This was an unannounced, comprehensive inspection visit completed on 12 November 2018. This was completed within six months of publication of the last inspection report as the service was previously placed in special measures, with an overall rating of inadequate.

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.’

This inspection took place on 18 and 19 April 2018, it was unannounced.

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

This inspection took place on 4 and 7 September 2017, it was unannounced.

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 w

This inspection took place on 11 and 12 January 2017, it was unannounced.

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 staf

During our inspection on 01 August 2013 we found that care plans for the people using this service were not up to date. They did not contain appropriate information which would have allowed staff to provide the care and support that people needed.

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.

We spoke with the relatives of two people using this service and they both expressed their satisfaction at the quality of the service their loved one received. One relative told us “I cannot fault the place – it is superb.” The second relative told us “The staff always sort everything my [relative] needs” and that they had “No complaints at all.” They further commented that they felt their relative was “…very happy…” living at Overbury House.

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.

Because some of the people using the service had complex needs, this meant they weren't able to tell us specifically about their experience of living in Overbury House. However, we gathered evidence of people’s experiences of the service by carrying out observations and reviewing information contained in care records and the complaints file.

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.

On this occasion we were not able to speak with anyone who uses the service about the way their medicines are managed.

Most people with whom we spoke were unable to verbally communicate their experience of the service. We spent time with people and made observations of their experience of living in the home and of how well staff interacted and supported people with their health, care and welfare needs. One person told us that staff were caring and they had no complaints. One relative told us that staff were very caring. Another told us that their relative was always assisted with their personal care in the way that they would have wished.

We observed that staff did not always provide appropriate support to promote people's privacy and dignity. There were times when people's needs were not being met and there was a lack of clear guidance for staff about people's needs and how to meet them. At lunchtime we saw a choice of food that looked appetising. People appeared to enjoy the food, but some people did not receive appropriate support to manage their food and maintain a good nutritional intake.

The majority of people using this service have dementia to varying degrees. During our visit we spent time talking with people using the service but those people with whom we spoke had some difficulty expressing their views about their experience of the service. However, we were able to identify expressions of need and wellbeing through observations of people engaged in daily activities and these have been incorporated where possible throughout the report.

Two people with whom we spoke said they enjoyed the food and the staff were kind to them.

Staff told us that they liked working in the home and that the service had improved since the new manager came into post. They also told us that there had been some issues with staffing sickness and turnover. Agency staff had been brought in to ensure adequate numbers of staff but the quality of some agency staff had been less than satisfactory.

One agency worker expressed concern about some of the agency staff working in the home and said they did not believe they had received adequate training.

The deputy manager told us the service had been working hard to implement a new care planning system and to ensure that people’s needs were properly assessed and met.

This inspection took place on 02 and 05 December 2014 and was unannounced. This meant that the provider did not know that we were coming.

Overbury House Nursing and Residential Home provides care and accommodation for up to 61 older people. On the days of our inspection there were 35 people receiving residential care and 20 people who required nursing care.

The service is required to have a registered manager in day to day charge of the home and the registered manager has been in post since January 2013. 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 this inspection we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in relation to the safe administration and recording of medicines.

We found that medicines were not routinely given to people at the prescribed time. This meant that there could potentially be an impact on their health conditions. There were gaps in the medication administration records and there were examples where they were not completed accurately.

We watched the interactions between people and staff and saw that people felt comfortable in the presence of staff. People had timely access to health professionals, including GP, community nurses and the speech and language therapy team. People’s privacy and dignity were promoted, with all personal care being given behind closed doors.

There were not enough staff available over the lunchtime period to ensure that people enjoyed their meals in a timely way. People told us they enjoyed the food and that there was plenty of it.

Records detailing the amount people had to eat and drink were not completed promptly and we found gaps in these records. There was evidence that action was not always taken quickly when there were fluctuations in people’s weight.

Staff received training that was appropriate to their role and there was a training programme in place to ensure staff remained up to date. Staff were well supported by senior staff and the management at the home.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to all care services. Policies and procedures were in place and we saw that staff training about this had been arranged.

Most people told us they knew who to speak with if they wanted to make a complaint or raise concerns. The home seeks the views of people, relatives, staff and health professionals to assess the quality of service. Regular quality audits of the systems and processes in respect of the management of the home were in place.