Archived: Oakhaven Care Home

Oakhaven Care Home is a large detached property situated in Oakwood on the outskirts of Leeds. The service offers accommodation for up to 24 older people.

There was a registered manager 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 and associated Regulations about how the service is run.

At this inspection we found some aspects of medicines management were not always safe or in line with the provider's policy. We could not be sure people had received their medicines as prescribed.

Overall we found there were enough staff to make sure people received appropriate care and support. However, there were times when people were not supervised which put their safety at risk. We have made a recommendation about this in the safe section of this report. Recruitment checks had been carried out on all staff to ensure they were suitable to work in a care setting with vulnerable people.

Staff knew how to keep people safe from the risk of harm and abuse; they had received relevant

safeguarding training and knew how to report issues of concern.

Our inspection of the building showed it was a safe environment in which to care for people. Equipment, such as hoists, bathing aids and pressure relieving mattresses were available in the home and these helped promote people's safety and comfort.

We found people's health care needs were met and relevant referrals to health professionals were made when needed.

People's nutritional needs were met. There were choices available on the menus and alternatives if people didn't like what was on offer. Nutritional risk was assessed and people’s weight was monitored.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. We saw appropriate DoLS authorisations had been made for people the service had identified were likely to have their liberty deprived.

When people were assessed as lacking capacity, staff acted within the principles of the MCA and ensured important decisions were made within best interest decision making processes.

Staff had completed training to ensure the care and support provided to people was safe and effective to meet their needs.

People told us they were treated with kindness and compassion. Our observations of care and

support confirmed this. People told us they were happy with the care provided.

People's needs were assessed prior to admission and this was kept under review and updated when there was any significant change. People had detailed person centred care plans which provided staff with guidance in how to look after them.

A range of activities were offered for people to participate in and people told us they enjoyed these.

There were systems in place to ensure complaints and concerns were fully investigated. The registered manager had dealt appropriately with any complaints received.

A range of checks and audits were undertaken to ensure people's care and the environment of the home were safe and effective. These checks had failed to identify the issues we noted around the management of medicines. Improvements were required to some of these processes to ensure they were effective in identifying and responding efficiently to issues.

We found the registered manager was approachable and people who used the service and their relatives were listened to.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to the Safe care and treatment. You can see what action we told the provider to take at the back of the full version of the report.

Below is the summary of what we found but if you want to see the evidence supporting our summary please read our full report. The summary is based on speaking with people who used the service, the staff supporting them, our observations and from looking at records.

Is the service safe?

People told us they were treated with dignity and their rights were respected. One person said, “Its excellent here.”

All the people we spoke with said they felt safe in the home and visitors said they felt their relatives/friends were safe; people also said they felt they got the care and support they needed.

We looked at the recruitment of new staff. We saw recruitment practice was safe and all necessary pre-employment checks had been carried out.

The Registered Manager set the rotas; they took people’s care needs into account when making decisions about the numbers, skills and experience required. We found there were sufficient staff to meet people’s needs.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, policies and procedures were in place and under review to ensure people’s rights were protected.

Is the service effective?

People who used the service were asked about their care and able to make decisions. People who used the service said they were always asked for their consent before care tasks were carried out. One person said, “They always ask what I want doing before they start.”

Staff we spoke with showed a good understanding of protecting people’s rights to refuse care and support. They said they would always explain the risks from refusing care or support and try to discuss alternative options to give people more choice and control over their decisions.

Some people who used the service told us they found the food in the home good. However, a number of people commented that food on the day of our visit was inedible, bland and cold. We found that systems were not in place to ensure people were fully protected from the risks of inadequate, nutrition. We were told there was a lack of involvement in menu planning from people who used the service. It was not clear if people’s cultural and health needs regarding their diet were properly assessed and catered for.

Is the service caring?

Throughout our observations we saw staff treated people with kindness and courtesy. We saw staff were kind, patient and encouraging when giving support to people who used the service.

People’s comments included:

“The care is good and I praise them highly. I give the care staff top marks.”

“The staff are kind they look after us.”

People’s family members were complimentary of the staff and care and support their relative received. One said, “I am very pleased with the care my relative receives.”

Is the service responsive?

We spoke with people who lived in the home about activities and the response was varied. Generally people said they would like more to do. One person said they did not enjoy joining in the activities on offer but would like to get out more. Staff said people who used the service enjoyed having entertainers coming into the home but this didn’t happen very often.

Care records showed that people’s needs were assessed. However, we found that whilst care plans held numerous care assessments of people we found it was difficult to find a profile of the person or key information to clearly show how a person’s needs should be met. Staff told us a new care planning system was being introduced and this included a key worker system which would ensure more involvement from people who used the service in planning their own care and support.

We saw people who used the service were responded to promptly when they asked for any support or assistance.

Is the service well led?

Staff said they felt the service was well managed and the Registered Manager was approachable. They said they had confidence in the Registered Manager and any issues brought to her attention were always dealt with properly and thoroughly.

The Provider had some systems in place to assess the quality and safety of the service provided, however, we found that from all of the checks in place it was not always clear of the action taken or who was responsible for taking action when issues were identified. We were given assurances that systems currently being introduced by senior management and the Registered Manager will fully address this. For example, surveys and meetings for people who used the service and their relatives.

We looked at staffing arrangements because at our last inspection visit we found there were not enough staff at all times to ensure people’s needs were being met. Since the last inspection the provider had increased the number of night staff and this ensured there were sufficient staff during the night. However, there were not always enough staff during the day or on an evening to ensure people’s needs were being met. Sometimes people could not eat their meal in the dining room because there were not enough staff. Some people were not getting regular baths and showers. Staff we spoke with told us there were insufficient staff.

We spoke with five people who used the service and one relative. They said they were happy with the care and didn’t have any concerns about the staffing arrangements. People were very complimentary about the staff and said they did not have to wait long if they wanted assistance. Even though people did not raise concerns about their care we concluded that the provider had not taken appropriate steps to ensure that at all times there were sufficient numbers staff to meet people’s needs.

Relatives we spoke with told us they were very happy with the care and treatment their relative received.

People’s privacy, dignity and independence were respected.

One member of staff we spoke with told us, “Staff are caring and people are safe here. I love my job.”

We saw that the home was clean, tidy and free from bad odours. People we spoke with told us that their rooms were cleaned on a daily basis. One person told us, “It looks clean enough to me. They are always cleaning my room and making my bed for me.”

People were cared for in a clean, hygienic environment.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

Overall we found that people's needs were being met however; we found that staffing levels were not adequate at all times which could lead to people's needs not being met or overlooked.

We saw that people smiled and appeared relaxed and comfortable with staff and others living in the home. During our inspection we saw that people received good care. We saw that people had a good rapport with staff and appeared to be comfortable and confident when interacting with them. Where they were able to people told us things like, 'I like it here', 'the food is good' and 'Staff are nice.'

We spoke with four visitors who had come to see relatives who used the service. They told us they were very happy with the care their relatives received. They said they had noticed positive changes in the service over the last few months. One said that 'The new team have been a marked improvement.' Another said 'Things are much better than when dad first came here. He is safe and they always contact me if the doctor has been to see him.'

The care plans we looked at recorded information about consent and staff understood when consent to care and treatment was required. Staff received training on the Mental Capacity Act and Deprivation of Liberty Legislation. The provider had systems to monitor the quality of the service. Staff said that they were well supported by the new manager.

We spoke to two people who used the service and they said they were happy with the care. One person told us she liked living at the home. Another person said they were very settled.

We spoke to four relatives and they told us people received good care. No concerns were raised about the service. Three of the relatives said the service had improved and they were much happier with the standard of care. One relative said they were happy with the care and had not had any previous concerns.

We spoke with four staff and the manager. They told us people received appropriate care and support, and staff were encouraged to speak openly.

We found the service had introduced some better systems to improve the service although they were still not compliant with three of the five outcomes we looked at. Following the inspection in May 2012, the commission took action so the service could not admit any people without the prior agreement of the Commission. The Commission would not consider removing this condition until the service has made the necessary improvements.