Archived: Occombe House

We carried out this inspection as a part of our scheduled programme and to follow up on concerns we had identified in our previous inspection of 20 November 2013. We found that action had been taken to address the concerns which had related to the upkeep and maintenance of the building.

However on this inspection we identified further concerns in relation to the assessment and care planning to meet people's needs.

We considered our inspection findings to answer questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found '

Is the service safe?

We found the systems for care planning and assessing of people's needs were not addressing all aspects of people's needs and were not all up to date. Some risk assessments or plans for example for moving and handling or assessing pressure area risks were not in place. This meant staff did not have the updated guidance they needed to do their job.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We saw that although no-one at the home was the subject of an authorisation to deprive them of their liberty this was being reviewed by the care trust and plans were in hand to make applications for authorisation under the Deprivation of Liberty Safe guards of the Mental Capacity Act 2005 by the end of May 2014. This would help ensure people's rights were protected and any restriction of people's liberty was lawful.

We found improvements had been made to the environment, including the repair of windows and replacement of broken tiling. This reduced the risks to people who lived at the home.

We saw there were arrangements in place to deal with foreseeable emergencies. Staff had received appropriate training, for example in first aid or in managing specific medical conditions such as epilepsy.

Is the service effective?

We saw staff responded well to people's non verbal communication and understood what people were communicating to them. This helped ensure people's needs could be identified and met.

We saw that staff at the home supported people's rights to make decisions where they were able to do so. Where people had lost this capacity the provider had taken steps to ensure that many best interest decisions had been or were being made when required. We saw records of recent best interest decisions in relation to people's health and welfare which described the rationale behind decisions and who had been involved. This demonstrated the home protected the rights of individuals in these instances. However we found that not all areas had been addressed, for example medication had not been subject to a best interests decision making process.

We saw that people were supported to take part in day activities. For some people this meant day services such as attendance at resource centres and for other people activities of people's choice were organised by the home.

Is the service caring?

We saw that people responded well to staff, and sought them out for support and guidance. Staff spoke about people and their needs respectfully.

We observed staff working with people. We saw that they used appropriate physical contact and had taken care to see that people's rooms were a reflection of their tastes and interests. Some staff had worked at the home for many years and knew individuals and their families very well. They were committed to supporting people while the move to new purpose built accommodation was completed.

We saw staff sharing jokes and laughing with people. Staff ate their meals with people which led to a more communal and informal feel to mealtimes. We saw staff were attentive to people's needs at that time.

Is the service responsive?

We saw that the staff at the home responded to people's requests and needs through their non-verbal communication. For example we saw a person taking staff to the service hatch to request a drink. We saw the person was given a drink.

We saw that where there had been significant changes to the health of a person who lived at the home staff had received the support and training needed to manage the person's health condition. This meant the person could return to their home and not need to move elsewhere to have their needs met.

We saw that the home had responded to the previous inspection report from CQC and made improvements to the environment. This helped ensure people lived in safe accommodation that respected their privacy.

Is the service well-led?

Since the last inspection the manager of the home had become registered. This meant they had a legal accountability for the day to day operation of the home.

We saw that Torbay and Southern Devon Health and Care NHS Trust supported the home with centrally operated policies such as for the management of health and safety assessments or medicines audits. We found some audits had not been carried out, for example for infection control.

We saw that people who lived at the home were being well supported by appropriate numbers of experienced care workers who knew them well. We saw that the systems for care planning and record keeping were in place and generally met people's needs. We saw that people were being protected against abuse.

However we found that the accommodation was looking tired and in some areas in need of repair or deep cleaning. We found damage to tiling and mouldy grout, unsecured windows and poor furnishings in some rooms. We also found trailing wiring and some institutional facilities, including an incomplete partitioning between a toilet and bathroom that compromised people's dignity and privacy.

We saw that people who lived at the home interacted well with staff on duty. We watched care workers supporting people and saw that they understood people's communication and behaviour, and used this to interpret their needs and wishes with regard to their care. One person we spoke with told us the staff 'helped me' and they had enjoyed going out with them that day. We saw another person seek out a care worker to help them

We found that people were being given choices about their care and support and asked for their consent to care wherever possible. Where people could not give their consent to care, arrangements were in place to respect their rights.

We saw that people's care was being supported well and that their wishes and choices were taken into account with regard to their care. One person living at the home told us that the staff were "nice", and then laughed. When we asked them if they were kind to them they told us they were. We saw other people being treated with respect for their individuality and privacy.

We saw in people's diaries that they were supported to take part in activities they enjoyed.

We saw people's medication was being managed safely.

We found that staff were being supported by supervision systems in place, and with training support. However some training updates had been difficult to access for staff.

The service was being managed well. Issues identified through surveys were being addressed through management systems.