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.