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Archived: Oakleigh Care Home Inadequate

The provider of this service has requested a review of one or more of the ratings.

Reports


Inspection carried out on 6 November 2017

During a routine inspection

The inspection took place on 6 and 21 November 2017 and was unannounced on both days. There were six people living in the home on 6 November and five on 21 November 2017. Four people were permanent residents at the home.

Oakleigh 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.

Oakleigh accommodates a maximum of 29 people in one adapted building.

The last inspection was in May 2017. At that time we found the provider was in breach of four regulations. Two of these Regulation 9 (Person centred care) and Regulation 17 (Good governance) were continued breaches since the previous inspection in November 2016. The other breaches were in relation to Regulation 12 (Safe care and treatment) and Regulation 11 (Need for consent). The overall rating was requires improvement, however, the service was placed in ‘special measures.’ We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. In this case we rated the service inadequate in the ‘well led’ domain on two consecutive inspections.

On the first day of our inspection there was a registered manager in place. However, they told us they were leaving on 17 November 2017. They have made an application to cancel their registration with CQC. 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.

On the second day of our inspection there was no registered manager and the provider told us the ex-manager would be returning to work in the home as a senior care worker.

People told us there were enough staff to meet their needs. There was some disruption to the staffing as in the course of our inspection the registered manager and two senior care workers left. This would have left the service without enough staff to cover the rota. However, all three staff retuned to work at the home within a week. We were concerned the registered manager, provider and care staff had not identified the staffing situation as a potential safeguarding issue.

People who lived at the home told us they felt safe. Staff knew how to recognise and report abuse. The provider did not always work co-operatively with external agencies to ensure safeguarding concerns were fully investigated.

We found the provider had not taken suitable action to be sure agency care workers had been properly checked before they started working in the home.

For the most part people’s medicines were managed safely. However, there was a risk of overuse of medication by staff who were not familiar with people’s needs.

Risks to people’s safety and welfare were not always well managed. The provider had addressed most of the issues with the environment which we brought to their attention at the last inspection. However, there were still concerns and some of these were repeated from the last inspection. For example, we found weekly checks on the fire systems had not been done. The design and décor of the building did not take into consideration the needs of people who lived at the home. This was the third consecutive inspection where we raised issues about the low levels of lighting.

Staff had received training on safe working practices and said they felt supported by the registered manager.

Overall, people were satisfied with the food and told us they were offered a choice of meals. We found the meals offered were not always nutritionally balanced.

The home was

Inspection carried out on 3 May 2017

During a routine inspection

The inspection was unannounced and took place on 3 May 2017. There were six people living in the home when we visited.

Oakleigh is registered to provide personal care for a maximum of 31 people. It is a converted property and the accommodation is provided in single and shared rooms. The home is within walking distance of all the amenities in the village of Clayton and is close to a bus route

The last inspection was in November 2016. At that time we found the provider was not meeting all the regulations; they were in breach of four regulations. One of these Regulation 19 (Fit and proper persons employed) was a continued breach since the previous inspection. The other breaches were in relation to Regulation 18 (Staffing), Regulation 9 (Person centred are) and Regulation 17 (Good governance). During this inspection we found some of the issues we had identified had been addressed but others had not. We found the provider remained in breach of the regulations about good governance and person centred care and we identified two further breaches of regulation in relation to the safe management of medicines and consent to care and treatment.

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 who used the service told us they felt safe and staff knew how to recognise and report abuse. No new staff had been recruited since the last inspection but the provider had put new recruitment policies and procedures in place to help protect people from the risk of being cared for by unsuitable staff.

People spoke very highly of the staff and there were enough staff to provide people with the care and support they needed.

People's medicines were for the most part managed safely. However, there was a risk that people would not be able to get prescribed medication at night because, at times, there were no staff on the premises with the necessary training.

Although risks associated with people's individual care needs, such as pressure sores and falls, were well managed we found shortfalls in how other areas of risk were managed. For example, we found bedrooms being used for storage were unlocked which meant people going in there could be at risk of injury. We also found torn floor coverings which created a trip hazard and found there was no bath thermometer to enable staff to check the hot water temperature and reduce the risk of scalding. None of these issues had been identified by the service prior to our inspection.

We found that staff had received training and the provider had put new and up to date induction standards in place. However, we found staff needed more support to put their training into practice for the benefit of people living in the home.

We heard staff asking people for consent before supporting them. However, we found there were no measures in place to ensure relatives who signed consent forms on people’s behalf had the legal authority to do so. This meant there was a risk people's rights were not always promoted and protected.

People told us the food was fair. People’s weights were monitored and action was taken in response to unplanned weight loss. However, we found that although there was lots of information about how to add extra calories to food the necessary ingredients were not available. We recommended the provider should consult current guidance about best practice in supporting people to eat and drink.

We saw people were supported to maintain their health and had access to the full range of NHS services.

People told us staff treated them with dignity and respect and we observed this during our visit. We saw staff supported people in a kind and compassion way. People were support

Inspection carried out on 15 November 2016

During a routine inspection

The inspection was unannounced and took place on 15 November 2016. There were five people living in the home when we visited.

Oakleigh is registered to provide personal care for a maximum of 31 people. It is a converted property and the accommodation is provided in single and shared rooms. The home is within walking distance of all the amenities in the village of Clayton and is close to a bus route

The last inspection was in August 2015. At that time we found the provider was not meeting all the regulations; they were in breach of the regulation dealing with the safe recruitment of staff. Following that inspection we also made a number of recommendations about ways in which the provider could improve the service.

During this inspection we found improvements had not been made and the provider had not taken on board our recommendations. We found they were still in breach of the regulation dealing with safe staff recruitment and were also in breach of a further three regulations.

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 who used the service told us they felt safe and staff knew how to recognise and report abuse. However, people were not always protected from the risk of being cared for by staff unsuitable to work in a care environment because the necessary checks were not always done before they started work.

People spoke very highly of the staff and there were enough staff to provide people with the care and support they needed.

People’s medicines were for the most part managed safely. However, there was no guidance for staff on the use of medicines prescribed to be taken ‘as required’. This created the risk of an inconsistent approach to the use of these medicines.

Although risks associated with people’s individual care needs, such as pressure sores and falls, were managed we found shortfalls in how other areas of risk were managed. For example, we found fire drills always took place on Tuesday mornings and this meant some staff, including the night staff, had not taken part in a fire drill. We also found the weekly checks on the fire alarm, emergency lights and fire extinguishers were not being done consistently.

We found the home was clean and people who lived there told us their rooms were kept clean.

Staff told us they felt well supported. However, we found the induction training for new staff was not based on current best practice. In addition, we found the provider did not have an effective system in place to make sure staff received the training they needed to carry out their duties. For example, we found three of the four night staff had not received any moving and handling training.

We heard staff asking people for consent before supporting them but we found staff did not fully understand their responsibilities in relation to the Mental Capacity Act 2005. This meant there was a risk people’s rights were not always promoted and protected.

People told us they enjoyed the food and we saw people were offered a choice of food and drinks which took account of their likes and dislikes. We saw when people were at risk of poor nutrition action was taken to improve their dietary intake; however, this was not always reflected in their care records.

We saw people were supported to maintain their health and had access to the full range of NHS services.

People told us staff treated them with dignity and respect and we observed this during our visit. We saw staff supported people to maintain their independence and do what they could for themselves. People told us they were supported to keep in touch with family and friends and said visitors were always welcomed and off

Inspection carried out on 11 August 2015

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

This inspection took place on 11 August 2015 and was unannounced. This meant the provider and registered manager did not have notice that we would be inspecting the service on this date.

During our last inspection on 2 March 2015 we identified eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We asked the provider to make improvements in relation to; care and welfare, assessing and monitoring the quality of the service, safeguarding, infection control, safety and suitability of premises, supporting workers, respect and involvement and the management of medicines. During this inspection we checked improvements had been made in these areas and re-rated the quality of the service.

We found improvements had been made to all eight areas where there had been previous breaches of regulation. However, there was still further work to be done to ensure these improvements could be sustained and to demonstrate that the new processes were fully embedded. We also identified one new breach of legal requirements in relation to how staff were recruited to work at the home. You can see what action we told the provider to take in relation to this at the back of the full version of the report.

Oakleigh Care Home is registered to provide personal care to a maximum of 31 people. Most people who use the service are older people and people living with dementia. Accommodation is provided in single and shared rooms. The service is situated in the village of Clayton on the outskirts of Bradford. On the day of our visit five people lived at the service and only the rooms on the ground floor were in use.

The home had a registered manager in place. However, since our last inspection the registered manager spent most of their time managing another of the provider’s homes. We found the deputy manager had taken on the responsibilities for the day to day management of Oakleigh Care Home. The deputy manager was on holiday during this inspection. However, the provider explained that the deputy manager intended to submit an application to become the registered manager on their return. 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.

Improvements had been made to how medicines were managed in the home. However, we saw two people did not receive their medicine before food, in line with the prescriber’s instructions. We recommend the service review their procedures to ensure medicines are given in line with the prescriber’s instructions.

Overall our findings showed that thorough and consistent checks were not being undertaken to ensure staff were suitable and safe to work with people who may be at risk. This was a breach of regulation. You can see what action we have asked the provider to take in relation to this on the back page of the full report.

We found improvements had been made to the training and support staff received to enable them to deliver safe and effective care. We found sufficient numbers of staff on duty to meet people’s needs. The provider had plans in place to ensure the number of staff were reviewed as the occupancy of the home increased.

Significant improvements had been made to the cleanliness of the home. We found the home to be clean, tidy and the areas which we had previously identified as being potentially unsafe had been addressed.

Improvements had been made regarding how safeguarding was managed and staff had a good understanding of how to identify, report and respond to any concerns they had about people’s safety and wellbeing. Our observations and review of records showed us risk was appropriately managed. However, some risk assessments needed to be updated to ensure they reflected what was happening in practice.

People’s healthcare and nutritional needs were evidenced as being met through effective care planning, being supported to access health professionals and staff promptly recognising and communicating changes to people’s needs so they could be reviewed and referred to other health services. Mealtimes were a positive occasion where people were offered different choices and options of food and drink and staff provided support and encouragement where appropriate.

Staff sought people’s consent before providing care and had a good understanding of how to meet the legal requirements under the Deprivation of Liberty Safeguards and Mental Capacity Act 2005 to protect the rights of the people they cared for.

People told us they felt safe and well cared for. We saw staff treated people with dignity and respect and supported people to maintain their independence and control over their own life where possible. Staff had a good understanding about people and they translated this knowledge into person centred care. Their understanding of people’s needs had been enhanced by the revised care plan format. Care records and the care review process evidenced that staff had involved people and their families in making decisions about their care.

A complaints process was in place and staff used a variety of ways to encourage people to provide feedback about their experiences. We saw evidence this feedback was then used to help adapt and improve the service.

The provider had employed the services of an external consultant. We saw they had provided support and guidance to the deputy manager to enable them to develop the skills and systems required to manage the day to day running of the service, such as developing care records and audit processes. Whilst it was clear the service was on a journey of improvement it was too early to be assured that these improvements could be sustained and to demonstrate the new processes were fully embedded.

We recommend the provider ensures a formal process is introduced to ensure policies and procedures are consistently reviewed, updated and reflect current best practice.

Only five people used the service at the time of our inspection. The provider explained that an increase in occupancy would be gradual and carefully managed to ensure the improvements were sustained and there were no adverse effects on the quality of care provided. Overall we found the service had made significant improvements since our last inspection and we saw evidence the provider and staff team were fully committed to ensuring these improvements continued.

We identified 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 the report.

Inspection carried out on 2 March 2015

During a routine inspection

We inspected the service on 2 March 2015. The inspection was unannounced.

Oakleigh Care Home is registered to provide personal care to a maximum of 31 people. Most people who use the service are older people and people living with dementia. Accommodation is provided in single and shared rooms. The service is situated in the village of Clayton on the outskirts of Bradford. On the day of our visit ten people lived at the service and only the rooms on the ground floor were in use.

When we last inspected the service on 17 June 2014 we found legal requirements had been breached in relation to; the care and welfare of people who use services, meeting nutritional needs, staffing and assessing and monitoring the quality of service. We asked the provider to make improvements and they wrote to us to say they would take action to ensure they met legal requirements in these areas by the end of September 2014. During this inspection we checked these improvements had been made and sustained.

The provider had failed to make the necessary improvements to ensure they met legal requirements in relation assessing and monitoring the quality of service. The systems in place to ensure the delivery of high quality care were inadequate. We found a number of concerns which had not been identified or addressed by the provider or registered manager prior to our visit. This showed an absence of robust quality assurance systems. Where issues were identified we found timely action was not always taken to address them. Risks to people’s health, safety and welfare were not appropriately reported, managed and analysed. Appropriate action was not always taken in response to incidents and accidents to reduce risks and protect people from harm.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (the 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 manager was also the registered manager for another of the provider’s services. We found that this meant they were unable to fully dedicate their time to ensure the consistent and effective management of Oakleigh Care Home and the leadership of staff.

The provider had failed to make the necessary improvements to ensure they met legal requirements in relation the care and welfare of people who use services. Risks to individuals had not been fully assessed and were not being appropriately managed to ensure people’s safety. Where care plans and strategies were in place to manage known risks, these were not always being followed by staff to ensure people were kept safe. Care was not planned and delivered in a way which met people’s needs or ensured their welfare and safety. The provider did not ensure that the care provided was responsive to changes in people’s needs.

We found the staff culture was focused on routines, rather than delivering person centred care. Although we saw some positive interactions between staff and people who used the service, people were not consistently treated with dignity and respect. There were occasions where staff did not provide people with appropriate support and interaction and some practices showed a lack of respect for people using the service. There was a lack of meaningful occupation for people and most staff interactions were centred on care tasks.

We found the service was not safe. The provider and registered manager were not taking appropriate steps to ensure people were protected from the risk of abuse. People were not always protected against the risks associated with medicines because there were not effective arrangements in place to manage medicines safely.

People who used the service were put at risk because good standards of hygiene and cleanliness were not being maintained and staff demonstrated some poor infection control practices. The provider was also not appropriately protecting people from the risks associated with unsafe or unsuitable premises.

Staff did not receive sufficient training and support to ensure they provided people with safe and effective care. We saw evidence that this directly impacted upon people through our observations of some inappropriate and unsafe staff practices. Care staff were knowledgeable about people. However, what they knew about people was not always reflected in people’s care records or in how they delivered care and support to people.

We found the provider had made improvements to ensure people consumed sufficient quantities of food and drink. People’s weights were stable and feedback was that the food was “ok” and “passable”.

The provider had made improvements in relation to staffing arrangements. The number of care staff on duty during the day had been increased. We found this meant that there were now sufficient numbers of staff to meet the needs of the people who used the service. Recruitment procedures were in place to ensure the staff employed were suitable for the role.

Overall people told us they were well cared for and liked living at the service. However, people told us and the records showed that they were not being consistently involved in planning their care.

People were supported to access a range of healthcare professionals to help ensure their general health needs were met. Feedback from visiting health professionals was that staff were helpful and quick to alert them of any issues people may have had.

There were mechanisms in place to obtain people’s feedback such as resident’s meetings and surveys. We found complaints were investigated and responded to and lessons learned were fed back to care staff to ensure similar issues did not occur again.

We found evidence that the Commission was not being notified of some safeguarding incidents which had occurred at the service. We wrote to the provider and the registered manager and reminded them of their duty to ensure they notified the Commission of certain incidents, such as safeguarding incidents. We explained that if we found evidence they had failed to notify the Commission of these incidents in the future this could result in enforcement action being taken against them.

Systems were in place to monitor and manage situations where people’s freedom may have been restricted in order to keep them safe. However, care staff would have benefitted from additional training on the Deprivation of Liberty Safeguards (DoLS) and the Mental Capacity Act 2005 (MCA) to ensure they were fully aware of their duties in protecting the rights of people with limited mental capacity.

We identified eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take in relation to this at the back of the full version of the report.

Inspection carried out on 17 June 2014

During an inspection in response to concerns

The inspection visit was carried out by two inspectors. During the inspection, they spoke with the home manager, four members of care staff, the cook, seven people who lived at the home, three regular visitors and two visiting health care professionals. The inspectors also looked around the premises, observed staff interactions with people who lived at the home, and looked at records.

We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five key questions we always ask;

• 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. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

Is the service safe?

At the time of our visit there were 11 people who lived at the home. We spoke with seven people. They all told us there were not always enough staff available to provide them with the support they needed. We also found there were not always sufficient numbers of suitably qualified and skilled staff on duty to meet people’s needs and ensure people received a consistent and safe level of support. We have asked the provider to tell us how they will make improvements to meet the requirements of the law in relation to the staffing arrangements at the home.

From what people told us, our observations and review of records we found that people were not always protected from the risks of unsafe or inappropriate care and treatment. We saw evidence the service had not always taken appropriate action to reduce risks for people. We also saw identified risks were not always supported by appropriate care plans to ensure people received safe and consistent care. We have asked the provider to tell us how they will make improvements to meet the requirements of the law in relation to the care and welfare of people who live at the home.

Is the service effective?

From what people told us, our observations and our review of records we found evidence that the service was not effective in meeting people’s nutritional needs and ensuring people were appropriately protected from the risk of inadequate nutrition. We have asked the provider to tell us how they will make improvements to meet the requirements of the law in relation to meeting the nutritional needs of people who live at the home.

We found staff were not always correctly following the care plans which were in place to protect people from risks to their health and wellbeing. We also found some care records were not updated to reflect changes to peoples’ needs. We have asked the provider to tell us how they will make improvements to meet the requirements of the law in relation to the care and welfare of people who live at the home.

Is the service caring?

Overall people told us staff were caring, kind and approachable. However, they told us there were not enough staff to ensure people’s needs were consistently met. We found the care staff we spoke with demonstrated a good knowledge of people’s needs and were able to explain how individuals preferred their care and support to be delivered. Despite the positive comments people made and the positive interactions we observed we found staff had no time to spend with people unless they were completing a specific task. One person told us “Staff are lovely; but they never have the time to talk to me. They only come into my room if they have a specific task to complete”.

Is the service responsive?

People’s needs had been assessed before they began to use the service. However we found care records did not always reflect people’s current needs or incorporate the advice given by healthcare professionals. We also saw staff did not always have sufficient time to ensure people’s health and social needs were appropriately met.

Is the service well-led?

We saw there were some processes in place to enable management to continually monitor and identify shortfalls in the service. However, from our findings about care and welfare, staffing and nutrition we found this was not an effective monitoring system because it did not identify important areas for improvement. We also found where areas for improvement were identified prompt action was not always taken to address them. We have asked the provider to tell us how they will make improvements to meet the requirements of the law in relation to how they assess and monitor the quality of service people receive.

Inspection carried out on 23 January 2014

During a routine inspection

In November 2011 the service closed but remained registered with the Commission, we refer to this as a dormant service. The service re-opened on 16 December 2013.

There were four people who used the service at the time of the inspection. We spoke with two people and they told us they were happy with the care and support they were receiving. They said they enjoyed the food and said the staff were kind, caring and attentive.

People were treated with respect and they or their representatives were involved in making decisions about their care and treatment. We found people’s care and welfare needs were assessed and they were supported to have access to a full range of NHS services. People were offered adequate amounts of food and drink and their dietary preferences were catered for.

The service was clean and safe. However, there were only six bedrooms ready for use at the time of the inspection; work was ongoing to improve the rest of the accommodation.

A permanent staff team had not been appointed at the time of the inspection. The staff team was made up of staff from another service operated by the provider; they were working in Oakleigh on a temporary basis. The staff were experienced and trained to meet people’s needs; however, going forward people would be cared for by a different staff team.

The provider had put systems in place to monitor and assess the quality of the service people received; however, we were not able to test their effectiveness.

Inspection carried out on 10 November 2011

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

People did not express any direct views about the service they receive. From observation there were not enough staff on duty with the right skills to meet people’s needs. There were staff practices that did not respect people living in the home and that are not keeping people safe.

Inspection carried out on 15 September 2011

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

Due to their complex needs the majority of people were not able to tell us about their experiences. However, we spoke with one person who uses the service and they told us that the staff were generally good at explaining things, although they felt there was little to do at the home other than to sit around all day.

Inspection carried out on 13 April 2011

During a routine inspection

During the visit we spoke to a visitor who told us they were satisfied with the care their relative receives at Oakleigh. They told us they had visited the home before choosing it for their relative and said they had no regrets. They said they are kept informed about their relatives care and are able to talk to the staff if they have any questions or concerns.

Many of the people living in the home were not able, due to their complex needs, to tell us about their experiences but those that were said they were well looked after. They told us the staff are “very good” and look after them well. A visitor told us the staff are always friendly and helpful. During the visit we observed positive interactions between staff, people using the service and visitors.

One person told us that there is nothing very much to do all day. They said they sometimes sit outside if the weather is nice and occasionally go for a walk with staff when they have time but said mostly people just sit around. People told us there are little or no organised activities for them to take part in.

People who were able told us that they enjoyed living at the home and were generally pleased with the accommodation and facilities provided. On the day we visited people told us they enjoyed their meal at lunch time particularly the home made rice pudding.

A relative told us that they had not had to make a formal complaint but was aware of the procedure and would have no hesitation in approaching the acting manager or provider if they had any concerns about the care or facilities provided. People who were able told us that they felt safe living at the home and would speak the acting manager or other senior members of staff if they had any concerns about their safety.

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