Oak House Care Home

Oak House Care Home is a grade two listed building situated in the town of Axminster. The service is registered to provide care and accommodation for up to 17 people. They provide care and support for frail older people and people living with dementia. There were 16 people living at the service when we visited.

People’s experience of using this service and what we found

People experienced safe care from staff who understood how to protect them from abuse and avoidable harm.

People were supported by sufficient staff who received training to support them in their role. We discussed ensuring the communal areas were regularly monitored to ensure people were safe.

People's risks were assessed, and care plans put in place to support people in the way they wanted. Risks to people's safety were mitigated and people received their medicine as prescribed.

Where incidents or accidents occurred, these were investigated and analysed to reduce the risk of reoccurrence.

People's needs and preferences were assessed prior to their move to Oak House to ensure their needs could be met.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff said they were well supported by the registered manager and senior team.

The home was clean, and the risk of infection was reduced by effective infection prevention and control measures being followed. The provider had refurbished some areas of the home and had plans for further development. At the time of our visit the lift was undergoing a major refurbishment and the main lounge was being decorated.

People were encouraged to eat a healthy balanced diet and staff effectively managed their identified risks associated with poor hydration and nutrition.

The management team made timely referrals to relevant professionals and implemented their guidance to achieve good outcomes for people.

The culture we observed within the service was open and friendly. The registered manager and senior team were visible throughout the service and adopted an open-door policy.

Regular audits and checks were carried out by the registered manager and designated staff. These were used to review the quality and safety of the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 11 June 2022).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We undertook a focused inspection to review the key questions of safe, effective and well led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Oak House Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

People’s experience of using this service and what we found

People were receiving safe care. The provider had made improvements at the home with the support of the local authority Quality Assurance and Improvement team and a specialist nurse and occupational therapist. They had produced a service improvement plan (SIP) which they were working through. At the time of the inspection not enough time had passed for the changes made by the provider to have become embedded at the home.

There were improvements to the systems they had in place to measure and monitor the quality and safety of the service. Audits had been completed regularly, were meaningful and action had been taken if required. However, we could not be assured if the systems would become embedded, remain effective and identify concerns.

Since the last inspection, risk management had improved. People had appropriate individual risk assessments in place which were regularly reviewed to ensure they reflected their current level of risk.

Staff understood how to recognise and respond to concerns of abuse and supported people to keep safe. Staff had received training and were confident action would be taken by the management team if they raised a concern.

There were enough staff to support people and new staff were recruited safely.

Medicines were managed in a safe way.

People had their dietary needs met. Staff had clear information to guide them about people’s required consistency of diet and fluids.

There was on the whole an effective infection prevention control measures in place. However, under some people’s beds we found dust. The provider did not have a deep cleaning schedule in place, to ensure all areas were regularly cleaned.

Relatives told us the home had followed the Government guidelines regarding Covid 19. One relative said, “I think it has been safe during Covid. We test, have masks and protective clothing once we arrive and we book visits.”

People had their needs assessed and planned for and were supported by staff who were suitably trained to meet people's needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff worked alongside other agencies and professionals to ensure people had access to healthcare as required.

The registered manager and management team had improved systems and practices, demonstrating they were able to learn lessons when things went wrong and improve care for people living at Oak House Care Home.

Fire management at the home had improved and the management team had an oversight of the fire monitoring system.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 25 December 2021). The provider completed an action plan and a service improvement plan (SIP) after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 25 December 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced responsive inspection of this service on 28 October 2021 and 1 November 2021. Seven breaches of legal requirements were found. These were, Person-centred care, Safe care and treatment, Safeguarding service users from abuse and improper treatment, Good governance, Fit and proper persons employed, Staffing and Notifications of other incidents.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions, Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Oak House Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

People’s experience of using this service and what we found

People were not safe at Oak House. There was not an effective system to identify and manage risks associated with people's care. People’s individual risk assessments for their health and safety had not been regularly reviewed to ensure they reflected people’s current level of risk.

People were at risk of poor nutrition and hydration as there was poor oversight of people’s fluid and diet intake. People were not being weighed regularly and there was no clear oversight about whether people had lost weight and whether appropriate referrals were needed.

Fire management at the home was unsafe. External contractors undertook regular servicing and testing of moving and handling equipment, fire equipment and lift maintenance.

The Environmental Health Technical officer had undertaken an inspection on 27 September 2021. They had identified major improvements were required at Oak House and gave the service a one-star rating. One of the areas they identified was that records were not completed. At the inspection we found continued gaps in kitchen and cleaning records. This indicated that lessons had not been learnt to ensure improvements were implemented. The registered manager told us they would restart the kitchen monitoring records and ensure they were completed.

Staffing levels were not always adequate to ensure people’s needs were met in a timely way or to keep people safe. People were sat in the communal areas for long periods of time with no staff present. People did not always receive person centred care due to the poor staffing levels. They were receiving task orientated care. Staff said they felt they were frequently short staffed on shifts. They explained this meant some people did not have their regular showers or baths.

People were not protected from potential abuse and avoidable harm because systems and processes in place were not always effective. The management team had not appropriately raised safeguarding issues with the correct authorities, notified Care Quality Commission (CQC) or completed thorough investigations.

The provider did not have a system to ensure relevant checks were made to ensure staff were of good character and suitable for their role prior to employment.

There were poor infection prevention and control measures in place at Oak House. Staff did not always use PPE effectively and safely and in accordance with current government guidelines. Although there was a cleaning regime in place, we found some areas of the premises were not clean.

Not all staff had received the required training to support people safely. New staff had not received a comprehensive induction when they started working at the home. People's needs were not reassessed when they returned from hospital to ensure staff had the required skills and equipment to support them.

Staff had not been supported through regular supervisions and staff meetings. They had not had the opportunity to discuss their work, receive feedback, and identify further training and development needs.

People were positive about the food they received. Improvements were made during the inspection to put in place menus to advise people of the meal choices. We were not confident people who chose to eat in their rooms were being offered a choice and whether staff were offering them an alternative if they didn’t like the meal brought to them. We raised this with the management team, who assured us people always had a meal choice.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests in practice although; the policies and systems in the service supported this practice.

Medicines were safely managed. The provider used a computerized medicine system which was linked to the providing pharmacy. Staff administered medicines using a handheld device which would alert staff if a medicine had been missed.

The providers quality monitoring systems did not identify concerns and ensure the safe running of the service. Most audits had not been completed and therefore had not identified risks and areas of concern found at the inspection.

The provider did not have an environmental plan. We found some areas of the home in a tired state of repair. We were told some carpets had been replaced and vacant bedrooms decorated and that they had plans to decorate the communal areas. They told us in their service improvement plan dated 28 October 2021 they would complete an audit of all rooms to prioritise works needed.

The providers and management team acknowledged to us they knew there were concerns at the home and said that everything we told them they already were aware of. After the first day of the inspection the management team completed a service improvement plan setting out how they were going to address the concerns we had identified.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 17 February 2018).

Why we inspected

We received concerns in relation to staffing levels, staff training, people’s safety, cleanliness of the service and the management style and culture. Following information of concern about food safety being shared with CQC, The Environmental Health Technical officer had undertaken an inspection on 27 September 2021. They identified that major improvements were required and gave the service a one-star rating. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, and well led sections of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safeguarding, risk management, person centred care, staffing levels, training and competency, recruitment and good governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider and request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Oak House Care Home on our website at www.cqc.org.uk.

Staff had received infection control training and followed up to date infection prevention and control guidance to help people stay safe. Staff used personal protective equipment (PPE) correctly and in accordance with current guidance to minimise cross infection risks to people.

There were sufficient stocks available including masks, gloves, aprons and hand sanitiser. Staff breaks had been staggered to allow for social distancing to be maintained.

Staff and people were regularly tested in line with the government's current testing programme.

The home was clean, systems were put in place to ensure regular cleaning of frequent touch points such as door handles and light switches.

Systems were in place for visitors to visit the home. There was a booking system which spaced visits to avoid potential infection transmission with other visitors.

Infection prevention and control audits took place. Staff had the opportunity to discuss IPC at staff meetings and this enabled them to clarify queries and make suggestions. This ensured the registered manager and management team had effective oversight of infection control measures.

The provider had contingency plans in place in the event of any outbreak of Covid-19 or other emergency.

Oak House is a ‘care home’. 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 home is a grade two listed building situated in the town of Axminster. The service is registered to provide care and accommodation for up to 17 people. They provide care and support for frail older people and some living with dementia. There were 17 people living at the service when we visited.

At the last inspection in November 2016, we found a breach of regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had not ensured that people were always treated with dignity and respect and their privacy was not always maintained. The service had been rated as requiring improvement overall. Following the inspection the provider sent us an action plan telling us the improvements they would make. This included staff receiving supervision to discuss concerns and putting in place curtain screens in shared bedrooms. At this inspection we checked to see whether the requirement had been met and found it had been addressed.

The registered provider is also the registered manager of the service. A registered manager is a person who has registered with 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. The registered manager had delegated the day to day running of the service to a new acting manager who had started working at the service in November 2017. The provider’s area manager worked at the home at least one day a week to provide support for the management team.

People, visitors and staff gave positive feedback about the management team. They were happy to approach them if they had a concern and were confident that actions would be taken if required. The management team and staff promoted person-centred care and a family-like atmosphere at the service. People were treated equally with any diverse requirements accepted and met.

There were sufficient numbers of suitable staff to keep people safe and meet their needs. People were supported by staff who had the required recruitment checks in place and were trained and had the skills and knowledge to meet their needs. Staff had received a full induction and were knowledgeable about the signs of abuse and how to report concerns.

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. The staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (2005) (MCA). Where people lacked capacity, mental capacity assessments were completed and best interest decisions made in line with the MCA.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS provide legal protection for those vulnerable people who are, or may become, deprived of their liberty. The service had made appropriate applications to the local authority DoLS team for people they had assessed as needing to be deprived of their liberty.

Staff were friendly in their approach and maintained people’s privacy and dignity while undertaking tasks. They supported people to maintain a balanced diet and knew people’s likes and dislikes and ensured people had their preferred meal choice. We observed two lunchtime meals where people were seen being supported discreetly and enjoying their meals.

People received their prescribed medicines on time and in a safe way. Improvements had been made regarding the applications of prescribed creams and people received these as prescribed.

People were supported to undertake activities. There was a new activity co-ordinator who was implementing a range of activities to suit different people’s personal interests. The co-ordinator confirmed people who could not take part in the group activities had one to one time allocated.

Risk assessments were undertaken for people to ensure their health needs were identified. Care plans reflected people’s needs and gave staff clear guidance about how to support them safely. Care plans were person-centred and people, where able, and their families had been involved in their development. The new acting manager had plans to improve people’s mental health care plans, to include further information about behavioural triggers and de-escalation techniques when people become agitated or distressed. People, where able, were involved in making decisions and planning their own care on a day to day basis. People were referred promptly to health care services when required and received on-going healthcare support.

The premises were well managed to keep people safe. There were individual emergency plans in place to protect people in the event of a fire or emergency.

The provider had a robust quality monitoring system at the service. The provider actively sought the views of people, their relatives and staff through staff and residents meetings, surveys and questionnaires to continuously improve the service. There was a complaints procedure in place. There had been two complaints since our last inspection, which had been responded to in line with the provider’s complaints policy.

Further information is in the detailed findings below.

Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work there.

We carried out an unannounced comprehensive inspection of this service on 26 February 2015. Two breaches of legal requirements were found. These were regarding the safe management of people’s medicines, accurate records and effectiveness of the quality monitoring of the service. At this inspection we checked to see whether the requirements had been met and found they had been addressed.

The registered provider is also the registered manager of the service. A registered manager is a person who has registered with 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. The registered person had delegated the day to day running of the service to an acting manager. They had recognised that even with their regular visits to the home the acting manager who also undertook care shifts required additional support. The area manager worked at the home two days a week to provide support for the acting manager. Further changes are planned for the management of the home in the near future.

Staff did not always treated with dignity and respect and ensure their privacy was maintained. People were supported to eat and drink enough and maintained a balanced diet. Staff relationships with people were strong and supportive.

The acting manager was very visible at the service and undertook an active role. They were very committed to providing a good service for people in their care and demonstrated a supportive approach to staff. They were supported by a deputy manager and senior care staff. The management team were open, friendly and welcoming. The area manager and acting manager had recognised there were areas which required improvement. They were developing their roles and responsibilities and were delegating staff roles and responsibilities. The provider had purchased a new quality monitoring system. This had been put into place to continually review and improve the service. Where there were concerns or complaints, these were investigated and positive action taken.

People were supported by staff who had the required recruitment checks in place. However improvements were needed regarding ensuring employment gaps had been checked for staff employed using the new employment application forms used by the provider. Staff received an induction and were knowledgeable about the signs of abuse and how to report concerns. All care staff with the exception of one had undertaken or were enrolled on recognised national qualifications in health and social care. However not all staff had undertaken refresher training of the provider’s mandatory training. This had been recognised and training was being scheduled. The area manager had taken on responsibility to ensure there were adequate staffing levels at all times to meet people’s needs.

Staff had a good understanding of what constituted abuse and how to report if concerns were raised. Measures to manage risk were as least restrictive as possible to protect people’s freedom. Medicines were safely managed on people’s behalf, with the exception of people’s prescribed topical creams. However action was taken during the inspection to put in place a safer system to improve the recording of people’s topical creams.

Care plans had been re-written in a new format which the provider had started to use. They were personalised and recognised people’s social and psychological needs. However they lacked detail regarding people’s behavioural needs and routines. People’s and relatives views and suggestions were taken into account to improve the service. Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them.

The area manager demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) 2005. Where people lacked capacity they put in place during the inspection mental capacity assessments in line with the MCA. This was to ensure where they had made a best interest decision on a person’s behalf they could demonstrate they did not have the capacity to make the decision themselves. However an incorrect DoLS application had been submitted.

The area manager worked with the acting manager to put in place appropriate applications to the local authority deprivation of liberties team where decisions needed to be made in peoples’ best interests to keep them safe. Training has been scheduled for staff to receive further MCA and DoLS training

Staff supported people to follow their interests and take part in social activities. Two designated activity staff were employed by the provider and supported people at the service to take part in activities.

The premises and equipment were managed to keep people safe.

We found a breach of the regulations at this inspection. 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 who use the service understood the care and treatment choices available to them and that they were involved in their care planning. People received regular stimulation and were able to choose to participate in appropriate activities or one to one time with staff and/or the activities co-ordinator.

The home had recently been refurbished and 13 rooms had been re-decorated, the dining and lounge refurbishment was on-going. The home was clean and tidy in all areas and there were effective systems in place to reduce the risk and spread of infection. There was a robust recruitment procedure which ensured that vulnerable people were kept safe from unsuitable staff. There was a clear complaints procedure and people were aware of how to complain or information had been given to their relatives.

We found that Oak House was meeting all of the outcomes we inspected.

People who use the service understood the care and treatment choices available to them and were treated in a respectful way.

People expressed their views and were involved in making decisions about their care and treatment.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People who use the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

There were effective systems in place to reduce the risk and spread of infection.

There were enough qualified, skilled and experienced staff to meet people's needs.

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on.