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Oaks Court House Requires improvement

Reports


Inspection carried out on 3 July 2019

During a routine inspection

About the service

Oaks Court House is a residential care home providing personal care for up to 41 older people, due to their frailty, health condition, restricted mobility or mental health needs. At the time of the inspection there were 29 people living at the home.

The building was designed as a care home and accommodation was over three floors. The home was not unitised, and most people used communal facilities on the ground floor, although there were smaller communal rooms on all floors.

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

Quality monitoring systems were in place, although these had not been consistently effective. For example some areas of recruitment practice needed improvement, and the environment needed to be improved so there was a better environment for the needs of people living with dementia.

People said they were happy living at Oaks Court and they were positive about the care and support they received from staff. They told us they usually received support from staff in a timely way and were not kept waiting for assistance. We saw staff usually responded to people’s needs and knew their preferences were known and respected by staff, although there were some occasions where people had to wait at times when staff were busy providing care to other people.

People looked comfortable in the presence of staff and people told us they felt safe at the home. Staff were knowledgeable about potential risks to people and were able to tell us how these would be minimised. People said staff were well trained although we did see skills in responding to people who may exhibit behaviour of concern could be improved. The lack of staff training in this area and the need to develop clear positive behaviour plans was agreed by the provider as an area where improvement was needed.

People’s care plans reflected people’s individual needs and preferences. Staff were knowledgeable about people’s needs and preferences and the staff fostered good relationships with the people. People said staff were kind and caring and staff respected people and promoted their privacy, dignity and independence.

People received effective person-centred care and support at the point this was provided and based on their individual needs and preferences. Staff were knowledgeable about people’s needs and preferences and the staff fostered good relationships with the people. There were missed views from people about the activities available to them, although the registered manager had recognised the need to develop these with recruitment of an additional activity co-ordinator, which was in progress at the time of inspection.

Staff understood their role, felt confident and well supported. Staff received supervision and felt well supported by the provider. People's health was supported as staff worked with other health care providers to ensure their health needs were met. 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 and their representatives knew how to complain although most people we spoke with said they had no complaints. People were able to communicate how they felt to staff, and said staff were approachable and listened to what they had to say.

People, relatives and staff gave an overall positive picture as to the quality of care people received and said management and staff were approachable.

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 this service was good (published 31/12/2016).

Why we inspected

The inspection was a planned scheduled inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive an

Inspection carried out on 1 November 2016

During a routine inspection

This inspection was unannounced and took place on 1November 2016. At the last inspection in September 2015, we found the provider was not meeting all of the requirements of the regulations we reviewed. We asked them to make improvements to maintaining the dignity of people living at the home and notifying CQC of incidents that occurred within the home. The provider had submitted an action plan detailing the improvements they planned to make and at this inspection we found improvements had been made and the provider was now meeting the regulations.

Oaks Court House is registered to provide accommodation and personal care for up to 41 older people, some of whom have dementia. On the day of the inspection there were 23 people living at the home. There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Relatives told us their family members were safe. People appeared comfortable in the presence of staff and staff knew how to protect people from the risk of harm. Staff supported people to manage their risks. There were staff available throughout the home to respond to people when needed. The provider had safe recruitment systems in place which ensured appropriate staff were employed to support people. People received their medicines as prescribed and had access to pain relieving medicines when required.

People were supported by staff who had the skills and knowledge required to meet their needs. Staff received training relevant to their role and were supported by the senior staff and registered manager. People were asked for their consent before care was provided and the registered manager had assessed people’s capacity to make decisions as required by law. People were happy with the food and drink provided and people were supported to access healthcare professionals when required.

People had developed positive relationships with staff and told us staff were friendly and kind. People were involved in making decisions about their care and support. We observed some occasions where staff missed opportunities to engage more with people and encourage or promote their independence. People were supported in a way that upheld their dignity.

People had not always been involved in the planning of their care due to their capacity to make decisions. However, we saw relatives and other professionals had been involved and had been asked to contribute to support and care planning. A programme of activities was available that was relevant to some people’s interests and pastimes, although some people told us they felt the activities offered were not of interest to them.

People and staff told us they felt the home was well managed. The registered manager and staff sought people’s views on the service they received. Staff felt supported by the management of the home and told us they felt their contribution was welcomed, and shared examples of where they ideas had been adopted and improvements made. The registered manager had notified us of events as required by law and felt supported by the provider. There were systems in place to review the quality of care people received and where improvements were identified action was taken to improve the quality of care people received.

Inspection carried out on 11 and 14 September 2015

During a routine inspection

The inspection took place on 11 and 14 September 2015 and was unannounced. At the last inspection in April 2014 the provider was meeting the requirements that we looked at.

Oaks Court House provides accommodation for people who require personal care, including people with dementia for up to 41 people. At the time of the inspection there were 22 people living in the home.

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.

People were not always provided with safe care when equipment was used to support them. The home did not always meet safety requirements with broken furniture and inadequate lighting in some communal areas.

Staff had a good understanding of how to report any concerns they had and knew the different types of abuse. Staff knew about the risks to people but did not always provide them with safe care when using equipment to support people to move.

There were enough staff to support people and the provider had followed safe recruitment procedures to make sure that staff members were suitable people to provide care.

People’s medicines were not always stored securely, but people did receive the correct medicines and staff knew how to support people’s medicines correctly.

One member of staff was not able to communicate effectively with people and did not have sufficient understanding of English to be able to read and understand people’s care plans. Staff members had received the training and support they required to support people effectively.

People were offered choices and were involved in making decisions about their care. If people were not able to make their own decisions, the provider had followed the correct procedures to assess people’s capacity and had obtained the correct authorisation to restrict people’s freedom.

People were given choices of food and drink and received the appropriate food for their needs and drinks were available when people wanted them. People were supported to access other health services they required and received the appropriate care for them.

People’s dignity was not always maintained by staff when supporting people to move in the communal areas. Care workers had good relationships with people and knew their individual needs and preferences. People were encouraged to make decisions about their care and were listened to by staff.

People did not always receive the stimulation and meaningful activities they required. Care plans contained some personalised information but were not always tailored to give staff the information they needed about people’s needs.

People and their families were able to make complaints and felt confident in raising any concerns and that these would be responded to.

The registered manager did not always make notifications about incidents as they are required to do by law.

People, their families and staff told us they felt involved in the home and that the management team listened to their views. The registered manager was visible in the home and staff told us they were approachable and supportive.

The registered manager had a quality assurance system in place to monitor the quality of the service and had made improvements based on these audits.

During this inspection we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Care Quality Commission (Registration) Regulations 2009. 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 5 March 2014

During an inspection to make sure that the improvements required had been made

In this report the name Margaret Sims appears, who was not in post and not managing the regulatory activities at this location at the time of this inspection. Their name appears because they were still identified as the registered manager on our register at the time.

At our previous inspection on 12 and 15 November 2013, we found that the management of people's prescribed medicines was unsafe. This inspection was carried out to see what action had been taken to ensure that people were appropriately supported to take their prescribed medicines.

During this inspection we looked at records and audits in relation to medicine management. We spoke with one care staff who was responsible for the management of medicines. The people who used the service were unable to tell us about the support provided to them due to their health condition.

We found that systems in place were more effective to protect people against the risks associated with the unsafe use and management of medicines. The care staff in charge said, “We have worked hard to put systems in place and the manager carries out regular audits."

Inspection carried out on 12, 15 November 2013

During an inspection to make sure that the improvements required had been made

We carried out an inspection on 22 July 2013 and found the provider was non-compliant in five out of seven outcomes we looked at. This inspection was carried out over two days to see what action the provider had taken to improve standards within the home. During the inspection we spoke with three people who used the service, the registered provider, manager, two care staff, the cook, a district nurse and a visiting relative.

We found that care plans provided sufficient information to promote staff’s understanding of people’s assessed care needs. One visiting relative said, “I am involved in X care planning and I sign it to agree the contents.”

People were provided with well balanced meals to meet their dietary needs. One person said, “I have a choice of meals and I have a big plate of food.”

Appropriate arrangements were in place to protect people from potential abuse.

The management of people’s medicines had improved but there were still areas that needed further attention to ensure systems were more robust.

People had access to appropriate equipment to promote their independence and safety.

Sufficient staffing levels were provided to meet people’s assessed needs.

Inspection carried out on 22 July 2013

During an inspection in response to concerns

This inspection was carried out because of concerns we had received from an anonymous source about the service provided to people. During this inspection we spoke with three people who used the service, six staff members, the general manager and the provider. The registered manager was not present.

We found that care plans provided staff with relevant information about people’s care needs but people could not always be assured that their needs would be met.

There were insufficient food provisions in place to ensure people's nutritional needs were met. One care staff said, “We occasionally have a gateaux for Sunday tea but that’s no good if we haven’t got the main food.”

Appropriate arrangements were not place to ensure that people were protected from abuse.

People lived in a clean and tidy environment but the absence of cleaning staff could compromise the daily hygiene standard. One care staff said, "Not having any cleaning staff has had a massive impact on the service."

People had access to appropriate items of equipment to promote their independence but the absence of frequent servicing of that equipment did not ensure that they would be safe to use.

There were insufficient staffing levels provided and this meant that people could not be confident that their needs would be met.

People had access to a complaints procedure that was also available in different formats to promote their understanding.

Inspection carried out on 3 June 2013

During a routine inspection

The home provided a residential care service for older people. During the inspection visit we spoke with two people who used the service, a visiting relative, registered manager, operation manager and four staff members.

We found that some improvements had been made to the management of people’s prescribed medicines but the provider was not entirely compliant in this area and further work was required to ensure practices were safe.

Some improvements had been made to the management of complaints but the provider was not entirely compliant in this area and further improvements were required. The home had a complaints procedure in place but not everyone who used the service was aware of this. One person who used the service said, “I’m not aware of the home’s complaint procedure but I don’t have many problems but if I did the staff would sort things out for me.” The home had received one complaint since the last inspection visit and we found that this had been responded to in a timely manner.

Inspection carried out on 29 January 2013

During a routine inspection

The home provided a service for people who were elderly frail and for those who had a diagnosis of dementia. The majority of people who used the service were unable to tell us about their experiences of living there. We observed staff interacting with people and talked to staff about how they cared for the individual.

We found that people were provided with information about their care and treatment choices but these were not provided in a format that everyone could understand. We observed that people's right to privacy and dignity was respected.

We found that care plans were in place and provided information about people’s care needs but these were not always followed and could compromise the care and support people received.

We found that the management of people’s prescribed medicines was inadequate and staff responsible for managing medicines had not received up to date training and this placed people at risk of not receiving the appropriate treatment.

The manager was confident that there were sufficient staffing levels to meet people’s needs but confirmed that there had been a shortage. A visiting relative raised concern about the deployment of care staff and felt this compromised the supervision of vulnerable people.

The complaints policy was not in a format that everyone could understand. We found that not all complaints were recorded or responded to. This meant people’s comments and complaints may not be listened to or acted on.

Inspection carried out on 30 January 2012

During a routine inspection

Staff had access to care plans and risk assessments to support their understanding of people’s needs. We observed staff assisting people in a caring manner.

One person who uses the service said, “I’m happy living here.”

Another person told us, “The staff do ask me how I would like to be cared for and they do listen to me.”

One visiting relative said, “The care provided here is good.”

Staff had received dementia awareness training to ensure they have the skills to assist people with this health condition.

A visiting general practitioner said, “Staff are aware of people’s care needs and care records are well maintained.”

Care plans provided staff with information about people’s cultural and religious needs.

The home had a number of quality assurance programmes in place to monitor the effectiveness of the service delivery.

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