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Oakwood Nursing Home Requires improvement

Reports


Inspection carried out on 17 October 2019

During a routine inspection

About the service

Oakwood Nursing Home provides personal and nursing care for up to 29 older people, some of whom live with a dementia.

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

The management of medicines required improving to ensure people received their medicine’s safely and had been stored appropriately, administered according to GP instructions and followed best practice guidance.

The environment was not always clean and repairs and maintenance were required in various areas of the home. This had not always been identified or addressed in a timely manner. The prevention and control of infection required improving to ensure clinical waste was disposed of safely and appropriately.

Staffing levels required reviewing to ensure there was enough staff adequately deployed to consistently meet people’s needs in a timely manner according to their wishes. Staff received irregular supervision and did not always receive feedback on their practice.

The systems and processes in place to monitor the safety and quality of the service required strengthening. Concerns identified at this inspection had not been identified by the provider, however, the provider took immediate action to respond to the concerns raised.

People received care from staff they knew which included the use of regular agency staff. Staff had a good understanding of people's needs, choices and preferences. People were encouraged to make decisions about how their care was provided and their privacy and dignity were protected and promoted. Staff gained people's consent before providing personal care.

People and their relatives were involved in the planning of their care which was person centred and updated regularly. People were supported to express themselves, their views were acknowledged and acted upon. There was a complaints system in place and people were confident any complaints would be responded to appropriately.

Staff understood their roles and responsibilities to safeguard people from the risk of harm. People’s risks were assessed at regular intervals or as their needs changed. Care plans informed staff how to provide care that mitigated these known risks. People were supported to access relevant health and social care professionals.

Staff were recruited using safe recruitment practices. Staff received training to enable them to meet people’s needs.

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 28 April 2017).

Enforcement

We have identified breaches in relation to insufficient management of medicines, prevention and control of infection and lack of governance and oversight of the service.

You can see what action we have asked the provider to take at the end of this full 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.

Inspection carried out on 30 March 2017

During a routine inspection

This inspection took place on the 30 March 2017 and was unannounced. The service is registered to provide accommodation with personal care and treatment for up to 29 older persons mostly with dementia and palliative care needs. At the time of inspection there were 27 people in residence being supported and cared for. At the last inspection in February 2015, the service was rated ‘Good’ and at this inspection we found the service remained a ‘Good’ 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.

People continued to receive safe care. Staff were appropriately recruited and there were enough members of staff to provide care and support so that people felt safe in the home. Staffing levels were kept under review to ensure that people’s needs were met in timely way.

People were consistently protected from the risks of harm. Staff understood their responsibilities to safeguard people and knew how to respond if they had any concerns.

People continued to receive effective care and treatment. People had detailed personalised plans of care in place to inform and enable staff to provide consistent care and support. They received their medicines in a timely way. People had enough to eat and drink and enjoyed a varied and nutritious diet. The staff support, training and professional development systems ensured staff had the right skills, knowledge and experience to effectively meet people’s needs on a daily and long term basis.

People were enabled to make choices about the way in which their care and support was provided. There were positive relationships between people using the service and the staff. The staff were caring and treated people with respect, kindness and compassion. They had a good understanding of each person’s care and treatment needs.

People’s representatives knew how to raise a concern or make a complaint and the provider responded appropriately to any concerns or complaints. There were systems in place to monitor the quality and standard of the service. Timely action was taken to address any shortfalls and make improvements. The registered manager was readily approachable by staff and service users alike for guidance and support.

Inspection carried out on 12 &13 February 2015

During a routine inspection

This unannounced inspection took place over two days on the 12 and 13 February 2015.

Oakwood Nursing Home provides accommodation for up to 29 older persons who require nursing or personal care. There were 28 people in residence during this inspection, some of whom had dementia care needs.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 were protected from the risks associated with the recruitment of new staff by robust recruitment systems, staff training and adequate staffing levels. Risk assessments were in place to reduce and manage the risks to peoples’ health and welfare. People were cared for by trained staff that were able to meet people’s needs safely. People’s rights were protected.

People received support from staff that were able to demonstrate that they understood what was required of them to provide people with the care they needed. Staff were caring, friendly, and attentive. People were treated with dignity and their right to make choices was upheld.

People’s care plans reflected their needs and choices about how they preferred their care and support to be provided. People had individualised care plans in place and their healthcare needs were regularly monitored, and assistance was sought from the relevant professionals so that they were supported to maintain their health and wellbeing. People were encouraged to be involved in the development and review of their care plan.

People’s healthcare needs were met and they had enough to eat and drink. People enjoyed their food and there was variety of meals to suit people’s tastes and nutritional needs. People were supported to maintain a balanced and varied diet.

People who used the service had access to a wide range of community based health professionals. Suitable arrangements were in place for the safe storage management and disposal of medicines.

There were systems in place in place to assess and monitor the quality of the service. People’s views about the quality of their service were sought and acted upon. There were activities to keep people entertained and constructively occupied if they chose to participate in them.

People knew how to raise concerns and complaints. Complaints and allegations were appropriately investigated and action was taken to make improvements to the service when this was found to be necessary.

Inspection carried out on 11 June 2014

During a routine inspection

The inspection of Oakwood Nursing Home was carried out by an inspector who gathered evidence to help us answer our five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive to people's needs? Is the service well-led?

Below is a summary of what we found. The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

We found that people's needs had been appropriately assessed before they were admitted to Oakwood Nursing Home. After admission to the home we saw that their needs were regularly reassessed to ensure they continued to receive safe care when their needs changed. This meant that staff had the up-to-date information they needed to minimise identified risks to people's safety and welfare.

We saw there were sufficient numbers of experienced and competent staff on duty to safely meet people's personal and healthcare needs. We found that staff had been appropriately trained to provide safe care. One person said, �The staff are helpful and kind so that makes me feel safe.�

There were suitable arrangements in place for staff to respond to emergencies, deal with incidents, or seek guidance from their manager or the nurse-in-charge. This meant that staff received the advice and support they needed to manage problematic situations safely, effectively, and in a timely way.

The three staff we spoke with said they had received training in the safeguarding of vulnerable adults (SoVA) and they knew how to report concerns. This meant that people were protected from the risk of neglect or unsafe care.

We found that the home had been appropriately maintained. We saw that people were cared for in an environment that was clean and hygienic. We found that the equipment in place for staff to use was appropriately serviced. This meant that people were cared for in a safe environment.

Is the service effective?

Staff had received the up-to-date information, training and managerial support they needed to do their job effectively. We spoke with staff and observed them going about their duties in an unhurried, purposeful way. They were able to tell us about people�s individual needs and how they delivered their care. This meant that because staff had a good knowledge of each person�s care needs and preferences they were able to provide effective care.

Is the service caring?

When we saw staff interact with people their manner of approach was patient, kind, and good humoured. They encouraged people who struggled to do things for themselves but made sure people were safe. We saw they provided people with timely assistance whenever that was appropriate but never 'rushed' anyone.

Is the service responsive to people's needs?

People said they received the support they needed to enable them to do what they could for themselves. One person said, �I try to do what I can but I know the staff will help me if I get in a muddle.�

We saw that there was enough staff on duty to meet people's needs. The three staff we spoke with said they were able to meet people's needs without feeling under pressure. One person said, "I only have to ask if I need anything. They always come when I need their help."

Is the service well led?

The staff we spoke with all confirmed that they had received the support and guidance they needed from the manager and other senior staff, such as the nurse-in-charge. They said they were encouraged to raise issues for discussion or make suggestions for improvements. They all said the manager and other senior staff were approachable and always supportive. This meant that people were assured of receiving care from staff that were appropriately managed.

Inspection carried out on 3 May 2013

During a routine inspection

We met and spoke in private with three people in the home who told us that they were happy, felt safe, and received the care and support they needed.

One person spoke with commented that the staff and owners were "always attentive" and "very kind". A visitor said that they were "pleased and happy" with the care their relative had received.

We saw that the home was being redecorated and that people had been asked to help choose new pictures to go on the walls.

We found the home to be clean, comfortable, free from odour, and well maintained. We found that 'Oakwood Nursing Home' was appropriately staffed to safely and effectively meet the needs of the sixteen people in residence when we visited.

Inspection carried out on 3 October 2012

During a routine inspection

Some people were unable to speak with us because their dementia had impaired their ability to communicate verbally. We used a number of different methods to help us understand the experiences of people using the service. For example, we spoke with two people in the privacy of their room who were able to tell us about the standard of care they had experienced at Oakwood Nursing Home. They said they received all the care and support they needed. One person said, "The staff are all very kind. I get on with them all and they make sure I am comfortable." Both people said the food was "very good".

We spoke with four visiting relatives who said they were welcome to visit at any reasonable hour. They all said they found the staff friendly and helpful. One visitor said, "I am more than happy with the care and attention mother receives."

We heard staff talk with people and their tone of voice was friendly, they explained what they were doing and they used words of encouragement when, for example, they physically assisted people to move around. We saw that people seated in the communal lounge were dressed in clean clothing .

Inspection carried out on 23 March 2012

During a routine inspection

We spoke with people who told us that they received the support and care they needed. Some people told us that sometimes they had needed to "�wait a bit when staff were really busy." Everyone we spoke with said that if they did have to wait it was not for too long and they had not seen anyone distressed or left without the help they had needed. One person said, "There is more staff around now so I am happy enough. If I have to buzz for help they see to me after a few minutes."

One relative we spoke with said that occasionally the home had seemed short staffed when they had visited. They said staff were friendly and helpful but had "�seemed really busy." They told us that they had seen that staffing levels had since increased and were reassured by that. They said, however, that their relative had always told them that they had received the care and attention they needed, so they were not unduly concerned.

Some people told us there was not much to occupy them during the day since the activities co-ordinator had left. They said no-one had yet been recruited to take that person's place although they had been told, and were pleased, that the post had been advertised.

A relative said, "I am always welcome to visit whenever I want. Mum says the staff are nice to her and from what I have seen so far I think they do treat her well. She tells me she is happy."

Inspection carried out on 3 June 2011

During a routine inspection

The people who spoke to us at Oakwood Nursing Home told us they were happy with the care and support they get. They said they liked the attitude of the staff, that they did �a good job�.

Comments from people we spoke to included, for example:

� �If I need help I only have to ask.�

� �Friendly staff. Nothing is too much trouble.�

� �I get well fed here.�

� �Whenever we visit we are made so welcome. That says a lot. It�s very reassuring.�

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