The Oaks Residential Care Home

Updated 23 March 2024

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 2 inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

The Oaks Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Oaks Residential Care Home is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced. Inspection activity started on 16 February 2023 and ended on 27 February 2023. We visited the service on both days.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We used observations to gather evidence of people's experience of care. We spoke with 4 people using the service, 7 relatives, and 9 members of staff including 2 seniors, 3 carers, 2 activities staff, laundress and the chef. We also spoke with the registered manager and nominated individual responsible for supervising the management of the service on behalf of the provider. We reviewed a range of records, including 3 people's care plans and associated risk assessments and a variety of records relating to the management of the service.

Updated 23 March 2024

About the service

The Oaks Residential Care Home provides personal and nursing care in one adapted building for up to a maximum of 30 people aged 65 and over, including people living with dementia. At the time of our inspection there were 21 people using the service.

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

People’s relatives told us they felt their loved ones received good care and were safe. Staff showed compassionate care and warmth when interacting with people, however care was delivered intuitively and not driven by best practice.

The lack of maintenance of the environment, including people's bedrooms and en-suite facilities compromised people’s dignity and did not show respect. The standards of hygiene and infection prevention and control (IPC) measures were poor, which placed people at risk of acquiring infections and associated implications to their health.

Risks to people's health, welfare and safety had not been adequately assessed and managed which placed them at risk of harm. This included failure to identify the risk to people from unguarded radiators, a window with no restrictor and insufficient information to ensure people could be safely evacuated in the event of a fire.

Staff had not been provided with training they needed to meet the specific needs of people using the service. This included, how to support people with dementia, and associated behaviours, in a positive way and those at risk of choking or aspirating when eating and drinking. This could have serious consequences to their health and put them at risk of avoidable harm.

Induction of staff, especially those new to care did not ensure they were adequately trained to carry out their roles. Recruitment practices needed to improve to ensure all relevant documentation was obtained, and available for inspection to ensure fit and proper staff were employed to work with people using the service.

Staff were not routinely provided with the appropriate supervision and appraisal to enable them to carry out the duties they were employed to perform and ensure they were competent to meet people’s specific needs.

There was not enough skilled and experienced staff deployed throughout the day to meet people’s needs and keep the service clean. Staff told us early morning and evenings needed additional staff to ensure they had time to provide personal care to those who required 2 staff, as well as ensure people in communal areas were safe.

People’s medicines were well managed. However, improvements were needed to ensure protocols were in place to guide staff when to administer medicines prescribed to relieve anxiety, on an as needed basis and ensure these were only administered as a last resort. Where people lacked capacity to consent to their care and medicines, relatives had been involved in making decisions in their best interests. People were supported to have maximum choice and control of their daily lives and staff supported them in the least restrictive way possible and in their best interests.

The service was not well-led, and governance and oversight systems were poor. Staff were aware the provider had a set of values they should adhere too, to deliver good care, but were not clear what they were. There was no effective system in place to check staff understood these values and ensure they were embedded into practice, and staff morale was low.

Systems to assess and monitor the quality and safety of the service were ineffective. Auditing processes did not provide an accurate overview of the service; ensure proper monitoring and review, identify shortfalls or inform an ongoing plan for improvement. Whilst it is recognised the registered manager took immediate action to make improvements, the governance arrangements had failed to identify the compromised quality and safety of the service.

There were no formal systems or processes in place to ensure incidents and accidents were reviewed and monitored to make sure action was taken to protect people, promptly escalate concerns to the relevant external bodies, such as safeguarding, remedy the situation or make improvements to prevent further occurrences.

Rating at last inspection and update

The last rating for this service was good (published 01 April 2021). Prior to this inspection this service has been rated requires improvement or inadequate for the last five consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service. We received concerns in relation to poor infection prevention and control (IPC), the environment, staffing and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe, caring 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 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.

The overall rating for the service has changed from good to inadequate based on the findings of this inspection. The improvements made at the previous inspection in March 2021 had not been sustained and we have found evidence that the provider needs to make improvements. Please see the safe, caring and well led sections of this report.

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

Enforcement

We have identified breaches in relation to safe care and treatment, staffing, recruitment of staff and governance arrangements at this inspection. You can see what action we have asked the provider to take at the end of this full report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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

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.