The Oaks Residential Care Home

The Oaks residential care home is a residential care home which was providing personal care to 21 people at the time of our inspection. All people living at the service were older people, most of whom were living with dementia. The service can support up to 26 people in one adapted building over three floors.

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

People were kept safe. There were systems in place to help protect people from abuse. Infection control practice followed national guidance and sought to keep people safe from infection. Visiting to the service was permitted; We spoke with registered manager at inspection, and they increased the times when people could be visited and removed the booking process they had for visits. People’s risks were assessed and monitored. People told us there were enough staff working at the service and recruitment processes were robust. Medicines were managed in a safe way. Lessons were learned when things went wrong as incidents were recorded and actions completed to keep people safe.

The service worked effectively. People’s needs were assessed in line with the law, prior to their admission. Staff received induction and training, so they knew how to work effectively with people. Staff were supported in their role through supervision and appraisal. People were supported to eat, drink and maintain healthy diets. Staff communicated effectively with other agencies, including health care services, to ensure people received good care. The provider had adapted the building to ensure it met people’s needs. 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’s choices were respected, and decisions made in their best interests.

The service was caring. People and relatives thought staff were caring. People were supported to express their views. People’s privacy and dignity were respected, and their independence promoted.

The service was responsive. Care plans were person-centred, and staff knew people’s preferences. People’s communication needs were met. People were able to take part in activities they could enjoy. People and relatives could complain and when they did, complaints were responded to appropriately. The service recorded people’s end of life wishes and people and relatives were treated with respect and dignity when people approached the end of their lives.

The service was well led. A positive person-centred culture was promoted. People, relatives, and staff thought highly of the management. The registered manager understood duty of candour and acted appropriately when it was felt the service could do better. Staff understood their roles and the registered manager fulfilled the service’s regulatory requirements. People, relatives, and staff were able to be engaged and involved with the service through meeting and providing feedback. There were quality assurance systems so care could be monitored and improved. The service worked with other agencies to the benefit of people using the service.

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 the service was good published on 18 January 2018.

Why we inspected

The inspection was prompted in part due to concerns received about potential safeguarding concerns raised via complaint and also visiting times. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

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

The Oaks is a 26 bed service providing accommodation and nursing care for older people, including those living with dementia. The service is accessible for people with mobility difficulties and has specialist equipment to support those that need it. For example, hoists and adapted baths are available.

At the last inspection on 8 and 12 October 2015 the service was rated ‘Good’. At this inspection on 6 and 7 December 2017, we found the service remained ‘Good’.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the home. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the legal requirements in the Health and Social Care Act 2008 and the associated regulations on how the home is run.

People continued to receive safe care. Risks were identified and actions were taken to minimise these risks to support people as safely as possible. Systems were in place to ensure medicines were administered safely and when needed. There were enough staff on duty to support people.

People continued to be supported by experienced staff who received training and support to enable them to continue to provide an effective service. People’s nutritional needs were met. The staff team worked closely with other professionals to ensure that people remained as healthy as possible and received the healthcare they needed. Staff provided caring support to people at the end of their life and to their families. This was in conjunction with the GP and the local hospice.

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, for example policies on the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards . People continued to receive care and support that was responsive to their needs.

People continued to be supported by kind, caring staff who treated them with respect. Their privacy and dignity were maintained. Staff knew how to keep people safe. We saw that staff supported people patiently and encouraged them to do things for themselves. Staff were attentive and supportive. They engaged with people and chatted and laughed with them throughout the day.

Management systems ensured the service continued to be well led. The management team monitored the quality of service provided to ensure that people received safe and effective care and support that met their needs.

People were involved in decisions about their care and about what happened in the service. They were able to provide feedback on the running of the service and this was acted on. Arrangements were in place to meet people's social and recreational needs.

The provider’s recruitment process ensured that staff were suitable to work with people who needed support.

Systems were in place to ensure that equipment was safe to use and fit for purpose. People lived in a clean, safe environment that was suitable for their needs.

Further information is in the detailed findings below.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found.

Is the service safe?

People who used the service and their relatives told us that this was a safe service with kind and caring staff. One person said 'I feel safe and secure.' However we found that care was not planned and delivered in a way that ensured people's safety. Staffing levels in the late afternoon and evening were not sufficient to adequately monitor and support people. In addition there had been a lot of unwitnessed falls resulting in injuries and skin tears. Recommendations made by district nurses were not followed through and any changes or issues were not discussed with the district nurse.

We looked at staff recruitment records and these showed that staff were properly recruited and checked to ensure that they were suitable to work with vulnerable people.

Staff had received training to ensure that they supported people safely. This included training about safeguarding vulnerable adults, moving and handling and administering medication.

The home had policies and procedures in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) but no applications had been submitted. Staff had received MCA training.

The building was well maintained and equipment and utilities were serviced regularly to ensure that it was safe and did not put people at risk.

Is the service effective?

People who used the service and their relatives said that care was planned and delivered in a way that was intended to ensure their safety and welfare. They were very happy with the service provided. A relative told us 'they are good at dealing with health and emergencies. She is happy and likes to join in with everything.' However we found that the service had not effectively addressed the number of unwitnessed falls that occurred and had not effectively worked with the district nurses to ensure that people were being supported as robustly as possible to prevent pressure damage and to aid wound healing.

Is the service caring?

People who used the service and their relatives spoke highly of the care provided by the staff team. One relative told us 'I could not wish for a better service. She is so well looked after and they are really kind to her.' A person who used the service said 'the staff are around to help. They are kind and gentle.' We saw that staff supported people in a gentle, respectful and kind way. They offered people choices and talked to them about what was happening or what they needed to do.

Is the service responsive?

Care staff we spoke with were knowledgeable about the needs of people they supported and how to meet them. We saw that care plans included information about people's likes, dislikes and preferences and were reviewed and updated monthly to ensure that they had correct and up to date information about people's needs and how these should be met. However we found that appropriate action had not been taken in response to unwitnessed falls and that care plans did not include details as to how to respond to people's changing condition and needs. For example, we were told of reasons why for some people it had not been possible to follow instructions received from the district nursing team but no changes had been made to care plans as a result of this.

People who used the service and their relatives were satisfied with the way the service responded to their needs. One relative told us 'they adapted the care to suit her needs.' Another said 'I trust them to do what is right. If they need to call the paramedics they do. She is safe here.'

Is the service well led?

The service had a registered manager in place. Staff we spoke with said they received the support and guidance that they needed to carry out their duties and to meet people's needs. We saw that they had team meetings and also the opportunity for individual discussions with their supervisor. One member of staff told us that the management team took action on issues when needed and that any suggestions for improvement were listened to.

The provider had different quality assurance systems in place to enable them to monitor the quality of care provided. The provider was also the manager of the service and therefore had regular contact with people who used the service and their relatives. They were also able to observe and monitor staff work practice during this time. However records were not kept of this or the action taken when any issues arose. Quarterly quality assurance surveys were conducted and people were asked for feedback about the meals they received.

The provider failed to make the required notifications about deaths and about incidents that affect people who use services to the Care Quality Commission. This is required and enables appropriate to be taken where needed.

Medicines were safely administered. We saw that medicines were handled appropriately, kept safely and were safely administered. People told us that staff supported them with their medication.

Staff received appropriate professional development. Staff we spoke with said they received the training that they needed to carry out their duties. One person said "I was given lots of support when I came here. They still do (support me)." People said they knew what to do if they had a complaint. One person said "(the deputy manager) said if I've got any problems or queries I should come and see her and that her door is always open."