About the service:

Olive House is a supported living service for older people, some of whom have dementia, mental health issues or other physical or learning disabilities. This service provides care and support to people living in 50 flats within a ‘supported living’ setting and there were 36 people receiving personal care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service:

•People gave good feedback about care staff and told us they were kind and caring. However, relatives told us they thought understaffing was an issue that was affecting the delivery of care. We observed that the service was understaffed by three care staff on the second day of our inspection.

•People did not have any concerns about the competence of their care staff. However, records indicated that care staff did not have up to date training and were not being properly supported with supervisions.

•People did not have any concerns about the management of the service, however, relatives told us they felt the management of the service was poor. One relative told us communication about basic issues regarding the care of their family member was very poor. Another relative said they had noticed a decline in the service since the departure of the previous registered manager.

•People’s feedback was not actively sought and acted on. Where the provider received a formal complaint, we found these were responded to appropriately. However, the provider did not effectively seek people’s feedback on a regular basis and did not take action when advised of less formal concerns.

•People did not receive appropriate support with activities. The previous activities coordinator had left the service in January 2019 and since this time, there had been no effective provision for providing activities or ensuring that people were not at risk of social isolation.

•We found two breaches of regulations in relation to staffing and providing care staff with appropriate support. You can see what action we told the provider to take at the end of the full version of this report.

Rating at last inspection: Good. (report published 09 August 2016).

Why we inspected:

This was a planned comprehensive inspection based on the rating at the last inspection. The previous inspection was a comprehensive inspection.

Follow up:

We will ask the provider to tell us how they will make changes to ensure they improve the rating of the service to at least Good. We will continue to monitor information and intelligence we receive about the service until we return to visit as per our re-inspection guidelines. We may inspect sooner if any concerning information is received.

We conducted an inspection of Housing and Care 21- Olive House on 7 June 2016. Olive House is a supported living service for older people, some of whom have dementia, mental health issues or other physical or learning disabilities. There are 50 self-contained flats at the service. There were 33 people receiving personal care when we visited. At our previous inspection on 30 January 2014 the provider met the regulations we inspected.

There was a registered manager at the service. 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.

Staff had completed medicines administration training within the last two years and were clear about their responsibilities.

Risk assessments and support plans contained clear information for staff. Records were reviewed within three months or where the person’s care needs had changed.

Staff demonstrated knowledge of their responsibilities under the Mental Capacity Act 2005. Care records contained some consent forms demonstrating people’s valid consent had been obtained for various matters relating to the care and support they received.

Staff demonstrated an understanding of people’s life histories and current circumstances and supported people to meet their individual needs in a caring way.

People using the service were involved in decisions about their care and how their needs were met. People had care plans in place that reflected their assessed needs.

Recruitment procedures ensured that only staff who were suitable, worked within the service. There was an induction programme for new staff, which prepared them for their role. Staff were provided with appropriate training to help them carry out their duties. Staff received regular supervision although appraisals were not conducted. Although the registered manager told us the supervision process was supposed to incorporate appraisals we found this did not happen in one case. There were enough staff employed to meet people’s needs.

People were supported to maintain a balanced, nutritious diet. People were supported effectively with their health needs and were supported to access a range of healthcare professionals as required.

People using the service and staff felt able to speak with the registered manager and provided feedback on the service. They knew how to make complaints and there was a complaints policy and procedure in place.

The organisation had adequate systems in place to monitor the quality of the service. This included monthly auditing of medicines and medicines administration charts (MAR) and quarterly care plan review meetings. We saw evidence that feedback was obtained by people using the service and the results of this was positive.

People who use the service were given appropriate information and support regarding their care or treatment. When people joined the service they were given an information pack which contained details about the service. Staff respected people's dignity and gave them choices about how their care was delivered.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. The provider carried out an initial needs assessment when people first starting using the service. This included assessing mobility issues, medical needs and social needs. Care plans were reviewed regularly and risks were identified and assessed appropriately. There were arrangements to deal with foreseeable emergencies.

There were systems in place to reduce the risk of infection control. Staff were aware of the issues relating to infection control and wore personal protective equipment such as gloves and aprons. People we spoke with confirmed this. Audits were carried out to monitor adherence to infection control policies and procedures.

The provider assessed and monitored the quality of the service. Annual customer satisfaction surveys were completed as well as regular spot checks to staff visits. Records were maintained to show that they took account of complaints to improve the service.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We saw the file of someone who had moved in recently. The care plan identified the support that was needed and was signed by the person indicating they consented to the planned care and treatment. We spoke with one person. They received personal care from staff. They told us that staff always told them what they were going to do before they delivered personal care and if they did not want staff to do something they would stop.

During our visit we looked at peoples files. People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. All files had up to date care plans and risk assessments. People's care and support needs were identified and risks to the person and others were identified. Daily support tasks were documented.

People told us that they liked living at Olive House, they said staff were kind and friendly. We saw that staff sought to provide people with choices in the care they received. However, not everyone was supported to make decisions about the care provided to them.

People had written plans of care but these were not very person centred; they focused on the tasks staff were to undertake. We saw that people had other identified needs that were not properly addressed in their care plans.

The service safely managed people's medicines when they were unable to do so themselves.

People told us staff were friendly and kind. Staff employed by the service said they felt well supported by senior staff and all new staff had an induction and their competency assessed.

People told us they were happy with the service but if they had any complaints they would approach the manager. The service had proper systems in place to deal with concerns and complaints, in a timely fashion.

During our visit people said they were treated with dignity and respect. They were involved in choosing the type of care and support they needed and when they needed it.

They said the type and quality of care they received from caring and competent staff was very good and they felt safe receiving the service.

They did not tell us directly about the support staff received from the agency or the quality assurance system in place. They did tell us that they were in personal contact with the staff and manager daily to identify that they were satisfied with the service and staff delivering it.