Oaklands House

Oaklands House is in Milnrow, Rochdale and consists of a large period building that has been extended to provide 13 single bedrooms for people who are diagnosed with mental health problems and are over the age of 18 years. There were 13 people living at the home at the time of inspection.

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

The risk to people’s safety was not always well managed. We found there were areas of concern in relation to fire safety and the maintenance of the premises which put people at risk of harm.

There was no clear auditing process in place and policies and procedures were not available at the time of the inspection. There was a lack of auditing across the service which put people at risk of harm as it was not clear what oversight the provider had when things went wrong or people’s needs changed. We received some policies after the inspection, relating to medicines and safeguarding however not all of the information requested from the service was made available.

The recruitment of staff was not always robust and appropriate background checks of staff were not taking place prior to them starting work. People’s medicines were not always appropriately managed and the process for identifying medication errors was not robust.

People told us the management team were approachable and would address concerns. The manager at the home was in the process of applying to the post of registered manager. The person applying to be the registered with the Care Quality Commission as registered manager, will be referred to as ‘the manager’ throughout this report.

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 16 April 2018).

Why we inspected

The inspection was prompted in part due to concerns received about staffing and safeguarding management. As a result, we undertook a focused inspection to review 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. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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

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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and to hold providers to account where it is necessary for us to do so.

We have identified three breaches of regulation. These relate to the medicines management and recruitment (Regulation 12, Safe care and Treatment), the safe maintenance of the premises (Regulation 15, Premises and equipment) and the systems for oversight were not sufficiently robust to have identified all of the issues we identified (Regulation 17 Good Governance) at this inspection.

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

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.

At our last inspection in October 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.

Oaklands House is in Milnrow, Rochdale and consists of a large period building that has been extended to provide 13 single bedrooms for people who are diagnosed with mental health problems and are over the age of 18 years. The home provides 24 hour care and has a wide range of equipment and facilities to assist people with their care needs. At the time of our inspection the home was full with 13 people living in the property. There was enough room to allow for privacy and communal living. People had their own rooms, which were decorated to reflect their personal taste, and there were a number of communal areas which were well furnished and laid out with consideration of the needs of those who used the service. All areas were clean with close attention paid to minimising the risk of infection.

The home was secure, and there were no undue restrictions on people who were supported to maintain their independence. People told us that they felt safe and when we spoke with staff they demonstrated a good understanding of how to prevent abuse. The service had safeguarding procedures which were in line with legislation and local authority policies so when incidents of potential abuse occurred these were reported and appropriate action taken to protect people from harm.

Care records showed that risks to people's health and well-being had been identified, and where risk had been identified, corresponding detailed care plans were put into place, and reviewed on a regular basis. Risks were assessed in relation to each individual, taking into consideration their choices, abilities and lifestyle.

We saw that when recruiting new staff, appropriate processes were in place to ensure that they had the right quality and character to work with vulnerable people. Once in post all staff received regular supervision and appraisal and were provided with training opportunities to develop their skills. There were sufficient staff on duty, and we saw that there was a low turnover of staff. Care workers knew the people they supported and had time to spend talking and interacting positively with them.

Medicines were well managed and records showed that regular audits ensured that people received their medicines safely and effectively.

There was evidence to show good cooperation with health and social services professionals, and staff at Oaklands House showed knowledge of people who used the service. Needs were met in a person centred way. Staff were well trained and training needs were monitored, with refresher training on a regular basis. Staff told us they found their supervision sessions to be useful and helped them with their daily tasks.

People who used the service influenced the food provision, and when we spoke with them they told us they liked the food on offer. Dietary requirements were met, and individual tastes and preferences were catered for.

People who used the service were offered choices, and capacity and consent issues were considered. Where people lacked capacity, best interest decisions were taken and documented to show that decisions made were in their best interests. Where people were subject to a deprivation of liberty the service sought the appropriate authorisation to provide care and support.

The service recognised and responded well to people’s needs and wishes and people were treated with respect and dignity by kind and patient staff. People who used the service said they felt valued and included, and that their privacy was respected. All were comfortable in their surroundings. They were involved in planning their care and reviews and their wishes and needs were considered and acted upon. A complaints procedure was available and people told us that they knew who to speak to if they wanted to make a complaint.

To help ensure that people received safe and effective care, systems were in place to monitor the quality of the service provided, and ensure good recording of information. Communication amongst staff ensured that information was passed on in a timely manner. The service sought the views of people who used the service and other stakeholders to provide and improve on service delivery.

The action plan stated that quality assurance systems were to be updated and additional audits had been set up in checking of the mattresses, care records and infection control. We looked at the audits and found they had been set up and were being updated on a regular basis.

Both people told us they had freedom to choose their activities and one person told us he enjoyed painting but felt that sometimes support from the home was lacking.

Both people felt their medications were administered safely and staff prompted them on time.

Both people were complimentary about the staff and felt that staff treated them with respect and dignity and helped them maintain their independence.

There was no registered manager in place at the time of inspection which impacted on the quality monitoring provisions. We found that there was no overall audit programme in place.

Another person told us 'The staff are always available for confidential discussions about private issues.'

Both people were positive about the environment and living with the other people. Both people felt safe living at the home and did not have any concerns related to the wellbeing of any of the people at the home.

There were positive comments about the staff and the service that was being provided. One person said 'Everybody is friendly and there are always staff to help out.'

Neither person had any complaints. One person told us 'If I ever need to raise anything, I speak with the staff who would deal with it immediately.'

In this report the name of a Registered Manager appears who was not present and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.