Otterbourne Grange Residential Care Home

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.

Otterbourne Grange Residential Care Home is a residential care home providing personal care to up to 25 people who may be living with dementia. There were 19 people living in the home at the time of the inspection.

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

People’s health and mental health care risks had been assessed and care plans gave clear information for staff to follow, for example, how to support people living with diabetes. Senior staff had received training to support people living with diabetes and epilepsy.

Risks around the safety of the building had been identified and action taken to reduce the risks.

Rating at last inspection and update

The last rating for this service was requires improvement (published 24 August 2019).

Following our last inspection, we served a warning notice on the provider and the registered manager. We required them to be compliant with Regulation 12 (Safe care and treatment) by 16 August 2019. The registered manager and the provider had not ensured risks for people were appropriately assessed, or plans developed to mitigate the risks and professional guidance were followed.

Why we inspected

This was a targeted inspection based on the warning notice we sent to the provider and the registered manager following our last inspection. The Care Quality Commission are conducting trials of targeted inspections to measure their effectiveness in services where we served a warning notice.

We undertook this targeted inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to aspects of the safety of the service. The overall rating for the service has not changed following this targeted inspection and remains requires improvement. This is because we have not assessed all areas of the key questions.

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.

Otterbourne Grange Residential Care Home is a residential care home providing personal care to up to 25 people who may be living with dementia. There were 18 people living in the home at the time of the inspection.

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

People received a service which was not always safe, effective or well-led.

The registered manager and provider had not fully considered all the risks to ensure people were safeguarded from the risk of abuse or harm.

People were not always protected against risks associated with their care and support because risks had not been effectively assessed and plans implemented to reduce these. The provider did not have a robust procedure in place to ensure all new staff were safe to work in the home. Medicines were mostly stored safely, but we found two bottles of medicated topical cream in an unlocked cupboard. Staff had medicines training regarding the medicines they administered on a daily basis but may benefit from broader training as suggested by national guidance. People were not always supported by staff who were trained to meet their needs. There was a quality assurance system in place, but this had not identified the concerns we found during the inspection.

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’s consent was sought for the provision of their care but there was some confusion around signing consent forms and there were not always best interests decisions in place regarding sensor mats.

People’s needs were assessed before moving into the home, so the registered manager could be assured their needs could be met. People’s needs were met by suitable numbers of staff. People were supported to eat and drink enough and were offered choices. People were supported to see healthcare professionals such as dentists and doctors. People were supported by staff who respected their diversity and cared about them. People made decisions about their everyday care and support and staff respected people’s privacy and dignity

Staff received training regarding infection control and used personal protective equipment such as gloves and aprons when supporting people with personal care. The provider had invested in the building’s maintenance and the registered manager had considered people’s needs when decorating rooms.

People and their relatives, when appropriate, were involved in planning their care. People enjoyed a range of activities.

Staff liaised with other agencies to ensure consistency of care. Incidents and accidents were analysed to see what could be learnt from them. The provider had a complaints policy in place and the registered manager investigated any complaints.

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 10 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement:

We have identified breaches in relation to risk assessments, people’s safety, staff recruitment and management of the home at this inspection. You can see what action we told the provider to take at the back of the full version of this report. Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Follow up:

We will continue to monitor information we receive about the service and seek action plans until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Otterbourne Grange Residential Care Home is a care home providing accommodation and personal care for up to 25 older people. Some people using the service were living with dementia. When we visited there were 16 people using the service.

The service is a converted residential dwelling with accommodation over three floors. People live in single or shared rooms. There is a dining room and sitting room which is also used as an activity room.

The service had a registered manager. 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 and associated Regulations about how the service is run.

People, their relatives and staff spoke positively about the leadership of the service. Systems were in place to monitor the quality and safety of the service. However, improvements were needed to ensure shortfalls identified by the provider in relation to people’s care plans and the reporting of safety incidents would be addressed. This was important to be assured that staff had all the up to date information they needed in order to know how to care for people if they were to refer to care and service records.

Staff understood the signs of abuse and neglect and demonstrated a commitment to ensuring people were protected from harm. Staff had a good understanding of people's risks and how to support them to maintain good health and stay safe.

There were sufficient numbers of staff deployed to meet people's needs. Recruitment practices were safe and relevant checks had been completed before staff worked unsupervised.

Appropriate systems were in place for obtaining, storing and disposal of people's medicines and people received their medicines as prescribed.

People liked the food and told us their preferences were catered for. People received the support they needed to maintain good hydration and nutrition.

Staff were supported to carry out their roles and received an induction and on-going training and supervision to enable them to meet people’s needs effectively.

Staff sought people's consent before providing assistance. Where a person's ability to consent to their care arrangements was in doubt, a formal assessment of their capacity was undertaken. Where appropriate best interests decisions were made with people’s representatives as part of the care planning process. Relevant applications for a DoLS had either been authorised or were awaiting assessment by the local authority.

Staff had developed effective working relationships with a number of healthcare professionals to ensure that people received co-ordinated care, treatment and support.

People were cared for by kind and caring staff who respected their choices and were mindful of their privacy and dignity.

People had choice about their daily activities. They were involved in their support planning and chose what activities they wanted to undertake.

People told us they were able to express their views and to give feedback about the service. They were confident they could raise concerns or complaints and these would be dealt with.

Otterbourne Grange Residential Care Home was bought by a new provider in June 2013. The service had been without a manager until a new manager was appointed in May 2014. The provider has submitted plans to the local authority to refurbish this large, Victorian house and build a new extension.

We gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

Systems for learning from accidents and incidents and complaints were in place and were being embedded under the new management.

The provider had submitted plans to upgrade the premises but in the meantime we found that the bathrooms and kitchen required updating. Older parts of the home were difficult to maintain to a clean and hygienic standard and environmental risk assessments relating to specific parts of the building needed to be completed and actioned. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to cleanliness and hygiene and suitability of premises.

We found that staffing levels were not based on people's needs for care and support. There were insufficient staff to keep people safe and support their health and emotional wellbeing. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to safe staffing.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that an emergency DoLS had been requested for one person using the service.

Is the service effective?

Most aspects of people's health and care needs were assessed and care was planned and reviewed. However, we found that some aspects of care were not risk assessed and managed effectively. For example, there were gaps in the recording and delivery of people's care and treatment. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to protecting people from the risks associated with inappropriate or unsafe care.

Is the service caring?

The service was caring. People told us that staff were kind and caring. We heard that staff provided 'Fantastic care, second to none' and that the staff were very kind and caring. We observed that staff spoke with kindness and treated people with respect.

We observed care and support being provided to people in a kind, patient and considerate manner. Staff encouraged people but allowed them to make their own choices.

Is the service responsive?

The service responded to changes in people's needs and sought advice from health professionals promptly and followed their guidance. Health professionals were positive about the care people received and the way staff tried their best to provide the care people needed.

Complaints were managed promptly and people's concerns were investigated, and responded to appropriately.

Is the service well led?

The service had not had a registered manager in place for about a year before the current manager was recruited. This meant some systems for monitoring quality had not been fully embedded. Senior managers from outside the home had carried out training and audits and were committed to improving the quality of service provided.

Staff said they received good training and relatives were confident in the skills and attitude of the staff. There was effective leadership within the home.