We carried out an inspection of Olive House Home for Older People on 31 January and 1 February 2017. The first day was unannounced.

Olive House Home for Older People is registered to provide accommodation and personal care for up to 44 older people. Accommodation is divided into three areas: Balmoral Manor which provides care for people living with a dementia, Kensington Manor which provides people with personal care and Sandringham Manor which provides rehabilitative care to help people learn or relearn skills necessary for daily living. There were 39 people accommodated in the home at the time of the visit.

The service was managed by a registered manager. 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 the last inspection on 5 and 6 November 2014 we asked the provider to make improvements to the management of medicines, the maintenance of records and the quality assurance systems. Following the inspection, the provider sent us an action plan which set out what action they intended to take to improve the service.

During this inspection, we found improvements had been made in order to meet the regulations.

People living in the home said they felt safe and staff treated them well. There were sufficient staff deployed in the home to meet people's care and support needs. Safeguarding adults’ procedures were in place and staff understood their responsibilities to safeguard people from abuse. Risks associated with people’s care were identified and assessed. There was a whistle-blowing procedure available and staff said they would use it if they needed to. People's medicines were managed appropriately and according to the records seen people received their medicines as prescribed by health care professionals.

Staff had completed an induction programme when they started work and they were up to date with the provider's mandatory training. The registered manager and staff understood the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and acted according to this legislation. There were appropriate arrangements in place to support people to have a varied and healthy diet. People had access to a GP and other health care professionals when they needed them.

Staff treated people in a respectful and dignified manner and people's privacy was respected. People living in the home had been consulted about their care needs and had been involved in the care planning process. We observed people were happy, comfortable and relaxed with staff. Care plans and risk assessments provided guidance for staff on how to meet people’s needs and were reviewed regularly. People were encouraged to remain as independent as possible and supported to participate in a variety of daily activities.

Systems were in place to monitor the quality of the service provided and ensure people received safe and effective care. These included seeking and responding to feedback from people in relation to the standard of care.

People spoken with were very satisfied with the service provided, one person told us, “I’m happy here, I don’t have any worries” and another person said, “I like everybody, we all get on so well”. People told us their rights to privacy, dignity and independence were upheld and respected. Relatives spoken with were also complimentary about the service.

People’s care was planned and delivered in accordance with their needs. People had individual care plans which were supported by a series of risk assessments. People told us they had discussed their needs with staff and had been involved in the reviews of their care. We saw people had signed their care plans wherever possible to indicate their participation and agreement.

We found staff had received training on safeguarding vulnerable adults and had access to appropriate policies and procedures. Staff had an understanding of the safeguarding processes and knew how to raise an alert.

We noted appropriate checks were made during the recruitment of new staff.

There were effective systems in place to monitor and assess the quality of the service. People were asked their opinion of the service on a regular basis and were given the opportunity to complete a customer satisfaction questionnaire. This meant people were able to have input into the development of the service.

We carried out this inspection to follow up areas of non compliance found during our inspection on 14 June 2012. During this inspection, we found the necessary improvements had been made and the service was compliant with all outcomes assessed. We focussed the inspection on the experiences of people using the rehabilitation unit.

People spoken with told us they were satisfied with the service provided, one person commented, “It’s been very good, I’ve been quite happy with everything”. People told us their rights to privacy, dignity and independence were upheld and respected and they had a good relationship with the staff.

People’s care was planned and delivered in accordance with their needs. People had individual care plans which were supported by a series of risk assessments and daily care records. This meant people’s care could be readily monitored and evaluated.

People were generally satisfied with the food provided. There was a choice of meals and people confirmed the food was of a good quality and there was always plenty to eat. Drinks and snacks were served throughout the day or on request.

Suitable arrangements were in place to manage medication.

Appropriate systems were in place to ensure appropriate records were maintained and kept up to date.

We focused our inspection on the intermediate care unit and spoke to seven people and three relatives, as well as the staff, manager and care business manager. We also looked at a sample of records. All the findings from our inspection relate to this unit.

People told us they were satisfied with the care provided and all made complimentary comments about the staff team. One person said “It’s first class, I have no concerns or grumbles at all” and another person commented, “Everyone is very obliging and they help you as much as they can”. However, we found people were not involved and not familiar with their care plans, which meant they were not enabled to fully participate in decisions about their care.

We noted care plans were brief and lacked information about people’s needs and how they wished their care to be delivered. One person told us the staff were unclear how to care for them during the night and as a consequence they experienced some discomfort.

People made positive comments about the food and confirmed a choice was available. However, we noted one person’s nutrition and hydration needs were not accurately monitored in order to ensure they were receiving a proper diet.

People told us they were receiving appropriate support with their medication. However, we found some medication records were not fully completed and three medications were out of stock. We also noted two people had not been given their medication as prescribed.

People spoken with said there were sufficient number of staff on duty and made positive comments about the approach taken by staff. People told us they were aware of the complaints procedure and knew who to speak to if they wished to raise a concern.

People were aware records were maintained. From looking at a sample of records, we found some records were not fully completed and had not been properly maintained.

People told us they were happy living in the home and they were able to express their views and opinions about the care they were provided. One person said “The staff are caring and very thoughtful”. People spoken with felt they were well cared for and the staff respected their rights to privacy and dignity.

People made complimentary comments about the food and confirmed they were offered a choice each mealtime in line with their preferences.

People liked their bedrooms and said they were able to furnish them with their own belongings and possessions.

Visitors were welcome in the home at any time and people said they were supported to maintain good contact with their family and friends. Relatives spoken with were very satisfied with the quality of care provided and felt that their family members were looked after in a caring and sensitive manner.

People made positive comments about the staff team and felt they could talk to the any of the staff or the manager if they had a problem or query.

We carried out an inspection of Olive House Home for Older People on 5 and 6 November 2014. The first day was unannounced. We last inspected Olive House on 23 October 2013 and found the service was meeting the current regulations. However, during this inspection we found the care home provider required to make improvements in the following areas: the management of medication, record keeping and the systems used to manage risks to people’s welfare. We also recommended improvements in the implementation and use of the Mental Capacity Act 2005 and the dining arrangements for people living with a dementia.

Olive House is a 44 bedded care home providing care to older people with a range of needs. Accommodation is divided into three units: Balmoral Manor which provides care for people living with a dementia, Kensington Manor which provides people with personal care and Sandringham rehabilitation unit which provides rehabilitative care to help people learn or relearn skills necessary for daily living. There were 37 people accommodated in the home at the time of the visit.

The service has a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 told us they felt safe and were well cared for in the home. All staff spoken with were aware of the procedures in place to safeguard people from harm. We observed staff were kind and compassionate in their interactions on all three units.

As Olive House is registered as a care home, CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. At time of the inspection one person had an authorised DoLS and an application had been submitted to the local authority in respect to another person’s needs. However, we found the people’s care plan documentation did not provide sufficient guidance for staff on how to meet these people’s needs in the least restrictive way.

We found that medicines were not always managed safely and the provider’s mandatory risk assessments had not been carried out when people had been admitted to Sandringham rehabilitation unit. These issues are important to protect the health and well-being of people living in home.

People were provided with a varied diet of food and all people spoken with told us they enjoyed the meals provided. However, we found in contrast to the other two units the dining tables were not set on Balmoral Manor unit and people were sat at empty tables. This meant it may have been difficult for people living with a dementia to recognise it was time for a meal.

People had individual personal plans that were centred on their needs and preferences. However, we found there were no care plans on file for two people who had been living in the home for six days. We also found there were omissions in the record keeping and charts were not fully completed.

We found the systems in place to manage the home required improvement. Feedback from healthcare professionals highlighted difficulties with communication systems and the organisation of the home. Whilst a series of audits had been carried out these were not always effective in picking up shortfalls.

We found staff recruitment to be thorough and all relevant checks had been completed before a member of staff started to work in the home. Staff had completed relevant training for their role and they were supported by the management team.

Our findings demonstrated a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.