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Oaklands Rest Home Requires improvement

Reports


Inspection carried out on 4 July 2019

During a routine inspection

About the service

Oaklands Rest Home is a residential care home providing personal care to 21 people aged 65 and over at the time of the inspection. The service can support up to 29 people accommodated in one adapted building.

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

Systems to assess, monitor and improve the safety and quality of the service were not always effective.

Systems and processes to manage the prevention and control of infections were not robust.

Risk to people had not always been mitigated in accordance with their care plan and risk assessment.

Robust processes were not always followed when checking staff for suitability before being employed by the service.

People’s needs in relation to social and mental stimulation were not all or consistently being met. Provision of activities had improved recently following the employment of dedicated member of staff. Continued improvements will need to be made and sustained.

People were given appropriate support to eat and drink enough to meet their needs. We recommend that the service seek advice and guidance from a reputable source about best practice mealtime provision for people who are living with dementia.

There were plans for the extensive refurbishment of the older part of the house and some work had already been completed. We recommend that the service seek advice and guidance from a reputable source for best practice for dementia friendly environments.

People were mostly 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 support this practice. We recommend that the service seeks advice and guidance from a reputable source on how to implement and review least restrictive practices for individuals.

There were sufficient numbers of staff deployed to meet people’s general health needs.

Staff were aware of their responsibilities in relation to safeguarding and said they would feel confident raising any concerns with the registered manager.

The management, storage and administration of medicines was safe.

The service had an on-line training and development programme that enabled the registered manager to monitor any shortfalls in staff training requirements. A supervision programme had been put in place.

We received positive feedback from some healthcare professionals who told us the service referred people appropriately to healthcare services.

People were on the whole supported and treated with dignity and respect; and involved as much as possible in their care.

Staff demonstrated knowledge of people’s individual needs and preferences regarding support. Occasionally staff did not follow care plans.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 16 October 2018) and there were three breaches of regulation. The provider’s action plan was not received after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been made / sustained and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about infection control, assessing needs, the environment, and poor practice supporting older people and those living with dementia. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Responsive and Well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

The provider had taken effective action

Inspection carried out on 10 September 2018

During a routine inspection

This inspection visit took place on 10,11 and 17 September 2018 and was unannounced.

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

Oakland’s rest home is registered to provide accommodation and personal care for up to 29 people. The service does not provide nursing care. At the time of our inspection 24 people were living at the home. The home provides a service for older people and people living with dementia. Accommodation is provided over two floors, which can be accessed using stairs or passenger lifts.

There was a registered manager in place. 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 provider did not have a robust and effective recruitment procedure in place that ensured the people they employed were of suitable character and background.

Staff had not received appropriate supervision and support to enable them to carry out the duties they are employed to perform.

The provider did not have effective systems in place to monitor and improve the quality of the service provided.

The provider had taken appropriate steps to protect people from the risk of abuse, neglect or harassment.

Medicines were managed in a safe way.

People, their relatives and staff told us the registered manager was supportive and approachable.

People were supported by staff who knew them well. Staff we spoke with were enthusiastic about their jobs, and showed care and understanding both for the people they supported and their colleagues.

Staff understood the requirements of the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People and their relatives told us they enjoyed the food served which considered peoples individual dietary needs and preferences.

People’s privacy and dignity was respected and promoted. Staff understood how to support people in a sensitive way, while promoting their independence. People told us they were treated with dignity and respect.

People’s care records reflected the person’s current health and social care needs. Care records contained up to date risk assessments.

There was a complaints policy and procedure in place. People’s comments and complaints were taken seriously, investigated, and responded to.

Safety and maintenance checks for the premises and equipment were in place and up to date.

We recommend that the service seek advice and guidance from a reputable source about engaging people in activities to reduce the risk of social isolation.

We found three breaches 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 this report.

Inspection carried out on 4 July 2016

During a routine inspection

The inspection took place on the 4, 5 and 6 July 2016 and was unannounced.

Oakland’s rest home is registered to provide accommodation and personal care for up to 29 people. The service does not provide nursing care. At the time of our inspection 24 people were living at the home. The home provides a service for older people and people living with dementia. Accommodation at the home is provided over two floors, which can be accessed using stairs or passenger lifts.

The service had 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 2008 and associated Regulations about how the service is run.

People told us they were safe and well cared for at the home. Staff knew how to identify abuse and protect people from it.

The service had carried out risk assessments to ensure that they protected people from harm.

There were enough staff deployed to provide the support people needed. People received care from staff that they knew and who knew how they wanted to be supported.

Medicines were ordered, stored, administered and disposed of safely.

Staff had developed caring relationships with people who used the service. People were included in decisions about their care.

People who required support to eat or drink received this in a patient and kind way.

The registered manager was knowledgeable about The Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. The Metal Capacity Act Code of Practice was followed when people were not able to make important decisions themselves. The manager understood their responsibility to ensure people’s rights were protected.

People and relatives were asked for their views on the service and their comments were acted on. There was no restriction on when people could visit the home. People were able to see their friends and families when they wanted.

Inspection carried out on 16 December 2014 and 5 and 6 January 2015

During a routine inspection

Oakland’s Care Home is registered to provide accommodation and support for 29 older people some of whom may be living with dementia. On the day of our visit 13 people were living at the home. The home is located in a rural area one mile from the town of Hythe. There is no public transport nearby. The home has two large living rooms, a dining room, an open lounge area on the first floor and a kitchen. People’s private bedrooms are on both the ground and first floors. There is a passenger lift to the first floor. Due to some people’s complex health needs we were not able to verbally seek people’s views on the care and support of some of the people living at the home.

The local authority had advised us of concerns they had in relation to the safety and welfare of people living at the home.

We undertook an unannounced inspection of Oaklands on16 December 2014 and the 5 and 6 January 2015.

The service did not have a registered manager in post at the time of our 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.

Activities were advertised on the notice board and around the home however people told us they “didn’t often happen”. During two of the days we visited the home we did not see people were engaged in meaningful and stimulating activities and only saw one activity taking place.

Some staff told us they did not feel supported by the manager. One member of staff said, “I would like to see the manager on the floor with a more “Hands on approach and leading by example”. Another member of staff said, “It’s got better since the office was moved from upstairs to downstairs but it could still be better”.

Staff spoke with people in a friendly and respectful manner. The service had a personalised culture Staff told us they were encouraged to “get to know the people” by spending time with them to “get to know the real person”.

Staff could raise any concerns about possible abuse. One member of staff said, “Everyone works hard to ensure we keep people safe”. Staff understood the needs of the people and care was provided with kindness and compassion. People were dressed in appropriate clothing and were clean and tidy, as was the home.

People were treated with respect and care was based on people’s preferences and aimed at supporting people to be as independent as possible. People appeared to be relaxed and their expressions indicated they were settled and happy. Staff were appropriately trained and skilled and provided care in a safe environment. They all received a thorough induction when they started work at the home and fully understood their roles and responsibilities. Staff also completed training to ensure the care delivered to people was safe and effective.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been authorised by the local authority as being required to protect the person from harm. People’s freedoms were not unlawfully restricted and staff were knowledgeable about when a DoLS application should be made.

Referrals to health care professionals were made quickly when people became unwell. One health care professional told us the staff were responsive to people’s changing health needs and that referrals to them were made in a pro-active manner. A GP told us they had no concerns regarding the safety, welfare and how care was provided at the home.

People had their needs assessed and plans of care were in place. These were personalised and took account of each person’s individual wishes and preferences. Risks to people were identified and plans were in place to make sure people were kept safe whilst ensuring their rights were promoted.

There were recruitment procedures in place. Staff were supported and trained to ensure they were able to provide care at the required standard to ensure people’s needs were met.

Systems were in place to monitor and check the quality of care and to make sure the environment was safe and well maintained.

Regular staff meetings were held and we saw that, where required, actions resulting from these were assigned to named staff to follow up. The manager used team meetings to provide staff with feedback from within the organisation which helped them to be clear about the aims and objectives within the service both locally and at provider level.

We have made a recommendation about how the provider can reduce the risk of social isolation. You will find this in the responsive section of this report.

Inspection carried out on 4 August 2014

During a routine inspection

Oakland’s Rest Home is a privately run care home and provides care and support for up to 29 older people, some of whom may be living with dementia and or related health disorders. On the day of our inspection 23 people were living at the home.

During our inspection we looked at care plans, policies and procedures, training records, staff records, surveys and quality and audits. We spoke with four people using the service, the manager, head of care, four care workers and the chef.

We also used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us

In this report the name of Heidi Clarke appears who was not in post and not managing the regulated activity at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We gathered evidence against the outcomes we inspected to help answer our five key questions.

• 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?

The service was safe. Care plans contained information required to deliver the necessary care according to the person’s wishes and preferences. Care workers we spoke with all said the support plans contained the information they needed to deliver care and support to the required standard.

Care workers told us they had access to various training courses including diplomas in Health and Social Care. They also said other training courses included: medication procedures, moving and handling, dementia care, first aid, infection control and first aid. This was also confirmed by staff training records we saw. This meant that there were enough qualified, skilled and experienced staff to meet people's needs.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had been submitted the provider was working with the local authority to ensure proper policies and procedures were in place. The manager understood when an application should be made and how to submit one; and was aware of recent changes to the legislation.

Is the service effective?

The service was effective. People’s care plans included specific guidance to meet their individual needs. Examples of these included plans associated with maintaining a safe environment, communication, medication, personal care and skin care.

The chef had an “Allergies and Preference” board in the kitchen area. This was a record of people’s different dietary needs, likes, dislikes and food allergies. For example some people required a diet low in sugar because they were diabetic. One person had intolerance to eggs and cheese. The chef told us when people first came to the home they spoke to the manager about their needs. This meant that people's individual food preferences and needs were acted upon.

We looked at training records for care workers. Training had been provided in a range of relevant subjects. For example, manual handling, safeguarding of vulnerable adults, infection control, fire safety, dementia care and first aid. We spoke with two care workers who confirmed they had access to a variety of training courses.

Is the service caring?

The service was caring. When people needed assistance to eat, this was done in a friendly, cheerful way. Care workers spoke clearly and made eye contact when they explained things to people. People were treated with kindness and respect in a caring manner.

Is the service responsive?

The service was responsive. Where people had specific conditions or risks, such as diabetes, there were customised care plans. There were records to show that where people needed support from other healthcare providers this had been made available to them.

Is the service well led?

The service was well led. Care workers we spoke with all said support plans contained the information they needed to deliver care and support to people to the required standard.

People who used the service said they were able to raise concerns with the staff or owner and were confident that action would be taken to address any issue.

We saw that reviews of care plans included feedback from people and their relatives about the service they received. Care workers we spoke with said they were able to raise concerns with the owner and were confident that they would be addressed.

Inspection carried out on 2 July 2013

During a routine inspection

During the visit we inspected the care plans and assessments of four people who used the service. Each person had a detailed assessment of their needs that was completed before they moved into the home. We saw that care plans had been completed with personalised information about how people's needs should be met. One relative told us: “I was involved in the initial assessment of my relatives needs and the home certainly does try to meet them”.

The home had procedures in place to respond to allegations of abuse, including the action to take to keep people safe. Care staff had received training in safeguarding people from abuse. We spoke with four care staff during the visit, who demonstrated a good understanding of types of abuse people may experience, signs of possible abuse and action to take if abuse is reported, witnessed or suspected.

We looked at four medicine administration records in the home, which kept a record of medicines staff had administered to people. These had been fully completed. All medication administration records included a photograph of the person for whom the medication related to.

People told us that they would get up in the morning and go to bed at night when they wanted to, and care staff were always available to help them when they needed help. One person told us: "I never get up at the same time every day but when I press my bell for help in getting up my care worker is there "in minutes".

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. The home had recently started to use an on line feedback service and the responses we saw were all very positive about the way people were cared for at the home.

Inspection carried out on 16 July 2012

During a routine inspection

During the visit we spoke with seven people who use the service. People told us they were well treated by staff and that they liked the home. Comments included that there was a “nice atmosphere” and that staff were “agreeable” and “treat us well”.

We observed staff supporting people to make decisions, for example, about what communal room to use, where to have lunch and what drinks to have. Staff took the time to listen to people’s requests and to respond to them. Staff provided discreet support for people to go to the toilet when necessary and ensured that people’s privacy was maintained when discussing their care needs.

People told us staff provided the care and support that they needed.

During the visit we saw examples of good staff interactions with people who used the service, for example, responding to questions and supporting people to make choices about drinks and biscuits. Staff demonstrated a good understanding of people’s needs and communicated with people in different ways.

People said they liked the food and confirmed that they could choose a different meal if they didn’t like the main meal being prepared. Comments included that the food was “quite flavoursome”. We saw that people were provided with support to eat their meals where they needed it and were able to eat where they chose, for example, in the lounge or in their bedroom as well as in the main dining area. We saw that people had access to hot and cold drinks. People we spoke with said they were confident that staff would help them to resolve any concerns they had.

Inspection carried out on 21 December 2010 and 17 February 2011

During an inspection in response to concerns

People who use the service spoke positively about living at Oaklands Rest Home. People told us that they are happy with the care and support that they receive and like living there.

Staff told us that they feel supported to carry out their role.

Care managers told us that they are working with the home to improve standards following safeguarding concerns and have found the provider and registered manager to be positive about their input into the home.

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