Overbury House Nursing and Residential Home

Overbury House Nursing and Residential Home is a care home providing personal and nursing care for up to 61 people, some of whom are living with dementia. At the time of our inspection there were 43 people using the service.

The care home is built over two floors. The majority of bedrooms have en-suite facilities. There are several shared living areas, a shared dining room and an accessible garden for people and their visitors to use.

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

Medicines were not always safe at the service. Information to ensure the safe handling and administration of medicine was not consistent. Some medication administration records contained gaps and were not completed accurately. Medicines were not always ordered in a timely manner to ensure people had adequate and continual supply.

A quality assurance system was in place. This had not identified or addressed the discrepancies we saw in the handling and administration of medicine.

On the day of inspection we observed adequate staffing levels. However, relatives provided mixed feedback regarding staffing levels. Some relatives felt there were not adequate staff employed to meet the needs of people in a timely manner. However, all relatives found the staff to be caring and kind.

Relatives told us they felt the care provided by staff was safe.

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.

A recruitment process was in place to support the safe recruitment of suitable staff. Staff received an induction and training which prepared them for their role.

Relatives and staff told us they found the registered manager to be approachable and were confident they would be listened to if they raised concerns.

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 13 September 2019).

Why we inspected

We received concerns in relation to the management of risk and the governance of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Overbury House on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to management and administration of medicine at this inspection.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

• The home had a purpose-built visiting pod in the garden which had a substantial screen, intercom and heating. This enabled it to be used all year round and where visiting could take place in the event of an outbreak.

• The layout of the building was used to the best advantage with rooms having their use changed. For example changing a lounge to a dining room, to help with COVID-19 guidelines. Areas were able to be split up and people who used the service segregated when there was an outbreak, with staff working within the specific areas and not mixing.

• Relatives said the management and staff have been very good at keeping them informed of changes to guidance in a timely manner. This included holding relative’s meetings over video calling and setting up a private social media page so pictures could be shared.

• A member of staff was employed to manage visiting procedures for relatives including, meeting them when they arrived to ensure processes were followed and supporting the visits to take place.

• A person who used the service had hearing difficulties, which was exacerbated by staff wearing masks, so to aid communication a white board was used by staff to write questions and messages for them to respond to.

• Themed days were organised, including fancy dress, judged by the people who lived in the service. These were to improve people's wellbeing and help lift people’s spirits.

We found the following examples of good practice.

¿ Staff were familiar with infection, prevention and control practices, including the use of personal protective equipment (PPE), and how to put this on and take it off correctly to keep people safe.

¿ The service had made changes to the layout of the home and had designated staff teams working in bubbles to prevent the spread of infection.

¿ The service worked collaboratively with the GP practice to ensure people’s overall health and wellbeing was being monitored. Staff were using specialist tools to monitor for changes in people’s health and ensuring this information was acted on in a timely way.

¿ People participated in one to one activities with staff and the service’s activity co-ordinator, they were also supported to use technology to maintain regular contact with friends and family.

¿ The service had a designated infection, prevention and control lead who completed regular monitoring and spot checking to ensure staff were familiar with, and following current government guidance. Staff were up to date with infection, prevention and control training, and had completed additional courses to enhance their understanding of COVID-19.

Further information is in the detailed findings below.

Overbury House Nursing and Residential Home is a care home providing personal and nursing care to 33 people, 15 of whom were receiving nursing care, aged 65 and over at the time of the inspection. The service can support up to 61 people. Accommodation is provided over two floors, the majority of bedrooms have en-suites. At the time of our inspection people were only accommodated on the ground floor and the first floor was undergoing refurbishment. There are several communal lounges, two dining areas, and a secure garden area on the ground floor.

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

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. Systems and information relating to the management of people’s deprivation of liberty safeguard authorisations required further work. We have made a recommendation about the provider’s management of deprivation of liberty safeguard applications.

The environment was clean, tidy, and infection control issues addressed. Some general improvements were needed to the décor of the home and we have made a recommendation regarding changes to the environment to better support people living with dementia.

People received a good service however records relating to people’s care did not always evidence the support people were getting. We have made a recommendation relating to records of people’s care and support.

Risks to people were identified and addressed, this included the safe management of the premises. People were supported by enough staff to meet their needs in a timely manner. The registered manager kept staffing levels under review and adjusted these as necessary. Systems were in place to protect people from abuse. Safeguarding concerns and other incidents that occurred, such as falls, were reviewed, analysed, and actions taken in response. Medicines were managed safely, people received their medicines as prescribed.

People’s needs were assessed, and staff supported people in line with best practice guidance using nationally recognised tools. Staff received appropriate training and support, including when they first started working in the service. People were supported by a team of staff who worked well together and with health and social care professionals. People received enough to eat and drink, any concerns relating to their eating and drinking were monitored and addressed.

People were supported by kind and caring staff, who involved them, and others important to them, in decisions regarding their support. People’s dignity was promoted, staff were attentive to people’s appearance and respectful in their interactions.

People had care plans that were personalised and detailed their preferences and life stories. Staff knew the people they supported, and this helped them to deliver care in a person-centred way. A range of activities were on offer, this included regular entertainment events in the service, and external trips out. Any complaints or concerns raised were investigated, people, relatives, and staff felt able to raise concerns.

Effective governance systems were in place to monitor and improve the quality of the service provided. The registered manager had a good oversight of the service. This included ensuring the service met its regulatory responsibilities and keeping up to date with wider requirements and changes within health and social care. There was an open and inclusive culture in the home, regular opportunities to discuss the service and provide feedback were available. The service was calm, organised, and staff understood their roles and responsibilities.

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

The last rating for this service was requires improvement (published 22 January 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

Overbury House is a ‘care home’ providing residential and nursing care to people, including some people living with dementia. People in care homes receive accommodation and nursing or personal care as 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 is registered to provide care to a maximum of 61 people. There were 29 people living at the service at the time of the inspection, 10 receiving nursing care.

They had an unregistered manager who had been in post for approximately four months prior to the inspection. The service had not had a registered manager since January 2017. 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 2008 and associated Regulations about how the service is run.

At our last inspection on 18 and 19 April 2018 we identified breaches of regulation in relation to safe care and treatment, the condition and cleanliness of the service, staff training completion to meet the requirements of their roles, reporting of safeguarding incidents to the local authority, governance and managerial oversight of the service. We also identified examples of incidents that had not been notified to CQC.

As an outcome of the last inspection, imposed conditions remained on the home’s registration to encourage continued improvement. The provider was responsible for submitting an improvement plan and monthly updates to CQC. This information was reviewed during this follow up inspection.

During this inspection on 12 November 2018, we identified ongoing concerns in relation to the cleanliness and condition of the care environment, and infection prevention control practices. These issues had not been identified through the service’s quality audits and environmental checks. We found examples of staff not following guidance from healthcare professionals to manage and prevent the risk of choking. There continued to be non-compliance in relation to submitting notifications to CQC. We identified areas of concern in relation to the service’s compliance and implementation of the Mental Capacity Act into practice.

We did identify areas of improvement since the last inspection. Standards of medicines management and staff oversight of medicines had improved. Staff morale was better, with improved working relationships between staff and the management team. There were ongoing improvements in the level of staff training completed since the last inspection. The management team had introduced resident meetings offering people an opportunity to raise concerns or give feedback on the service.

The overall rating for this service is ‘Requires improvement’, with the decision for the service to be taken out of ‘special measures.’

Overbury House Nursing and Residential Home provides residential and nursing care to a maximum of 61 older people, some of whom may be living with dementia. At the time of our inspection there were 32 people living in the home, 14 receiving nursing care.

Overbury House Nursing and Residential Home is a ‘care home’ with nursing. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager appointed in June 2017; they were in the process of completing their registration with CQC. 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 2008 and associated Regulations about how the service was run.

We last inspected this service on 4 and 7 September 2017 and found the provider was in breach of six regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued a requirement notice in respect of a breach of regulation relating to the need for consent.

We imposed positive conditions on the provider’s registration at this location in respect of a breach of regulations relating to person-centred care, dignity and respect, safe care and treatment, meeting nutritional and hydration needs and good governance.

The overall rating for this service as an outcome of the inspection completed 4 and 7 September 2017 was 'Inadequate' and the service was therefore placed in 'Special Measures'. Services in special measures are kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

Following our inspection in September 2017, the provider sent us an action plan to tell us about the actions they were going to take to meet these regulations. The action plan was reviewed with the manager and regional director during this inspection.

From this inspection, 18 and 19 April 2018 we identified areas of concern in relation to safe management of medicines, cleanliness of the environment and infection prevention control impacting on the care people received. This has resulted in the service continuing to be in breach of the conditions imposed as an outcome of the last inspection, with the service remaining rated as Inadequate and therefore continuing to be placed in special measures.

The service did not have robust governance processes in place for monitoring standards and quality of care provided. Findings from clinical audits in areas such as medicines management and environmental condition did not reflect our findings during the inspection.

Staff did not consistently recognise the need to report safeguarding concerns to the local authority or to CQC.

Staff were not up to date with the provider’s mandatory training or receiving annual performance appraisals.

However, we did find some areas of improvement at this inspection. We saw that staffing levels reflected the use of a dependency tool, with higher staffing levels in place in the morning, during meal times and early evening.

Staff treated people with care and compassion, and took pride in their caring roles. Staff approach and people’s records demonstrated adherence to the Mental Capacity Act and Deprivation of Liberty Safeguards.

People had choice of food and fluids, with value placed on nutrition and food quality. People accessed activities in the local community and at the home, however, some people identified a need to improve access spiritual support to aid wellbeing.

People and their relatives knew how to make a complaint, and were encouraged to give feedback to the manager and provider.

Overbury House Nursing and Residential Home provides residential and nursing care to a maximum of 61 older people, some of whom may have dementia. At the time of our inspection there were 34 people living in the home, 16 of whom were receiving nursing care.

At the time of our inspection visit a registered manager was not in post. 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 2008 and associated Regulations about how the service is run. However, a manager had been appointed and had been working in the home since May 2017. They told us they intended to make an application for registration.

We last inspected this service on 11 and 12 January 2017 and found the provider was in breach of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued requirement notices in respect of these breaches. Following our inspection in January 2017, the provider sent us an action plan to tell us about the actions they were going to take to meet these regulations.

We carried out this September 2017 inspection to check if the improvements had been made in order to achieve compliance with the regulations. At this inspection we found insufficient improvements had been made and governance arrangements in the home were not effective enough to rectify the breaches found at the previous inspection. The provider was still in breach of regulations for: safe care and treatment, management of nutrition and hydration, dignity, and good governance. We found that there had been deterioration in the quality of care in other areas, which meant the provider was in breach of a further two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This meant that risks to people’s welfare had increased.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We found people were not being provided with safe care. Risks to people’s health and safety were not always identified. We found in cases where risks had been identified, that insufficient action had been taken to manage and mitigate the risk of any further harm. In addition we identified concerns relating to the cleanliness of the home and practices which put people at risk of the infection spread by cross contamination Medicines were not always managed safely. People did not always receive their medicines as prescribed. The service remained in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People’s nutritional and hydration needs were not always met. People did not always receive adequate support to access fluids. Meals were not provided in a way that ensured people’s nutritional needs or preferences were met. This was a breach of Regulation 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The service did not fully adhere to the mental capacity act which meant people’s rights to provide consent were not always appropriately protected. This was a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The care provided did not to take in to account people’s individual needs and preferences. Recommendations made by health and social care professionals were not implemented and followed in order to make sure the care provided was appropriate and met individual needs. Care plans did not always contain sufficient information or guidance, including on how people wanted to be cared for. The activities on offer did not always meet people’s individual needs and interests.. This was a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There were occasions when staff were not mindful of people’s dignity; this included a lack of attention to meeting people’s continence needs which placed people in undignified situations. This was a breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider had failed to implement effective systems to assess, monitor and improve the quality and safety of the service. This had contributed to some people experiencing poor care and support. They had also failed to maintain an accurate and complete record in respect of each person who used the service. Necessary improvements to the service had not been made. Not all the staff in the home were clear about their responsibilities or took appropriate actions suitable to their roles. The provider had not always taken action to ensure staff understood their roles and responsibilities, and held them to account. The service remained in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Although there were sufficient staff numbers on duty staff were not always deployed effectively so as to meet people’s needs in a timely manner, for example over the lunchtime period, in order to ensure people had a pleasurable lunch time experience.

Staff received training and support; however the number of concerns identified regarding the care and support provided throughout our inspection meant we could not be confident that the training provided was effective, took in to account best practice, and was imbedded in staff practice.

The provider worked collaboratively with the appropriate authorities to respond to safeguarding concerns. However, not all safeguarding incidents had been identified and reported as required, which meant we could not be confident all staff understood how to identify and report such incidents.

There were opportunities for people, relatives, and staff to provide feedback and be informed about the running of the service. People and relatives felt comfortable and able to raise any concerns or complaints they had. The provider took action to address any concerns raised.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Overbury House Nursing and Residential Home provides residential and nursing care to a maximum of 61 older people some of whom may have dementia. At the time of our inspection there were 43 people living in the home, 15 of whom were receiving nursing care.

At the time of our inspection visit a registered manager was not in post. 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 2008 and associated Regulations about how the service is run.

We last inspected this service on 02 and 05 December 2014 and found the provider was in breach of regulation 12(f)(g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because people were not protected against the risks associated with unsafe administration and recording of medicines. At this inspection we found improvements in the administration of medicines had been made. The provider had introduced a new system to help ensure people received their medicines and to improve the recording in relation to this, this had been effective in making the improvements required. People received their medicines within the required specified time frames and we saw medicines being administered safely.

We concluded the provider was no longer in breach of regulation 12(f)(g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the safe administration of medicines. However, at this inspection we found the provider remained in breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because we found additional concerns in respect to the assessment and management of risk. This is because we found risk assessments were not always in place for identified risks, sufficient actions were not taken to protect people at risk of malnutrition, dehydration, and skin breakdown, and actions were not always taken in response to accidents and incidents.

We found the provider was in breach of three further regulations. They were in breach of Regulation 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because not everybody living in the home received the support they required at mealtimes and action was not always taken to ensure people were adequately hydrated. We found that people were not always treated with dignity and respect. This was a breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider’s quality assurance systems had failed to identify in a timely manner that improvements were needed and had failed to sustain areas where there had previously been no concerns. We found the quality of records in the home was poor. Care records did not always contain sufficient information, there were gaps in the records, and at times records were illegible. This meant the provider was in breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. Improvements were required in this area. We have made a recommendation that the provider review this legislation and associated guidance to ensure they are acting in accordance with the MCA.

There was a lack of documented personal preferences to ensure that staff delivered support the way people living in the home wanted. Activities and some of the design in the home did not always take in to account people’s individual needs or preferences.

People felt safe living in the home; however we were not confident that all staff in the home understood the importance of identifying and responding to safeguarding concerns. People and relatives told us they felt able to raise concerns and confident that the provider would take action to address these.

The provider and management team took concerns and complaints, including the issues identified at our inspection, seriously and responded thoroughly. They and the management team were open, honest, and transparent in regards to the issues in the home and the improvements required. There was a clear plan of action to drive improvements and the provider was taking action to make the improvements required in the home; this included clear oversight at provider level.

The provider had recently reviewed people’s needs in the home and increased staffing levels. As a result of there was sufficient staff to meet people’s needs.

The provider had made recent changes to ensure staff felt supported and had the necessary skills and knowledge to carry out their roles. Staff and relatives were positive about these changes and the benefit they had brought to people living in the home. New staff received the support they needed to carry out their role.

People told us they felt involved in decisions regarding the care they received. Staff supported people to maintain important relationships and encouraged relatives to visit the home.

We also found that staff were not enabled to access formal supervision sessions or take part in annual appraisals. This meant there was no system in place to allow the staff employed at Overbury House to individually discuss issues they may have had at work or to monitor their professional development.

We told the provider to make improvements and during this follow up inspection we found that they had.

However, we found that care planning had not been undertaken in three of the care files that we reviewed. Care plans were blank. There was therefore no plan that staff could refer to in order to understand a person's care needs. We also noted that for three other people care plans were in place, but they did not reflect people's current needs.

Our observations of the home demonstrated to us that it was clean, mostly free from unpleasant odours and that infection control practices were in place. For example, we observed staff using alcohol gel, wearing disposable gloves and aprons. We also saw cleaners undertaking their duties.

We found that people were cared for, or supported by, enough suitably qualified, skilled and experienced staff.

However, whilst we found that staff received training relevant to their role, they were not receiving regular supervision or appraisal.

From the care records we looked at, we saw that people received regular input, as needed, from healthcare professionals such as a general practitioner, district nurse, chiropodist, optician, dentist and speech and language therapist.

We saw that the lunchtime period was a dignified and sociable occasion. We saw that the tables were laid with nice quality table cloths, place settings and menus. Subtle background music also helped to create a comfortable restaurant feel to the dining room. From our observations, we saw that people looked comfortable and relaxed, whilst alert and interested in the people around them and their surroundings in general.

We observed staff going about their duties during our inspection. We saw that when people were being supported by staff, they were given time to respond and were not rushed. We noted the atmosphere in the home to be cheerful, relaxed and comfortable.

A number of systems were in place to assess and monitor the quality of service provided in this service.