Archived: Oak House Residential Care Home

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.

Oak House Residential Home is the only home owned by the provider. It provides accommodation for up to 14 people living with dementia, learning disabilities and autistic spectrum conditions. On the day first of the inspection there were nine people living at the home, on the second day of the inspection there were eight people living at the home. The home is a large property spread over three floors with two communal lounges, a dining room and a garden.

There have been two comprehensive inspections since October 2015. We carried out an unannounced comprehensive inspection on 19 October 2015. Breaches of legal requirements were found. We carried out another unannounced comprehensive inspection on 3 January 2017. The previous registered manager was no longer in employment and the deputy manager had become the acting manager. They had been in post as manager for 12 months and had started the process of applying to become 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. We also identified breaches of legal requirements in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), a lack of quality monitoring processes, failure to notify CQC of reportable incidents, inflexible staffing, insufficient management of risks and a lack of records to inform staffs' practice. Practices that needed to improve related to peoples’ dining experiences, a lack of reviews to ensure that peoples’ care was meeting their current needs and a lack of activities and meaningful occupation for people. The home received an overall rating of 'Requires Improvement' and we took enforcement action against the provider. After our inspection in January 2017, the provider wrote to us to say what they would do to meet the legal requirements in relation to these breaches.

We carried out this unannounced comprehensive inspection on 15 August 2017 and 13 September 2017. At this inspection, although some improvements had been made, in relation to the concerns found at the previous inspection, there were continued and further breaches of legal requirements. The overall rating for this service is ‘Inadequate’ and the service is therefore placed 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’.

The manager was still in the process of applying to become the 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. Therefore the home had been without a registered manager for 19 months and the provider was in continued breach of their registration.

The manager had been responsible for the day-to-day management of the home. Although some minor improvements had been made since the previous inspection, these were not sufficient and there were continued concerns with regards to the management of the home and the provider’s failure to improve the service people were provided with. The home is the only home owned by the provider. When the manager was asked what improvements had been made by the provider since the last inspection, they told us that the provider showed much more of an interest in the service and was always available to contact should the manager have any concerns or queries. However, there was no evidence to support this. The provider had not provided guidance to the manager in order to provide support during the manager’s development. Neither had they had oversight of the home during a time that required concentrated managerial oversight to address the shortfalls and breaches that had been identified in the previous two inspections. As a result there was inadequate leadership and management of the home.

Despite the multiple breaches that had occurred during the past two inspections, neither the manager nor the provider had taken sufficient action to identify and adequately address the shortfalls of the systems and processes to make sure that they were providing people with a safe environment and good quality care. Following the previous inspection the provider could not demonstrate that they had maintained an oversight of the home or taken action to address the shortfalls and concerns that were found. There was a lack of action, effective governance, including assurance and auditing systems and processes, to assess, monitor and drive improvement in the quality and health and safety of the service provided. Neither the manager nor the provider had conducted any audits of the systems and processes to enable them to have oversight of them and to ensure that any improvements that were required, were made. The provider has a responsibility to ensure that this happens at all times to ensure that they are responding to the changing needs of people and that the service is continuously improved.

The lack of quality monitoring by both the manager and the provider meant that shortfalls in some of the systems in place had not been recognised. For example, the lack of audits meant that the provider had not recognised that medication management systems were not sufficient, that essential health and safety checks had not all been completed, that peoples’ mental capacity had not been assessed, nor conditions on any DoLS implemented. In addition they had not recognised that people were not always involved in their care, that they were not always afforded choice within their lives, nor their independence promoted and that there was a lack of person-centred planning, implementation and review. Other shortfalls in peoples’ care related to peoples’ poor dining experience and the lack of access to stimulation, meaningful occupation and activities. Neither had the provider reviewed staffing levels in response to peoples’ changing needs to ensure that these were sufficient.

The culture within the home was not always person-centred or empowering. It was not clear how people were involved in decisions that affected their lives and the care they received. Peoples’ independence was not always promoted and staff did not always encourage people to retain the skills they had or to develop new ones. Peoples’ care records were not always person-centred and it was sometimes difficult to see ‘the person’ within them. Staff knew people well, however, their knowledge of peoples’ preferences and life histories were not documented and therefore it was not evident if peoples’ aspirations and goals had been encouraged. Reviews of peoples’ care had not been undertaken and therefore there was a risk that the care they were provided with, was not current. People did not always have access to activities, meaningful occupation or stimulation. There were missed opportunities for daily engagement in activities to promote peoples’ self-esteem and confidence.

People were cared for by staff that had undergone appropriate checks to ensure they were safe to work within the health and social care sector. Staff had access to training and development, however, had not always completed courses that were specific to peoples’ individual conditions, to ensure that their knowledge and skills were appropriate to enable them to meet peoples’ needs. People were asked for their consent when being supported in day-to-day activities, however, their mental capacity had not been assessed with regards to specific decisions that affected their lives and the care provided. Some restrictive practices were used, such as the withholding and limitation of sweets, crisps and certain lifestyle choices, to promote a healthier lifestyle for people. However, it was unclear if people had been involved in this decision or if their mental capacity had been assessed in relation to this before best interests decisions were made. People had Deprivation of Liberty Safeguards (DoLS) in place which had been authorised by the local authority. However, some of these DoLS had conditions associated to them. These conditions had not b

We found that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

We found that people are supported to have adequate nutrition and hydration. This is because a choice of food and drink is offered which is nutritionally balanced and supports people's health.

We found that people's needs were assessed and reviewed regularly. Care was planned and delivered in line with individual care plans. One person told us, "I have my friends around me and the staff who are lovely, they really care."

People were cared for in a clean, hygienic environment. During our inspection, we viewed people's bedrooms, communal areas, bathrooms and the kitchen. We saw the equipment the service used was clean and well maintained.

We found there were suitable arrangements in place to ensure that staff were supported in relation to their responsibilities. One care worker told us, 'I feel supported. There's someone there to help me take on the work and help me. We're a small team so it's easy for us to talk and share.'

We made observations throughout the visit and saw people being offered choices as to what they wanted to eat and one person told us how they had chosen the colour of paint used to decorate their room. Rooms we looked at were personalised.

We saw people being addressed in a respectful manner. We looked at peoples individual support plans and observed that these were discussed with people who used the service and that these discussions were recorded. We saw that monthly audits of the service were completed by the provider ensuring that people who used the service benefit from a service that monitors the quality of care that people received.

Staff told us that they had received training in protecting adults from abuse and that they felt that they were supported and trained to carry out their roles and meet the needs of people who used the service.