressure area care and how to ensure transferred safely. They were also aware of the risks presented by accessing the community and went into the town most days on their own or with friends.
People’s needs were met, but this did not always happen in a timely manner as there were insufficient staff on duty at times. At the time of this inspection there were nine people living at the home. Two people spent all their time in bed. Four people required two staff to help them with personal care or moving and transferring. Rotas showed there were two care staff on duty plus the manager on duty during the week. At weekends when the manager did not work, there were only two care staff on duty. Staff told us that they were able to meet people’s personal care needs, but had to prioritise things in order to do so. They told us that there had been a shortage of staff, but that new staff were due to be employed. Prior to us finishing the inspection the registered provider agreed to ensure there would be three care staff on duty when the manager was not working at the home.
Records relating to people’s nutritional intake were not robust. Where people had been identified as being at risk from malnutrition and dehydration food and fluid charts were used to monitor the person’s intake. However, these were not being completed fully or in accordance with the plan of care. However, people were supported to maintain a healthy balanced diet. People praised the standard of food provided and told us “the food is very good...well cooked” and “the food is delicious....very nicely cooked....you get three veg per meal”.
The environment needed updating and tidying and was not entirely suitable for people living with dementia. Bedroom doors had no identification by colour or numbers to enable people easily find their own rooms. There were few signs indicating where toilets were located and there was no calendar or clock to help people orientate themselves to the date and time. There was limited access to outside space as people could not safely leave the home without staff support. The driveway was uneven and open to the road. The rear access was uneven and there were building materials around the area. There were some seats at the front of the property, but people could not access this without the support of staff.
Staff did not receive support and supervision to enable them to effectively care for people living at the home. Two staff that we spoke with told us they had never received any supervision from the manager or registered provider. None of the four staff files we looked at contained evidence of supervision or appraisal.
Staff had not received training in relation to the Mental Capacity Act 2005 or the associated Deprivation of Liberty Safeguards. Some people were living with dementia and there was doubt as to whether they had the capacity to make some decisions. We did not see any evidence that decisions were being made that were not in the person’s interest and saw throughout the inspection staff offering people choices and options. However, where people need to make some decisions, an assessment of their capacity to make a specific decision must be made, and records should demonstrate that where decisions are made on behalf of people, they are made in their best interests with the involvement of others. Staff were not doing this at Overleat.
People told us they felt staff were caring. Comments included, “Very good here they look after you...they care for you and are kind to me”.
Records in relation to the care and support people should receive were confusing and information was not easily accessible. Although people told us staff knew their personal care needs, there was no recorded evidence people had been supported to say how they wanted to receive their care. The manager told us they were planning to start using a new care planning system and some people had a ‘new’ style plan. However, they had not been fully completed and reviewed.
Staff were aware of people’s preferences and arrangements had been made to ensure they were respected. For example, a member of staff who would have been ‘sleeping’ stayed on full waking duty to enable one person to go to bed at the time they preferred. One person had been able to bring their pet with them when they moved in.
People did not benefit from individual activity plans to ensure they had meaningful activities to promote their wellbeing. Information about the person’s life, the work they had done, and their interests was limited so could not be used to develop individual ways of stimulating and occupying people. There were no games, books or puzzles around that people could take advantage of. Although there was no regular programme for social interaction staff told us they did spend some time with people. One staff member told us “I like to just sit with them....at the weekends I do this...I bring in a selection of films and residents choose. There is a piano player booked sometimes”.
There was no evidence that the service listened and learned from people’s concerns and complaints. The manager did not know if there had been any recent complaints and there was no complaints file. However, people told us they knew how to raise a concern if they needed to.
People were protected from the risks of abuse. Staff demonstrated a good knowledge of different types of abuse. They told us how they would recognise abuse, and what they would do if they suspected abuse was occurring within the service. People told us they felt safe and one said “staff are not rude, cruel or unkind to me”.
Medicines were stored safely and records were kept for medicines received and disposed of. Medication Administration Record (MAR) sheets confirmed oral medicines had been administered as prescribed. Arrangements for the application of topical creams ensured people received them as prescribed. For example, records contained a body map that indicated where the cream should be applied.
There was evidence that staff had received training in a variety of subjects including fire procedures, safeguarding people , health and safety and caring for people living with dementia. Although there was a system that showed when staff had received training, there was no way to identify when updates would be required.
People were supported to receive care from a number of visiting healthcare professionals. Care notes indicated people had received visits from GPs, community nurses and dentists. One visiting health care professional told us they felt people’s health care needs were well met.
They was much chatter and laughter with staff and people sharing stories about their past. Staff knew people well, what their needs were and how people liked their needs to be met. People’s privacy was respected and all personal care was provided in private. One person told us that when staff helped them with their bath, staff respected their dignity.
The visitor we spoke with told us that they could visit at any time, were always made welcome and sometimes had meals with their relative. They also told us staff discussed their relatives care with them and were always informed about any changes to their relative’s health and welfare. One person told us “my visitors are made very welcome”.
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 this report.
We found that people’s needs were assessed and care and treatment was delivered well and with kindness. We looked at three care plans. We found that these contained pre-admission information which assisted care workers, such as information about on-going medical needs or recent changes in medication. We saw risk assessments were in place and improvements had been made since the last inspection. However records were not completely up to date. Peoples’ needs were not recorded fully.
At the last inspection we found that mandatory staff training was out of date which meant that staff did not always have the skills to look after people properly. At this inspection we saw that all staff had receiving updated training.
We saw systems in place which were effective in monitoring the quality of the service and managing risk.
Many people who lived at this home had dementia. We saw that people were relaxed in the company of staff. One person told us "they are very nice here." We found that although people liked living at the home and looked well cared for, some of their needs were not met adequately. People did not benefit from meaningful daytime activity that met their individual needs.There were not adequate arrangements in place to deal with foreseeable emergencies.
Medication sytems were managed effectively.
The home was clean and tidy.
We found that mandatory staff training was out of date which meant that staff did not always have the skills to look after people properly.
Systems in place were not effective in monitoring the quality of the service and managing risk.
People living at Overleat felt that this was their home. One person said “I am happy here they are lovely”.
The home has planning permission pending to extend and improve the whole home. Some redecoration including new carpets and curtains had taken place in individual bedrooms. However other areas looked tired needing maintenance and redecoration.
Not all areas of the home were clean.
The home has planning permission pending to extend and improve the whole home. Some redecoration including new carpets and curtains has taken place in individual bedrooms other areas looked tired needing maintenance and redecoration.
People living at the home, their relatives and staff had opportunities to feedback their views about the service, systems were in place to regularly monitor and assess the quality of the service.