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Archived: Oakleigh House Nursing Home Inadequate

Reports


Inspection carried out on 21 June 2018

During a routine inspection

This inspection took place on 21, 25 and 26 June 2018. We arrived on the 21 June 2018 early in the morning and did not announce our inspection. We told the registered provider that we would need to visit again on 25 and 26 June 2018.

During our previous inspection on 14 & 15 June 2017 we rated Oakleigh House Nursing Home as ‘Requires Improvement’ and found five breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. We found that the premises and equipment used was not secure, clean and suitable for carrying out the regulated activities, Regulation 15 premises and equipment. We found that people who used the service were not always protected from detecting and controlling the spread of infection, Regulation 12 safe care and treatment. We found that the treatment and care provided did not always reflect peoples assessed needs, Regulation 9 person-centred care. We found that the registered person failed to have an effective system in place to monitor and assess the quality of care and make improvements because of these quality assurance measures, Regulation 17 good governance. We found that treatment and care was not always provided in a safe way and the registered provider did not take reasonable steps to mitigate such risks, we served a warning notice for Regulation 12 safe care and treatment.

Following our comprehensive inspection in June 2017, the service submitted an action plan detailing how they would improve to ensure they met the needs of the people they were supporting and the legal requirements.

We undertook a focused inspection on 3 October 2017 to assess the breach of regulation 12 in relation to inadequate risk assessments to ensure people were safe from receiving inappropriate care. At this focused inspection, we found that the service had followed their plan and legal requirements had been met. We found that risk assessments were in place for areas such as pressure ulcers, falls, epilepsy and diabetes. There were measures in place to give guidance to staff on how to manage risks. There was evidence the risk assessments were reviewed regularly to ensure they remained relevant and reflective of people's needs.

Oakleigh House Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Oakleigh House Nursing home is registered to provide accommodation and nursing care to maximum of 20 people. At the time of this inspection 17 people were living at the home.

At the time of our inspection there was no manager registered with the CQC. The registered manager left in November 2017. A registered manager is a person who has registered with the CQC to manage the service. Like registered services, 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 home was managed by one of the company directors, who was not a registered nurse.

During our inspection we had some concerns about the fire safety at Oakleigh House Nursing Home. We shared our concerns with the London Fire and Planning Authority (LFEPA). The LFEPA is the regulator for fire safety in non-domestic premises, such as care homes. The LFEPA visited Oakleigh House Nursing Home on 2 July 2018 and issued Oakleigh House Nursing Home with an enforcement notice. In the response to this enforcement notice the registered provider decided to initiate the closure of Oakleigh House Nursing Home. We received written confirmation from the registered provider that on 20 July 2018 all people using the service had moved to alternative accommodation and that the home was planning to close.

We found that while people’s risks had been assessed, guidance to mitigate such ri

Inspection carried out on 3 October 2017

During an inspection looking at part of the service

We undertook this unannounced focussed inspection on 3 October 2017 to look at progress with meeting a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Oakleigh House Nursing Home is a registered to provide accommodation and nursing care to 20 older people. Some people have dementia and mental health problems. The home is located in a residential area in Hatch End, North West London.

At our last comprehensive inspection on 15 and 16 June 2017 we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the service did not have detailed risk assessments and risk management plans for people who used the service. We served a waring notice to the provider.

Following our comprehensive inspection in June 2017, the service submitted an action plan detailing how they would improve to ensure they met the needs of the people they were supporting and the legal requirements.

We undertook this focused inspection on 3 October 2017 to check that the service had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to this focussed inspection which looked at whether the service was 'safe'. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Oakleigh House Nursing Home on our website at www.cqc.org.uk.

There was a registered manager in post who was present throughout 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 2008 and associated regulations about how the service is run.

At this focused inspection, we found that the provider had followed their plan and legal requirements had been met.

We found that risk assessments were now in place for areas such as pressure ulcers, falls, epilepsy and diabetes. There were measures in place to give guidance to staff on how to manage risks. There was evidence the risk assessments were reviewed regularly to ensure they remained relevant and reflective of people’s needs.

The home had also been recently adapted to meet the needs of people with mobility difficulties. Mobility aids were in also place for people.

Inspection carried out on 15 June 2017

During a routine inspection

This inspection took place on 15th and 16th June 2017 and was unannounced.

During our last inspection in September 2015 the provider met all legal requirements and was overall rated good.

Oakleigh House Nursing Home is a registered to provide accommodation and nursing care to 20 older people. Some people have dementia and mental health problems. The home is located in a residential area in Hatch End, North West London.

A manager is registered with the Care Quality Commission (CQC). 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.

External and internal checks to help to maintain the safety of the building were not always carried out and we found that the premises were not always safely maintained. No window restrictors were fitted to one room on the second floor. Sharps were not disposed of in a timely manner. Carpets mainly on the ground floor were uneven and loose and lighting was not always maintained. Adaptations to support people to walk safely and independently were not in place throughout the home. Risks to people who used the service in relation to the treatment or care were not always assessed and managed appropriately.

People who used the service were safe from bullying and harassment as appropriate systems were in place to ensure people were protected from abuse.

Sufficient staff were deployed to meet people’s needs and they were suitably vetted and checked to ensure they were permitted to work with vulnerable people.

Medicines were managed safely and people were confident that they received their medicines as prescribed.

The environment was dated and was not decorated regularly, this resulted in carpets being very dirty and worn, curtains in people’s rooms not hung properly and some en-suite showers in people’s rooms not working properly or not working at all.

Care workers had access to a range of training and received appropriate support from their manager to ensure they had the skills and knowledge to meet people’s needs.

People who lacked capacity to make some decisions in relation to their treatment or care had their capacity assessed and appropriate safeguards had been put into place.

People who used the service were provided with nutritious and well balanced meals and had access to drinks and snacks at any time during the day.

The service ensured that people’s health care needs were met and appropriate support was sought from health care professionals if required.

People told us that they felt comfortable in the presence of care workers and were well cared for and their privacy and dignity was respected.

Care plans were in place and specific to the person, however care plans did not always reflect people’s needs and lacked detail to ensure people’s needs could be met holistically.

People were offered a range of activities which met their needs.

Appropriate procedures were in place for people to make complaints or raise concerns. Over the past 12 months the service received six complaints which had been dealt with appropriately.

Quality assurance systems were not always effective and quality of care was not monitored to ensure improvements can be made in a timely manner.

The staff worked well together as a team, with a positive and compassionate attitude.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are currently considering what action to take. 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.

Inspection carried out on 3 September 2015

During a routine inspection

We carried out this unannounced comprehensive inspection of this service on 3 September 2015.

At our previous inspection on 5 August 2014 we found three breaches of legal requirements. Medicines were not being managed safely; appropriate records for the monitoring of nutrition and hydration were not being maintained and complaints were not recorded and dealt with appropriately.

We completed a focused inspection on 25 June 2015 to check these matters and we found that there had been some improvement. At this inspection we carried out a comprehensive inspection to assess if the provider had maintained compliance with all legal requirements and review the overall rating of the service.

Oakleigh House Nursing Home is a nursing home for up to 20 people some of whom have dementia, some who require nursing care and some of whom who require personal care support. There was one vacancy on the day of our inspection. The home is located in a residential area of Hatch End in the London Borough of Harrow.

The home has a registered manager. 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.

People told us they felt safe at the home and safe with the staff that supported them. They told us that staff were attentive, kind and respectful. They said they were mostly satisfied with the numbers of staff.

The registered manager and staff at the home had identified and highlighted potential risks to people’s safety and had thought about and recorded how these risks could be reduced.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and told us they would presume a person could make their own decisions about their care and treatment in the first instance. Staff told us it was not right to make choices for people when they could make choices for themselves.

People told us they were happy with the food provided and staff were aware of any special diets people required either as a result of a clinical need or a cultural preference.

There were systems in place to ensure medicines were handled and stored securely and administered to people safely and appropriately.

Staff were able to demonstrate that they had the knowledge and skills necessary to support people properly. People told us that the service was responsive to their needs and preferences. However people also told us that there was a lack of stimulating person centred activities provided.

People had good access to healthcare professionals such as doctors, dentists, chiropodists and opticians and any changes to people’s needs were responded to appropriately and quickly.

People told us staff listened to them and respected their choices and decisions.

People using the service and staff were positive about the registered manager. They confirmed that they were asked about the quality of the service and had made comments about this.

We found one breach 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.

Inspection carried out on 25 June 2015

During an inspection looking at part of the service

We carried out an unannounced comprehensive inspection of this service on 5 August 2014 at which three breaches of legal requirements were found. The registered provider did not ensure that medicines were managed safely; the registered provider did not ensure that appropriate records for the monitoring of nutrition and hydration were maintained and the registered provider did not ensure that complaints were recorded and dealt with appropriately.

After the comprehensive inspection we did not request an action plan from the registered provider.

We undertook a focused inspection on the 25 June 2015 during which the registered provider produced an improvement plan. The purpose of our focused inspection was to check that the registered provider had followed their plan and to confirm that they now met all legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Oakleigh House Nursing Home on our website at www.cqc.org.uk.

Oakleigh House Nursing Home is a nursing home for up to 20 people some of whom have dementia, some who require nursing care and some of whom who require personal care support. The home is located in a residential area of Hatch End in the London Borough of Harrow.

At our focused inspection on the 25 June 2015, we found that the provider had followed their action plan and legal requirements had been met.

The home has a registered manager. 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.

We found that the registered provider had taken action in the management, recording and storage of controlled drugs and people who used the service can now be assured that controlled drugs were administered safely.

We saw that appropriate systems and records had been put into place to ensure people who were at risk of dehydration or malnutrition were monitored and assessed frequently. This ensured any changes can be responded to swiftly.

The registered provider had taken appropriate action and had put systems in place to record, investigate and respond to complaints.

Inspection carried out on 5th August 2014

During a routine inspection

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, and to pilot a new inspection process being introduced by the Care Quality Commission (CQC) which looks at the overall quality of the service.

This was an unannounced inspection. Oakleigh House Nursing Home is a nursing home that provides personal care and accommodation for up to twenty older people. Some people had dementia, physical disabilities and/or a sensory impairment. There were eighteen people living in the home at the time of the inspection. The home is located in a residential area of Hatch End in the London Borough of Harrow.

The home had a registered manager in place. A registered manager is a person who has registered with the CQC to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. The registered manager is also a director of the organisation.

Most people told us that they were happy living in the home. Conversations with visitors and others important to people indicated there was general satisfaction with the service provided. Feedback from some people however, indicated they were unhappy about some aspects of the service including limited opportunity to participate in activities, and response to concerns and complaints.

People’s safety was compromised by the way some medicines were administered.

Staff liaised with healthcare and social care professionals to obtain specialist advice so people received the care and treatment that they needed. Some care monitoring records however, were not up to date so it was not evident if people always received the care they needed.

People told us that they were treated with dignity and respect and there were enough staff. Staff were up to date with core training and had qualifications in health and social care. Staff received regular supervision and support. Appropriate checks were carried out when staff were recruited. There was reliance however, upon the use of agency nursing staff which did not promote consistency of care.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). Staff had received Mental Capacity Act 2005 (MCA) training and had knowledge of DoLS. People had risk assessments to protect them from harm whilst promoting their independence. The registered manager knew what constituted restraint and knew that a person’s deprivation of liberty must be legally authorised. The service had plans to review whether any applications needed to be made in response to the Supreme Court judgement in relation to DoLS.

People’s needs were assessed and care and support were planned and delivered to meet people’s individual needs. Staff were familiar with people’s individual needs and their key risks.

There were some systems in place to monitor the quality of the service and improvements were made when needed. However, there were areas where it was not apparent that strategies were in place to minimise risk, make improvements and ensure the smooth running of the service.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 2 May 2013

During an inspection looking at part of the service

This visit was to check that the provider had undertaken the actions they said they would complete after our previous visit on 2 March 2013. We spoke with several members of staff who informed us of changes made to the systems used in the service to ensure people's safety and welfare, and observed care being provided in line with the changes and with dignity and respect for people using the service. Staff also told us about changes in their responsibilities, and we saw records of checks confirming these.

We found that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. All care plans had current assessments for the person's health needs, including the risk of falls, pressure care and mobility. We saw that people's wound management plans were accurate and reflected current guidance.

People's medicines were managed to ensure they received the correct medicines at the right time, in the manner prescribed by their doctors. We found that records were maintained accurately and consistently.

Inspection carried out on 2 March 2013

During a routine inspection

During the inspection we talked with three people using the service, two relatives and four members of staff to obtain their views about the service.

People were generally satisfied with the care and support they received in the home. Their relatives were also content that they were being cared for and treated appropriately. We however, found that people�s needs were not always assessed in a timely manner to ensure their needs were identified and for care plans and risk assessments to be developed to address their needs.

We found that the service provided equipment to ensure people received the appropriate treatment when they had pressure ulcers. On a few occasions, people who had pressure ulcers were seated for more than two hours. This could prevent current pressure ulcers from healing or put people at risk of developing new pressure ulcers.

People were supported with their healthcare needs and referred to healthcare professionals according to their needs. However, we found that the arrangements to manage their medicines were not effective to protect them against risks associated with medicines.

Records were not always kept accurately to demonstrate that people received safe and appropriate care. For example fluid balance and turning charts were not completed in a consistent manner to confirm that people were receiving safe and appropriate care.

Inspection carried out on 23 May 2012

During an inspection looking at part of the service

We spoke to people using the services but their feedback did not relate to these standards. However, we saw various staff interactions with people which were pleasant, supportive and appropriate. People appeared relaxed in the company of the staff.

Inspection carried out on 8 November 2011

During a routine inspection

People told us that they were comfortable and content at the home. They said that there were enough activities for them and they could choose whether to be involved.

People told us that staff were polite, pleasant and friendly towards them and that they respected the privacy and dignity of people living at Oakleigh House Nursing Home. They said that meals were pleasant and nutritious and that they were given a choice.

People told us that appointments with medical professionals were arranged on their behalf when necessary and that they had regular access to their GP.

Each of the people we spoke with told us that they felt that most of their needs were being met.

However, we found evidence that a lack of established monitoring procedures by the provider may have meant that not all of the needs of people living at Oakleigh Nusring Home had been met.

Reports under our old system of regulation (including those from before CQC was created)