Background to this inspection
Updated
8 July 2021
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.
The inspection took place on the 3 January 2017 and was unannounced. The inspection team consisted of one inspector and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. The home was last inspected in October 2015, where we found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because we identified concerns with regard to a lack of mental capacity assessments in relation to specific decisions, a lack of deprivation of liberty safeguards (DoLS), a lack of audits to monitor the systems and processes within the home to ensure they were effective and meeting peoples’ needs and a lack of notifications submitted to CQC. The home received an overall rating of 'Requires Improvement'. After our inspection in October 2015, the provider wrote to us to say what they would do to meet the legal requirements in relation to these breaches.
On this occasion we did not ask the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the home, what the home does well and improvements they plan to make. Prior to the inspection we looked at the previous inspection report and
information that had been shared with us. We used this information to decide which areas to focus on during our inspection.
During our inspection we spoke with three people, two care staff and the manager. After the inspection we contacted two healthcare professionals. Some people had complex ways of communicating and most people had limited verbal communication. We spent time observing care and used the short observational framework for inspection (SOFI), which is a way of observing care to help us understand the experience of people who could not talk with us. We reviewed a range of records about peoples’ care and how the service was managed. These included the care records for four people, medicine administration record (MAR) sheets, three staff training and support and employment records and records relating to the management of the home. We observed care and support in the communal lounges and dining room during the day. We also spent time observing the lunchtime experience people had and the administration of medicines.
Updated
8 July 2021
The inspection took place on 3 January 2017 and was unannounced.
Oak House Residential Home is the only home owned by the provider. It provides accommodation for up to fourteen people living with dementia, learning disabilities and autistic spectrum conditions. On the day of the inspection there were ten people living at the home. The home is a large detached property spread over three floors with two communal lounges, a dining room and a garden.
We carried out an unannounced comprehensive inspection on 19 October 2015. Breaches of legal requirements were found and following the inspection the provider sent us an action plan outlining what they would do in relation to the concerns found. However, this action plan was not sent to us within the agreed timescales, and therefore the provider was in breach of regulation. At the previous inspection the current manager had been the deputy manager. At this inspection they had been in post as manager for 12 months and had started the process of applying to be registered manager. However, they had not taken reasonable steps to complete this process in a timely manner and the home had been without a registered manager for 12 months. Part of the provider’s condition of registration states that a registered manager must be in place, therefore the provider was in breach of their registration. At this inspection, although some improvements had been made, there were continued and further breaches of legal requirements.
When asked if they felt safe, one person told us, “Definitely”. However, risks assessments to assess peoples’ safety had not always been completed and control measures to minimise risks in relation to health and safety had not always been implemented. Risks to people, who spent time in their rooms and who were unable to use call bells to summon assistance from staff, had not been assessed to ensure that there were suitable measures in place for staff to assure their safety and well-being. Personal emergency evacuation plans (PEEPS) that provided staff with guidance as to how to assist people to evacuate the building in the event of a fire were not in place for all people. Regular checks to ensure that emergency equipment, such as emergency lighting and fire alarms were working effectively had not taken place. Cleaning products were not stored securely and there was a potential risk, due to peoples’ cognitive abilities, that they could have come into contact with these and caused themselves harm.
Staffing levels were not reviewed when there were changes in peoples’ needs and therefore lacked the flexibility to ensure that there were sufficient staff to meet peoples’ needs. The provider had ensured that they had made deprivation of liberty safeguard (DoLS) applications to the local authority for people who lacked capacity to access the community unsupported. However, they had not ensured that one of these was renewed when it expired. Records showed that several people had lost significant amounts of weight within a short period of time. This had not been recognised and therefore appropriate action had not been taken in response. Peoples’ care plans had not always been reviewed and their records lacked detail. Staff were not always provided with the most up-to-date information to enable them to provide appropriate care.
Some people were able to maintain their independence by undertaking daily tasks such as dusting. External activities were provided for some people such as attending day services, however, for people who did not attend these there was a lack of meaningful activities and stimulation available and people spent most of their time watching television. A healthcare professional told us, “It is our belief that the home still needs to develop meaningful person-centred occupation for their residents with dementia. There are minimal dementia-specific resources available. The home is used by residents with learning disabilities who attend day centres and a possible consequence is that the home still needs support with understanding their role in delivering this aspect of care to their other residents”.
There was a lack of quality assurance systems to enable the provider to have sufficient oversight and awareness of all of the systems and processes within the home. There had been no notifications sent to CQC. This is part of the provider’s responsibilities. By not being informed of these incidents CQC were potentially unable to ensure that the appropriate actions had been taken to ensure that people were safe.
People were protected from harm and abuse. Staff were appropriately skilled and experienced and had undertaken the necessary training to enable them to recognise concerns and respond appropriately. People received their medicines on time and according to their preferences, from staff with the necessary training and who had their competence assessed. There were safe systems in place for the safe storage and disposal of medicines.
People were asked their consent before being supported. People and their relatives, if appropriate, were fully involved in the planning of care and were able to make their wishes and preferences known. Staff worked in accordance with peoples’ wishes and people were treated with respect and dignity. It was apparent that staff knew peoples’ needs and preferences well. Positive relationships had developed amongst people living at the home as well as with staff. Staff were caring and treated people with kindness and compassion. Peoples’ health needs were assessed and met and they had access to medicines and healthcare professionals when required. People were made aware of their right to make comments or complaints about the care they received.
We found a number of 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.