Four Oaks Care Home

Updated 8 February 2022

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

As part of CQC’s response to the COVID-19 pandemic we are looking at how services manage infection control and visiting arrangements. This was a targeted inspection looking at the infection prevention and control measures the provider had in place. We also asked the provider about any staffing pressures the service was experiencing and whether this was having an impact on the service.

This inspection took place on 28 January 2022 and was announced. We gave the service 24 hours’ notice of the inspection.

Updated 8 February 2022

The inspection took place on 2 and 3 August 2018 and was unannounced. The first day of the inspection was carried out by two inspectors, a pharmacy medicines inspector, an assistant inspector 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. The expert had personal experience of services for people living with dementia. Two inspectors and an assistant inspector returned for the second day.

The last inspection of this service was on 7 and 8 December 2017 where we found breaches in six regulations of the Health and Social Care Act 2008, including concerns that placed people at serious risk of harm. These were in relation to service user safety, falls prevention, mitigating known risks, training of staff, medication, staffing levels and shift management, the monitoring of fluids and the governance and leadership at all levels. Following the inspection, we asked the service to take some immediate action and told the home to produce an action plan to address the issues we had found. We returned to Four Oaks on 19 January 2018 to check that these actions had been taken and the action plan was being implemented.

At the last inspection, we rated the service overall inadequate and the service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this time frame. During this inspection the service demonstrated to us that improvements have made and is no longer rated as inadequate overall or in any key questions. Therefore, this service is now out of Special Measures.

At this inspection, we found significant improvements had been made for the safety and welfare of people living at the home. Further details can be found throughout the body of the report.

Four Oaks is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Four Oaks is a modern purpose-built property which can accommodate up to 62 people in four separate units on two levels. Two units specialise in providing care for people living with dementia. At the time of our inspection there were 59 people living at Four Oaks.

A registered manager was in 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.

A new computerised care planning system, person centred system (PCS) had been implanted throughout the home which had largely improved the care planning of each person living at the home. The system was easy to use and staff could record onto the system in real time which had improved daily recording for people. Staff also had access to people’s care and support needs quickly and the system gave prompts to staff to ensure they had completed each task required.

Everyone living at the home said they felt safe. People told us if they had concerns about their safety, then they would have no hesitation is telling someone. Staff we spoke with were aware of their responsibilities in reporting any concerns they had and had completed safeguarding training to enhance their knowledge.

Staffing levels across the home had improved and staff were visible throughout our inspection. All staff we spoke with said there was enough staff on duty. We received mixed responses from people living at the home and relatives with comments being that the home was short staffed at weekends. Agency staff were still used and rotas showed that staffing levels remained consistent across the week. The staff from the agency were regular for consistency.

Staff were recruited safely and received the required checks before employment commenced to ensure they were suitable to work with vulnerable groups.

The management of falls has significantly improved and people who were at high risk of falls were regularly monitored and had appropriate equipment such as falls sensors and mats in place. Staff had received training in falls management and regular reviews of falls looked for themes and patterns with actions identified to assist in preventing future occurrences.

People at risk of choking were regularly assessed and protocols were in place to give advice to staff on suitable consistencies of food and fluids. Staff could clearly describe food and fluid consistency for each person they supported.

People whose behaviour may challenge were risk assessed and some good techniques to reduce agitation were recorded for staff to use. Staff had received training in managing challenging behaviour.

Accidents and incidents were clearly recorded and outcomes shared to prevent future occurrences. Each person had been assessed to ensure they could reach and use their call bell. For those who could not, additional room checks were made to ensure peoples safety.

Medicines were well managed and staff had been appropriately trained to administer medication safely. Improvements had been made to the safe administration of medicines to ensure people who wished to stay in bed, could have their medication at a later time without having to miss any doses. Medicines were regular audited to ensure the safe administration and all medicines were stored securely.

People received an assessment of their needs prior to moving into the home. The assessment then was used to generate care plans using the PCS system. Care plans were generally completed within one to three days of the person moving into the home and where possible, care plans from previous care providers were used while staff got to know the person.

Improvements were needed to enhance people’s dining experience. Although people had choice around meals, they were not planned in advance. Lunch was late on the first date of inspection and items were missed on the food trolley which meant people did not have the item with their meal.

Staff were able to record on the PCS system what people had to eat and drink and hydration checklists were in place to ensure people had at least six to eight glasses of fluids per day. People had clearly recorded in their care plans, their likes and dislikes and their dietary requirements. One person preferred a diet from their own culture and this was observed. The chef met with people to discuss their dietary needs and had details of people’s preferences and requirements including any allergies.

Staff received training to enable them to carry out their job role effectively. The service was in the process of registering with a training consortium to be able to engage in standardised training across the local authority. Additionally, the organisation was working with a training provider to provide diplomas in health and social care. This meant staff could receive training to enhance their knowledge and their role.

The service was working in line with the Mental Capacity Act 2005. People who had their liberty deprived, did so in their best interests. Families were involved in making decisions for their relative and we saw some good examples of best interest’s decisions being taken.

People received appropriate referral and support from health professionals. People told us that they could see a GP when they needed to and we saw that where concerns had been identified in people’s health and wellbeing, referrals were made in a timely manner.

We observed kind and caring interactions from staff to people who lived at the home. We spoke with a relative who had concerns about the home at the last inspection and whom now spoke highly of the service.

People were given choice to how they spent their day and staff were able to describe how best to support each person. Staff told us how they observed people’s dignity and we observed staff to knock on people’s doors and ask for permission to enter. Staff told us that they always explained what they were doing when assisting people with personal care and people told us that staff sought consent from them.

Care planning for people had significantly improved with the implementation of the PCS system. Care plans were person centred, had involved people and captured people’s support needs and preferences. Staff had access to people’s care plans at the touch of the button using the PCS iPod system which meant staff could continually access and update information.

People received support at the end of life and we saw that people could be supported to stay at home at the end of life if that was their preference. People and their families were included in end of life planning and staff were clear on what people’s preferences were.

Complaints were responded to in a timely manner. Outcomes of the complaints we viewed were factually correct and shared with the complainants with actions learned from the complaint.

The registered manager had complete oversight of the service. We observed that they conducted daily walk around of the service and had a team of support working alongside them to continue to monitor and improve the home.

Staff felt well supported by the registered manager, deputy manager, clinical lead and nurses. Relatives we spoke with felt the registered manger had largely contributed to the improvements within the home.

Audits were in place and regularly reviewed to monitor and improve the service. Clear action plans were in place to highlight where improvements were needed and the actions to be taken.

The service had worked closely with the local authority to improve the service and they acknowledged the work the service had un