We carried out an unannounced comprehensive inspection of Otterbourne Grange Residential Care Home on 11 January 2016.

Otterbourne Grange Residential Care Home is a care home providing accommodation and personal care for up to 25 older people. Some people using the service were living with dementia. When we visited there were 16 people using the service.

The service is a converted residential dwelling with accommodation over three floors. People live in single or shared rooms. There is a dining room and sitting room which is also used as an activity room.

The service had 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 and associated Regulations about how the service is run.

People, their relatives and staff spoke positively about the leadership of the service. Systems were in place to monitor the quality and safety of the service. However, improvements were needed to ensure shortfalls identified by the provider in relation to people’s care plans and the reporting of safety incidents would be addressed. This was important to be assured that staff had all the up to date information they needed in order to know how to care for people if they were to refer to care and service records.

Staff understood the signs of abuse and neglect and demonstrated a commitment to ensuring people were protected from harm. Staff had a good understanding of people's risks and how to support them to maintain good health and stay safe.

There were sufficient numbers of staff deployed to meet people's needs. Recruitment practices were safe and relevant checks had been completed before staff worked unsupervised.

Appropriate systems were in place for obtaining, storing and disposal of people's medicines and people received their medicines as prescribed.

People liked the food and told us their preferences were catered for. People received the support they needed to maintain good hydration and nutrition.

Staff were supported to carry out their roles and received an induction and on-going training and supervision to enable them to meet people’s needs effectively.

Staff sought people's consent before providing assistance. Where a person's ability to consent to their care arrangements was in doubt, a formal assessment of their capacity was undertaken. Where appropriate best interests decisions were made with people’s representatives as part of the care planning process. Relevant applications for a DoLS had either been authorised or were awaiting assessment by the local authority.

Staff had developed effective working relationships with a number of healthcare professionals to ensure that people received co-ordinated care, treatment and support.

People were cared for by kind and caring staff who respected their choices and were mindful of their privacy and dignity.

People had choice about their daily activities. They were involved in their support planning and chose what activities they wanted to undertake.

People told us they were able to express their views and to give feedback about the service. They were confident they could raise concerns or complaints and these would be dealt with.

During our inspection at Otterbourne Grange Residential Care Home we spoke with the manager, three other members of staff, two people using the service and two visiting relatives. We also spoke with community nurses, the nominated individual and the provider’s head of care. Not everyone who lived at the home was able to tell us what they thought about living there so we undertook a short observational tool for inspections (SOFI) at lunch time to help us understand the experience of people who could not talk with us.

Otterbourne Grange Residential Care Home was bought by a new provider in June 2013. The service had been without a manager until a new manager was appointed in May 2014. The provider has submitted plans to the local authority to refurbish this large, Victorian house and build a new extension.

We gathered evidence against the outcomes we inspected to help answer our five key 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. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

Systems for learning from accidents and incidents and complaints were in place and were being embedded under the new management.

The provider had submitted plans to upgrade the premises but in the meantime we found that the bathrooms and kitchen required updating. Older parts of the home were difficult to maintain to a clean and hygienic standard and environmental risk assessments relating to specific parts of the building needed to be completed and actioned. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to cleanliness and hygiene and suitability of premises.

We found that staffing levels were not based on people’s needs for care and support. There were insufficient staff to keep people safe and support their health and emotional wellbeing. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to safe staffing.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that an emergency DoLS had been requested for one person using the service.

Is the service effective?

Most aspects of people’s health and care needs were assessed and care was planned and reviewed. However, we found that some aspects of care were not risk assessed and managed effectively. For example, there were gaps in the recording and delivery of people’s care and treatment. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to protecting people from the risks associated with inappropriate or unsafe care.

Is the service caring?

The service was caring. People told us that staff were kind and caring. We heard that staff provided “Fantastic care, second to none” and that the staff were very kind and caring. We observed that staff spoke with kindness and treated people with respect.

We observed care and support being provided to people in a kind, patient and considerate manner. Staff encouraged people but allowed them to make their own choices.

Is the service responsive?

The service responded to changes in people’s needs and sought advice from health professionals promptly and followed their guidance. Health professionals were positive about the care people received and the way staff tried their best to provide the care people needed.

Complaints were managed promptly and people’s concerns were investigated, and responded to appropriately.

Is the service well led?

The service had not had a registered manager in place for about a year before the current manager was recruited. This meant some systems for monitoring quality had not been fully embedded. Senior managers from outside the home had carried out training and audits and were committed to improving the quality of service provided.

Staff said they received good training and relatives were confident in the skills and attitude of the staff. There was effective leadership within the home.

We carried out an unannounced comprehensive inspection of Otterbourne Grange Residential Care Home on 12 and 14 October and 6 November 2015.

Otterbourne Grange Residential Care Home is a care home providing accommodation and personal care for up to 25 older people. Some people using the service were living with dementia. When we visited there were 18 people using the service. The service is a converted residential dwelling with accommodation over three floors. People live in single or shared rooms. There is a dining room and sitting room which is also used as an activity room.

The service did not have a registered manager in place. 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 is required by a condition of its registration to have a registered manager. The manager was leaving the service and had withdrawn her application to be registered with the Care Quality Commission (CQC). Though the service had consistently had managers in place, these managers had not fully completed the registration process with CQC to enable the provider to meet their registration requirements.

The provider told us they were finalising the appointment of a new manager, in the interim they had appointed the Deputy Manager to the post of Interim Manager  until such time as the new manager was able to take up the post.

We previously inspected the service in July 2014 and found several regulatory breaches. During this inspection we checked whether the provider had taken action to address the concerns we found. The provider and staff were motivated to improve the service and we found the required improvements had been made and sustained.

During this inspection we found where people lacked the capacity to agree to the restrictions placed on them to keep them safe, the provider made sure people had the protection of legal authorisation instructing them to do so. Records did not show restrictions were only placed on people as a last resort after less restrictive approaches had been exhausted. We have made a recommendation about the recording of mental capacity assessments and best interest decisions supporting Deprivation of Liberty Safeguards(DoLS) applications.

The manager undertook regular audits to monitor the quality of care provided to people. Although these had resulted in some improvements to the service being made not all audits had consistently identified where improvements were needed. We have made a recommendation about governance systems to ensure their effectiveness.

People were safe at Otterbourne Grange Residential Care Home. Risks to people’s health and safety had been identified and managed by the staff. Improvements had been made to support people’s mobility, nutrition, skin and emotional needs. Action had been taken to ensure a safe, clean and hygienic environment for people.

There were enough staff to meet the needs of the people that lived here. People were very positive about the staffing levels and said they received support quickly when they needed it.

People received their prescribed medicines safely and had access to healthcare services when they needed them. People liked the food and told us their preferences were catered for. People received the support they needed to eat and drink enough.

Staff had a good knowledge of their responsibilities for keeping people safe from abuse. The provider had carried out appropriate recruitment checks to ensure staff were suitable to support people in the home. Staff received training and supervision to support the individual needs of people effectively.

Care plans were based around the individual preferences of people as well as their medical needs. They gave a good level of detail for staff to know what support people required. People told us that they had been included in the development of their care plans, and involved in reviews.

People were treated with kindness, compassion and respect and staff promoted people’s independence and right to privacy. The staff were committed to enhancing people’s lives and provided people with positive care experiences.

People knew how to make a complaint. People told us the manager and staff would do their best to put things right if they ever needed to complain.