Oaklands Rest Home Limited

Oaklands Rest Home is a residential care home providing accommodation and personal care for up to 32 people. At the time of our inspection there were 19 people living at the home. The home is an adapted building, set in its own grounds.

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

Relatives spoke positively about the home and were very happy with the care and support given to their loved ones. The home was clean and well-maintained. Equipment had been checked to ensure it was safe to use. Systems were in place to protect people from the risk of abuse. There were enough staff working at the service to meet people's needs and the provider had robust staff recruitment practices in place. Medicines were managed safely.

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.

The home was well managed by a knowledgeable registered manager. Governance systems were in place to ensure all aspects of the service were reviewed and checked regularly.

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 27/02/2018).

Why we inspected

The inspection was prompted in part due to concerns received about the financial viability of the service. A decision was made for us to inspect and examine the risk. As a result we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Oaklands Rest 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.

We last completed a full inspection of Oaklands in December 2016, when we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: regulation 9 (person centred care), regulation 15 (premises and equipment), regulation 12 (safe care and treatment) and Regulation 17 (good governance) There was a further breach of the Care Quality Commission (Registration) Regulations 2009 as the service did not display the latest rating. We returned to conduct a focussed inspection in March 2017, when we found some improvements but the service remained in breach of regulations relating to the maintenance of premises and equipment, and good governance. At this inspection we found the service continues to improve, but we made one recommendation that the service responds quickly to external inspections and reviews to improve the safety of people who use the service.

Oaklands is registered to provide accommodation for up to 32 older people who require residential care. At the time of our inspection there were 18 people living at the home. When we visited the home there was a registered manager in place. 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.

When we toured the building we saw that the home was clean and free from any unpleasant odours. The registered manager showed us where improvements had been made since our last inspection, such as a new medicines room, so that medicines could be stored safely and efficiently; refitted bathrooms and new carpets throughout the building.

The building was secure and staff ensured the safety and well-being of the people who lived at Oaklands; they were aware of the safeguarding and whistleblowing procedures, understood signs of abuse and demonstrated an understanding of how to protect vulnerable people from harm. When we asked, people who used the service told us they felt safe. When accidents and incidents occurred we saw that there was appropriate follow up and investigation to minimise the risk of repeat occurrences. The manager kept a register which showed when any maintenance and safety checks were due.

People were treated with respect, and consideration of their cultural needs and background was taken into account when planning care, along with people’s ability to gauge their own risks. When we looked at care records we saw they reflected people’s needs and choices. Care plans were detailed and staff kept good daily notes which cross referenced and reflected plans of care. We saw that support was delivered in a timely manner.

There were enough staff on duty, and we saw that safe recruitment procedures were followed. A training timetable showed when staff had attended training courses and reflected good access to training from a variety of resources. Staff training was regularly reviewed and updated to keep in line with current best practices, and when we spoke to staff they were able to tell us how they had benefitted from their training.

People who lived at Oaklands told us that they enjoyed the food provided, and we saw that attention was paid to diet and hydration. Day to day health needs were monitored and the service worked well with external health and social care agencies, particularly commissioners and general practitioners (GPs).

Care was delivered in a person centred way by staff who knew the people who lived at Oaklands well, and we saw that all were treated with kindness and respect. People were involved in planning their care, and where they lacked capacity to consent to care and treatment the service complied with the relevant legislation around capacity and consent. All the staff we spoke with were mindful that Oaklands was a person’s home. For example they did not place any restrictions on visitors, care plans reflected physical, mental and social needs and people were encouraged to follow activities that they enjoyed. Relationships between people who lived at Oaklands were nurtured and encouraged.

There were few complaints made. The service kept a log of all complaints and recorded all investigations and any actions needed in response to concerns raised about the service.

We saw that attention was paid to people at the end of their lives, and saw a number of cards from relatives thanking the staff for the care provided for people at the end of their lives. However, care plans did not include information provided by people who used the service and their relatives about how they would like to plan for their last days.

Staff and people who used the service told us that the registered manager was approachable, fair and open minded, and we saw that she promoted a person centred culture and good team ethic, encouraging openness and honesty amongst the staff team.

We had inspected Oaklands on 8 and 9 December 2016 when we found breaches of five of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found that the registered manager had taken action to address some of the issues previously raised, for example, issues of infection control and disposal of waste, and the previous inspection rating was displayed. We also saw that the registered manager had purchased equipment for activities and when we spoke to people who used the service they told us that they had enough to do at Oaklands. However, the service remained in breach regulations relating to the maintenance of premises and equipment, and good governance.

Oaklands Rest Home Oaklands Rest Home is registered to provide accommodation for up to 32 older people who require residential care. At the time of our inspection there were 23 people living at the home.

When we visited the home there was a registered manager in place. 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.

People told us that they were supported by staff who knew them well and felt safe at Oaklands. There were adequate staffing levels. Staff were willing to put extra time in unpaid to ensure the needs of the people who used the service were met, and the registered manager ensured the food budget was managed effectively, with any surplus being used to provide essential items to enhance the safety and comfort of the people who lived at Oaklands.

We saw that improvements were being made to the structure and décor of the building. The service had contracted a maintenance officer to repair the ground floor window frames. A number of bedrooms had been redecorated, with new carpets and curtains. However, a frayed carpet in the communal lounge which we had previously identified as a trip hazard had not been replaced..

The service had taken steps to address issues of infection control. When we toured the building we saw that hazardous materials were locked away when not in use and clinical waste was disposed of correctly.

The registered manager told us that the owners were providing some support to improve the quality of life of the people who lived at Oaklands Rest Home. She showed us some new equipment bought to help provide activity and stimulation, and some old equipment had been replaced. However, staff told us that they were still concerned that they may not get paid on time and we saw that the registered manager was using an old laptop which was incompatible with systems used by other agencies such as the local authority. This affected her ability to send reports to outside agencies.

People told us that the service promoted a homely atmosphere and that the staff were open and friendly. We saw that they worked well together and promoted the well being of the people who used the service. There was a low staff turnover, and staff would raise money to pay for events such as special lunches or to provide entertainment for the people who used the service. The registered manager was held in high regard, and although tied by financial constraints was able to use the resources at her disposal to meet the day-to-day needs of the people who used the service.

We last inspected the home in June 2015. At that time we rated the service ‘Requires Improvement’ with a rating of ‘Inadequate’ in the ‘well-led’ domain. We identified breaches in five of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to make improvements in relation to infection control, storage facilities, maintenance of equipment, working within the principles of the Mental Capacity Act, monitoring the quality of the service, provision of activities, supervision of staff and gathering feedback from people who used the service. At this inspection although we found there had been improvements in some areas, some issues we identified at the last inspection had not been addressed.

At this inspection we identified breaches of five of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to infection prevention and control, maintenance of premises and equipment, disposal of offensive waste and unsafe storage of equipment; the provision of activities; failure to display the Care Quality Commission (CQC) inspection ratings and lack of governance.

We identified one breach of the Care Quality Commission (Registration) Regulations 2009. This was because the registered provider had failed to notify the CQC that they had entered into a Corporate Voluntary Arrangement. This is an arrangement that allows an insolvent company to pay creditors over a fixed period of time and continue trading during this period.

We made one recommendation. This was in relation to the communal living space. You can see what action we told the provider to take at the back of this report. We are currently considering our response in relation to enforcement for some the breaches of regulations and we will update the section at the end of this report once any such action has concluded.

Oaklands Rest Home is registered to provide accommodation for up to 32 older people who require residential care. At the time of our inspection there were 24 people living at the home. When we visited the home there was a registered manager in place. 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.

Staff had a good understanding of how to keep people safe and what action they should take in order to protect vulnerable people in their care. Recruitment checks had been carried out on all staff to ensure they were suitable to work with vulnerable people. During our time in the home we observed there to be sufficient numbers of staff to care for people and to respond to their needs promptly.

The home was clean and free from unpleasant odours. However, we found that there were problems with the general maintenance in some parts of the home and steps had not been taken promptly by the registered provider to rectify them. Two storage rooms which contained equipment that could cause injury to people if they entered unsupervised were not locked. This had been identified during our previous inspection, but no action had been taken to rectify this.

Staff wore personal protective equipment (PPE) such as disposable gloves and aprons when carrying out care tasks and we found toilets and bathrooms were well stocked with soap and paper towels. This measure helped protect people from the spread of infection. However, waste bins were not foot-operated, which meant that staff risked contaminating their hands when disposing of soiled items.

The provider did not have a contract with an approved company for the safe disposal of offensive/hygiene waste, such as incontinence products and wound dressings and, at the time of this inspection, staff disposed of this material in the domestic waste collection. Information contained in the ‘Health and Social Care Act 2008 Code of Practice on the prevention and control of infections and related guidance’ states: ‘If the home employs carers to assist in the activities of daily living then waste should not enter the domestic waste stream’.

The kitchen was clean and food was stored safely. Safety checks for the building, such as for the hoists, passenger lift, electrical appliances and gas were up-to-date.

There were appropriate systems in place for the effective ordering, control, management and administration of medicines at Oaklands.

Staff had undertaken a variety of training, including dementia awareness, safeguarding vulnerable adults and end of life care which ensured they had the skills and knowledge required for their roles. Staff supervision was undertaken regularly by the registered manager.

The home was working within the principles of the Mental Capacity Act (MCA) and where people were deprived of their liberty to receive care and treatment the appropriate deprivation of liberty safeguards (DoLS) authorisations were in place.

People spoke highly of the staff and told us they were kind and caring. Our observations during the inspection confirmed this. Care plans were ‘person-centred’ and were reviewed regularly.

People were supported to maintain good health and where needed specialist healthcare professionals, such as district nurses were involved with their care. People had their weight monitored regularly and the food was of a good standard.

The home had a large lounge which provided a communal living area for people who used the service. However, the layout of the room did not make social interaction between people easy, as all the chairs were placed in a long line around the walls of the room. This limited the possibility for conversation. There was a lack of meaningful activities for people to take part in.

The home had a complaints procedure and people we spoke with knew how to make a complaint if they needed to. Only one complaint had been received during 2016 and this had been dealt with appropriately.

There were some quality assurance processes in place; however they had not identified the issues we found during our inspection nor had they addressed some of the issues we identified at our last inspection in June 2015.

During our inspection we identified that the registered provider had entered into a Company Voluntary Arrangement to pay their creditors over a fixed period. Despite this, the registered manager and staff provided a supportive and caring environment for the people who lived at Oaklands.

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.”

Below is a summary of what we found. The summary is based on our observations during the inspection; speaking with people using the service, the manager and from looking at records.

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

Is the service caring?

The atmosphere in the home was found to be calm, relaxed and welcoming. Care staff were observed interacting with people using the service in a professional and attentive manner.

People were given time to make choices and decisions about the care they wished to receive. Care staff were seen to support people sensitively and with patience. One person using the service told us, 'The staff are wonderful. Nothing is too much trouble; I wouldn't want to live anywhere else.' One visiting relative told us, 'I'm just so glad [relative] lives in this home.'

During this scheduled inspection of the service we checked to see if the provider had made the necessary improvements to those areas where urgent action was required.

The inspection was undertaken by two inspectors. This summary addresses five key questions: is the service safe; is the service effective; is the service caring; is the service responsive; and is the service well led?

The full report contains the evidence to support this summary.

Is the service safe?

All the people who used the service and their relatives who we asked said that they felt safe with the care and support they received. One person using the service said, 'Yes, I do feel safe living here'.

A visiting healthcare professional told us that she had visited the service for a number of years and found the care staff good at making timely referrals, she said, 'The staff here are very good and on the ball. They know exactly what they are doing'.

Is the service effective?

All people using the service, their relatives and visiting healthcare professionals who we asked, were positive about the service provided.

All staff who we spoke with demonstrated a very good understanding of individual care needs. It was evident from information seen in individual service user care files that care staff knew the person well and had access to good background information about the person. This was re-enforced by comments received from visiting healthcare professionals who told us that staff had a good knowledge and understanding of people's individual care needs.

There were effective systems in place to assess, monitor and regularly evaluate how well the service was operating.

Is the service caring?

Everybody who used the service, their relatives and visiting healthcare professionals who we asked, spoke positively about the attitude and caring nature of the staff that supported them. Comments included: 'I've lived here for a while. The staff are brilliant ' there is always someone around to help you', 'Staff are lovely, they listen to me and they know what I need. They speak to me in a kindly way', 'There are always enough staff around. The staff here are very good and very helpful when you need it' and 'I like to talk with the staff and yes, there are always enough [staff] around to help you'.

Another person, when describing the care and support their relative received said "The staff are busy, but they still give excellent care to everyone, I feel confident that my relative is well looked after here. The staff are good at keeping me informed and I feel they are very knowledgeable about specific needs - that's what makes them good".

Is the service responsive?

There was a complaints procedure in place, with accessible information available for the people who lived at Oaklands Rest Home. One person using the service told us "I have never had any complaints, but if I did I would speak with the manager, but I can sort things out myself if I need to".

One visiting healthcare professional told us that the service made appropriate referrals and were good at following any instructions she leaves with them. She told us she noted staffs attitude was positive.

There were clear lines of accountability within the service although the manager of the service was not yet registered with the Care Quality Commission. The provider confirmed that an application would be made to register that manager without further delay.

We saw that there were systems in place to regularly audit (check) and monitor the service provided which was the responsibility of the manager and senior staff team.

In October 2013 we found that we found that people were not fully protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to safely manage medicines within the home. At that time we also found that there were not enough qualified, skilled and experienced staff to consistently meet people's needs. During this inspection we found that this remained the case.

During this inspection we asked the manager to produce a number of records for inspection. The manager was not always able to locate the documents requested. Records were not stored in an accessible way that allowed them to be located promptly when required.

The provider did not have procedures in place for dealing with emergencies which are reasonably expected to arise from time to time and affect the provision of service. The provider did not have arrangements in place to mitigate risks arising from such emergencies to service users.

When we inspected Oaklands Rest Home Limited on 6th March 2013 we found that people were not fully protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. The provider had made some changes to address the issues identified at our last inspection. However, we found further concerns at this visit.

The provider had protected the home against the risks associated with unsafe or unsuitable premises.

People living at the home generally spoke highly of the staff. However, there were insufficient numbers of suitably qualified, skilled and experienced people employed to safeguard the health, safety and welfare of people using the service. One person said 'my only bugbear [source of irritation] is that there are not enough staff'. Another said they 'didn't' like to complain because the staff have got a lot on'.

The provider had a complaints procedure in place which was readily available to people using the service.

We saw that people received discreet care and support quickly. We spoke briefly with two people living in the home, two visiting families and one healthcare professional that visited the home regularly. Everyone spoke positively about the home, the quality of the service and the staff. The healthcare professional said 'people are looked after' and 'there are always staff at hand to assist me'. One visitor said 'My [relative] is looked after properly" and 'I wouldn't change it [the home]. It is a friendly home and we are made to feel welcome'.

We found that checks were carried out on different aspects of the service but these were not always recorded. We saw that care records were reviewed monthly, records of medications entering and leaving the home were available and as were monthly checks on the home environment. We heard that additional weekly medication checks and monitoring of the quality of people's laundry was also undertaken. The manager confirmed that these were not yet recorded.

At this inspection, we found that the manager had some taken action to address the identified areas of non compliance but she confirmed to us that there was a lot more work to do.

We found that care plan records had improved. They reflected the wishes of people who lived in the home, they explained to staff how to deliver care safely and they were reviewed and updated regularly.

We saw that staff files had been tidied up and these contained training certificates and records of individual one to one meetings (supervision).

Staff told us about what they would do if they witnessed or suspected that someone was being abused. One person living at the home said 'I feel safe'.

We saw that people and visitors had been asked for their thoughts on the service. We spoke with people living in the home, visitors and two health care professional. They all praised the quality of care and the staff. However checks on the quality of service had not been undertaken.

At this visit, we saw that prescription medications were not stored securely enough. This was unsafe and put people at potential risk.