Oaklands House Care Centre

We found the following examples of good practice.

Measures were in place to prevent the potential spread of infection by visitors. The service had developed a visiting policy based on national guidance. The service also ensured that people had opportunities to maintain contact with their family members through the use of social media, video and telephone calls.

There were clear procedures in place for donning, doffing and disposal of personal protective equipment (PPE). Staff adherence to procedures was regularly checked and audited to ensure compliance with current guidance. There was also regular monitoring of staff handwashing practice.

Housekeeping and other staff worked in specific areas to reduce movements around the home. This also enabled deep cleaning to take place each day. Infection prevention and control (IPC) stations and hand sanitisers were situated throughout the home.

Staff were up to date with training and supervision. Staff had completed IPC training and additional training including donning and doffing of PPE. Coronavirus workbooks including a knowledge test had been issued to all staff.

Following the most recent IPC audit in January 2021, six air mattresses had been replaced. A new specific Covid-19 audit was being introduced. The service took part in Care Commissioning Group (CCG) IPC webinar discussions to promote continued learning and development. As a result of this, the registered manager was purchasing IPC trolleys that could be moved more easily in response to need.

Oakland's House Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

Oakland's House Care Centre provides accommodation and nursing care for up to 54 people who are living with dementia and related health conditions. The building is bright, modern and designed for the provision of care in a homely environment.

There was 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.

People were cared for in a safe way. Risk assessments and care plans were completed and staff provided care according to these plans.

The provider had a robust recruitment process and only people that had been checked as suitable to be employed in caring roles were recruited by the service.

Medicines were stored and administered safely. Clear and accurate medicines records were maintained.

The provider had systems in place to respond and manage safeguarding matters and make sure that safeguarding alerts were raised with other agencies. Staff understood they had a duty to report any concerns they had about people in their care.

The service had a new, online training system giving them access to training and policies.

We recommend that policies provided by St Cloud are updated to reflect the Oakland's location.

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests.

People’s nutritional needs were met, information was shared with the chef who produced meals that were pureed, fortified and to the individual requirements of people living in the home.

There was an activities programme that provided group and individual activity sessions. In addition, external entertainers visited the service on a regular basis.

The home had an end of life care pathway and people and their relatives were supported to plan for the future.

There was a clear and freely available complaints procedure. People knew who to talk to if they had a complaint.

Compliments about the care people received were also recorded.

The registered manager had systems in place to monitor the service and drive improvement

Oaklands House Care Centre is registered to provide accommodation for up to 54 older people who may be living with dementia or have a physical disability. At the time of our inspection there were 51 people living at the home. The home is located in a semi-rural area on the outskirts of Southampton.

The home did not have 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. A new manager was appointed in August 2016. At the time of the inspection they had not submitted their application to become the registered manager.

Recruitment checks needed to be more robust and include all of the requirements laid out in the Regulations.

We found the provider had not made sufficient improvements to ensure they acted in accordance with the requirements of the Mental Capacity Act (MCA) 2005. People's capacity to consent to care had not always been assessed and where best interest decisions were required these had not always been recorded. Staff had still not received appropriate training on the MCA 2005.

There had been little improvement in people's care plans. Care plans had not always been reviewed in a timely manner and did not contain enough information to enable staff to meet people's individual needs effectively.

The quality assurance systems in place needed to be more robust to ensure they were effectively driving improvements. The provider had not acted upon requirements from previous inspection reports from the Care Quality Commission in order to improve the safety and quality of the service provided.

People told us that they felt safe living at Oaklands House Care Centre. Agency staff had been used to cover where there were staff shortages and the manager was focusing on the recruitment of new staff.

Staff had a good understanding of abuse and how to identify this. They knew what actions to take to keep people safe.

Medicines were administered safely but improvements were needed to ensure that interruptions to the medicines rounds were minimised.

People were complimentary about the support that they received from staff. They told us that staff were kind and caring. We found that people were treated with dignity and respect.

People had sufficient to eat and drink and were supported to maintain a balanced diet. They had access to a range of healthcare professionals and services.

While people were not unhappy with the activities on offer. Relatives told us they felt that more varied activities could be offered.

People living at the home all thought that the home was well-led. They all spoke positively about the manager and the staff group.

The staff were positive about the new manager and felt they were supportive and approachable.

Complaints policies and procedures were in place and were available to people and visitors. People and their relatives told us they were confident that they could raise concerns or complaints and that these would be dealt with.

We found four 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.

Following a scheduled inspection in February 2014 we found the home had not met the required standard in respect of:

' Cleanliness and infection control. The registered person had failed to ensure all parts of the environment and all equipment was clean and hygienic. Procedures and routines had not ensured that all areas were cleaned regularly and to a satisfactory standard. Audits had failed to identify inadequate infection control within the home.

' Safety and suitability of premises. The environment was not suitably adapted to meet the needs of the people with dementia who were living at the home. Areas of the home had not been maintained and were not pleasant or safe for people to use.

The provider contacted us in April 2014 and told us what action they would take to ensure they met the required standard.

During our inspection we looked at policies and procedures, training records, surveys and quality and audits. We spoke with three people using the service and three relatives. We also spoke with the manager, two members of the care staff, the maintenance person and two domestic assistants [cleaners]. We gathered evidence against the outcomes we inspected to help answer our questions;

' Is the service safe?

This is a summary of what we found '

Is the service safe?

During our inspection in February 2014 we found some parts of the home were not clean and hygienic. The walls and doors of the home were grubby and equipment in the corridors was dusty and looked dirty. We found areas of the home had not been maintained and were not pleasant or safe for people to use.

At this inspection we looked around the service and found the home was generally clean, hygienic, and odour free. Walls and doors were clean as was the floor throughout the home.

We observed Personal Protective Equipment [PPE] was available in all communal bathrooms and toilet areas. We also saw care workers wearing PPE when helping people with personal care. This meant that people who used the service were protected against potential infection control risks.

We saw all bedroom floors had non carpet flooring. At our previous inspection we saw in one bedroom the laminate flooring had warped considerably and presented a trip risk to the person. At this inspection we saw the flooring in the room had been replaced. The provider had taken steps to provide care in an environment that was suitably designed and adequately maintained.

The maintenance person told us they routinely walked around the home to see if there were any issues which required attention. They said whilst they were able to complete many jobs they had contact phone numbers for specialists where this was required such as for gas or electrical services.

Following a scheduled inspection in February 2014 we found the home non-compliant with seven outcome areas. We issued four warning notices which required the provider to become compliant by 21 April 2014. We also made three compliance actions and asked the provider to tell us how they would become compliant with those areas. This inspection was to assess if the home had met the warning notices and complied with one of the compliance actions.

We spoke with eight of the 49 people at the home. We also spoke with nine relatives, members of the provider's management team and eight staff. We observed care in communal areas and viewed records relating to care, staffing and the management of the home.

We considered five outcomes during this inspection. These being

Outcome 4 Care and welfare of people who use services

Outcome 5 Meeting nutritional needs

Outcome 7 Safeguarding people who use services from abuse

Outcome 14 Requirements relating to workers

Outcome 16 Assessing and monitoring the quality of the service

We considered all the evidence we had gathered under the outcomes inspected. We used the information to answer the five questions we always ask.

Is the service safe?

People told us they were happy with the service they received. They said they had continuity of care with staff who knew what support they required. We also spoke with relatives and visitors who were also positive about the service and said they felt their relatives were safe. Staff had completed safeguarding of vulnerable adults and other essential training. They were able to tell us what they would do if they had any concerns about people's safety or welfare.

Risks to people's health and safety had been assessed and plans were in place to reduce these risks. We saw specific equipment had been identified in people's care plans, which was in place to reduce the risks and keep people safe. This included equipment such as pressure relieving mattresses and moving and handling equipment. Staff told us they had received training to use this equipment and we observed them being used correctly. People were receiving safe care and the warning notice in respect of safeguarding people who use the service had been met.

We found the home to be meeting the requirements of the Deprivation of Liberty Safeguards. People's human rights were therefore properly recognised, respected and promoted.

Is the service effective?

People had individual care plans which identified their needs and how these should be met. Records of care, food and fluid provided showed people were receiving the care they needed. For example, people at high risk of pressure injuries were being assisted to reposition every two hours and equipment to support their pressure areas was in use. Staff had received training to ensure they had the skills necessary to care for people. They told us about the care they were providing for specific people which matched information in the person's care plan. The management team and staff were aware of who to contact for specialist advice and when this may be required. We saw specialist tissue viability nurses had been consulted for wound management advice.

We spoke with people and visitors, all of whom were positive about the service provided. Visitors said their relative's health needs were met and they were kept informed when medical professionals had attended. Therefore, the care provided was effective and people's needs were being met.

Is the service caring?

People were supported by kind and attentive staff. One person said 'this can't be better'. Visitors commented their relative was 'always well-dressed in co-ordinated colours and that staff took the time to put on her necklace'. Another relative said they felt they 'could not have chosen better'. A third visitor told us they visited virtually every day and they were very happy with the way their relative was treated. They added '[my relative] always took great care in their appearance' and they were pleased the staff 'took care' in how they were dressed now'. We saw care had been taken with a person's hair so that it did not become unnecessarily tangled when they were in bed.

Staff said they had time to meet people's identified needs and could provide care at times people wanted it. We observed staff interacting in a warm and friendly way with people. Before staff began to provide any care they always told people what was to happen. Staff used people's names and we observed the use of reassuring gestures such as touching a person's arm, hand or putting an arm around someone's shoulders.

Is the service responsive?

The service had responded promptly to address the concerns raised at the inspection in February 2014. Improvements to the environment had been made, staff had received training in moving and handling, safeguarding and dementia and procedures had been revised to ensure people were receiving the care they required.

The service was able to respond to people's daily needs. We observed call bells were answered promptly. One relative told us they had requested a room change for their relative and this was done within a week. We saw a person slide out of their chair at lunch time. Staff acted appropriately to check for any injuries. They used a suitable hoist to lift the person back into a chair. Plans and procedures were in place to manage unexpected events which could potentially interrupt the smooth running of the service.

Is the service well-led?

Since the inspection in February 2014 the registered manager had retired. The provider's management team has spent a considerable time at the home and addressed the concerns from the previous inspection. We were told a new manager had been appointed who was due to commence employment towards the end of June 2014.

Meetings with people and relatives have taken place. These have enabled the management team to keep everyone informed about proposed changes and improvements to the service. People and relatives were positive about the improvements. One relative commented on the 'big improvement in the d'cor in the rooms'. They were particularly pleased that their relative's 'room had been redecorated; it had new furniture and bed linen'.

A range of audits and procedures to monitor the quality of the service have been commenced. Where subsequent audits had occurred we saw action had been taken to address issues identified in the first audits. Staff and relatives told us they felt able to raise issues with the management team and knew they would be responded to.

We found care plans did not provide sufficient individual information. There was a lack of social interaction and activities for people. Staff were not responsive to people's needs. We saw most people did not have access to drinks at all times and people in their rooms did not have access to call bells.

Procedures were not in place to monitor and ensure adequate cleaning was completed and parts of the environment were in a poor state of repair.

Induction training was inadequate and placed people at risk of not having their needs met and being abused. The systems in place to monitor the quality of the service provided had not identified the concerns we found.

We used the Short Observational Framework for Inspection (SOFI2) to observe care and help us understand the experience of people who could not talk with us. We completed this over lunchtime in one of the lounge dining rooms. We observed that care and support was provided in a warm, friendly and respectful way. Staff were aware of how people should be supported and the help they required. They were encouraging of people to promote independence and staff were aware of people's likes and dislikes.

We spoke with four visiting relatives. They said that there were usually the same staff and that staff were friendly. They were all happy with the care that was being provided. We also contacted some external professionals who were also positive about the home. We spoke with staff who were aware of safeguarding procedures and confirmed that they had completed a range of training. Staff were aware of care plans and stated that these were used on a regular basis.

We found that appropriate records such as care plans, food and fluid and care records were completed. These showed that people were receiving care as detailed in their care plans. We found that all necessary equipment was available and in use. Quality monitoring by the manager had been extended and staffing levels were now determined by a formal dependency assessment.

Staff had been trained and were aware of the local safeguarding procedures. However, local safeguarding procedures had not always been followed. Quality assurance procedures were being developed which included consultation with people who receive the service, relatives and staff. But the quality assurance system was not comprehensive. In addition it could not be demonstrated that the level of support needed by individual people had been taken into account when calculating staffing levels.