Oakland Court

At the last inspection, the service was rated Requires Improvement overall and in each domain apart from Caring and Responsive which were rated Good. The rating of Requires Improvement was awarded in relation to the storage of medicines, arrangements to prevent avoidable accidents, support for people with their nutrition and hydration, safe recruitment systems and audits. At this inspection, we found that steps had been taken to address all these issues and the rating has improved to Good in each domain and overall.

Oakland Court is registered to provide accommodation and care for up to 37 older people with a range of needs. At the time of our inspection, 34 people were living at the home. Communal areas include a dining room, lounge leading to a large conservatory, additional conservatory area next to the reception and accessible, landscaped gardens. All rooms are en-suite and accommodation is over three floors serviced by a lift. Oakland Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

A registered manager was 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.

Medicines were managed safely. Risks in relation to people and in the management of premises had been identified, assessed and were managed satisfactorily. People felt safe living at Oakland Court and staff had been trained to recognise the signs of potential abuse and knew what action to take. Staffing levels were assessed based on people’s care and support needs. Robust recruitment systems were in place. Lessons were learned when things went wrong and case conferences provided opportunities for issues to be discussed and improvements made. The home was clean and odour free; effective infection control systems were in place.

People’s risks in relation to nutrition and hydration were monitored and steps taken to ensure people maintained a healthy lifestyle. Healthcare professionals and services were available to people as required. Menus offered people a range of choices at mealtimes and people were involved in the planning of menus. Staff completed a range of training considered essential for their role and received regular supervisions with an annual appraisal. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were looked after by kind and caring staff who knew them well. Positive and meaningful relationships had been developed. People were encouraged to express their views and to be involved in all aspects of their care. Their privacy and dignity were maintained.

People received care that was person-centred and responsive to their needs. Care plans were detailed and provided guidance to staff about people, their likes, dislikes and preferences. Monthly review meetings were held with people to discuss their care and information was available in an accessible format. Staff completed equality and diversity training and understood how to treat people as individuals. People’s spiritual and religious needs were catered for. Activities were organised and were varied. Complaints were addressed in line with the provider’s policy. People could be cared for until the end of their lives at Oakland Court and had access to appropriate healthcare support.

Audits were robust and identified any areas for improvement so that actions could be taken. People and staff were complimentary about the management of the home. Residents’ meetings took place and people felt their views were listened to at meetings and through questionnaires they completed. Staff were also asked for their feedback and felt supported in their roles. People were happy with the quality of care and life at Oakland Court.

Oakland Court can provide accommodation and personal care for 37 older people. There were 34 older people living the service at the time of our inspection.

The service was run by a company. There was a registered manager in post. They were supported by the company’s chief executive who regularly called to the service. 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. In this report when we speak both about the company and the registered manager in relation to their running of the service we refer to them as being, ‘the registered persons’.

We completed an inspection of the service on 17 June 2014. This was because we had received concerning information about the care some people were receiving. We had found that there were four breaches of legal requirements. This was because the registered persons had not made suitable provision to ensure that care was consistently provided in a way that respected people’s legal rights. We also found that people were not always being reliably assisted to eat and drink enough. In addition, the arrangements in place to reduce the risk of people having falls were not robust and staff had not received all of the training the registered person said they needed. Furthermore, quality checks had not always been effective in identifying and resolving problems including shortfalls in record keeping.

After our inspection the registered persons sent us an action plan. This described the improvements they intended to make in order to meet the legal requirements in relation to the breaches. We then carried out a further inspection of the service on 29 September 2014 to check that the breaches of legal requirements had been met. We found that sufficient improvements had been made to address each of the breaches.

At the present inspection we found that suitable steps had not always been taken to avoid preventable accidents and that medicines were not consistently being managed in the right way. We also found that the procedure used to recruit staff needed to be strengthened as did some of the arrangements to support two people to have enough nutrition and hydration. In addition, we noted that quality checks had not always quickly resolved problems in the running of the service.

Staff knew how to respond to any concerns that might arise so that people were kept safe from abuse, including financial mistreatment. There were enough staff on duty and people were helped to receive any healthcare assistance they needed.

Staff had most of the knowledge and skills they needed to care for people in the right way and they had received most of the training and guidance they needed. The registered persons had ensured that people’s rights were respected by helping them to make decisions for themselves. The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 and to report on what we find. These safeguards protect people when they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this, the registered persons had taken the necessary steps to ensure that people only received lawful care that respected their rights.

People were treated with kindness and compassion. Staff recognised people’s right to privacy, promoted their dignity and respected confidential information.

People had been consulted about the care they wanted to receive and they had been given most of the assistance they needed. People had been helped to pursue their hobbies and interests and there was a system for quickly and fairly resolving complaints.

People had been consulted about the development of their home. The service was run in an open and inclusive way, good team work was promoted and staff were supported to speak out if they had any concerns. People had benefited from staff acting upon national good practice guidance.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with eight people who lived at the service, the manager, the chief executive of the company that owns the service and three members of staff. We also reviewed records that related to the management of the service. These included three people's care and health records, policies and procedures and audit reports. We spent time observing interactions between staff and people who lived at the service. At the time of our inspection there were 32 people who lived at the service.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. On the day of our inspection no one who lived at the service was subject to a DoLS. However, there were policies and procedures in place to guide staff and to uphold people's rights. Since our last inspection the manager and staff had received further training and guidance about safeguarding and DoLS. The provider is in the process of reviewing documentation for the use of bedrails to ensure people's rights are upheld.

Is the service effective?

Since our last inspection improvements had been made to the assessment and care planning systems in place at the service. Those we sampled contained sufficient information to meet people's needs safely. This also meant that records were in place for staff to follow in order to meet people's needs consistently and safely.

Everyone that we spoke with told us that they were happy with the care that had been delivered and that their needs had been met. For example, one person told us, 'It's very good here. They are kind and look after you well'. Another person told us, 'I'm independent and push myself to do things like strip my bed. The staff don't stop me, they say things like would you like a hand with that?'.

Is the service caring?

People were supported by kind and attentive staff. People that we spoke with confirmed this. One person told us, 'I've no complaints about the staff. They are very respectful'. Another said, 'The staff help me wash and cream my feet. They are very good to me, gentle'.

Is the service responsive?

Since our last inspection the home had introduced a new care planning system. This included obtaining the views of people in relation to their individual needs, choices and preferences. The new system helped promote individualised care. Staff confirmed that the new care planning system helped them deliver the right care to people. One person told us, 'I like the new care plans, they are easier to go through and understand'.

Is the service well-led?

Since our last inspection the provider had taken action to improve the quality assurance systems at the service. We found that sufficient steps had been taken to meet the compliance action set at our last inspection. The manager and chief executive acknowledged that work should continue to ensure that quality monitoring is fully embedded at the service.

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with eight people who lived at the home, two relatives, the registered manager and five members of staff. We also reviewed records relating to the management of the home which included four people's care and health records, policies and procedures, accident records, complaints and audit reports. At the time of our inspection there were 32 people living at the home, some of whom had reduced memory or dementia. As some people could not talk to us about their experiences of living at the home we spent time observing how they were cared for and treated by staff. We observed interactions between staff and people who lived at the home for two hours during the morning and afternoon.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. On the day of our inspection the manager told us that no one who lived at the home was subject to a DoLS. The manager and staff had received training in relation to DoLS but did not understand what they must do to comply with the Mental Capacity Act 2005 and DoLS. Some people who lived at the home were being restricted in their movements. The manager told us this was being done to keep people safe. However, we found that people's rights had not been upheld. A compliance action has been set and the provider must tell us what they intend to do to address this.

Is the service effective?

Everyone that we spoke with told us that they were happy with the care that had been delivered and that their needs had been met. For example, one person said, "I get help to get ready in the morning. I'm quite independent so do not need any more help". A relative said, "We have no issues with the care provided. They come and help X (referring to their family member) when they ring the call bell. They arranged for a walking frame and as a result there have been no falls or accidents". We found that although systems identified people's care needs, instructions within assessments and care plans were not always in place. This meant that records were not in place for staff to follow in order to meet people's needs consistently and safely. A compliance action has been set and the provider must tell us what they intend to do to address this.

The home had a supervision and training programme in place and staff told us that they were able to attend courses relevant to their roles and responsibilities. This meant that the provider provided support to staff so that they had the necessary knowledge to care for people.

Is the service caring?

People were supported by kind and attentive staff. People that we spoke with confirmed this. As one person told us, "It's very good here. I think it's because of the staff. They notice how you are feeling. They are kind and helpful". We saw that staff showed patience and gave encouragement when they supported people. For example, we saw staff assisting people to move around the home. When doing this they encouraged people to do as much for themselves as possible, whilst still offering support and guidance.

Is the service responsive?

The home was in the process of changing its care planning system. The new system that was being introduced was more person centred than the previous. It included obtaining the views of people in relation to their individual needs, choices and preferences. This would then promote individualised care.

People who lived at the home received prompt attention when they raised concerns or made a complaint. As one person told us, "You can speak to the manager or X (referring to a member of staff) any time. They always listen and look into your concerns". Records confirmed that people had been given clear explanations following investigations.

Is the service well-led?

The manager did not demonstrate a clear understanding of good quality assurance procedures. Quality assurance systems were in place but were not consistently applied. There was a lack of action planning to address identified shortfalls. The manager was open to suggestions and to making improvements however we found that leadership at the home was reactive rather than proactive. A compliance action has been set and the provider must tell us what they intend to do to address this.

People told us they were satisfied with the food and drink provided in the home and the choices available to them. A person said "the food is absolutely wonderful". We found that risks to people from poor nutrition and/or hydration were assessed and acted on.

We found that people's medicines were administered safely by staff who were trained and assessed as competent to do so. People told us they were satisfied with the management of their medicines.

We found that staff completed training to meet the needs of the people they supported. We observed that staff were respectful and caring with people and staff we spoke with were knowledgeable about people's needs. A staff member told us "we see a lot of the managers out and about chatting to people - this is a good home".

We found that the provider had an effective system in place to deal with complaints and information about the complaints system was available to people and or their representatives.

We made observations throughout the visit and saw people being offered choices as to what they wanted to eat or what activities they wanted to take part in during the day.

We saw people being addressed in a respectful manner. We looked at peoples care plans and saw that information recorded in these enabled staff to deliver care and support in accordance with people's individual needs.

We saw that audits of the service were completed by the provider ensuring that people who used the service benefited from a service that monitored the quality of care that people received.

Staff told us that they had received regular training and that they were supported to carry out their roles and meet the needs of people who used the service.

People who used the service told us that they like living at the home and that the service meets their needs. Reference was made to the good relationship that the people who live at the home have with the staff.

People said that they had no concerns about the staffing levels at the home, they told us that there was always someone around to provide help and support. Comments included the following: "I am very happy here', the staff are very kind", "I have a nice room" and, "I am very comfortable."