This inspection took place on 29 and 30 January 2018 and was unannounced.

Ottley House is a ‘care home’. 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. Ottley House provides accommodation with nursing care for up to 72 people. The home is purpose built and all accommodation is on ground floor level. Bedrooms are for single occupancy and have en-suite facilities. The home consists of two separate units; The Ann Carter unit provides general nursing care and the Memory Lane unit provides care for people who are living with dementia.

At the time of the inspection there were 67 people living at the home.

At the last inspection in June 2016, the service was rated Good

At this inspection we found the service remained Good overall with Requires Improvement for the Effective key question.

People were supported by adequate numbers of staff who had the skills and knowledge to meet their needs. Staff knew how to protect people from the risk of harm and abuse. There were systems in place to identify and manage risks and to protect people from harm or abuse. People received their medicines when they needed them and medicines were stored and managed in a safe way.

Most people continued to receive effective care. However due to recent incidents, improvement was required in this area to ensure people’s health care needs were monitored and met. People were supported by staff who were well trained. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were cared for by staff who were kind and considerate. There was a cheerful atmosphere in the home and people were supported in a relaxed and unhurried manner.

People continued to receive a service which was responsive to their needs and preferences. Staff knew what was important to the people they supported and people were involved in planning and reviewing the care they received. There was a varied programme of activities for people if they wanted to join in. Complaints were taken seriously.

Staff told us the management within the home were open and approachable. The registered manager and provider continually monitored the quality of the service and made improvements where needed.

Further information is in the detailed findings below

This inspection took place on 11 July 2016 and was unannounced. The home was last inspected on 16 June 2015 where we gave it an overall rating of requires improvement.

Ottley House is registered to provide accommodation with nursing and personal care to a maximum of 72 people. There were 67 people living at the home on the day of our inspection. People were cared for on two units, the Ann Carter unit which provides nursing care and the Memory Lane unit which provides care for people with dementia.

A registered manager was in post and was present during our inspection. 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.

People felt safe living at Ottley House and felt safe when staff supported them. Staff protected people from abuse, discrimination and avoidable harm and understood action they would need to take if these occurred. Concerns that were raised about people’s safety were dealt with quickly and referred to the appropriate agencies.

There were enough staff to safely meet the needs of people. People were not kept waiting for support and a reduction in the use of agency had helped to ensure a consistency of staff. Any risks to people and their environment were managed through regular assessment and monitoring. Staff had good knowledge of the risks people faced, how to reduce these risks and clear plans were in place which staff followed.

People felt well cared for and staff demonstrated affection and warmth when supporting them. People’s privacy and dignity was respected and people and staff had developed positive relationships with each other. Staff knew people’s individual needs and made sure people understood the choices available to them. People were given information in a way they could understand and staff gave people time to respond and communicate.

The provider had introduced a new programme to enhance dementia care. This had improved the well-being of people who lived in the Memory Lane unit.

Staff had the skills, knowledge and support to effectively meet the specific needs of people. Staff training and development was invested in to make sure they had the skills and knowledge to carry out their roles.

People’s right to make their own decisions and give their consent to their care and treatment was sought and respected. Where people could not make their own decisions staff made sure these were made in their best interests and involved families and other professionals where necessary.

People enjoyed the food they received and had choices of what they ate and drank. People were provided with enough well-balanced food and drink which helped to make sure their nutritional needs were met.

People were encouraged to spend their time how they wanted to. A range of events took place at the home which most people enjoyed and took part in. Staff also spent one to one time with people to support them with whatever they wanted to do.

Staff were proud to work at the home and they were enthusiastic about their roles within the home and the improvements that had been made since our last inspection.

Good leadership was demonstrated at all levels and there were systems in place which assessed and monitored the quality and safety of care provided.

This inspection took place on 16 June 2015 and was unannounced.

Ottley House is registered to provide accommodation with nursing and personal care to a maximum of 72 people. There were 60 people living at the home on the day of our inspection and people were cared for on two units, Ann Carter and Memory Lane.

A registered manager was in post and was present during our inspection. 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.

The home was last inspected on 22 July 2014 where we gave it an overall rating of Inadequate. We asked the provider to take action to make improvements to ensure people received the care and support they needed and were treated with respect and consideration at all times. We had asked the provider to make improvements to ensure people were protected from abuse. We had also asked the provider to make improvements to staffing levels and how staff were supported in their roles. We asked the provider to send us an action plan detailing the actions they intended to take. At this inspection we found that these actions had been completed and improvement had been made in areas we had concerns about.

The provider had clear systems in place for recording information about medicines and specific aspects of people’s care. Although these systems were in place we found they were not always followed consistently. People’s care had not been affected by this but these issues had not been identified by staff checks.

The continuity of care people received was affected by the use of agency staff. Recruitment was underway to provide a more stable staff base and reduce the reliance on agency staff but these new staff were not yet working at the home.

Staff had received training and had their work practice monitored on an on-going basis to ensure it continued to meet people’s care needs. Checks had been completed on new staff to make sure they were suitable to work at the home before they started working there.

Staff were trained and understood their responsibilities in the prevention and reporting of potential harm and abuse. Risks to people had been assessed and staff knew how to minimise risk when supporting people with their care. Staff understood their responsibility in dealing with any accidents or incidents that may occur and these were monitored to identify any issues or concerns.

Staff respected people’s right to make their own decisions and choices about their care and treatment. People’s permission was sought by staff before they helped them with anything. Staff made sure people understood what was being said to them and used alternative ways to communicate when necessary.

People enjoyed the food they received and were supported to eat and drink enough to keep them healthy. People and their visitors had access to snacks and drinks throughout the day. When staff supported people at meal times they did so with respect and ensured people’s dignity. When they needed it people had access to other healthcare professionals to make sure their health needs were met.

People felt staff treated them with kindness and compassion and they felt involved in their own care. Staff respected people’s dignity and privacy and supported them to keep their independence. Staff spoke with people in a way they could understand and this helped them to be involved in making choices about their care.

People received care that was personal to them because staff knew what their individual preferences and needs were. Staff responded to changes in people’s wellbeing and supported them as necessary.

People were comfortable to complain and felt able to discuss any concerns with the care staff or the registered manager. The registered manager encouraged people and their relatives to give their opinions of the home through meetings and talking with them and staff.

The registered manager had been recruited since our last inspection and was supported by the provider in making significant improvements within the home. The home’s positive values and culture were seen during our inspection and everyone we spoke with commented on the improvements that had been made recently.

We saw that the provider had systems in place to monitor and check the quality of care and to make sure the environment was safe.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014.

This inspection was unannounced and we visited the home over two days.

Ottley House is registered to provide accommodation and nursing or personal care for 72 people. People were cared for in two units Ann Carter and Memory Lane. The service was meeting the requirements of the Health and Social Care Act 2008 prior to this inspection. There were no enforcement actions being taken against this provider. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

We found the provider needed to make improvements to ensure people’s needs were met and they were safe. We saw a person requiring one to one support left unsupervised and staff unclear about their role in supervising this person, placing that person and others at risk. Staff had not followed the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards; this meant that some people were potentially unlawfully having their movements restricted. We saw one example where a person was potentially being deprived of their liberty. Staff did know how to spot the signs of abuse and knew who to refer these concerns to when they happened.

We saw that staffing levels were suitable but the way in which the leadership team had deployed staff meant there was no effective way of making sure people had continuity of care. Recent changes to the rota system meant that staff were now clear about when they should come to work.

The support and training that staff received needed to be improved. Despite the provider having training resources and supervision procedures in place they had not been followed by the registered manager. As a result staff told us they felt unsupported and lacked direction.

We found that people’s experience of meal time varied considerably on each unit and improvements were needed to make sure that meals and drinks were served for people in a respectful and dignified manner. Improvements had been made to the way the staff assessed and recorded the risk to people when not being able to eat and drink a balanced diet.

We found that people were not always treated with respect, dignity or consideration. This was particularly evidenced in Memory Lane unit where people’s care needs were not consistently being met. Most of the relatives and people who used the service told us they thought the care was good but staff were rushed at times.

People we spoke with told us they did not have confidence in the registered manager when dealing with complaints. They did however acknowledge the provider had a system in place to deal with complaints and if complaints were escalated to senior managers in the organisation they were addressed.

This service was under internal scrutiny by the provider because they had identified that it was failing to meet their required standards. We found breaches of regulations during this inspection that meant the service was not meeting the required standards of the law. The service lacked effective leadership.

You can see what action we told the provider to take at the back of the full version of the report.

Not all the people we met were able to speak with us about the care they received and their experience of living in the home. Therefore we observed how staff interacted and supported people. This helped us to make a judgement on how their needs were being met.

People who used the service and their representatives told us they were happy with the care and support they received.

Each person had a care plan with up to date information about the care and support they needed and people told us, "Nothing is too much trouble; the staff help me with the things I can’t manage".

Staff were aware of how to respond to any allegation of abuse in a way that safeguarded vulnerable adults.

The provider had effective recruitment procedures in place.

We found the home to be clean and regular checks had been carried out to ensure the required standards of cleanliness and infection control.

People were cared for, or supported by, suitably qualified, skilled and experienced staff.

People told us that they were generally happy with the service they received, although two people told us that they sometimes had to wait for their call bells to be answered.

People told us that the staff were, “All good”, and that they were, “All friendly”. Relatives were also complimentary about the service. One told us that “Everyone was so lovely”, and “Nothing is too much trouble”.

We saw that staff were respectful and kind to people. We saw staff taking time to understand people’s needs. Staff told us that they sometimes felt a little rushed when they were busy.

We found that care plans were detailed and gave staff the information they needed to provide support for people. People’s needs and preferences were clearly recorded. Staff told us that they preferred not to switch between the two units within the home because they were not always as familiar with the people they were caring for in the other unit.

We found that the staff had received a range of training to support them in their roles. We also found that the home had robust systems in place to ensure that the quality of service was maintained or improved.

People living at Ottley House on the Charles Darwin unit appear happy and well looked after. People enjoy a range of daily activities both in groups and individually with designated staff.

People are offered choices in order to remain in control of their lives as far as they are able and the home is working closely with relatives and outside agencies to ensure that the home meets all of people’s care and support needs.

Staff respond immediately to calls for assistance and are sensitive and discreet in support offered. Staff consider that there are enough staff on duty to ensure people’s needs are fully met. Staff manage people’s behaviours well although we considered that improvements to the detail in care plans will inform newer staff to the home of possible triggers and best approaches to manage individual behaviours.

The home works closely with health care professionals to keep people well. One person told us that they think that the home does a good job. They wanted to commend the home for the way they have supported one person in particular saying, “They have managed them extremely well”.

Two relatives told us that they are very happy with the way that they home supports their family member. One person said that they always feel welcome.

Staff feel well supported and receive good training opportunities relevant to their roles. Staff know what constitutes abuse and would be confident to recognise and report it. Senior staff know how to report abuse. Over the last nine months the home has worked openly with the local safeguarding team, acting swiftly to make improvements, to ensure the ongoing protection of vulnerable people.