Oakland House Nursing Home

Oakland House Nursing Home comprises of three separate units, Elm, Cedar and Willow. The accommodation situated over three floors is for people who require nursing or personal care and have enduring mental health needs. People with more complex physical health problems who require higher nursing needs live on the ground floor. The fundamental purpose of Oakland House Nursing Home is to support people to recover, rehabilitate and become independent.

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

The provider's quality monitoring checks had failed to highlight the issues found during this inspection. Not all risks to people had been identified and mitigated against. Whilst there were checks and systems in place these were not always consistently managed to ensure the environment was safe for people living at the service.

Accidents and incidents were recorded and analysed to support staff in taking actions to keep people safe and to reduce the likelihood of future harm and learn lessons.

Medicines were managed safely and there were close links with health and social care professionals to ensure people's physical and mental health needs were met and changes responded to quickly. The provider had a safe recruitment process in place to ensure appropriate people were employed.

The provider was following current national guidance for the management of the COVID-19 pandemic.

Housekeeping staff monitored all areas of the home ensuring high standards of infection prevention and control were delivered and that suitable supplies of personal protective equipment were available. The home was clean and well maintained.

Staff had been best deployed to positively support people during the COVID19 pandemic. People told us they felt safe living at the service. Staff knew how to safeguard people from abuse.

People spoke very highly of staff and said staff were caring. People had established positive relationships with staff and conversations were relaxed and comfortable.

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.

Rating at last inspection

The last rating for this service was good (published 9 July 2019).

Why we inspected

The inspection was prompted in part by notification of a specific incident, following which a person using the service sustained a serious injury. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of contact with hot surfaces. We reviewed the information we held about the service. No areas of concern were identified in the key questions of effective and responsive. 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.

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 improvement. Please see the safe and well led sections of this full report. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

The provider has taken action to mitigate the risks we found on this inspection.

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

Follow Up

We will request an action plan from 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.

We found the following examples of good practice:

Staff were provided with clear guidance on the correct use of personal protective equipment (PPE) and how often this should be changed.

Refresher Infection Prevention and Control (IPC) training had been provided to all staff.

Medical devices used for monitoring oxygen levels and temperatures were checked by a specialist company to ensure they were working correctly.

Individual care plans to mitigate the impact of Covid-19 had been implemented for those people who lacked capacity. This helped to raise awareness of the impact of restrictions and how this can affect people’s lives not only during a pandemic but in more usual times.

The care home worked closely with local GP's resulting in effective coordination of care and strengthened professional relationships. This included the roll out of the Covid-19 vaccine programme.

Independent advocacy support continued to be provided to people via telephone and email.

We found the following examples of good practice

¿ The provider was swift to respond to the emerging coronavirus crisis. The Infection Prevention and Control lead co-ordinated the providers strategic and operational response. This included early implementation of a 'phase one' risk assessment and action plan.

¿ The provider was approached by local health and social care commissioners to train other care homes in infection prevention and control procedures. An integrated model of support was developed to enhance the city response to the coronavirus crisis. This collaborative effort involved staff from both Equilibrium Healthcare and the local NHS.

¿ Enhanced levels of support were provided to staff to ensure wellbeing. This ranged from support with provisions for staff with younger children, support with household groceries, and financial assistance.

¿ Implementing individual care plans to mitigate the impact of coronavirus with people who lack capacity; and raising awareness of the impact of restrictions and how this can affect people’s lives not only during a crisis but in more usual times.

¿ Working closely with the local GP's resulting in effective coordination of care and strengthened professional relationships, including good use of technology to carry-out virtual consultations.

¿ Independent advocacy support continued to be provided via telephone. On occasions this was also provided out-of-hours.

Oakland House is a nursing home that was providing personal and nursing care to 36 people aged 18 and over at the time of the inspection. The service can support up to 38 people, with accommodation provided across three floors, each of which has separate adapted facilities.

People’s experience of using this service:

There was a truly open and welcoming atmosphere on entering the premises. The registered manager, staff and people who used the service were enthusiastic about the inspection visit and were eager to share experiences.

The service’s ethos, vision and values promoted people’s rights to make choices and live fulfilled and valued lives. This was well reflected in the outstanding care and support people received from a committed, passionate and caring group of staff.

Staff demonstrated kindness, patience and respect and people were given time to express themselves fully. Staff knew people well and interactions were relaxed. People who used the service spoke with great fondness and affection about the staff.

The open, inclusive and supportive nature of the service meant that promoting equality and diversity and respecting people’s human rights was fundamental to every aspect of the service.

People were well supported when transitioning between services. This included support provided before a person moved into the service and throughout their placement.

The registered manager and the wider senior leadership team were committed to providing support which met the highest of standards. They continually strived for excellence through collaboration, they were passionate and dedicated.

Managers led with a dynamic approach and continually reflected on how to improve the service further. They demonstrated a strong and supportive leadership style, seeking feedback in order to further improve what was offered. The culture of the service was open, transparent and progressive. All the staff were committed to continuous improvement of the service.

People were actively encouraged to share their views and raise concerns or complaints. Feedback was consistently acted upon.

A comprehensive induction and training programme was in place for new staff and a framework for continuous professional development was embedded for established staff. All new employees were required to complete the Care Certificate.

Rating at last inspection:

At the last inspection the service was rated requires improvement (published 18 April 2018). This was because we found breaches of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment, person-centred care and good governance. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve. At this inspection we found significant improvements had been made and the provider was no longer in breach of regulations.

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

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

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

We last inspected Oakland House Nursing Home on 9 and 10 January 2017 when we rated the service Requires Improvement overall. At that inspection we found breaches of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment and person centred care. We issued two requirement notices to the provider to inform them of the reasons they were in breach of the regulations and to tell them improvements must be made.

At this inspection we found that although there had been improvements to some aspects of the service, we identified ongoing concerns and continued breaches of the regulations. We found breaches of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment, person centred care and good governance. You can see what action we asked the provider to take at the back of the full version of this report.

Oakland House Nursing Home is registered to provide nursing and residential care for up to 38 people who have enduring mental health / complex needs. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our inspection there were 35 people living in the home. The fundamental purpose of Oakland House Nursing Home was to support people to recover, rehabilitate and become independent.

Oakland House Nursing Home currently comprises of three units, Elm, Cedar and Willow. Accommodation is provided over three floors and each unit comprises of a communal dining room/ lounge area and kitchen and all bedrooms are single occupancy. There is a lift to all floors and a sheltered smoking area is provided in the garden.

At the time of our inspection there was no registered manager in place. The previous registered manager had left the service shortly after our last inspection in January 2017. The provider recruited a new manager soon after this; however they withdrew their application to become the registered manager in November 2017 and left the service. Since then the provider appointed an interim manager who was the previous clinical manager at the service. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Existing staff received the training and supervision they required to be able to deliver effective care. However, we found the majority of agency workers the service used had not received training in mental health awareness and physical intervention. At the time of our inspection the provider and manager did not have an overview of what training the agency staff had completed. This meant the agency staff working at the service did not have the necessary training requirements to enable them to understand and know how to support people with their mental health needs.

There were enough skilled staff available to meet peoples' care needs and records showed planned staffing levels were routinely achieved. However, due to vacancies and staff sickness the service had recently relied on agency staff to cover nursing and care shifts at the service. The provider was proactive at recruiting new staff to the service, with three new nurses recently recruited. After the inspection we were provided with a report the provider had produced which indicated for the period of week commencing 03/12/2017 to week commencing 18/02/2018 a total of 15.3% of agency cover was required to cover a mix of nursing and care shirts.

At our last two inspections we found that Oakland House Nursing Home was not supporting people to become independent; this was partially due to the model of care used at the home. We also found that care plans did not include people's goals and aspirations. At this inspection we found limited progress had been made. The head of governance felt changes in the management team had delayed this process.

People told us they felt safe living at Oakland House Nursing Home and had no concerns about the care and support they received. Staff had received training in safeguarding adults and knew the correct action to take if they witnessed or suspected abuse. Staff were confident that the manager would act on any concerns raised.

During the two day inspection we a observed a number of positive and caring interactions between staff and the people. People had developed very positive relationships with staff and there was a friendly and relaxed atmosphere.

Medication was correctly administered, stored and recorded. We looked at six people's medication administration records (MARs) and medication stocks and found that the MARs had been appropriately completed and medication stocks were accurately accounted for. The nurse we spoke with told us that they were confident managing people's medication and people received the right medication at the right times. We saw that relevant staff had received training on medication administration and there were policies and procedures in place to support staff.

Risks both within the service and in relation to people's care needs had been assessed and staff were provided with guidance on how to protect people from identified risks. Where accidents or incidents occurred these had been investigated by the manager to identify any further actions that could be taken to improve people's safety.

People’s needs were assessed before they moved into the service to ensure those needs could be met. People were encouraged to visit the service before deciding to move in, to ensure they understood the service's routines, rules and policies. Based on information gathered during the assessment process individualised care plans were developed. These documents provided staff with clear guidance on how to meet each person's individual needs.

People were able to choose how to spend their time and to access the community independently if they wished. However, during our inspection we noted that there was a lack of activities for people to engage with within the service. We have recommended that the service reviews staff working practices with the aim of supporting and encouraging people to engage with more meaningful activities.

Management and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). We saw that staff sought people's consent before providing care and support. Where people had been identified as lacking capacity in making certain decisions the service acted in accordance with legal requirements. Necessary DoLS applications had been made and subsequent conditions were complied with.

The managers and staff understood their obligations under the Mental Health Act 1983 and worked within these legislative frameworks. Permanent staff had received training in mental health awareness and were fully informed of any changes at team meetings to ensure they continued to provide care within the law.

Systems were in place to help ensure people's health and nutritional needs were met. Records we reviewed showed that staff contacted relevant health professionals to help ensure people received the care and treatment they required.

People and those important to them had opportunities to feedback their views about the home and quality of the service they received. Complaints and concerns were taken seriously and used as an opportunity to improve the service.

We noted there were a number of quality audits in the service; these included medicines, care records, infection control and health and safety. Actions were identified following the audits completed. We saw plans were in place to improve the care records and refurbishment of the premises. However the service had been slow to implement the recovery model, as this had not progressed since our last inspection. Improvements in the level of activities varied and the provider did not have an overview of the training agency staff working at the service.

This is the third consecutive time the service has been rated Requires Improvement.

Oakland House Nursing Home currently comprises of three units, Elm, Cedar and Willow which accommodates up to 38 people. At the time of our inspection there were 32 people living in the home. Accommodation is provided over three floors and each unit comprises of a dining room/lounge area and kitchen and all bedrooms are single occupancy. There was a lift to all floors and a sheltered smoking area was provided in the garden.

The service provides accommodation for people who require nursing or personal care and have enduring mental health needs. The fundamental purpose of Oakland House Nursing Home was to support people to recover, rehabilitate and become independent.

There was a registered manager in post, however the manager had recently stepped down and was in the process of deregistering. The operational and deputy manager were on hand to provide leadership and direction in the registered managers absence. The provider had already identified a new manager that would be soon appointed. 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.

At our last inspection we found that Oakland House Nursing Home was not supporting people to become independent; this was partially due to the model of care used at the home. We also found that care plans did not include people's goals and aspirations. At this inspection we could find no documented evidence that this had improved and people living at the home said it had not. The care records did not always document where people or their relatives had been involved in the creation of care plans and whether consent had always been obtained.

Appropriate plans were in place to guide staff in how to minimise risks to keep people safe. Staff knew what action to take to ensure people were protected if they suspected they were at risk of harm. They were encouraged to raise and report any concerns they had about people through safeguarding and whistleblowing procedures.

Improvements had been made to the management of medicines, for example the implementation of medicine profiles for people and a system of auditing. Medication records were well maintained and detailed policies and procedures were in place.

Checks were carried out to ensure the premises were safe, such as fire safety checks, water temperatures and health and safety. However, we found people’s personal emergency evacuation plans (PEEPS) did not accurately capture the person’s mobility. We have asked the Greater Manchester Fire and Rescue Service to advise the provider on fire safety arrangements in the home.

We observed people were treated with dignity and respect. Throughout the inspection we saw staff engaging with people in a positive and caring manner. Staff spoke to people in a respectful way and used language, pace and tone that was appropriate to the individual. Staff took time to listen to people and responded to comments and requests. People felt staff were kind and respectful to them.

At the last inspection some staff told us and records showed that not all staff had received all the necessary training and support needed to carry out their role. At this inspection all staff now had access to the provider's training and had completed updated training where required. New staff had completed induction and were signed off by the manager as being competent, following the provider's procedure.

The managers and staff understood their obligations under the Mental Capacity Act 2005 and Mental Health Act 1983 and worked within these legislative frameworks. Staff had received training in both subjects and were fully informed of any changes at team meetings to ensure they continued to provide care within the law. We found that all staff were not fully aware of which people using the service were subject to a DoLS and were in need of training in respect of these provisions. We have received assurances from the deputy manager that action will be taken to address these issues.

The food menus were varied and two choices were offered at every meal. We observed some people being supported with their meals by members of staff. Some people had specific dietary needs, which were appropriately catered for.

There was predominantly enough skilled and experienced staff on duty to meet people's needs. However, some people felt additional staff would be beneficial.

There were robust recruitment procedures in place. Staff had received formal supervision and an annual appraisal. Staff received training to be able to fulfil their roles and responsibilities.

Some people told us that activities could be limited at times. We noted the home had continued to work on the activities that were on offer for people and were in the process of recruiting a second activities coordinator. The last activities survey in February 2016 also identified that activities could be further improved. An action plan had been devised by the home to continue with these improvements. We noted this action plan will need to be reviewed if the service establishes a new rehabilitation care model to ensure people receive one-to-one support to develop new skills.

Support staff helped people to book appointments and accompanied them when they needed it. We saw from records that people had access to GPs, podiatrists, dentists, social workers and mental health specialists.

People also had access to advocacy services if they needed them. The registered manager told us that the home would provide end of life care when needed, however we found no documentation that evidenced people’s future wishes and we found the home did not follow any recognised end of life accreditations, such as the Six Steps end of life care programme.

Accident and incidents were appropriately monitored and referrals made to the falls prevention team when necessary. There were systems in place to ensure that the risk of Legionella in the home's water system was managed and there were a range of health and safety checks in place that ensured the home's equipment and environment was safe.

Staff gave positive feedback about the recent changes at the home. We saw evidence a number of audits had been undertaken to assess and monitor the quality of the service provided to people. Meetings had also been held with staff and relatives to share information.

During our inspection we found evidence of significant improvements which had been made to improve the quality of the service provided to people. However, as evidenced within the main body of the report there remain a number of areas where there is a need for further development.

In relation to the two breaches of regulations identified you can see what action we told the provider to take at the end of the full version of the report.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Below is a summary of what we found.

Is the service safe?

People were cared for in an environment that was generally clean and hygienic, and although we did find a small proportion of equipment that was in need of repair; this was quickly resolved by staff on the day of the inspection.

At the time of the inspection, there was one Deprivation of Liberty Safeguards procedure in place, which meant that people had measures in place to keep them safe from harm.

The management of medication procedures were followed and ensured that people received medication as required and it was administered safely.

The home had emergency procedures in place to keep people safe from harm, including adequate fire evacuation procedures and missing person's protocols.

Is the service effective?

People told us that they were happy with the care that was delivered and their needs were met. It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and that they knew them well. Staff had received adequate training to meet the needs of the people living at the home.

We spoke to relatives and one told us, 'I have seen a great improvement since my relative moved in.' This showed evidence of an effective service.

Is the service caring?

Our observations showed that staff were supportive and gave encouragement to people living in the home. We saw one staff member comforting a person who had become distressed and another talking quietly to a person about how they were feeling that day. One person told us, 'Staff help me to do things I struggle with.' Another said that staff had helped them with their future plans.

We asked three relatives if they had any concerns about the care provided by the home and they told us that were generally happy with the care provided.

Is the service responsive?

People's needs had been assessed before they moved into the home. We could see from care records, that when a person's needs changed appropriate actions were taken to ensure that needs were met, including for example; arranging for people to see a GP.

We saw evidence of meetings for people living at the home, including one meeting which was attended by a nominated person chosen by the people living at the home. These meeting provided an opportunity for people to raise concerns or issues and have them addressed.

Activities were organised throughout the home, although currently limited until the new activity coordinator if fully inducted into the service.

Is the service well-led?

We found a good management team in place, although responsibilities had changed since the last inspection, staff had a very good understanding of the ethos of the home and quality assurance processes were in place to ensure that this was maintained. We suggested that staff monitor these changes by regular feedback from people and their relatives or carers.

'I love it here, I feel safe and the staff are great.'

'It is much nicer than the hospital here. The staff talk to you and help you when you feel bad.'

'I have lived here a long time. It is the best place I have been. The staff are very fair and look after me well.'

'My [relative] has been really well cared for during their time here. The staff are very responsive to my [relative's] physical and mental health needs. I cannot praise them enough.'

Where people using the service did not have capacity to make their own decisions best interest meetings were held with people who understood that person. People using the service were being supported to access treatment and care from a wide range of community health services as their health needs required. We also found that people were being cared for in a suitable environment by adequate numbers of appropriately recruited and trained.

A suitable system was operated to manage complaints effectively.

'My staff treat me well and make sure I am ok'.

'I like it here and they (staff) look after me well.'

'The nurses and support staff are all decent with me and we get on really well.'

'I have lived here a long time and have always been treated well, the staff ask my views about how I am looked after'.

'The food is nice and there is always plenty to eat'.

'I like most of the meals. They (staff) ask you what you would like and there is always enough to eat'.

'I like some meals more than others but on the whole the food has been good'.

We found that the care, support needs and nutritional needs of service users at Oakland House Nursing Home were being met appropriately. We also found that systems were in place to keep them safe and ensure they were being supported by sufficient numbers of staff.