Archived: Oakapple Care Home

Updated 14 September 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 4 and 5 April 2018. The inspection visit was unannounced, and was carried out by one inspector. The inspection was prompted by concerns shared with us by the local authority in relation to the quality of care provided at Oakapple Care Home. These concerns related to staffing levels and skills, people’s needs not being met, poor record keeping, and how infection prevention and control was being managed. This inspection examined those risks. The local authority also was investigating specific concerns about individual people’s care under their safeguarding adults’ responsibilities. We also undertook a visit to Oakapple Care Home on 24 May 2018 to assess whether measures had been put in place to mitigate some of the environmental risks. We then undertook a further check on 14 June 2018 to establish that action had been taken to reduce risks in relation to fire safety.

Before our inspection visit we reviewed the information we held about the service including notifications the provider sent us. A notification is information about important events which the service is required to send us by law. For example, notifications of serious injuries or allegations of abuse. We also sought the views of local authority and health commissioning teams. Commissioners are people who work to find appropriate care and support services which are paid for by the local authority or by a health clinical commissioning group.

On this occasion we did not ask the provider to send us a Provider Information Return (PIR). This is a form that asks the provider information about the service, what the service does well and improvements they plan to make. However, we offered the provider the opportunity to share information they felt relevant with us.

During the inspection we spoke with the three people who used the service, and one relative. Not all the people living at the service were fully able to express their views about care, so we also spent time discreetly observing how they were supported by staff during the inspection visit. We spoke with four care staff. We also spoke with registered manager and the provider. We sought the views of four external health and social care staff. We looked at a range of records related to how the service was managed. These included three people’s care records, including how their medicines were managed. We also looked at two staff recruitment and training files, and the provider’s quality auditing system.

Updated 14 September 2018

This inspection took place on 4 and 5 April 2018, and was carried out in response to concerns about the quality of care. The first day of our inspection visit was unannounced. We also undertook a visit to Oakapple Care Home on 24 May 2018 to assess whether measures had been put in place to mitigate some of the environmental risks. We then undertook a further check on 14 June 2018 to establish that action had been taken to reduce risks in relation to fire safety.

Oakapple Care Home was last inspected in September 2017 and was rated as Requires Improvement. We found one breach of Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to implement effective systems to monitor, assess and improve the quality of care provided to people. Records relating to incidents and injuries did not provide accurate and complete information in relation to people’s injuries and how they occurred. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the quality of care in relation to the breach, and we received this. On this inspection, we found that improvements had not been made to ensure the provider delivered care that met legislative requirements.

Oakapple Care Home 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. Oakapple Care Home provides personal and nursing care for up to 10 people. At the time of our inspection, there were three people living there.

People were not kept safe. Risks associated with their health conditions were not consistently identified or reviewed. There was a risk that information available to staff about people’s needs did not reflect their current needs. Risks associated with the environment were not reduced and mitigated.

People were not kept safe from risks arising from their health conditions. Action was not always taken to monitor and respond to changes in people’s health needs. People were at risk because the provider could not assure themselves that staff were consistently monitoring people’s health conditions and making timely referrals to health professionals.

There were sufficient staff to meet people’s needs. However, staff did not always have training, support or checks on their care practices. There was a risk staff would not understand how to effectively support people’s health and care needs.

The provider was not consistently working in accordance with the Mental Capacity Act 2005 (MCA), and people were at risk of not having their rights respected in this regard. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice.

People were not consistently supported to eat and drink enough to maintain a balanced diet.

People were not supported to participate in designing or reviewing their care. People’s needs and choices were not always identified and delivered in line with current legislation and evidence-based guidance. People did not always have care provided in a dignified or caring way.

The provider had not considered people’s different communication needs in order to ensure people could participate in daily life in the service. For people who found verbal communication difficult, there was no evidence the provider had considered other ways of promoting effective communication. This meant people's views about their care were not heard and acted on, and the provider did not ensure people’s autonomy and independence was enhanced.

The service was not managed well. There were failures to meet the fundamental standards in relation to safe care practices, managing risks, and staff training, planning and delivery of people’s care, and following relevant legislation. Quality assurance processes to ensure people’s safe care were not effective. The provider had not used feedback from external organisations to drive effective changes in the quality of care.

People’s needs were met by the adaptation, design or decoration of Oakapple Care Home.

The service had a registered manager at the time of our inspection visit. 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.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found one breach of the Care Quality Commission (Registration) Regulations 2009.

Full information about CQC's regulatory response to these concerns found during inspection is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.