Overcliffe House

Overcliffe House is registered with the Care Quality Commission as a residential care home providing the regulated activity of personal care and accommodation for up to twelve adults with a learning disability and/or autistic people. At the time of the inspection there were 7 people using the service. The service consisted of two houses next door to one another with 2 people living in one house and 5 people in the other house. Each house had a communal kitchen and lounge and a shared garden to the rear. People had varying degrees of independence and some people had lived at the service for over thirty years. Most people had limited verbal communication so were unable to provide feedback by speaking to us directly.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support: People were not always supported to have maximum choice and control of their lives and it could not be assured staff supported them in the least restrictive way possible and in their best interests; staff did not always follow the policies and systems in the service to support best practice. Mental capacity assessments had not always been undertaken to assess if people had the capacity to make specific decisions. It could not be assured the conditions in people’s DoLS were met as the service did not monitor them for compliance.

The service gave people care and support in a clean environment, but the décor did not always meet people’s expectations. The provider was working with the landlord to make improvements.

Staff enabled people to access specialist health and social care support in the community. However, only half the staff team had received updated training or competency checks in how to administer medicines safely. Staff prepared food and drink to meet people’s dietary needs and requirements. Staff supported people to take part in activities and pursue their interests in their local area. They had access to day services provided specifically for autistic people. Staff communicated with people in ways that met their needs and planed for when they may experience periods of distress and anxiety.

Right Care: Information about people’s care, treatment and support was easy to access to ensure people’s wellbeing was promoted. People received kind and compassionate care from staff who understood and responded to people’s individual needs.

People and relatives were positive about the quality of the service. People indicated by the ‘thumbs up’ sign that staff gave the support they needed. Relatives said staff were caring and helped ensure people followed a routine that made them feel safe.

People were supported by staff who understood the wide range of strengths, impairments or sensitivities autistic people may have. People who had individual ways of communicating, using body language, sounds, Makaton (a form of sign language) and pictures, could interact comfortably with staff and others involved in their care and support because staff had the necessary skills to understand them.

There were enough staff to meet people’s needs and keep them safe. Staff understood how to protect people from poor care and abuse.

Right Culture: Quality assurance and monitoring systems were not always effective in identify shortfalls and improving the service for the people who used it. People’s family members were not always fully involved in providing feedback about the service so their views could be acted upon.

People benefitted from the open and positive culture of the service where the management team was approachable and listened and responded to people’s views.

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 9 January 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service and in part due to concerns received about care planning, risk assessments and oversight of the service.

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

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.

Enforcement and Recommendations

We have identified breaches in relation to monitoring the quality of the service, staff training in medicines, recruitment of agency staff and assessing people’s capacity to make at this inspection.

The overall rating for the service has changed from Good to Requires Improvement based on the findings of this inspection. You can see what action we have asked the provider to take at the end of this full report.

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

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.

The home provides care and support for up to twelve people with learning disabilities and/or autism. People who used the home had moderate to low care needs, with some now needing consideration as elderly people having lived at the home for over thirty years. At the time of our inspection there were twelve people living at the home. The home consisted of two houses next door to each other with accommodation split over two floors. There was one bedroom on the ground along with communal living space and the rest of the bedrooms were on the first floor.

A registered manager was employed at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

At the previous inspection on 30 September 2016, we made one recommendation concerning finances and found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At the last inspection, we found people were at risk of scalding as the water temperature had been too hot. Records showed that the temperature had been taken regularly, however when they had gone above what is considered safe for people who are vulnerable, no action had been taken to protect people.

At this inspection, we found the registered manager had robust audits of water temperatures around the home and immediate action had been taken when necessary to keep people safe.

At the last inspection we found that there were not robust quality control measures in place. The manager had not reviewed audits being undertaken by staff and therefore opportunities had been missed to improve the service provided to people and keep them safe.

At this inspection we saw that the manager was monitoring monthly checks being completed by staff. That the quality of records such as daily records and medication records were reviewed and action taken when appropriate.

At the last inspection, it was recommended that people’s finances be audited by an external auditor, the manager confirmed this had been arranged on a yearly basis.

People were assessed as individuals so that staff understood how people’s care was planned to maintain their safety, health and wellbeing. Risks were assessed within the home, both to individual people and for the wider risk from the environment. Staff understood the steps to be taken to minimise risk when they were identified.

The registered manager had plans in place for emergency evacuation should this become necessary. These were individual plans for each person and were kept in people’s care files and in a grab bag should the need arise. It ensured that all staff in the home would understand how to continue people’s care, should the home be evacuated in an emergency.

Incidents and accidents were recorded and checked by the registered manager to prevent these happening again.

People were kept safe by staff who understood their responsibilities to protect people living with learning disabilities and autism. Each person had a key worker who assisted them to learn about safety in and outside of the home. Staff had received training about protecting people from abuse. The staff and management team had access to and understood the safeguarding policies of the local authority and followed the safeguarding processes.

There were policies and procedures in place for the safe administration of medicines. Staff followed these policies and had been trained to administer medicines safely.

People had access to GPs and their health and wellbeing was supported by prompt referrals and access to medical care if they became unwell. Records were kept to assist people to monitor and maintain their health. Staff had been trained to assist people to manage daily health challenges they faced from conditions such as epilepsy. Staff were also mindful of those people who were now aging and the conditions they may now face.

The home was welcoming and friendly, with some people coming forward to find out who was at the door and introduced themselves. Staff provided friendly compassionate care and support. People were encouraged to get involved in how their care was planned and delivered. Staff were deployed to enable people to participate in community life, both within the home and in the wider community.

Staff upheld people’s right to choose who was involved in their care and people’s right to do things for themselves was respected. People were consulted about their care and staff were flexible to requests made by people to change routines and activities.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Restrictions imposed on people were only considered after their ability to make individual decisions had been assessed as required under the Mental Capacity Act (2005) Code of Practice. The registered manager understood when an application should be made.

Many people had been at the home over thirty years, others having lived in other homes within the organisation before coming here. Staff knew people extremely well and people were very involved in their own routine and activities.

Recruitment was robust. The registered manager recruited staff with relevant experience and the right attitude to work well with people who had learning disabilities and autism. New staff were given extensive induction and on-going training which included information specific to learning disability and autism services.

Staff received supervisions and training to assist them to deliver a good quality service and to further develop their skills.

Staff understood the challenges people faced and supported people to maintain their health by ensuring people had enough to eat and drink and had access to health care professionals when required.

The registered manager produced information about how to complain in formats to help those with poor sight or communication skills to understand how to complain. This included people being asked frequently if they were unhappy about anything in the home.

At our last inspection on 6 March 2015 the service met the regulations inspected.

There was a registered manager 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.

Care plans were person-centred, and specific to each person and their needs. Care preferences were documented and staff we spoke with were aware of people's needs. Care plans were reviewed monthly and were updated when people's needs changed.

Relatives informed us that they were satisfied with the care and services provided. Relatives also told us that they were confident that people were safe in the home.

Systems and processes were in place to help protect people from the risk of harm and staff demonstrated that they were aware of these. Staff had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse.

People needed support with their finances as they did not have the capacity to do so. Records showed checks were being carried out by staff and the registered manager.

Systems were in place to make sure people received their medicines safely. Arrangements were in place for the recording of medicines received into the home and for their storage, administration and disposal.

The premises were clean and tidy. There was a record of essential maintenance carried out at the home. Bedrooms had been personalised with people's belongings to assist people to feel at home. However, the water temperatures in the home were not controlled and had reached temperatures above the recommended safe water temperatures. Although, the registered manager told us the issue had been reported and were waiting for this to be fixed by the housing association. we identified that there were inadequately controlled risks being presented to people using the service in the meantime.

Staff had been carefully recruited and provided with induction and training to enable them to support people effectively. They had the necessary support, supervision and appraisals from management.

Staff we spoke with had an understanding of the principles of the Mental Capacity Act (MCA 2005). Capacity to make specific decisions was recorded in people's care plans.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The home had made necessary applications for DoLS as it was recognised that there were areas of the person’s care in which the person’s liberties were being deprived. Records showed that the relevant authorisations had been granted and were in place.

There were suitable arrangements for the provision of food to ensure that people's dietary needs were met.

Staff were informed of changes occurring within the home through daily handovers and staff meetings. Staff told us that they received up to date information and had an opportunity to share good practice and any concerns they had at these meetings.

A satisfaction survey had been carried out in July 2016 and the results from the survey were positive. The service undertook a range of checks and audits of the quality of the service and took action to improve the service as a result.

There was a management structure in place with a team of support workers, registered manager and the provider. Staff spoke positively about working at the home. They told us management were approachable and the service had an open and transparent culture. They said that they did not hesitate about bringing any concerns to the registered manager.

The current systems in place were not robust enough to monitor and improve the quality of the service being provided to people using the service. Although some checks had been completed by the registered manager, there were areas which had not been promptly followed up or identified.

Relatives spoke positively about management in the home and staff. They said that the registered manager was approachable and willing to listen.

We made one recommendation concerning finances. We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We are currently considering what further action to take. 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 spoke with the registered manager and deputy manager to follow up on the actions they had told us they had taken following our previous inspection. We considered all the evidence we had gathered under the outcome we inspected. We used the information to answer the five 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?

Below is a summary of what we found.

Is the service safe?

There were systems in place to ensure people's needs were assessed and risks were identified. Personal and environmental risk assessments were carried out, reviewed and control measures were put in place to help manage risk. Care was planned in a way that ensured people's safety was a priority and care was reviewed regularly to support this.

Is the service effective?

People were supported in promoting their independence and community involvement. People's health needs were met and there were records kept where health information was recorded. Decisions in relation to promoting people's independence had been recorded to show that the risks had been assessed and written plans were in place to manage the identified risks and ensure the safety and welfare of people who lived at the service.

Is the service caring?

Records showed that people and their families were involved in their care and were encouraged to do so. Records relating to behaviour support demonstrated that people's likes and dislikes were taken into account when planning their care and that staff adopted strategies to support people's choice in their care.

Is the service responsive?

People's needs were assessed before they moved into the service and care was planned in response to these assessed needs. Individual objectives and goals were established and staff responded to the needs of individuals in a way that promoted choice and independence.

Is the service well led?

We saw evidence of learning and monitoring of the quality of service delivery. The management of the service focused on meeting the needs of individuals and we viewed records that demonstrated a focus on the individuals in the service and meeting their needs. The manager and deputy manager told us that staff, people who use the service and their families were involved in shaping those services.

Below is a summary of what we found

Is the service caring?

Our observations showed that people had a positive experience of their care and appeared happy, settled and relaxed. They were provided with the support they needed from staff. The person we spoke with at the service told us that if they had any problems they could talk to the staff and they would help. They added, the staff were 'Nice', and they looked after them well.

Is the service responsive?

We saw that people's needs were assessed before they moved into the service. The accommodation was used flexibly to meet people's needs. For example, one person's mobility had become restricted following an accident. Therefore, they had moved to a bedroom on the ground floor to ensure their safety while moving about the service.

There was evidence that learning from incidents and investigations took place and appropriate changes were implemented.

Is the service safe?

There were systems in place to ensure staff were competent in being able to meet people's needs safely and effectively. We saw that new staff received an induction to the service.

There were systems in place to monitor health and safety within the service. These checks included water temperature checks and tests of portable electrical appliances. We also saw that audits were undertaken of medication.

We saw that the service was well maintained. There was a system in place to report and monitor repairs needed at the service.

There were arrangements in place to deal with foreseeable emergencies.

Is the service effective?

Staff ensured people's privacy and dignity was upheld. For example, we saw that staff knocked on people's doors to their bedrooms and bathrooms before entering.

People were supported in promoting their independence and community involvement. We saw that the service used a system of support that focussed on promoting people's independence.

People were given opportunities to participate in activities they enjoyed. For example, the day of inspection people were visiting a beach to enjoy the warmer weather.

People's health needs were met and staff recorded health information on people's health records. We saw that people's appointments with health professionals were recorded.

There were enough staff on duty to meet people's needs effectively.

However, not all decisions in relation to promoting people's independence had been recorded to show that any risks had been assessed. There wasn't always a written plan in place to manage the risks to ensure the safety and welfare of the individual.

Is the service well led?

There were systems in place to monitor the quality of service delivery. These included meetings with people living at the service and surveys provided to people, their relatives and visiting professionals. There were opportunities provided to staff for them to feedback about the service. We saw that there was a complaints process in place and there were systems in place to monitor staff training and competency.

We spoke with relatives of three people. One person told us 'the service was very good and they were very impressed with the very experienced staff and amount of activity'.

We observed that staff demonstrated knowledge and understanding of the people they were supporting and that staff respected the rights of people to consent to day to day activities. We observed that where a person was not able to consent the provider made appropriate arrangements in line with legal requirements.

We looked at care records of four people using the service and saw that risk assessments and care plans were regularly reviewed and people were involved in the decisions about their care. We observed there were adequate numbers of skilled and experienced staff to deliver safe and appropriate care.

We observed that the provider had clear procedures in place to handle medicines prescribed for people using the service and there was clear guidance about adverse events related to the handling of medicines.

We found there were systems in place for people and their relatives to make a complaint about the service if required.

One person told us that they had recently been involved in a review of their care and felt that staff listened to and respected their opinions.

People told us that they had been on holiday last year and that they knew where they were going on holiday this year.

We found that there was a professional and personable relationship between service user's and staff. Staff understood the needs of people using the service and were able to meet the individual needs of people.

There were systems in place which enabled the provider to assess the quality of the service being provided, and where necessary, changes could be made to ensure that people benefited from receiving a quality service.