Archived: Oakapple Care Home

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.

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.

At our last inspection 14 and 21 June 2016 the service had been rated as requires improvement. At this inspection we found that some improvements had been made in relation to the environment, staff supervision and staff following the principles of the Mental Capacity Act. We also found that where required the service had made applications to the local authority to legally deprive people of their liberty. However, the provider had failed to implement effective systems to monitor, assess and improve the quality of care provided to people. This had lead to additional concerns.

People could not always be sure that they received their medicines as prescribed. The medication audits had identified concerns but no action had been taken to effectively address them.

Staff felt supported and received regular supervision. There was no effective monitoring of staff training to ensure that staff had received the training needed and as required to fulfil their roles.

Improvements had been made to the communal areas of the home. People's bedrooms required some additional monitoring in relation to infection control.

People felt safe at the service and were supported by staff that knew them well. Staff were knowledgeable about people's preferences, likes and dislikes. People were supported to live in a homely environment.

People had detailed plans of care that they and their relatives had been involved in developing to guide staff in providing consistent person centred care and support.

Risks associated with people’s care had been assessed and control measures to reduce the risks had been put in place. People had personal emergency evacuation plans in place should they be needed in an emergency.

Staff understood the importance of enabling people to make their own choices and decisions. People's dignity and privacy was respected by care staff.

We found one breach 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.

On the day of our inspection 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.

During this inspection we checked to see whether improvements had been made since our last inspection on 19 March 2015 in the following areas; assessing the risk to people’s safety, the maintenance of the premises, and staff training and supervision. We found improvements had been made in these areas but some further improvement was required.

The risk to people’s safety was reduced because staff understood how to identify the signs of abuse and who to report concerns to. Risk assessments had been completed in areas where people’s safety could be at risk. Improvements had been made to the way the environment was managed. Staff were recruited in a safe way, although a small number of staff had started their role before the results of their criminal checks had been received. There were enough staff to meet people’s needs and to keep them safe.

Accidents and incidents were investigated. Personal emergency evacuation plans (PEEPs) were in place. People’s medicines were stored, handled and administered safely.

People were supported by staff who received an induction and supervision of their work; however some staff still required refresher training in some areas. The registered manager was aware of the principles of the Mental Capacity Act (2005) and how to apply them if needed. However, we found assessments had not always been carried out where required. Applications to the local authority for legally depriving people of their liberty had not yet been made.

People spoke highly of the food and were supported to follow a healthy and balanced diet. People’s day to day health needs were met by the staff and external professionals. Referrals to relevant health services were made where needed.

Staff supported people in a kind and caring way. Staff understood people’s needs and listened to and acted upon their views. Staff responded quickly to people who had become distressed.

People were able to contribute to decisions about their care and support needs. Information about how to contact an independent advocate was available for people. Staff understood how to maintain people’s dignity and people were encouraged to lead as independent a life as they wanted. People’s friends and relatives were able to visit whenever they wanted to. Some staff needed to complete equality and diversity training.

People and their relatives were involved with reviews of care. People’s care records were person centred and focused on what was important to them. People were supported to reduce the risk of them becoming socially isolated. People were provided with the information they needed if they wished to make a complaint, although the information was not written in an appropriate format for all people to understand.

People and staff got on well together and they spoke highly of the registered manager and provider. There was a positive atmosphere at the home. The registered manager understood their responsibilities and adhered to the terms of their registration with the CQC. People and staff felt able to contribute to the development of the service.

There were a number of quality assurance processes in place that regularly assessed the quality and effectiveness of the support provided. However, improvements were needed to ensure the issues identified within this report were managed effectively.

We found that records of care and support offered were detailed and individualised. However, not all records were up to date and some risks had not been fully identified.

Meals were offered with choice and records of what was eaten and drunk throughout the day assisted staff with ensuring people had enough nutrition and hydration.

Some areas of the premises were found to be unsafe. Trailing wires and uncovered radiators were found.

The home did have a complaints procedure that would be accessible to any person who wished to make a complaint.

We found people were involved in planning their own care as far as possible. One person told us, "I can choose what I want to eat and they (the staff) help me when I want help. I just have to tell them." Another person told us," I have everything I want here and its warm." We observed staff speaking to people with respect and we heard staff requesting permission to assist people to move.

We found the care was well planned and staff we spoke with were well aware of people's individual care needs. Two regular visitors to the home told us they were very satisfied with how the staff cared for people. One relative told us, "We're happy, because we know she is well looked after here and its a small homely place.

Before we visited we received some information telling us of concerns about the staffing of the home. We found there were enough qualified, skilled and experienced staff to meet people's needs and no one was working at night without support.