Oakhurst Court Nursing Home

Oakhurst Court Nursing Home is registered to provide nursing and personal care for up to 57 older people. At the time of our inspection there were 43 people living at the service. Some people using the service were living with dementia.

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

People felt safe using the service because they were supported by staff who knew their needs well and knew how to manage risks associated with their care. Staff understood their responsibilities in terms of keeping people safe from abuse and avoidable harm. Action had been taken to reduce the risk of the spread of infection and the provider had ensured practices were updated according to national guidance during the COVID-19 pandemic.

People's needs and choices were assessed and planned for, and their preferences had been considered. Staff were safely recruited and inducted. They had access to training and supervision to ensure they had the skills to support people effectively.

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 were supported by staff who knew them well and had the information required to meet their needs. People and relatives were all consistently positive about the staff and the support they received.

Staff supported people to access healthcare services as required. Any specialist support was recorded, and actions completed. People were supported to access activities, outings and celebrations. Friends and relatives were welcomed into the service and people were supported to maintain relationships.

The manager provided clear direction and positive leadership. Staff felt valued and supported and were confident that people received good care. Systems and processes for monitoring quality and safety were effective.

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 31 August 2021).

Why we inspected

The inspection was prompted in part due to concerns received about governance and safeguarding concerns. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

Follow up

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

Oakhurst Court Nursing Home is registered to provide nursing and personal care for up to 57 older people. At the time of our inspection there were 35 people living at the service. Some people using the service were living with dementia.

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

People told us they felt safe living at Oakhurst Court Nursing Home. Relatives reflected this view and told us they felt comfortable and more relaxed knowing their family member was safe and well cared for. Relatives told us they felt communication from the management team had improved to provide updates on anything relating to their loved one’s health.

There were enough staff to meet people’s needs. People received their care from staff who knew people’s health needs well and had the training they needed to provide safe care.

People’s individual health needs were fully risk assessed and there was detailed guidance in place to support staff to manage known risk. Lessons were learned from adverse events. Accident and incident records were analysed, and measures put in place to reduce the risk of a similar incident happening again.

The provider’s recruitment procedures helped ensure only suitable staff were employed. Staff understood their responsibilities in protecting people from abuse and knew how to report any concerns they had.

Medicines were managed safely. There was detailed guidance, body maps and wound management processes in place to ensure people received safe care.

People had access to personalised activities. People gave input into the things they enjoyed taking part in and the staff team worked hard to ensure these were provided to people. The staff also monitored people who declined to participate in activities to encourage them with a variety of different options to avoid any social isolation. People had person-centred plans which had been developed with people and their relatives’ involvement.

The provider’s quality monitoring systems helped ensure people received safe care. The management team and staff communicated important information about people’s needs effectively. People’s care records were accurate and up to date.

People and their relatives told us their views about the service were listened to. Relatives were encouraged to be involved as partners in their family members’ care. People and relatives provided positive feedback about the management team.

The provider ensured relatives were kept informed about their family members’ wellbeing during the COVID-19 pandemic. The provider had also considered the effect of the pandemic on staff and put support mechanisms in place.

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

The last rating for this service was Requires Improvement (published 27 July 2019) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 08 March 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve person-centred care.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to 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 Oakhurst Court Nursing 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.

We found the following examples of good practice.

The provider had implemented a safe zoning process for the home. This was supported by a robust COVID-19 contingency plan. The provider had been able to split the home into zones which enabled people coming into the service to complete their isolation period in a safe environment away from other residents which minimised any risk of infection until their isolation period had been completed.

The registered manager had completed individual risk assessments for people around their needs and potential risks caused by COVID-19. This took into account each person’s unique personal circumstances and health needs. Risk assessments had also been completed for staff taking into account any additional risk factors. Actions were taken to support people and staff where potential risks had been identified.

People had been supported to access the outside environment when possible and also to partake in activities whilst keeping to social distancing guidance. People’s wellbeing had been monitored and actions taken should a person be identified as being at risk of struggling during the pandemic. This included additional risk assessed visits, video calls or engagement with different activities to maintain stimulation.

Links have been maintained with relatives via phone calls and updates being placed on the service’s private Facebook page. This has enabled relatives to keep up to date with what is happening within the home whilst they have been unable to visit in person.

Staff have been provided with a variety of training to support their personal development and encourage regular updates in infection prevention and control.

The provider was preparing for the visiting process at the home to continue following the recent government announcement about restarting visits to care homes. A safe and sterile visiting area had been established previously at the home and this would be used to restart visits. All visitors to the home are required to go through a robust visiting process which involves their temperature being taken, a lateral flow test for COVID-19, and completing a health declaration form. Full PPE is provided by the service.

People’s experience of using this service: At our inspections on 4 July 2017 and 22 September 2017, we asked the provider to take action to make improvements in relation to the safety of people, how people were being safeguarded against the risk of abuse, staff training, the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS), the involvement of people in their care, how people were respected and activities provided., Improvements were also required in the leadership at the service, quality assurance processes and how complaints were being responded to. At our inspection in February 2018 we found improvements had been made. The service was rated Requires Improvement to ensure the improvements were embedded into practice.

At this inspection we found that whilst the service had continued to develop in many areas, people’s care was not always person-centred and care plans did not always contain information regarding specific conditions or health issues. People who spent the majority of their time in their rooms did not always have regular social contact to support their needs. The registered manager told us they continued to develop care plans and additional training in relation to supporting people living with dementia and person-centred care was planned in the near future. We have made a recommendation regarding this continued emphasis on providing person centred care.

Although safe infection control procedures were followed there remained malodours in areas though the service. The registered manager and staff continued to look at ways to address this. Improvements have been made to the environment to support the needs of those living with dementia. However, further work is required to ensure that the decoration provided is meaningful to people. We have made recommendations regarding these areas.

People told us they felt safe living at Oakhurst Court and safeguarding process were in place to protect people from potential abuse. There were sufficient staff available and people did not have to wait for their care. Health and safety checks were completed and accidents and incidents were monitored for any trends.

People were supported by staff who treated people with kindness and affection. Staff spent time with people in communal areas and a range of activities and visiting entertainers were planned. People’s religious and cultural needs were supported. Staff encouraged people to maintain their independence and ensured their dignity and privacy was respected. The care people wished for at the end of their life was recorded and the registered manager told us this was an area of on-going development.

Healthcare professionals were involved in people’s care and advice provided was followed. Safe medicines practices were followed and people received their medicines in line with their prescriptions. People’s legal rights were protected as the principles of the Mental Capacity Act 2005 were followed. People told us they enjoyed the food provided and alternatives were offered when requested.

People, relatives and staff told us they felt the service was managed well and their views on the service provided were sought and acted upon. Quality assurance systems were used to maintain and develop the service and action plans were continually monitored. Links had been formed with the local community which had led to regular visits from community groups and the church. People told us they knew how to raise a complaint and felt this would be addressed by the registered manager.

Rating at last inspection: At the last inspection the service was rated Requires Improvement (report published on 19 April 2018)

Why we inspected: This was a planned inspection based on the previous rating

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. We will check that the provider has made the improvements we identified as necessary through further inspections.

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

This inspection site visit took place on 9 February 2018 and was unannounced.

There was no registered manager in post on the day of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. Instead we were supported by the senior nurse for part of the day and the interim deputy for the remainder of the inspection.

At the last inspections on 4 July 2017 and 22 September 2017, we asked the provider to take action to make improvements in relation to the safety of people, how people were being safeguarded against the risk of abuse, staff training, the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS), the involvement of people in their care, how people were respected, activities for people, the leadership at the service, the quality assurance and how complaints were being responded to. We found at this inspection that these actions had addressed and improvements had been made.

There were appropriate levels of care staff to support people when they needed it. The management of medicines was safe by staff that had the appropriate training.

The environment was not always set up to meet the needs of people living at the service for those people living with dementia. We have made a recommendation around this.

People and relatives felt that staff were competent in their role. Staff received training and supervision and staff felt supported. However we have recommended that all staff are provided with dementia training given that this is what the service specialises in.

There were appropriate plans in place to ensure that risks to people were managed. Staff understood what to do to minimise risks in relation to people. Emergency evacuation plans were in place and staff understood what to do if an emergency occurred at the service. Where people had accidents and incidents actions were taken to reduce this risk of them reoccurring.

People told us that they felt safe with staff. Staff had received training in safeguarding people from abuse and they had a good knowledge of what they needed to do if they suspected abuse. Staff at the service had robust recruitment undertaken before they started work.

People’s rights were protected because staff acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Appropriate assessments had been completed where people’s capacity was in doubt and applications to the Local Authority were submitted if people were being restricted in their best interest.

People enjoyed the meals at the service and said they had sufficient choices. People’s health care needs were monitored included weight loss and any changes in their health. People had access to appropriate health care professionals where needed.

People and their relatives told us that staff were kind and caring and treated people in respectful and dignified way. This was confirmed through our observations. People had choices around their care and felt involved in their care planning. Relatives and friends were welcomed at the service to visit people. People and their relatives were given support when making decisions about their preferences for end of life care.

People had a range of activities that they could be involved in including those that were cared for in their rooms. People that were socially isolated in their rooms had one to one activities arranged for them. Care plans were detailed and included specific guidance for staff to ensure that people’s needs were met. Staff communicated changes to each other about any changes in people’s care.

Complaints were investigated, recorded and responded to appropriately. People and staff felt the management of the service had improved significantly. Staff said they felt more empowered and valued. We could see that they staff team worked well together and that staff enjoyed working there.

There were effective systems in place to assess the quality of care and to make improvements. This included audits, meetings and surveys where feedback was sought. Improvements were made as a result of this. The manager had informed the CQC of significant events including incidents and accidents and safeguarding notifications.

We could not improve the rating for well-led and safe from inadequate to good because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

This 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 timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

The registered manager was present on the evening of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. The Nominated Individual was also present at the inspection.

The service was last inspected on the 4 July 2017 where breaches of regulations were identified in relation to the lack of appropriate training and supervision for staff, risks that were not always being identified and managed appropriately ,the lack of mental capacity assessments, people not always being treated with dignity and respect, the lack of detailed care planning and the lack of effective governance. Recommendations were also made around how staff were deployed. At the inspection on the 4 July 2017 the service was rated as Inadequate and the service was placed into special measures.

After that inspection we received concerns in relation to the lack of infection control, the suitability of the environment and equipment, the lack of staff and the suitability of the management oversight of the service. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Oakhurst Court Nursing Home on our website at www.cqc.org.uk.

People were not always protected from the risks of unsafe care. Staff did not adhere to basic infection control measures when needed to reduce the risks of cross-contamination. People were at risk of acquiring infections because appropriate action was not taken to reduce the risks of cross contamination. Areas of the service were untidy and in need of a deep clean. People’s bedroom smelled strongly of urine. The premises and equipment at the service was not always stored or maintained appropriately to keep people safe.

The management of medicines was not always safe which put people at risk. The room where medicines were stored was not fit for purpose. There were errors on the medicine charts where it was not clear if people had received their medicines when needed.

People did not always have access to call bells and were unable to alert staff when they needed support. Staff levels at the service were not appropriate to support people when they needed.

People were not always treated with dignity and respect. People had to endure a strong smell of urine in their rooms. There were times where people were unable to access their rooms when they wanted. There was a lack of stimulation for people living with dementia.

Quality assurance was not effective and there were no appropriate actions in place to address the standards of care that staff were providing. The provider had not met breaches in regulation from the previous inspection.

There was a lack of management oversight at the service. Staff were not being supported or supervised effectively.

The overall rating for this service is 'Inadequate' and the service remains in 'Special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

During this inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The service was run by a registered manager, who was not present on the day of the 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 and associated Regulations about how the service is run. The registered manager was away on leave on the day of the inspection. The deputy manager was in charge; however she had only worked at the home for two weeks. The provider told us that the deputy manager was supported by the senior care team.

At the last inspection in March 2016 we found concerns with the support provided. Following the inspection in May 2016 we told the provider and registered manager to take action to make improvements to ensure people’s care and treatment was safe. We told them to ensure staff had the right skills and knowledge to care for people safely. We also told the provider to take action to ensure that the requirements of the Mental Capacity Act 2005 (MCA) were met and that people received dignified and person centre care. We also told the provider to take action to ensure that there were robust systems in place to monitor, review and improve the quality of care. These actions and requirements had not been met.

People were not always protected from harm. Risks to people had not always been identified and assessed and therefore put them and others at risk of harm. People did not have their own individual slings. This puts people at risk of poor positioning and is an infection control risk. This put people at potential risk of serious harm. The registered manager had not informed CQC of safeguarding allegations.

People were not always safe from avoidable harm. One potentially serious safeguarding had not been reported to the local authority and staff had not recognised it as an incident of abuse.

There was enough staff on duty to ensure people were safe, however staff deployment needed to be reviewed at meal times and other busy times. We have made a recommendation in this area. There were recruitment practises in place to ensure that staff were safe to work with people.

People’s medicines were administered safely. Medicines were always stored and disposed of safely.

People’s human rights could have been affected because the requirements of the Mental Capacity Act were not always followed. For people who lacked capacity to make decisions about their care, mental capacity assessments and best interests decisions had not occurred. The registered manager had applied for some Deprivation of Liberty safeguards (DoLS), when people had restrictions to their care, however some were missed.

People did not always receive effective care. Staff did not always have the knowledge; skills and regular supervision to enable to them care for people safely and effectively.

People did not always receive care that met their cultural or religious needs. Staff were not always aware of people’s choices and preferences. People’s care provided was not always dignified.

People and their relatives said that they were involved in their care. However this was not always evident in peoples care records. People and relatives said that the staff were kind and caring.

People did not always receive personalised care. Care plans were in place; however they were not detailed or personalised. Care records were inconsistent, for some people who had health conditions they did not have the appropriate care plan in place to tell staff how to manage the health condition. People’s preferences and wishes were not always recorded in their care plans.

People and their relatives knew how to make a complaint. The provider had not responded to the complaints in line with the current regulations. There was no evidence of an investigation and the provider had not advised the complainant that if they were not satisfied with their response they could contact another organisation.

The home was not well led. There was not a robust process in place to monitor and evaluate the care provided to drive improvements. Record keeping was inconsistent and records were not sufficiently detailed to guide staff. There was a lack of leadership from the provider and registered manager to drive the improvements.

Staff told us that they now felt supported by the management and were feeling positive about the changes.

People had sufficient food and fluids. People said they thought the food was ‘Okay’.

There was an activities programme in place; people said they enjoyed the activities. However we have made a recommendation about activities for people who received bed based care.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

We found six continued breaches and two new breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found one breach of the CQC (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place on 16 March 2016 and was unannounced.

There was a registered manager in place, who was present on the day of the 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 and associated Regulations about how the service is run.

The registered provider has been in breach of regulation 18 since June 2015, Staffing. They had failed to take action in response to requirements for regulation 18 of the Health and Social care act which had highlighted risks to the safety of people and the effective operation of the service.

During this inspection the home did not have a sufficient number of staff deployed to meet the needs of the people who lived there. Care was provided to people by staff who were not always competent to carry out their role effectively. Staff did not always show they had an understanding of the needs of people living with dementia.

People were not always safe living in the home and risks they took were not always minimised. Risk assessments had not been completed for people and staff were not always aware of people’s needs.

People’s rights were not protected because the staff had not acted in accordance with the Mental Capacity Act 2005.

We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty were being met DoLs. We saw related assessments and meetings to make a decision in someone’s best interest had not been undertaken.

Care plans did not always contain information to guide staff on how someone wished to be cared for. People were not involved in their care and support. We did not see staff encourage people to do things for themselves. We found staff did not always make people feel as though they mattered or treated them with consideration.

We saw people sitting for long periods of time without social interaction from staff. Appropriate personalised activities for people living with dementia were not always provided.

Medicines were managed appropriately and people received most of their medicines in a safe way. However PRN (as required) protocols were not robust. We have made a recommendation about this.

Staff understood what safeguarding meant and different types of abuse. We were assured by some staff they knew how to report any concerns they may have. However staff were not always able to identify situations that constituted ill-treatment.

People’s views were not obtained by holding residents’ meetings and sending out an annual satisfaction survey.

The provider did not have effective quality assurance systems in place, including regular audits on health and safety, infection control, dignity, care plans and nutrition.

At our last inspection we found people were not always supported to have enough to eat. During this inspection we saw a choice of meals was provided to people and people were involved in making decisions about what they ate. However staff did not always support people to eat and drink to support their wellbeing.

At our last inspection we found the environment was not always clean at this inspection the provider had started the process of refurbishment and we saw floors and some beds had been replaced.

The registered manager met CQC registration requirements by sending in notifications when appropriate. We found both care and staff records were stored securely and confidentially.

The provider had ensured they followed good recruitment processes to help them employ suitable staff to work in the home. However the registered manager had not always ensured agency staff had the skills and knowledge for their role.

Staff referred people to external healthcare professionals when appropriate and the local GP was actively involved in the home. We saw that advice and guidance given by these external professionals had been followed and documented by staff.

Complaint procedures were available for people. The registered manager had received complaints and was responding to them. People told us that they had not needed to complain but they went on to say that would feel confident that they could complain and that people would listen to their concerns.

During the inspection we found six 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 the report.

We spoke with some people who used the service and comments included 'I am very happy here, they can't do enough for you', 'and The staff are kind and look after me well'. A relative told us they were happy with the care and treatment that they or their relatives received and were satisfied that it met their needs.

We saw needs were assessed and care and treatment was delivered according to people's wishes. A relative told us they were involved in developing their family member's plan of care. They were also aware that regular reviews of their care plans took place and they were informed of any changes that were required.

People told us the food was nice and they had a choice. They said the food was 'very good'.

Staff we spoke to told us they liked working in the home. They said they had the training and supervision required to undertake their roles and responsibilities.

A relative that we spoke with told us that they were able to express any concerns to the manager or senior staff at any time. They said their concerns were usually addressed fairly quickly. They also told us they had access to the home's complaints procedure.

We spent time observing people who were not able to communicate their views directly to us. They were well cared for by a team of staff who had a good understanding of their assessed physical and emotional needs.

People told us that they enjoyed the activities that were offered and we saw people enjoying a game of musical bingo in the activities room.

People had individual care plans that outlined agreed care and treatment.

People told us that the food was very good and that they were offered a choice of meals. We saw someone enjoying a sandwich for lunch as they did not wish to eat a cooked meal.

One person told us that their room was very comfortable and that they had personal items that mattered with them.

We saw that there were sufficient staff on duty to care for people and staff told us that they enjoyed working in the home.