Archived: Oaklands Care Home

Oakland's care home is a residential care home providing personal and nursing care for up to 40 older people, some of whom live with dementia. At the time of the inspection the service was supporting 34 people. The care home accommodates people in one adapted building.

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

Systems were in place to gain feedback from people, but action was not taken in a timely manner to respond to areas that were identified for improvement. Call bells were not always accessible to people, but action was taken to address this. The registered manager took immediate action to ensure people’s needs were responded to in a timely manner, and people had access to meaningful engagement with staff.

People told us they felt safe, and staff were aware of any potential risks when providing support to individuals. People received their medicines as required. Staff wore gloves and aprons to ensure they protected people from cross infection. Lessons were learned from any incident and accidents that had occurred in the service.

Staff had received training for their role and felt supported. People accessed healthcare services to ensure they received ongoing healthcare support. People, as much as practicably possible, had choice and control of their lives and staff were aware of how to support them in the least restrictive way and in their best interests; the policies and systems in the service supported this practice.

People made positive comments about the staff that supported them. People told us the staff encouraged them to be independent, protected their privacy and treated them with dignity and respect.

People had care plans in place which provided staff with information about their needs and preferences and how they would like these to be met. A complaints procedure was in place and people and their relatives knew how to raise concerns and felt confident these would be addressed.

People, relatives and staff thought the service was managed well. The registered manager was described as approachable, open and transparent in the way they managed the service. Systems were in place to monitor the delivery of the service.

Rating at last inspection

The last rating for this service was good (published 6 December 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

Oaklands Care Home is registered to accommodate and deliver nursing and personal care to a maximum of 40 people. People who used the service may have needs associated with mental health, old age or a physical disability. At the time of our inspection 34 people were using the service.

The manager was registered with us as is required by law. 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.

People were kept safe and trusted the staff supporting them. Staff had received training and were knowledgeable about how to protect people from avoidable harm. Risks to people were assessed in relation to their individual health needs and staff took account of these risks when providing support. The provider took appropriate action to ensure peoples current and future safety and well-being when an incident occurred. Regular checks and audits of the safety of the environment were routinely undertaken. People received the support they needed to take their medicines safely. Staffing levels were regularly reviewed based upon people’s needs and level of complexity or as more admissions were taken. Staff had to provide satisfactory evidence that they were of suitable character to provide peoples’ care before commencing in their role.

Staff received the appropriate level of supervision and training that developed their skills in order to meet people’s needs effectively. The provider’s induction program gave staff the opportunity to shadow more established staff and familiarise themselves in how to effectively support people in line with their specific needs. People were not restricted unnecessarily and their consent was actively sought by staff before assisting or supporting them. The provider ensured that people’s health and financial welfare was considered through the appropriate channels. People’s needs in terms of food and fluids were assessed and any risks or specific needs were catered for. People’s health and well-being was supported through regular monitoring and referrals were made to the appropriate external health care professionals as required.

Staff at the service were kind and compassionate towards the people they cared for. Staff were respectful towards people and acknowledged them by name when they came into contact with them. People were effectively communicated with and provided with the information they needed. People were at the centre of decision making about all aspects of the support they received. Information was available for people about how they could access independent advice from local advocacy support services. Staff communicated with people in a respectful manner and supported them to be as independent as possible.

People’s needs were assessed and their care was planned with them or their representative in line with their preferences. Staff were knowledgeable about people’s personal preferences and what was important to them, including their spiritual or cultural needs. Activities available to people were based on their individual preferences and abilities. The provider responded to complaints received in line with best practice and their own policy.

People were positive about their experience of the service and the effectiveness of its management and leadership. The provider sought people’s feedback through questionnaires and meetings about the quality of the service. The provider monitored and undertook regular checks on the quality and safety of the service. Staff openly discussed any concerns they had or suggestions about how to improve the service with management. We were able to confirm the information provided to us in the Provider Information Return (PIR) sent to us prior to our inspection of the service.

From our previous inspection some action had been taken to improve the service to people. There are still improvements to be made.

Below is a summary of what we found. The summary is based on our observations during the inspection. There were 40 people living at the home on the day of the inspection, 15 people were there on a short term basis receiving rehabilitative type support and respite care and 25 people lived in the home permanently. We were not able to speak with many people as they were unable to verbally express their views so we observed how people were supported. During our inspection we spoke with three people who used the service, three members of staff who supported people, three relatives and the manager who was supporting the inspection process. We looked at three people's care records.

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

Is the service safe?

We found that there were systems in place to support learning from events like accidents, incidents and complaints. People and relatives we spoke with told us that they would speak with the manager if they had a complaint and that the manager was very approachable. Records showed that complaints were logged so that any trends could be monitored as part of improving the service to people.

We found that people's safety was a key part of the service people received. Where there was a potential for risks, assessments were being carried out to identify the risk and put measures in place to reduce and manage the risks. People had access to regular fluids and where people's blood pressure needed to be monitored this was being done to ensure people's care and welfare needs were monitored. This meant that where people's health and welfare was a risk to their care needs this was being monitored on a regular basis.

We asked people if they felt safe living within the home and they all told us they felt safe. One relative said, "If I could I would live in the home". The relative told us the home was safe for their relative and that's why they would be happy to live there. This meant that the way staff were supporting people they felt safe.

We found that there was a systems in place to ensure staff were appropriately recruited and checked before working with vulnerable people. Records showed that appropriate risk assessment were in place to ensure staff suitability to work with vulnerable people. This meant that people could be confident that only appropriate staff were being recruited.

The home had policies and procedures in place in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) although no DoLS applications to the local authority had been made. Staff we spoke with were not clear if they had received relevant training in MCA and DoLS despite training records being in place indicating that they had received the training. Staff were knowledgeable about safeguarding people and they were able to explain the actions they would take to keep people safe from harm. we spoke with the manager who would make DoLS applications to the local authority in a person's best interest. The manager had adequate knowledge and understanding to be able to make these applications.This meant that people would be safeguarded as required.

We found that the provider had adequate processes and systems in place to meet the requirements of the law in relation to keeping people safe.

Is the service effective?

The provider had an effective care planning process in place to ensure people received the care and treatment they wanted. One person said, "I do like living in the home". We found that some records that were not consistent and clear. People who lived in the home on a short term basis had records that were not fully completed or signed. This meant that there was a potential risk to how people's needs were met where staff relied on the information within their records. These concerns were identified in the previous inspection and we raised our concerns with the manager again.

We found that where people needed support from health professionals, this was provided and records confirmed this. One relative said, "People are able to see a doctor when they are not well. I am contacted by staff when X is not well". This meant that people were able to access the support from health professionals when they needed it.

Some people we spoke with told us they were not always able to get support when needed to go to the toilet. We found that during the morning and after lunch there were occasions that staff were not always visible in the lounge area to support people. This meant that people would not always get the support they needed when they needed it.

We have asked the provider to tell us what improvements they will make in relation to ensuring the service is effective in meeting people's needs.

Is the service caring?

We saw staff interacting with people in a professional and caring way. Staff we spoke with had a very good understanding of people's needs and appropriate training was available to ensure staff had the skills and knowledge to meet people's needs. One person said, "Staff are very good and friendly". This meant that staff had the skills to ensure people were supported how they wanted.

People we spoke with told us they were able to get regular drinks when they wanted and the choices of meals were good. Our observations on the day of the inspection confirmed what people told us. People were seen to get a drink on a regular basis throughout the day. This meant that people's fluid levels would be maintained to ensure they did not dehydrate.

We found that the provider had adequate processes and systems in place to meet the requirements of the law in relation to ensuring the service was caring.

Is the service responsive?

We found from our previous inspection that the provider had taken some action to rectify concerns identified. We found that there were still areas that needed improvement. From our discussions with the manager we were told action would be taken deal with the areas of concern.

Relatives we spoke with all told us that the manager was very approachable and that where they had concerns they were able to discuss these with the manager. Record showed that there was a questionnaire survey being used to gather people's views and relatives to help improve the service. The manager also held regular relative meetings as another forum for people and relatives to share their views. This meant that there were systems in place to people were able to influence the service they received.

We found that the provider had a complaints policy in place so visitors to the home were able to raise complaints where necessary. Complaints made were logged to ensure they were monitored for how quickly they were actioned and trends analysed.

Is the service well-led?

The service was led by a registered manager, who was supported by the provider. On the day of our inspection the manager was available and assisted us with any information we needed.

We found since our last inspection, records had not improved sufficiently from the last inspection where the provider was judged to be non compliant with the regulations. Concerns identified about people's fluid intake not being recorded appropriately had not improved. The total fluid intake within a 24 hour period as determined by their doctor had not been properly recorded. We found inconsistencies between how much fluid a person had received and how much fluid had been determined was needed.

People that were able to speak to us confirmed that their consent was obtained before any support was provided. One person we spoke with said, 'It's a good home to be in, very pleasant and the staff are great. I need a lot of support which the staff provide. They never grumble just smile and get on with it.'

We found that people's needs were assessed, and care plans were in place. Most of the people and the relatives we spoke with told us they were happy with the care and support provided. One person said, 'The care is good and I feel safe.' Another person told us, 'It's good in here and the staff are very good to me.'

We found that improvements were required to ensure all of the required recruitment checks were in place to ensure that only suitable staff were employed to work at the home.

A complaints system was in place to enable people and their representatives to raise any concerns so that improvements could be made.

We found that care records did not always contain sufficient information about people's needs. This meant staff did not have access to detailed informtaion about people's needs.

The manager informed us that regular audits were undertaken to check the medication practices to ensure people received their medication safely, and staff were following the procedures in place at the home.

People told us they were happy with the care and support provided. One person said 'I am looked after, the staff help me to wash and dress, the staff are very nice'. Another person told us 'It is nice here, the staff are friendly'. We saw positive interactions between staff and people that lived at the home.

People told us that staff respected their privacy and dignity and that they were given choices about their care, how they spent their day and about what food they wanted to eat.

We saw that people's needs were assessed, and support plans were developed in consultation with them, or their relative. Staff spoken with were able to tell us about people's needs. This ensures they receive support in a way they prefer.

People said they felt safe living at the home. We found that staff were clear about the action to take should they become aware of an allegation of abuse in the home.

We found that the medication systems in place did not ensure people received their medication as required.

Staff spoken with told us they felt supported by the manager, and have regular training opportunities. This ensures staff are able to deliver care to an appropriate standard.

We found that there were systems in place to monitor the quality of the services, and make improvements where required.