Oakdene Rest Home

Oakdene Rest Home accommodates 27 people in one adapted building. There were 26 people living at the home on the day of our inspection. Some people were living with dementia.

People's experience of using this service

People were interacting with one another and staff were engaging with people. A relative told us, “I didn’t want [my relative] to go into a care home. Saying that the care that she gets is good, she is safe and happy.”

Risks to people had been identified. Risk assessments contained all the information needed to ensure risks were kept to a minimum and detailed action/s staff needed to take, if risk did occur.

Medicines were safely managed. Since the last inspection the provider had created a new medicine dispensing room and implemented new quality control and auditing procedures. This enabled staff to safely manage and dispense medicines.

Staff were recruited safely. Recruitment checks had been carried out to ensure that staff were of good character and have the skills and experience necessary to provide care. There were enough staff to provide safe care.

The management had a clear understanding of their roles and responsibilities. The registered manager conducted audits to assess, monitor and improve the quality and safety of the service. Staff told us they were supported by and able to approach management.

People were protected from abuse. Staff received safeguarding training and understood how to recognise signs of abuse and actions needed if abuse was suspected.

The registered manager and staff knew people well and quickly identified when people's needs changed. People who were unwell or needed extra support, were referred to health care professionals and other external agencies appropriately.

Care plans were updated regularly and were stored securely. They contained up-to date and relevant information to ensure people were safe and their choices were respected and recorded. This enabled staff to safely support people and understand how people wished to be supported.

People received care and support that was personalised to their individual needs. Staff had training to meet people's needs and had the skills to identify areas of concern.

Infection Prevention and Control policies and procedures were being followed. The premises looked clean and tidy and we were assured that the service had controls in place to minimise the risks posed by COVID-19.

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 14 December 2017).

Why we inspected

This was a planned inspection based on the previous rating.

We undertook a focused inspection to look at the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. Therefore, we did not inspect them.

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.

Ratings from the previous comprehensive inspection for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has remained Good. 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 Oakdene Rest Home on our website at www.cqc.org.uk.

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.

Oakdene Rest Home is a residential care home providing accommodation and personal care for up to 26 older people. Most people were living with dementia. There were 26 people living at the service at the time of the inspection.

People’s experience of using this service

People and their relatives were very positive about the care and support they received at Oakdene Rest Home. People felt safe and well-looked after. Staff were described as ‘kind’, ‘caring’ and ‘attentive’. Relatives said they were kept up to date with changes and significant events in people’s lives.

We identified an area for improvement with regards to preventing and controlling infections. The registered manager and cleaning staff were not wearing single use face masks. The registered manager was signposted to relevant national guidance and changed their mask to single use once this had been pointed out to them.

Staff continued to have a good understanding of potential risks to each person and how to keep people safe. One person’s care plan was updated immediately after the inspection to reflect staff practice.

Systems to monitor and improve the quality of the service continued to be effective. Additional cleaning hours had been rostered to ensure effective cleaning during the pandemic.

The management team knew people well and there continued to be an open and positive culture which benefitted people’s well-being.

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 14 December 2019).

Why we inspected

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 coronavirus and other infection outbreaks effectively.

The inspection was prompted in part due to concerns received about the management of risks and infection control practices. A decision was made for us to inspect and examine those risks.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. Targeted inspections do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

There was a registered manager based at the service who had taken up their employment since the last inspection took place. 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.

Oakdene Rest Home provides accommodation and personal care for up to 26 older people. There were 18 people living at the service at the time of the inspection.

People living in the service required care and support and had varying needs. All the people were living with dementia and some had medical conditions such as diabetes or respiratory conditions and some people were recovering from suffering a stroke. Most people living in the service were mobile, some independently mobile and others needed the support of one or two staff. Some people were unwell and cared for in bed.

The service was set over two floors with most bedrooms being available on the ground floor. A stair lift helped people to move between floors, this meant only people who were independently mobile or needed minimal support with mobility lived in the five upstairs rooms. Two lounges were available for people to use, one leading on to a private enclosed garden which was well maintained and easily accessible. A central conservatory area was used as a dining area where people could choose to eat their meals. There were no en-suite bedrooms available so people shared bathroom facilities.

Oakdene Rest Home was last inspected on 20 and 21September 2016. Four breaches of legal requirements were found in relation to Regulations 9, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider and registered manager to take action to meet the regulations. We also made three recommendations to improve the service provided.

After the inspection the provider did not send a formal action plan but sent updates via email informing CQC of the action taken to make improvements. Emails were dated 23 September 2016, 26 September 2016, 11 October 2016 and 12 October 2016.

At this inspection we found improvements had been made in all areas of concern found at the last inspection.

Risks had been identified and measures were now in place to mitigate and prevent harm, helping to keep people safe. Fire safety was considered and remedial work had been carried out to ensure fire precautions and procedures were safe.

Medicines were managed safely and people received them as prescribed.

There were now suitable numbers of staff deployed to meet the needs of people living in the service. The registered manager kept this under review.

The provider and registered manager had introduced a more robust and effective system for monitoring the quality and safety of the service provided. Improvements had been identified and action plans in place to make sure timely action was taken.

A more person centred approach was now taken and people had better opportunity to take part in meaningful activities. Further improvements were planned. The registered manager had started to involve people’s families more in their care plan reviews.

The provider had embarked on a refurbishment programme and many areas of the service benefitted people with more effective lighting and decoration.

People were supported to be safe by staff who knew what their responsibilities were in relation to keeping people safe from the risk of abuse. Staff recognised the signs of abuse and what to look out for. Staff had the information they needed to raise concerns they had with external organisations if necessary.

The registered manager followed safe recruitment practices by having appropriate arrangements in place to check the suitability and fitness of new staff. New staff received a good induction into the service and had the training necessary to carry out their role.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider and staff understood their responsibilities under the Mental Capacity Act 2005.

Staff showed a caring approach and created a positive atmosphere where people felt safe. Staff knew people well and used their knowledge to create a service that focussed on people. People were treated with dignity and respect and supported to maintain their independence.

Care plans were detailed and provided the information and guidance staff required to support people well in the way they wanted.

The registered manager provided good leadership. They made sure staff focussed on providing good quality care and support. People and staff were encouraged to provide feedback about how the service could be improved. This was being used to make changes and improvements. Records were consistent and robust.

The provider and registered manager had responded to improvements that were required and continued their journey of improvement.

Oakdene rest home was registered to provide accommodation and personal care services to 26 older people. 17 people were living at the home on the day of our inspection.

Oakdene rest home was situated on the Isle of Sheppey in a central location. There were two floors in the home providing care and support to older people with varying needs, many of who were living with dementia. Access between floors was via stairs or a chair lift so only people who were independently mobile were accommodated in the five upstairs bedrooms. There were two lounge areas for people to sit in or to take part in activities. One lounge led onto a garden area where people could sit out in fine weather if they wished. There were no en-suite bedrooms, people shared bathroom facilities. Some people chose to eat their meals in a small pleasant dining area.

We last inspected this service on 12 and 14 October 2015 when we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to Regulation 12, Safe care and treatment and Regulation 15, Safety and suitability of premises. Following the inspection the provider did not send an action plan to inform us how they intended to improve the service and meet the requirements of the regulations.

However, at this inspection we found that the provider had taken action to address the breaches from the previous inspection and had made some improvements to the service provided. Improvements had been made to managing infection control measures and the safe management of medicines. Improvement was still required to adequately assess risks to the health, safety and welfare of people receiving care. A new registered manager was in place who was addressing the areas of concern.

There was a registered manager based at the service who had taken her post since the last inspection. 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 and their relatives told us they felt safe living at the home. They told us who they would speak to if they were worried about anything and were confident they would be listened to. We spoke to staff who were able to tell us how they kept people safe. They understood their responsibilities in ensuring people were safe from abuse and their role in reporting any concerns they had. There was evidence that staff had previously raised concerns with the local authority and CQC, helping to keep people safe.

Risks to people’s safety and wellbeing were not always managed effectively to make sure they were protected from harm. The care home did not have all associated individual risk assessments in place to identify and reduce risks that may be involved when caring for people in the home.

Fire evacuation drills had not been undertaken to make sure staff understood the fire evacuation procedure and how to implement it. Personal emergency evacuation plans were not in place for individual people to guide staff how to support people appropriately in such an event.

There were not sufficient numbers of staff deployed effectively to meet the needs of people living at the home. Staff were expected to carry out a number of other tasks around the home as well as their primary responsibility of supporting people. This meant there were not always enough staff available when required to assist people.

There were no activities plans in place in order to ensure people were meaningfully occupied with activities that matched their hobbies, interests and preferences. Activity records showed the activities on offer were limited. An activities coordinator had been recently recruited to provide more opportunities for people.

There were no regular monitoring and auditing processes in place to check the quality and safety of the service provided. Some auditing mechanisms were in place, however these had not been carried out at the correct regular intervals. Surveys had not been undertaken to hear people’s views and use the information from them to improve the service.

The provider’s whistleblowing policy did not include how staff could raise a concern outside of the organisation should they have concerns they felt were not being dealt with by the provider. We have made a recommendation about this.

Medicines were managed well by staff who were trained and competent to administer peoples prescribed medicines safely.

The home was maintained reasonably well, however it was in need of updating. The provider was in the process of decorating bedrooms and changing the flooring in the communal areas. The main lounge area was quite dark and dull with little natural daylight which could impact on people’s abilities to undertake activities and on their well-being. We have made a recommendation about this.

The provider used safe recruitment processes when employing new staff to make sure only suitable staff were employed to work with people. The registered manager had a training plan in place and all staff received the training they required to carry out their role well. There had been a lapse in staff receiving regular supervision and appraisal due to the change in management, however, the new registered manager had a plan in place that had already commenced.

People’s care needs were assessed before moving into the home to make sure the registered manager was confident the staff team had the skills to support people well. The registered manager was in the process of changing the paperwork for care plans to make them more person centred.

People’s relatives told us they had not been involved in reviewing their loved one’s care plans. We have made a recommendation about this

People were complimentary about the food and the choices they were given. People could choose something different to the choices on the menu if they wished. People’s specialist nutritional needs were catered for and well recorded.

People were supported to look after their health. Health care professionals were contacted and their advice sought to ensure people got the care and support they required to maintain their health and well-being.

People’s relatives said they would be happy to take any concerns they had to the registered manager. Staff were complimentary about the new registered manager and the improvements she had already made. They said they would raise their concerns with her and were confident she would act on them.

During this inspection, we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.