Olive House

Olive House is a residential care home providing personal care to older people, some were living with dementia. The service can support up to 45 people and 40 people were resident when we visited. Olive House is a purpose-built single storey care home, all bedrooms had en-suite bathrooms. There is one main dining room and several lounge areas. There is access to safe outside space.

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

People were living in a purpose-built care home that was well designed for access, but was in need of upgrade. There were plans in place to address this. Cleanliness was evident with good systems in place to prevent infections. This will further be enhanced by the developments planned for the laundry.

Care planning had improved, however there was a need for consistency in care plans when reviewed. The system used required several paper sections to be updated when needs had changed. This will not be an issue once the transfer to electronic recording is complete.

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 told us they were happy at Olive House and felt well cared for. People received prescribed medication safely. There were sufficient, suitably recruited staff that knew people well.

A new manager had recently been appointed. There were effective systems in place to monitor, respond and drive improvements within Olive House. People were involved and listened to.

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

Rating at last inspection and update

The last rating for this service was requires improvement. [Published 19 November 2019]

At our last inspection we found breaches of the regulations in relation to people having unmet needs from staff, infection prevention and control and management oversight. The provider completed an action plan after the last inspection to tell us what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was now meeting this regulation.

Why we inspected

We carried out this inspection 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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Olive House is a residential care home providing personal care to 32 people aged 65 and over at the time of the inspection. Some people living in the home were living with dementia. The service can support up to 45 people. Olive House is a purpose-built single storey care home, all bedrooms had en-suite bathrooms. There was one main dining room and several lounge areas.

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

Staff, including the registered manager, had not adhered to restrictions on social gatherings. This had placed people at greater risk of COVID-19. Some environmental risks were identified during the inspection. The provider took immediate action to address these at the time. We provided some advice and guidance on other infection control processes which related to audits and cleaning records.

People were supported by enough staff. Systems were in place to ensure staffing levels met people’s needs. Risks to people relating to food, fluid, and pressure care were assessed and responded to.

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 19 November 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

The inspection was prompted in part due to concerns received about pressure care, hydration, staffing levels and infection control. A decision was made for us to inspect and examine those risks.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We have found evidence that the provider needs to make improvements. Please see the safe sections of this report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to infection control at this inspection.

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.

Olive House is a residential care home providing personal care to 41 people aged 65 and over at the time of the inspection. Some people living in the home were living with dementia. The service can support up to 45 people. Olive House is a purpose-built single storey care home, all bedrooms had en-suite bathrooms. There was one main dining room and several lounge areas.

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

A task focused culture and staffing issues impacted on the ability of staff to provide support in a way that recognised and met people’s individual needs and preferences. This included in some instances the support provided to people to engage in activities. A lack of truly collaborative care planning with people, and those involved in their lives, meant that care plans did not fully reflect people’s needs.

People’s care and support was monitored through established systems. However, these systems had not always identified all the issues found at this inspection, including issues relating to staff culture. When areas for improvement had been identified these had not always been used to drive forward the improvements required.

Risks to people were not always correctly identified or assessed. Robust actions had not always been taken to mitigate identified risks to people, however this had a limited impact from this on people’s safety and no one had come to any harm as a result. People did not always receive support from enough staff. There were periods where people were left in communal areas without staff support readily on hand. People, relatives, and staff shared some concerns with us regarding insufficient staffing levels in the service. The general environment was clean and tidy, however we noted areas of malodour throughout the service. The provider was carrying out some refurbishment to the service, this had included replacing stained and dated carpets. Systems were in place to safeguard people from the risk of abuse, in most instances these had operated effectively. People received their medicines as prescribed.

People’s needs were assessed prior to using the service, although we identified some gaps in preadmission assessments. People’s care plans did not always show that best practice guidance had been considered and implemented in relation to identified needs. There was mixed feedback on how well people were supported to stay hydrated. People spoke positively about the food on offer and their feedback regarding the menu was sought. However, we identified some improvements needed to people’s meal time experience. People’s health needs were not always well supported due to poor communication within the service. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. There was mixed feedback regarding staff knowledge and competence.

People’s dignity and independence was compromised by a task focused staff culture and staffing issues. People were not always well supported with their personal care which impacted on their dignity. People were not always provided with the support they needed to maintain or improve their independence. The task focused culture and staffing levels also impacted on the time staff took to fully listen to and involve people in the care and support provided to them.

People were supported by staff who were well intentioned and kind in their individual interactions. A system was in place to provide people with an opportunity to discuss their care. People and relatives told us they felt able to discuss any concerns with the registered manger and that these would be responded to. The management team were open, honest, and keen to make improvements to the service so that people provided good quality care. The registered manager engaged in learning and development. They had already identified some issues within the service and were taking action to make the improvements required. The management team were open to issues raised during the inspection and took prompt action to start to address issues identified.

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 8 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to person centred care and good 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 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 service was safe; staff understood their responsibilities to protect people from harm or abuse and had received training. People received their medicines as prescribed. Safe recruitment processes were in place which contributed to protecting people from harm.

There were enough staff to keep people safe, and the service had recently recruited more staff so that there would be less use of agency staff and improve consistency for people living in the home.

There were effective processes in place to minimise risks to people. Assessments had taken place regarding people’s individual risks and clear guidance was in place for staff to follow in order to reduce them. However, improvements were needed to the consistent recording of supporting people to change position when they were at risk of pressure ulcers.

Staff knew the people they cared for and understood how to meet their needs. People planned their care with staff and relatives, and a variety of activities were carried out in line with people’s preferences. There were close links with the local community to encourage people to participate in events which were carried out with the local church or school.

Staff understood the importance of gaining people’s consent to the care they were providing to enable people to be cared for in the way they wished. Staff were able to explain how they promoted choice where people had variable capacity. The home complied with the requirements of the Mental Capacity Act 2005 (MCA).

People were supported to access healthcare wherever necessary and in a timely manner, with prompt action taken in response to changes to a person’s health needs. People’s hydration needs were met by the service. Drinks were available throughout the day.

We inspected Olive House on 7 March 2016, and we found that the quality of the food required improvement. People’s nutrition needs were met in line with recommendations such as speech and language therapy, however the food was not always to everybody’s taste and adequate choice was not always available. It had not been improved significantly.

Staff were kind and they had meaningful interactions with people. Feedback from people and their relatives about the care they received was complimentary. Staff respected people’s privacy and dignity.

The quality assurance systems in place had identified shortfalls and the registered manager was working with the management team and quality monitoring staff from the organisation to improve these areas.

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 registered manager was absent on the day of our inspection.

The service was safe; staff understood their responsibilities to protect people from harm or abuse and had received appropriate training. Staff were confident in reporting incidents and accidents should they occur.

Staff understood the importance of providing a high standard of care to the people living in the service. Staff felt that there was good teamwork within the service, although at times felt that they were rushed as staffing levels were variable.

There were effective processes in place to minimise risk. Assessments had taken place regarding people’s individual risks and clear guidance was in place for staff to follow in order to reduce the risks.

Staff had good knowledge about the people they cared for and understood how to meet their needs. People planned their care with staff and relatives, and activities were carried out in line with people’s preferences.

Robust recruitment processes were in place to ensure that staff employed in the service were suitable for the role. People were safely supported with medicines administration by senior staff.

Staff understood the importance of gaining people’s consent to the care they were providing to enable people to be cared for in the way they wished. Some people had applications in for the lawful deprivation of their liberty (Deprivation of Liberty Safeguards (DoLS)) and staff were able to explain how they promoted choice where people had variable capacity. The home complied with the requirements of the Mental Capacity Act 2005 (MCA).

People were supported to access healthcare wherever necessary and in a timely manner, with prompt action taken in response to changes to a person’s health needs. People’s nutrition needs were met in line with recommendations made by professionals such as speech and language therapists, however people told us that the food was of poor quality. Whilst there were quality assurance systems in place, they had not picked up the problems we found with the food.

Staff were kind and they had meaningful interactions with people. Feedback from people and their relatives about the care they received was complimentary. Staff respected people’s privacy and dignity.

We spoke with five people who used the service. People we spoke with were complimentary about the care and support they received. One person told us, “There are good facilities here and staff are caring and supportive”.

We spoke with three staff who expressed confidence in the newly appointed homes manager and told us they were optimistic for the future. They felt there had been a noticeable difference with positive changes made to improve the quality of care provided to people who used the service.

People told us that staff listened to what they had to say. One person told us, "I had a few complaints and when I spoke to the manager he sorted things out straight away."

We found care records were not being audited and reviewed and did not contain accurate up to date information. This meant that people were at risk of receiving care and treatment that was inappropriate or unsafe.