Twin Oaks

Twin Oaks is a care home providing personal and accommodation to older people. At the time of the inspection, 6 people were receiving regulated activities at the home. The service can support up to 7 people. The home is large adapted house with bedrooms, a lounge area and a dining room on the ground floor. The second floor has more bedrooms and the 2 floors are connected by stairs and a stair lift.

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

People were safe and protected from the risk of harm. Risks were appropriately identified, assessed and managed. Staff were safe to work with vulnerable people and appropriate safety checks had been made.

Staff were competent with safeguarding processes and knew how to protect people from the risk of abuse. People said they felt safe in the home and were trusting of staff and management. We observed good practices and interactions between management, staff and people during the inspection.

Infection, Prevention and Control (IPC) processes were in place and we were assured about the service's ability to mitigate the transmission of infections.

Staff supported people to have access to healthcare professionals and specialist support and the service worked with external specialists.

People were confident in the management team at the home and praised how approachable they were. The service made appropriate notifications to CQC and other authorities of safety incidents to ensure these incidents received appropriate oversight.

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 23 February 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended that the provider improved the storage system for medicines. At this inspection we found the provider had acted on the recommendation and noted improvements.

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we carried out a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for 'Twin Oaks' on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Twin Oaks is a residential care home registered to accommodate up to seven people in need of personal care. Accommodation is provided over two floors with single rooms, all with en-suite facilities. On the days of the inspection there were six people living at the home.

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

Care planning and risk assessing was inconsistent. Some records had not been updated and some were incomplete. They did not always provide a reliable and accurate record to guide staff. There were a limited amount of environmental checks at the home and none of these were documented. Additional checks were also required around fire safety. We have imposed a breach of the regulations around these concerns that can be seen in the 'Safe' section of this report.

In some areas, management and provider oversight and responsibility was poor. The registered manager had purposefully completed care records in advance of the care being provided. This could mislead someone reviewing these records and in particular health care professionals. The provider’s systems and processes for the oversight, quality monitoring and safety of the service had been ineffective in anticipating and addressing concerns we found during the inspection. This placed people at risk of harm. We have imposed a further breach of the regulation that can be seen in the 'Well-led' section of this report.

Recruitment processes needed to be reviewed as they did not meet current legislation and guidelines. They were not effective at ensuring staff members were always suitable with working with vulnerable people. Some essential safety checks had not been made. We have imposed a further breach of the regulation that can be seen in the 'Safe' section of this report.

We found some improvements were required with medicines storage. The service needs to make sure medicines are stored consistent with manufacturer's guidelines and have made a recommendation around this in the 'Safe' section of the report. People did however receive medicines as prescribed by their health care professionals

Infection, Prevention and Control (IPC) processes were appropriate and we were assured about the service's ability to mitigate the transmission of infections.

Staff were competent with safeguarding processes and knew how to protect people from abuse. Relatives said their loved ones felt safe in the home and were trusting of staff and management. We observed good practices and interactions between staff and people during the inspection. The service's safeguarding processes were robust.

Staff supported people to have access to health professionals and specialist support and the service worked well with external professionals.

The provider and registered manager acted during and immediately after the inspection to address the risks we found. This included improved monitoring, checks and reviews.

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 17 May 2018).

Why we inspected

We received concerns regarding a specific incident involving a person who lived in the home and management oversight of the service. As a result, we undertook a focused inspection to review the key questions of 'Safe' and 'Well-led' only. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the 'Safe' key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Twin Oaks on our website at www.cqc.org.uk

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

At this inspection, we have identified breaches of regulations in relation to the oversight of the service and systems used to oversee the quality and safe running of the home. In addition, breaches have been preferred around recruitment issues and safe care planning and risk assessing.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The registered manager and her husband are directors of the company that provides the care. They both work in the home and employ one member of staff.

We found the following examples of good practice.

There were suitable arrangements in place for relatives to visit. Visitors were happy to visit outside of the home and preferred to visit at a distance. The registered manager said that if any relative wanted to visit inside the home then lateral flow tests and personal protective equipment [PPE] would be made available.

The home had suitable stores of PPE and we saw the two team members wearing suitable PPE. There was a simple cleaning schedule in place and suitable cleaning materials to combat bacteria and viruses. We walked around the home and found it to be clean, fresh and orderly in all areas.

The providers and the staff member were tested weekly and the service users had been tested every month. Staff and service users had all received two vaccines against Covid-19. The home had remained free of the virus throughout the pandemic.

The team had received recent training and the registered manager ensured that they kept up to date with current good practice. Simple, yet effective policies and procedures were in place.

Twin Oaks 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.

At our last inspection we rated the service as good. At this inspection we found the evidence continued to support the rating of good. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

People told us this was a good home and said they would recommend it.

People received support from a small staff team that included the registered manager and the provider. The staff team were aware of how to identify and report abuse. The staff team were trained in how to provide people’s care safely.

People received their medicines safely and as their doctors had prescribed. The staff identified if people were unwell and contacted their doctors if they needed.

People enjoyed meals and drinks that took account of their personal preferences. They were provided with the support they required to enjoy their meals.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People’s rights were protected. They were asked for their consent before care was provided and the decisions they made were respected.

The staff team were kind and caring to people.

People had been included in planning and agreeing to the care they received. Each person had a care plan to guide staff on the support they needed and how they wanted this to be provided. The staff team worked with other appropriate services to support people who were reaching the end of their lives.

The provider had a procedure for receiving and responding to concerns about the service.

The register manager and provider were the owners of the home. They worked with the care staff providing people’s care. They were available to provide guidance to the staff and the staff felt well supported by the owners of the home.

The registered manager and provider asked people for their views and carried out checks on the quality and safety of the service.

Further information is in the detailed findings below.

We re-visited the service on 2 June 2015 and undertook an unannounced focussed inspection. We did this to check that they had followed their plan and to confirm that they now met legal requirements. We focussed on four of the breaches of those regulations where we had issued warning notices requiring the registered provider and registered manager to take action to comply with the requirements of those regulations. We found the registered provider and manager had addressed the breaches and taken action to comply with the requirements of those regulations.

During our inspection undertaken on 17 February 2016 we found no breaches of legal requirements.

Twin Oaks is a large detached property situated not too far from the centre of Windermere. The building has been adapted for its present use as a small family run care home for up to seven people. Communal space includes a large lounge and dining room. Accommodation is over two floors and the first floor is accessed by a stair lift. All bedrooms had ensuite bathroom facilities. At the time of our inspection visit there were seven people who lived at 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.

We found the registered manager had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report any unsafe care or abusive practices. People we spoke with told us they felt safe and their rights and dignity were respected.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions.

We found care plans were organised and had identified care and support people required. We saw people or a family member had been involved in the assessment and had consented to the support being provided. We found care plans were informative about the care people received. They had been kept under review and updated when necessary to reflect people’s changing needs. People we spoke with said they were happy with their care and they liked living at the home. One person said, “They take very good care of me. Everyone is so kind.”

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

There had been no new staff members recently recruited to work at the home. We discussed recruitment procedures with the registered manager. We were satisfied safe recruitment procedures were in place and appropriate checks would be made before new staff commenced their employment.

We found sufficient staffing levels were in place to provide support people required. We saw the registered manager and staff member on duty could undertake tasks supporting people without feeling rushed. One person we spoke with said, “The staff are never far away if you need them.”

We found medication procedures in place at the home were safe. Staff responsible for the administration of medicines had received training to ensure they had the competency and skills required. Medicines were safely kept and appropriate arrangements for storing were in place.

The home was well maintained, clean and hygienic when we visited. No offensive odours were observed by the inspection team. People we spoke with said they were happy with the standard of accommodation provided.

The staff member spoken with was positive about working for the registered manager and felt well supported. They said they received regular training to make sure they had the skills and knowledge to meet people’s needs.

People were happy with the variety and choice of meals available to them. Regular snacks and drinks were available to them between meals to ensure they received adequate nutrition and hydration. One person we said, “The meals are very good and we get plenty to eat.”

People who lived at the home had freedom of movement around the building. They were involved in decision making about their personal care needs and the running of the home. We saw no restrictions on people’s liberty during our visit.

People told us they were happy with the activities arranged to keep them entertained. These were arranged both individually and in groups.

The service had a complaints procedure which was made available to people on their admission to the home. People we spoke with told us they were happy and had no complaints.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included satisfaction surveys and care reviews. We found people were satisfied with the service they received.

People told us they were happy with the levels of care and support provided by staff at the home. One person told us, 'It is the staff that makes living here a pleasure'.

We saw staff related to people positively and were supportive and knowledgeable about people who lived at the home. The family member of a person lived at the home told us, 'We waited to get mum in here as it has such a good reputation'.

"It's grand."

"Ten out of ten!"

We found that people were well looked after and treated respectfully. Staff demonstrated knowledge about issues such as consent to treatment and knew how to protect people from abuse.

We saw that the owners of the home recruited people in an appropriate way and had systems in place to monitor the quality of service that they provided.