Overton 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.

The service is registered to provide personal care and accommodation for up to 40 older people, including people who are living with dementia. The home is situated in Cottingham, in the East Riding of Yorkshire and close to the city of Kingston upon Hull. All accommodation is on the ground floor and there are enclosed courtyards where people can access the outdoors. At the time of our inspection 36 people were using the service.

At a previous inspection in September 2015 and we rated the service good overall but found one breach of legal requirements in respect of the need for people to consent to their care. We therefore inspected the service again in November 2016 to check that improvements had been made in this area, and to re-assess the rating for the key question: ‘Is the service effective?’ We found improvements had been made and the rating for this key question was upgraded to good. At this inspection we found the evidence continued to support the rating of good overall and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. However, one key question: ‘Is the service well-led?’ has been down-graded to the rating of requires improvement, due to some record keeping and quality assurance issues we identified. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected.

Medicines were stored, administered and recorded safely. The premises were clean and well maintained to keep people safe.

Risks to people were assessed and action taken to mitigate them. However, we found examples where information about risk and about contact with healthcare professionals was not always clearly recorded.

Staffing levels were sufficient to meet people's needs. Robust recruitment and selection procedures were followed and appropriate checks had been undertaken before staff began work. Staff received the support and training they needed to give them the skills and knowledge to meet people's needs.

People were supported with their nutritional and healthcare needs and had access to healthcare professionals when required.

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.

Staff treated people with dignity and respect; they knew people well and could anticipate their needs. We observed positive, caring interactions between staff and people who used the service. The environment was stimulating and people were able to access a range of activities and entertainment.

The provider had a system in place for responding to people's concerns and complaints. People, relatives and visiting professionals were asked for their views in meetings and surveys.

Care plans were in place to give staff the information they needed to support people in line with their preferences and assessed needs. However, we found variation in the quality and amount of information in some files. Quality assurance systems in place had not been effective in identifying and addressing this. We have made a recommendation about this in our report.

Further information is in the detailed findings below.

We carried out an unannounced comprehensive inspection of this service on 24 September 2015 and we found a breach of legal requirements in respect of the need for people to consent to their care. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to this breach. We undertook this focused inspection to check that they had followed their plan and to check that they now met legal requirements. This report covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Overton House on our website at www.cqc.org.uk

The home is registered to provide accommodation and care for up to 40 older people, including people who are living with dementia. The home is situated in Cottingham, in the East Riding of Yorkshire and also close to the city of Kingston upon Hull. All accommodation is on the ground floor and there are enclosed courtyards where people can access the outdoors safely. People have single bedrooms with en-suite facilities, and there are also communal bathing and showering facilities.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager who was registered with the Care Quality Commission (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 is run.

The service was working within the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). We saw that people’s capacity to make decisions had been assessed and when people lacked the capacity to make decisions for themselves, best interest decisions had been made on their behalf and had been recorded.

Staff had received the training they needed to carry out their roles effectively, and they received support from a senior manager in supervision and appraisal meetings.

People’s nutritional needs were assessed and their special diets were catered for. People received support from health care professionals when required and we found that staff followed any advice and guidance they were given.

The premises continued to provide suitable accommodation for people who were living with dementia, including signage to help people find their way around the premises.

We carried out this inspection on 24 September 2015 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 registered provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

This was an unannounced inspection which meant that the staff and registered provider did not know that we would be visiting.

At the last inspection on 2 June 2014 we found Overton House Care Home was meeting the requirements of the regulations reviewed.

Overton House is in Cottingham, in the East Riding of Yorkshire and is registered to provide personal care and accommodation to 40 older people who may also have a memory impairment. Accommodation is all on the ground floor and in single occupancy bedrooms.

The provider is required to have a registered manager in post and on the day of the inspection there was a manager registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like 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 registered manager understood the Deprivation of Liberty Safeguards (DoLS); however, we found that Mental Capacity Act (2005) guidelines had not been fully followed. This was a breach of a regulation. You can see what action we told the provider to take at the back of the full version of the report.

We found that people were protected from the risks of harm or abuse because the registered provider had effective systems in place to manage any safeguarding issues. Staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm.

We saw that there were sufficient numbers of staff on duty and people’s needs were being met. We found that effective recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

The home had a system in place for ordering, administering and disposing of medicines and this helped to ensure that people received their medication as prescribed.

We found that the homes premises and equipment were clean and properly maintained. The registered manager was aware of guidance in respect of providing a dementia friendly environment and progress had been made towards achieving this.

We saw that staff completed an induction process and that they had received a wide range of training, which covered courses the home deemed mandatory such as safeguarding, moving and handling and infection control and also home specific training such as dementia awareness.

Staff told us that they felt well supported by the registered manager and could approach them if needed. They told us that they received formal supervision, but could also approach the registered manager with any concerns at any time.

We found that people’s nutritional needs were met. We also saw that the lunchtime experience for people living in the home was a relaxed and enjoyable experience.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff or relatives to hospital appointments.

We observed good interactions between people who used the service and the care workers throughout the inspection. We saw that people were treated with respect and that they were supported to make choices about how their care was provided.

People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. The care plans contained detailed information about how each person should be supported, although more detail was required in plans relating to managing behaviours that challenge.

The service employed an activity coordinator and offered a variety of different activities for people to be involved in. People were also supported to go out of the home on day trips or to access facilities in the local community.

People’s comments and complaints were responded to appropriately and there were systems in place to seek feedback from people and their relatives about the service provided.

We found that the provider had audits in place to check that the systems at the home were being followed and that people were receiving appropriate care and support.

We carried out this inspection to answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the staff who supported them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risk to people and helped the service to continually improve.

The home had policies and procedures in relation to Deprivation of Liberty Safeguards (DOLS) although no application had needed to be submitted. The manager had a good understanding of when an application should be made and in how to submit one. This meant that people were safeguarded as required.

The home was designed to meet the needs of people who lived there and the provider ensured the environment was regularly maintained, safe and fit for purpose. The doorways to bedrooms, communal spaces and toilet/bathing facilities were wide enough for wheelchairs or people with walking frames to mobilise comfortably through them. People who used the service were pleased with the facilities offered by the service. One person told us “I have a lovely room and the staff keep it nice and clean.”

People were protected from unsafe or unsuitable equipment because the provider had ensured the equipment used in the service was serviced and maintained and service certificates were available for inspection.

Is the service effective?

People’s health and care needs had been assessed and care plans were in place. There was limited evidence of people being involved in assessments of their needs and planning of their care. However, people said they could discuss their care with the staff or manager and on the whole felt well supported and cared for.

People’s needs were taken into account with signage and the layout of the service enabled people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people with dementia and conditions relating to old age.

Our checks of the records and documents within the service showed that staff received training in safe working practices. Health and safety risk assessments were in place with regard to fire, moving and handling and daily activities of living.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. One visitor told us that they visited the service daily and they were delighted with their relative’s care. The visitor said “X has really settled here. I am really pleased with their care and I think the staff do a marvellous job of looking after them and everyone else in the service. The staff are really good at letting me know if anything happens to X and I can visit when I like.”

People who spoke with us said “We are very satisfied with our care, the food is good and there are plenty of choices available” and “I like it here.”

Feedback from people who used the service, relatives and staff was obtained through the use of satisfaction questionnaires, meetings and one to one sessions. This information was usually analysed by the provider and where necessary action was taken to make changes or improvements to the service.

Is the service responsive?

People we spoke with said they were confident about using the complaints system if they needed to. They told us that they would speak to the staff or the manager about any issues and that when this happened action was taken quickly to resolve any problems.

Is the service well led?

The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff told us they were clear about their role and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure people received a good quality of service at all times.

At the time of our visit there were 37 people residing at the service. People who used the service were living with dementia.

Care records were detailed and were reviewed regularly to ensure they accurately reflected people’s current needs. People we spoke with were often unable to tell us their views of the standard of the care they received. We used an observational tool and general observation throughout the day in order to comment on the delivery of care.

We considered the safeguarding of vulnerable adults as our records showed there had been a large number of safeguarding notifications. We found the provider had acted in accordance with the local safeguarding authority’s reporting protocol and had taken all reasonable steps to try to reduce the number of safeguarding incidents.

We saw that systems were in place to maintain the required standards of cleanliness and hygiene. However, relatives of people who used the service told us there had been a decline in the previously very standards maintained at the service. On the day of our visit some mal odours were present in the main entrance and communal areas.

The manager explained the staffing levels employed at the service and that the needs of potential new people were assessed prior to their admission to the service to ensure their needs could be met within the staffing structure.

The manager worked in accordance with the provider’s quality assurance policy to ensure they monitored the quality of the service provided.

We were unable to communicate effectively with people that used the service so we carried out a' short observational framework for inspection' to determine peoples' demeanour and mood within the service and we spoke with staff about the care and welfare of people. We also asked staff to describe the culture within the home. They said it was one that fostered involvement and empathy.

We saw from the observations we carried out and from documentation held by the service that people were respected and involved in their care programmes. They were asked for their written, verbal or gesticulative consent to care and treatment before staff proceeded to provide care, and where the provider could not obtain consent then the correct legislative procedures were used to identify the action needed to ensure a person's best interest was achieved.

We found that while people did not always experience frequent interactions with staff and other people that used the service, they did have their care and health care needs satisfactorily met.

We found that there was a good audit trail for the management of medicines in the home. Staff handled medication safely and people received it in a timely manner, according to the prescribed instructions.

We found that staff were appropriately trained and supervised to carry out their roles and that there was an effective system in place to monitor and assess the quality of the service provision.

Some people who lived in the home had complex needs and we were unable to verbally communicate with them about their views and experiences. We did communicate with people about their immediate needs for nutrition though.

We spoke with people in the home about food and observed them enjoying breakfast and lunch.

One person told us the food they had been given was very tasty and that they liked it. They ate everything they had been given and looked as though they had enjoyed their food.