Archived: Kents Oak Rest Home

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.

We last inspected this service on 24 April 2017 and found the provider was in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued requirement notices in respect of those breaches.

Following our inspection the provider sent us an action plan on 31 May 2017 to tell us about the actions they were going to take to meet these regulations and make the necessary improvements. At this inspection we found action had been taken to meet the requirements of the regulations the service had breached.

The provider had taken appropriate steps to protect people from the risk of abuse, neglect or harassment. Staff were aware of their responsibilities in relation to safeguarding.

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 received their medicines safely, accurately, and in accordance with the prescriber’s instructions. Medicines were stored safely.

Assessments were in place to identify risks that may be involved when meeting people’s needs. Staff were aware of people’s individual risks and were knowledgeable about strategies’ in place to keep people safe.

People were supported to maintain good health and have access to healthcare services. The home worked in partnership with a local GP practice and received regular visits and support.

The provider operated safe and effective recruitment procedures.

There were sufficient numbers of qualified, skilled and experienced staff deployed to meet people’s needs. Staff were not hurried or rushed and when people requested care or support this was delivered quickly.

Staff received supervision and appraisals were on-going, providing them with appropriate support to carry out their roles. Training records showed that staff had received training in a range of areas that reflected their job roles.

People and where appropriate their relatives were involved in their care planning, Care plans were amended to show any changes, and care plans were routinely reviewed to check they were up to date.

Care plans were developed and maintained about every aspect of people’s care and were centred on individual needs and requirements. This ensured that the staff were knowledgeable about the person and their individual needs.

Staff responded appropriately to accidents or incidents. Staff recorded all accidents and incidents and the registered manager responded appropriately and further actions were taken to prevent incidents reoccurring.

People knew who to talk to if they had a complaint. Complaints were passed on to the registered manager and recorded to make sure prompt action was taken and lessons were learned which led to improvement in the service.

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.

Kent’s Oak Care Home is registered to provide accommodation and support for up to 13 older people who may also be living with dementia. This home is not registered to provide nursing care. On the day of our visit 10 people were living at the home. The home is located in a rural area two miles from the town of Romsey, Hampshire. The home has a large living room, conservatory, dining area and kitchen. People’s private rooms are on both the ground and first floors. There is a stair lift to the first floor. The home has a garden and a patio area that people are actively encouraged to use.

Where people did not have the capacity to consent to care and treatment, mental capacity assessments had not always been carried out in accordance with the requirements of the Mental Capacity Act (2005) and associated code of practice

Staff had not received appropriate support through supervision.

During our inspection staff did not always follow the provider’s policy in relation to the security of medicines.

The provider followed safe recruitment procedures.

The provider had systems in place to respond and manage safeguarding matters and make sure that safeguarding alerts were raised with other agencies.

People who were able to talk with us said that they felt safe in the home and if they had any concerns they were confident these would be quickly addressed by the staff or manager

Assessments were in place to identify risks that may be involved when meeting people’s needs. Staff were aware of people’s individual risks and were able to tell of the strategies in place to keep people safe.

There were sufficient numbers of qualified, skilled and experienced staff deployed to meet people’s needs. Staff were not hurried or rushed and when people requested care or support, this was delivered quickly. The provider operated safe and effective recruitment procedures.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. At the time of our inspection applications had been submitted by the managing authority (care home) to the supervisory body (local authority) and had yet to be authorised. The manager understood when an application should be made and how to submit one.

Care plans were amended to show any changes, and care plans were routinely reviewed to check they were up to date.

People were treated with kindness. Staff were patient and encouraged people to do what they could for themselves, whilst allowing people time for the support they needed.

People had access to and were supported with their healthcare needs, including receiving attention from GPs and routine healthcare checks.

People knew who to talk to if they had a complaint. Complaints were passed on to the registered manager and recorded to make sure prompt action was taken and lessons were learned.

We identified two 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 the report.

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Our inspection took place over two days. On the first day we visited the home. We looked at documentation such as care plans, policies and procedures, training records, staff records, surveys and quality and audits. We spoke with the manager, four care workers, the chef and a visiting health care professional. We also spoke with four people who use the service and one relative of a person who used the service.

On the second day we undertook telephone conversations with two relatives of people who use the service. This is a summary of what we found -

Is the service safe?

People were safe because the provider had undertaken risk assessments to identify people who were at risk of falling and had plans in place to prevent future falls.

We spoke with four care workers who confirmed that they have a very close working relationship with the local GP practice and community nurses. They were able to seek professional advice when needed. This meant that people who use the service received safe and appropriate care.

Medicines were safely administered. We watched some people being given their medicines at lunchtime. We saw they were given in a safe way. We saw records being completed after people had taken their medicines. We saw that the care worker who was giving medicines was taking time with people to make sure they took their medicines correctly.

References to confirm that care workers were of good character were obtained before they started work. We saw that references were obtained for all staff and were contained within their recruitment records.

Is the service effective?

We saw that nutritional assessments had been undertaken and people had their weight recorded monthly. Where people were identified as being at risk of malnutrition there was a clear plan of care to prevent this. There were daily records completed by care workers to record and monitor the person’s intake of food and fluids.

Fluids and fresh fruit were readily accessible. Jugs of juice and water were available in communal areas and in people's bedrooms. We saw care workers encouraging one person to drink more as they had a chest infection. Drinks were placed where people could reach them and we saw care workers help people to drink where needed.

Is the service caring?

Risk assessments were comprehensive and had been undertaken in key areas which included personal hygiene, skin care, safe environment and moving and handling. For example, one person had a risk assessment in place for mobility. This showed that they required a walking frame to aid their mobility, that the frame should be within their reach at all times and that they needed time to mobilise when staff attended them.

We observed positive interaction between people who use the service and care workers. For example when care workers were talking with people who were sat in chairs the care workers ‘knelt down’ to be at ‘eye level’ with the person they were talking with. One care worker explained: “It is respectful to talk to people and to have them engage with us in a way that they are comfortable. Kneeling down and engaging with them at ‘eye level’ also helps people to understand especially if they have a hearing impairment”.

Is the service responsive?

A visiting healthcare professional told us that they were rarely called to the home and felt that the people living at the home were safe and very well cared for. They also told us: “The care home is responsive to people living at the home and will call us for advice and guidance on how to manage people’s needs, for example, dietary needs, continence needs and general day to day health concerns. We have a good relationship with them”.

Is the service well led?

The service has not had the consistency of a registered manager however the manager is going through the registration process with The Care Quality Commission.

The four care workers we spoke with confirmed that they have a very close working relationship with the local GP practice and community nurses and were able to seek professional advice when needed.

Care workers received regular training and development. We saw recent staff training certificates that included food hygiene and safeguarding vulnerable adults. We saw records that showed staff received regular supervision.

We looked at records that showed that each person living at Kent’s Oak Care Home had a monthly review of their care undertaken by the manager. The manager explained that there was an opportunity during this process for people to give feedback regarding the service provided.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. A person told us that the staff were “excellent, first class. Nothing is too much trouble”. A relative said that the staff were “very good, I can’t fault them”. Steps had been taken to provide care in an environment that was suitably designed and adequately maintained. We saw that a range of audits were carried out, which showed that there was an effective system in place to identify, assess and manage risks to people’s health, safety and welfare. One person told us that they went to meetings where they were asked “how things were going”. They told us they had “no complaints at all” and were “quite happy here”. A relative told us they were “always kept informed about what’s happening”.