Archived: Oaklands Care Home

Updated 26 October 2017

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 had made the improvements required following our inspection in September 2016 and was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Two inspectors and an expert by experience completed this unannounced comprehensive inspection on 14 and 15 September 2017. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before our inspection we reviewed the information we held about the home, including previous inspection reports and action plans the registered provider had sent to us since the last inspection. We also reviewed notifications of incidents. A notification is information about important events which the service is required to send us by law. On 8 August 2017 the registered provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed the PIR for this home.

We spoke with six people and two relatives to gain their views of the home. Some people who lived at the home were not able to talk with us about the care they received, so we used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to understand the experience of people who could not talk with us. We observed care and support being delivered by staff and their interactions with people in communal areas of the home.

We spoke with the nominated individual for the registered provider and an independent care consultant the registered provider had employed to support the changes needed in the home. We spoke with the manager and deputy manager, a senior carer and four members of care staff, two members of kitchen staff and a member of cleaning staff.

We looked at the care plans and associated records for six people and the medicine administration records for 25 people. We looked at a range of records relating to the management of the service including records of; accidents and incidents, quality assurance documents, five staff recruitment files and policies and procedures.

Following our visit we received feedback from seven health and social care professionals who supported some of the people who lived at the home.

Updated 26 October 2017

We carried out an unannounced inspection of this home on 6 and 7 September 2016 and found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People were at risk of social isolation due to the lack of activities on offer to them (Regulation 9). People did not always receive their medicines safely (Regulation 12). The registered provider had failed to ensure the home environment was clean and free from offensive odours (Regulation 15). The registered provider had failed to respond in reasonable time in respect of maintenance requests (Regulation 17). The registered provider had failed to ensure there were adequate numbers of suitably skilled, experienced and qualified staff deployed to meet the needs of people (Regulation 18). Following this inspection we served requirement notices on the registered provider. They sent us an action plan which gave details on the actions they were going to take to be fully compliant with all the Regulations by end of November 2016.

We carried out an unannounced inspection of this home on 14 and 15 September 2017 to check the provider had made the required improvements. At this inspection we found that, whilst the registered provider had taken some steps to address the concerns we found in September 2016, they had failed to be compliant with all of the required Regulations. You will find further information on the breaches of regulation we found in the full version of the report.

The overall rating for this provider is ‘Inadequate’. This means that it would be placed into ‘Special measures’ by CQC. The purpose of special measures is to:

¿

¿ Ensure that providers found to be providing inadequate care significantly improve

¿ Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

¿ Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures would be inspected again within six months. If insufficient improvements had been made such that there remained a rating of inadequate for any key question or overall, we would take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This would lead to cancelling their registration or to varying the terms of their registration within six months if they did not improve. The service would be kept under review and if needed urgent enforcement action would be considered.

However, on 11 October 2017 following our inspection, the registered provider advised CQC of their intention to close this home. An application has been received to remove this location from our register.

The home provides accommodation and personal care for up to 45 older people, some of whom live with mental health problems or dementia. Accommodation is arranged over four floors with stair and lift access to all areas. At the time of our inspection 39 people lived at the home and one person was in hospital.

At the time of our inspection the home did not have a registered manager in post. 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 manager had been employed at the home in June 2017 and had begun the process to register with the Commission as the registered manager. However, they left the service the week before our inspection. Another manager, (who had previously been registered with the Commission in this home and knows the home well), had now begun the process to re-register with the Commission as the registered manager for this home.

Whilst there were safe recruitment practices in the home, there were not sufficient staff with suitable skills, knowledge and experience deployed to meet the needs of people. There was a high dependency on the use of agency staff in the home.

Medicines were not managed in a safe and effective manner. Medicines orders were not always managed effectively and people did not always receive their medicines in a timely way to ensure their safety and welfare.

Risk assessments had not always been completed to support staff in mitigating the risks associated with people’s care. Care records were poor and lacked up to date information and order.

Whilst systems were in place to support staff in recognising signs of abuse, they had not identified any concerns about the safety and welfare of people in the home as we found during our inspection.

People were not always valued and respected as individuals. Staff did not always know people well and could not always demonstrate how to meet people’s individualised needs. Whilst some care staff cared for people in a kind and empathetic way, we observed some very poor practices which did not always show respect and dignity for people. These practices were not challenged by other staff or the registered provider. The training staff had received was not always reflected in the care some staff provided.

People did not always receive care which was person centred and individual to their specific needs. Institutionalised routines were in place which did not reflect people’s wishes and preferences. There was a lack of meaningful activities and interactions in the home to reduce the risk of social isolation for people.

There was a lack of leadership and organisation in the management of the home. Staff did not have a good understanding of their roles and responsibilities.

Whilst there was a system in place to allow people to express any concerns or complaints they may have, there was a lack of robust and effective audit in the home to monitor and review the quality and effectiveness of the service provided at the home.

Where people could not consent to their care, staff sought appropriate guidance and followed legislation designed to protect people’s rights and freedom. However, care records did not always reflect this information.

People received nutritious food in line with their needs and preferences although care records were not always an accurate reflection of these.

The home was clean and maintenance was completed in a timely way.