Archived: Oak Wood House

We found the following examples of good practice.

Procedures were in place to ensure the risk of any visitors to the service introducing infection were minimised. This included 30 minute on site testing for covid, taking peoples temperature, supplying personal protective equipment (PPE) and a sink near the entrance to ensure people washed their hands before entering the building.

The majority of people at the service were living with dementia, without capacity to understand and follow social distancing guidelines. Risks were minimised by staff and visitors wearing PPE appropriately. People new to the service were tested for covid before arrival and supported to adhere to an isolation period. People were assessed twice daily for the development of a high temperature or symptoms of covid. Programmes for regular testing of people and staff were in place.

All people and staff had received their first covid vaccinations. This was celebrated with a 'Happy Covid Vaccination' party and a cake. This encouraged one person, who had refused the vaccination initially, to request it so they wouldn't be left out.

The registered manager had assessed the impact of how PPE may cause fear and anxiety for people and make communication difficult. They had ensured all staff were able to communicate clearly and people could understand them. They reported people were now used to staff wearing PPE and there were no issues.

People were supported to maintain contact with their loved ones using a range of technology. Visits were arranged one at a time by appointment. They took place in a room away from communal areas with a separate entrance.

There were comprehensive policies and operating procedures in place. A new team of domestic staff had been recently recruited. They had a clear understanding and commitment to the enhanced cleaning programme required to prevent the spread of infection.

Oak Wood House is a residential care home providing personal care for up to 18 people aged 65 and over. The service was registered in December 2018. At the time of inspection 14 people were

living at the home.

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

The registered manager was continuing to develop and embed systems to manage the quality of the service and drive improvements. A programme of audits was in place, and quality assurance surveys and meetings for people and their relatives planned. Monitoring and accountability was being improved through the introduction of ‘lead roles’ for senior staff, a key worker system and formal supervisions and appraisals.

A range of mandatory training supported staff to meet people’s needs. This included health and safety, information governance, fire safety, equality and diversity, infection control, moving and handling and safeguarding. The registered manager had also worked alongside the local authority QAIT team (Quality Assurance and Improvement Team) and external health professionals to ensure staff had the practical training they needed. This included continence management, falls prevention and pressure area care.

People were cared for safely. Personal risks were assessed, and measures put in place to mitigate identified risks. Care plans were detailed, person centred and reviewed regularly with people and their relatives where appropriate. Staff were recruited safely, and safeguarding processes helped to protect people from abuse. There were systems to ensure information about any changes in people’s needs was shared promptly across the staff team.

People received their medicines safely, and in the way prescribed for them. The provider had good systems to manage safeguarding concerns, accidents, infection control and environmental safety.

People were supported by sufficient numbers of competent and skilled staff. This meant their healthcare and nutritional needs were met. External professionals were complimentary about how the service worked in partnership with them.

People enjoyed the homely ambience and social interaction at Oak Wood House. They were supported to participate in activities if they wished. A relative told us, “At home [my family member] was just staring into space, and conversation was limited.” They now described them as ‘animated and chatty’. The activities programme was due to be further developed, with the newly recruited dementia lead planning to build greater links with the local community and outside world.

Staff were caring and kind and had developed positive and meaningful relationships with people. People were respected, included in decisions, and their privacy and independence promoted. The care provided was sensitive to people's diverse needs. All information was available in an accessible format if required. Further improvements were being considered, for example the provision of a picture menu.

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.

People, their representatives and staff were confident if they had a complaint they would be listened to and action taken to address the issue. There was an open culture and ideas to develop and improve the service were welcomed.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

This service was registered with us on 19 December 2018 and this is the first comprehensive inspection.

A focused inspection was carried out on 18 April 2019. There were two breaches of regulation. The inspection considered the Key Questions of Safe and Well-led only. It was prompted by notification of a specific incident, following which a person using the service died. This incident is subject to a criminal investigation by the CQC. As a result, the focused inspection did not examine the circumstances of the incident. As the service had only been recently registered and the inspection was not comprehensive, (that is looking at all five domains), a rating was not given. The provider completed an action plan after the inspection to show what they would do and by when to improve. At the current inspection we found improvements had been made and the provider was no longer in breach of regulations.

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.

People’s experience of using this service:

Following a serious incident where a person had died following a fall, the registered manager had undertaken a detailed review of safety features in the home and put in place additional measures to ensure people were kept safe.

However, the quality assurance systems were not robust as they had not identified issues we found during the inspection.

Although risk assessments to support each person had been carried out when they first came to live at Oak Wood House, records did not fully reflect how staff should support the person. Records of what care had been provided by staff also did not reflect all aspects of the care described in people’s care plans.

People received their medicines from staff who were trained and competent. However, some aspects of medicine administration did not ensure people received the right medicines. This was because the medicine administration records systems did not ensure that people were clearly identified. Improvements were made to the medicine administration records during the inspection. Medicines were stored safely.

The registered manager was experienced and understood their role. They were working cooperatively with external agencies including the local authority safeguarding team and quality assurance improvement team.

People said they were happy and felt safe living at Oak Wood House Throughout the inspection, staff showed people respect and were very caring and mindful of people’s privacy and dignity.

The home was clean and well maintained, with no malodours. People were cared for by staff who followed good infection control procedures.

People were cared for by staff who had been recruited safely. The registered manager ensured that there were sufficient staff with the right knowledge, skills and experience to support people safely. However, the registered manager had not fully identified what staffing was needed at times when staff were supporting people to get up in the morning. By the second day of inspection, action had been taken to address this.

Rating at last inspection: The service had been registered with the CQC in December 2018. Newly registered services are usually inspected within 12 months of the registration date. Therefore, this service had not been inspected following its registration, so the service had yet to be rated in all key areas. Given at this inspection, we only undertook a focussed inspection in two domains, we have not rated the service overall.

Why we inspected: This was a focussed inspection which checked to see whether people were safe and the service was well-led following a serious incident which had occurred in March 2019. During this focussed responsive inspection, we did not inspect the key questions which consider whether the service was effective, caring or responsive as ongoing monitoring did not raise any information about risks or concerns in these areas.

Enforcement Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up: We have asked the provider to send us an action plan telling us what steps they are to take to make the improvements needed. We will continue to monitor information and intelligence we receive about the service to ensure good quality is provided to people. We will return to re-inspect in line with CQC’s inspection timescales.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk