Olive Tree House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People told us they felt safe at Olive Tree House and were encouraged to understand risks that may affect them. People’s capacity was assessed, and their decisions were respected whilst managing risks. Staff acted sensitively to protect people, respect their dignity and keep them safe. Staff received training about safeguarding and the management team took appropriate action when there were concerns or incidents. Staff were competent to safely support people with specialist tasks such as eating and drinking and moving people safely. Some risks were not adequately documented in care records which meant there was a lack of clear guidance for staff to follow to manage risks. Some care plans had not been regularly reviewed and others needed more personalised information. We highlighted this with the registered manager, and action was taken to improve records immediately after our visit. We did not find any evidence that people had been harmed, but this was a breach of Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There were appropriate staffing levels and skill mix to make sure people received consistently safe, good quality care that was person centred. The manager monitored staffing levels and altered these as and when people’s needs changed. Safe recruitment processes were in place to ensure staff were suitable to work at the service.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Incidents and concerns were addressed and reported to the appropriate professionals when required. Records showed actions were taken and lessons shared with staff to improve practice when necessary. Policies and procedures were available to guide staff about how to protect people from the risks of abuse or harm. Safeguarding materials were displayed in the staff room and reception area. People’s capacity to make decisions was assessed and efforts made to ensure decisions were in the individual’s best interests. Assessments were discussed with other relevant parties and outcomes recorded. If needed, appropriate legal authorisations were in place to restrict people. The manager had oversight of Deprivation of Liberty Safeguards (DoLS) authorisations and monitored these to ensure they remained up to date and proportionate for each individual.

People looked relaxed and comfortable with the staff who supported them. They told us they felt safe living at Olive Tree House. Comments from people included, “I don’t think anything can happen to you here” and “Yes, I’m safe. I’m fine. I don’t ask for much.” Relatives told us they felt confident their family members were kept safe. One relative said, “Absolutely” in response to our question, but another added “Some of the younger [staff] don’t seem to have the skills to do some things.”

Staff were motivated to make sure people felt safe living at Olive Tree House. They did not have any concerns about people’s safety. Staff received training about how to recognise and respond to safeguarding concerns. A deputy manager had recently completed an advanced safeguarding course to enhance the skills and competency of the team. The staff we asked demonstrated an understanding of safeguarding and their responsibility to report any concerns. One staff member said, “We have regular training and refresher training each year for safeguarding and I would report concerns to my manager, who would carry out an investigation.” The management team were aware of their responsibilities and made appropriate safeguarding referrals when there were concerns or incidents.

The provider had systems to assess risks to people. However, we found examples where risks had not been sufficiently documented which meant there was a lack of clear guidance for staff to follow to manage risks. For example, one person experienced seizures, but there was insufficient written guidance available and no risk assessment in place for staff to know how to support them in the event of a seizure. This was rectified immediately after our visit to the service. We found other examples where risks were not fully assessed and documented in people’s care plans and risk assessments. For example, assessments of falls, catheter care, pressure sore and diabetes management. Some parts of care plans had not been reviewed monthly in line with the provider’s policy. We found some care plans and risk assessments lacked personalised details. The registered manager told us they had adopted a new care planning system in June 2023, but there had been challenges which had not all been resolved. We did not find any evidence that people had been harmed, but this was the shortfall which led to the breach of regulation described in the key question commentary above. Despite the concerns above, other records shared with us showed a positive, person centred approach to the management of people’s risks. Following the inspection site visit, the provider promptly audited people’s care plans and risk assessments. During the assessment process, we were sent evidence that the service had updated all care records. We were also sent evidence of changes which had been made to the ongoing monitoring of records to ensure these improvements were maintained.

The environment was safe, and we saw staff supporting people safely when we visited the service. Staff knew people well and we observed positive interactions with people. Our observations did not raise concerns about the management of people’s risks. Some staff told us they did not usually work on the unit they were currently working on. This meant they did not know people so well. During our visit, we saw how staff supported people to reduce identified risks relating to eating and drinking. People received differing consistencies of food in line with their assessed requirements. Staff supported people as required and encouraged individuals to maintain their independence in this area. Staff had been trained in moving and handling and we saw people being assisted to move safely using specialist equipment.

People were encouraged to understand risks that may affect them and were supported to stay safe. Professionals felt staff balanced individual risks and choices well to meet safely people’s needs. When possible, people were involved in risk assessments and decisions. People’s capacity was considered, and their decisions respected. Where necessary, relatives or other representatives were involved in decision making in the person’s best interests. This meant there was a balanced and proportionate approach to risk.

Staff usually knew people well and understood the risks people faced. One staff member told us, “I have had training on dementia, capacity and deprivation of liberty, alongside training dealing with challenging behaviours. We know the residents well and are able to use different distraction techniques.” Staff encouraged people to make choices to reduce risks and stay safe. Staff displayed knowledge and skills to protect people safely without being unnecessarily restrictive. They knew the communication or actions of some people could impact on their own safety or that of other people. Staff acted sensitively to protect people, respect their dignity and keep them safe. Most staff told us people’s risk assessments contained enough up to date information to support people safely. They added that useful updates were shared at a daily handover meeting. One staff member said, “Some people’s care plans need to be upgraded.” Staff understood their responsibilities to report accidents, incidents, or concerns.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

The manager monitored staffing levels and altered these as and when people’s needs changed. Staff were recruited safely by the provider, and all relevant checks were carried out before new staff started working at the service. This included criminal record and employment checks to confirm staff were suitable to care for people. Systems and processes were in place to monitor and ensure training and supervision were up to date and supported best practice.

People did not have to wait long when they needed help. Staff did not seem rushed and had had time to speak with people or engage in brief activities while going about daily tasks. We looked at the staffing dependency tool and rotas, observed staff and spoke with people, relatives and staff. Staffing levels we saw were in line with those deemed safe by the provider. There were sufficient staff available to meet people’s needs. Staff knew people well and appeared competent. The registered manager and deputies maintained a visible presence within the service to monitor interactions and make improvements where necessary. They carried out regular documented ‘walkabouts’. These included observations of staff interactions with people living at the service.

Most people we spoke with confirmed there were enough staff to support people. Comments included, “They have quite a bit of staff” and “I think there are enough staff.” However, one person said, “They have got no staff. There are not enough night or day.” We received mixed views about staffing levels from family members. Relatives generally felt the staff were kind and did their best, but several felt there were not enough staff on each shift, and that this was particularly noticeable at weekends. However, one relative told us, “There always seem to be staff around and they respond quickly, including weekends.” Some people and relatives thought there had been a lot of staff changes, although they told us this had settled again more recently. People felt staff were equipped with the skills to support them effectively. Comments included, “They’re very good here”, “They’re all pretty good” and “They appear to be well trained.” One relative told us, “They know what they’re doing. Actually, one of them goes way beyond – fixes [Name’s] phone, remotes and anything technical. It’s not really personal care, but in other ways it’s a life saver.”

The staff team were positive, and they felt motivated to provide a high standard of care. The staff we spoke with said there were usually enough staff on each shift to meet people’s needs. Comments included, “I think we manage, and we are okay with staffing” and “Staffing levels are okay. We have enough staff to cover the residents.” Staffing numbers varied depending on people’s needs, but the registered manager told us there were always a core number of staff with the necessary skills to safely and competently care for people. Staff received training, supervision and support they were skilled in their roles. Staff told us the training they received was good. One staff member said, “Yes absolutely great, and I feel that any additional training that I request would be granted. The management team are good like this.” Staff support needs were met through a range of formal and informal means including team meetings, peer support, formal supervision and appraisal.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.