Archived: Oak Tree House Residential Care Home

At this inspection we found that improvements had been made to the cleanliness and safety of the premises and that quality assurance systems were more effective. This meant that the breaches of regulation identified at the last inspection had now been met. However, there had again been a delay in the registered provider arranging for the gas safety systems to be serviced. We will address this matter outside of this inspection process.

The home is registered to provide accommodation and care for up to 20 older people, including people who are living with dementia. On the day of the inspection there were 15 people living at the home. The home is situated in Preston, a village in the East Riding of Yorkshire but also close to the city of Kingston upon Hull. The premises are on two levels and the first and second floors are accessed by use of a stair lift.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager who was 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.

People were protected from the risk of harm or abuse because there were effective systems in place to manage any safeguarding concerns. Staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm.

There was evidence that the registered provider was working within the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff had received training on these topics and understood their responsibilities.

Care plans were a good reflection of people’s individual needs and how these should be met by staff. There was a lack of consistency in recording on monitoring charts. This had not resulted in any harm to people but had the potential to do so. We observed that the registered provider discussed the importance of accurate recording with staff on the day of the inspection.

People’s family and friends were made welcome at the home. A variety of activities were provided and people were encouraged to take part.

There were recruitment and selection policies in place and these had been followed to ensure that only people considered suitable to work with vulnerable people had been employed. On the day of the inspection we saw that there were sufficient numbers of staff employed to meet people's individual needs.

Staff told us they received the training they needed to carry out their roles effectively and confirmed that they received induction training when they were new in post. Staff told us that they were well supported by the registered manager.

Senior staff had received appropriate training on the administration of medication. We checked medication systems and saw that medicines were stored, recorded and administered safely.

People who lived at the home told us that staff were caring and that they respected people's privacy and dignity. We saw that there were positive relationships between people who lived at the home and staff, and that staff had a good understanding of people's individual care and support needs.

People told us that they were satisfied with the food provided. We saw that people's nutritional needs had been assessed and individual food and drink requirements were met.

The registered manager was aware of how to use signage, decoration and prompts to assist people living with dementia in finding their way around the home and some progress had been made in providing these.

There were systems in place to seek feedback from people who lived at the home and their relatives. People told us they were confident their complaints and concerns would be listened to. Any complaints made to the home had been investigated and appropriate action had been taken to make any required improvements.

Quality audits undertaken by the registered manager were designed to identify that systems at the home were protecting people's safety and well-being.

We carried out a focused inspection on 11 September 2015 to check that the registered provider had followed their plan and to confirm they now met legal requirements. We found that appropriate action had been taken and that legal requirements had been met.

We undertook this inspection to look at the overall quality of the service, and to provide a new rating for the service under the Care Act 2014.

The home is registered to provide accommodation for up to 20 older people who require assistance with personal care, some of whom may be living with dementia. On the day of the inspection there were 17 people living at the home, including one person who was having respite care. The home is situated in the centre of the village of Preston, close to the City of Hull and in the East Riding of Yorkshire.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager who was 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. The registered manager is also the registered provider of this service.

During this inspection we identified three breaches of regulation; this related to the risks associated with the safety of the premises and the prevention and control of infection. You can see what action we told the registered provider to take at the back of the full version of the report.

The home was not being maintained in a safe condition. There was no current gas safety certificate in place and had found this to be the case at the previous inspection. In addition to this, the contractor who serviced the home’s bath hoist had stated that the stair lift needed to have a repair carried out within three months, and this had not been actioned.

The communal areas of the home and bedrooms were being maintained in a clean and hygienic condition. However, we saw that the seat on the only bath hoist in use was damaged to the extent it could not be kept clean. The two boilers in the laundry room were located in the ‘clean’ area but the tops were rusty and therefore difficult to keep clean. Both of these issues created a risk of cross infection.

Although the registered manager monitored the quality of care and support provided, we saw that areas that had been identified as requiring improvement had not been actioned. This meant that the quality monitoring systems at the home were not effective.

People told us that they felt safe whilst they were living at Oak Tree House. People were protected from the risks of harm or abuse because the registered provider had effective systems in place to manage any safeguarding concerns. Staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm. Staff also told us that they would not hesitate to use the home’s whistle blowing procedure if needed.

On the day of the inspection we saw that there were some staff vacancies but the rotas were being covered by existing staff to ensure people’s individual needs were met. The recording of recruitment and selection information needed to be more robust to evidence that all safety checks were in place prior to staff commencing work. We made a recommendation about this in the report.

Staff confirmed that they received induction training when they were new in post and told us that they were happy with the training provided for them. Staff had received training on the administration of medication and people told us they were happy with how they received their medicines.

People told us that staff were caring and that their privacy and dignity was respected. People confirmed they received the support they required from staff and said that their care plans were reviewed and updated as required. Staff encouraged people to make decisions and have choice and control over their daily routines.

People were supported to access healthcare services. We saw that advice and guidance from healthcare professionals was incorporated into care plans to ensure that staff provided effective care and support.

People’s nutritional needs had been assessed; people told us they were happy with the food provided and were consulted about the menu.

People told us they were able to raise concerns or make complaints although they had not needed to. They felt their suggestions were listened to.

We saw there were good relationships between the registered manager, people who lived at the home, staff and relatives / friends. This led to a homely, relaxed atmosphere.

We found that people were asked for their consent whenever staff wanted to support them and so staff acted in accordance with peoples' wishes.

We found that people were satisfied with the service of care they received. They said, "The staff are helpful and friendly and they know what we need help with", "I have settled in nicely", "I accept that I am not able to look after myself any more, so it is the best on offer to me" and "I am quite content here".

From the information we were given and the medication management systems we observed in operation, we found that medication management was safe and people received their medicines when they needed them. People were satisfied with how their medication was given to them.

There were appropriate security checks carried out on staff before they began working in the service and we found that staff had been recruited according to the service's policies and procedures that adhered to the requirements of the regulation on recruitment. This meant that people were cared for by appropriately recruited and vetted staff.

We found that the systems in use for assessing and monitoring the quality of the service enabled people to receive an improved service of care.