Otterbourne Grange Residential Care Home

Updated 23 July 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by two inspectors.

Service and service type

Otterbourne Grange Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service did not have a manager registered with the Care Quality Commission. A registered manager and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. The provider was recruiting a manager and had appointed an acting manager to oversee the service with support from the operations director.

Notice of inspection

We gave a short period notice of the inspection because we were mindful that there was no registered manager in place, and we wanted to ensure the provider could support the service during the inspection.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.

During the inspection

We spoke with six people using the service. As some people were not able to share their experience of using the service with us, we also spent time observing interactions between people and staff. We spoke with six members of staff, including care workers, a senior care worker, a chef, the operations director and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We spoke with a health professional who regularly visits the service. We reviewed a range of records. This included five people’s care records and multiple medicines records. We looked at staff files in relation to recruitment, training and supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at further training data, quality assurance records and care records. We sought feedback from six relatives and five members of staff.

Updated 23 July 2021

About the service

Otterbourne Grange Residential Care Home is a residential care home providing personal and nursing care to 22 people at the time of the inspection. The service can support up to 25 people under and over the age of 65, some of whom may be living with dementia.

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

We found several concerns regarding the standard of cleaning and were therefore not assured that people were protected from risks associated with poor cleanliness. Since our visit, a deep clean of the service has been carried out. We were assured about other areas of infection control.

In line with recommendations in a fire risk assessment completed in March 2021, the provider had installed a break glass case with padlock key next to the dining room and lounge doors. This was to ensure that they could be used as an escape route in an emergency; however, we were not assured that all staff were fully aware of those evacuation procedures. The provider has since taken additional precautions and made all staff aware.

Health and safety checks were completed consistently to ensure the safety of the environment.

We received feedback that staffing levels had been low; however, the provider was addressing this concern and improvements had been made. Staff were recruited safely, and we observed staff supporting people in a kind and attentive way. Staff received a range of training and had access to group and individual supervisions.

We identified that in one case, staff were not working in line with best practice guidance when administering a person’s medicines, which could have put the person at risk. The provider took immediate action to review the practice and ensure that the person received their medicines safely. Overall, medicines management systems were robust, and we were assured that people received the right medicines at the right time from staff who had received appropriate training.

People mostly had detailed and person-centred care plans in place, which also addressed any risks identified. The provider had identified that not all care plans were fully up to date, and a quality assurance manager had been appointed whose initial focus was to review these.

We observed people enjoying a comfortable mealtime with food and drinks of their choice. Staff supported people in line with their requirements and in a dignified way.

People’s relatives told us that communication with them needed to be improved and they were not always involved in planning their relatives’ care.

The nominated individual and operations director had started working with the home in March 2021 and had implemented robust quality assurance systems. The leadership team was committed to driving improvements to the service and had detailed action plans in place to facilitate this.

Staff told us that they had previously not felt listened to and that their concerns had not been acted upon. However, we received positive feedback about the current leadership team. Staff told us that they could see succesful changes being implemented in the home and felt their concerns were now being addressed.

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

At the last comprehensive inspection (published 24 August 2019), the rating for this service was requires improvement and multiple breaches of regulation were identified. The provider completed an action plan after the last inspection to show what they would do and by when to improve. A targeted inspection was later carried out and the last rating for this service was requires improvement (published 17 December 2019). At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 04 June 2019. Breaches of legal requirements were found in relation to safeguarding service users from abuse and improper treatment, good governance, employing fit and proper persons and safe care and treatment.

A targeted inspection took place on 05 November 2019 to check whether the Warning Notice we previously served in relation to regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met on a specific concern we had about the provider not ensuring that risks to people were appropriate assessed, or plans developed to mitigate the risks and professional guidance being followed. At that inspection, enough improvement had been made and the provider was no longer in breach of regulation 12. Other key questions and breaches of regulation were not assessed at that inspection.

We undertook this focused inspection to check the provider had followed their action plan to improve safeguarding service users from abuse and improper treatment, good governance and employing fit and proper persons, and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this 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 last comprehensive inspection, by selecting the ‘all reports’ link for Otterbourne Grange Residential Care Home 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.