Archived: Oakfield Care Home

Oakfield Care Home is a care home and was providing personal and nursing care to 22 people aged 65 and over at the time of the inspection. The service can support up to 28 people.

The home is laid out over three floors: the basement, ground and first floor. Each floor offers bedroom accommodation and all of the bedrooms, except one, include en-suite facilities. The ground floor incorporates a lounge, dining room, the registered manager’s office and medicines room. The first floor is made up of bedrooms, the nurse’s station and administrator’s office. The basement offers further bedrooms, a hairdressing salon, the kitchen and laundry room. Each floor provides access to communal toilet and washing facilities and can be accessed by the lift. A chair lift is available from the ground to the first floor. There is level access to gardens that surround the property and parking to the front.

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

Overall staff were employed safely; however, we did identify that some staff recruitment records did not include a full employment history. The provider contacted us after the inspection and confirmed this information had been collected and recorded in relevant files. People told us they felt safe and staff knew how to protect people from potential harm and abuse. Potential risks to people were assessed and monitored. Guidance was available for staff about how to keep people safe. People received their medicines and topical creams as prescribed. The provider ensured people were protected from the potential risk of infection.

People told us they were supported by staff who were kind and caring, our observations confirmed this. People were supported to retain their independence and express their views. Staff ensured people’s dignity and privacy was upheld.

People’s needs and choices were assessed and reflected in their care plans. Guidance was also available for staff so they knew how to meet people’s needs. Staff told us they received relevant support and training to carry out their roles. People were supported to eat and drink enough.

At our last inspection we made a recommendation for the provider to review their processes in relation to the mental capacity act (MCA). At this inspection we found sufficient improvements had been made and the provider was acting in line with the principles of the MCA. 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.

Staff and people spoke positively about the registered manager, staff confirmed they worked as a team to meet the needs of people. There were governance systems in place that were used to identify errors and omissions. Notifications were submitted to the commission as required. The provider had built links with local schools and religious organisations.

Rating at last inspection

The last rating for this service was Good (published June 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Oakfield Care Home is registered to provide accommodation and nursing care for up to 28 people. At the time of our inspection there were 19 people living at the service.

A registered manager was not in post at the time of inspection. 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. A manager has recently been appointed and they told us that they intend to process their registered manager’s application.

People's rights were not consistently upheld in line with the Mental Capacity Act (MCA) 2005. This is a legal framework to protect people who are unable to make certain decisions themselves.

Staff were not consistently supported through a regular supervision programme. Supervision is where staff meet one to one with their line manager. Since their appointment the manager has introduced a regular programme of supervision. The supervision matrix identified that the majority of staff had received a supervision in April. New staff undertook an induction and mandatory training programme before starting to care for people on their own.

At our previous inspection the provider was not consistently responsive to people’s needs. The quality and content of care plans was variable. Although some were well written, with clear guidance for staff to follow, this was not consistent. Care plans were not consistently written in conjunction with people or their representative and people had not signed their care plans to indicate their agreement. Although some care plans required further development in relation to catheter care we found sufficient improvements had been made to care plans.

At our previous inspection the provider was not deploying sufficient numbers of staff to ensure they could meet people’s care and treatment needs. Although we received mixed comments about staffing levels we found sufficient improvements had been made. Staffing levels were in the main maintained in accordance with the assessed dependency needs of the people who used the service.

At our previous inspection risk assessments relating to the health, safety and welfare of people were not sufficiently detailed to mitigate potential risks to the person. At this inspection we found sufficient improvements had been made. Where risks had been identified, care plans detailed the steps staff should take in order to keep people safe.

At our previous inspection we found there were ineffective governance systems in place to monitor health and safety and the welfare of people. At this inspection we found sufficient improvements had been made. A full time maintenance person has been appointed. Regular maintenance audits relating to fire safety records, legionella, water temperatures, maintenance of safety equipment, gas safety, boilers, call systems, portable appliance testing (PAT) and window restrictors are now undertaken.

Arrangements were in place for reporting and reviewing accidents and incidents. This included auditing all incidents to identify any particular trend or lessons to be learned.

Medicines were managed safely. We observed part of a medicines round and the nurse administering the medicines knew people, their medicines and why they had been prescribed them.

People’s nutrition and hydration needs were effectively managed. Care plans contained nutritional assessments and where risks had been identified specialist advice and support had been sought.

People and their relatives felt that the staff were caring and we received a number of positive comments.

We observed positive interactions between staff and people using the service. Staff knew people well and there was friendly atmosphere around the building. We observed staff laughing and joking with people. Staff were knowledgeable about people's needs and told us they aimed to provide personalised care to people.

Relatives were welcomed to the service and could visit people at times that were convenient to them. People maintained contact with their family and were therefore not isolated from those people closest to them.

There is a full time activities coordinator in post who has been proactive and imaginative in creating sessions in consultation with people.

To ensure continuous improvement the manager has introduced a more effective auditing programme. This has resulted in a number of improvements being made since the previous inspection. The provider’s action plan telling us how they intended to meet the requirements of the regulations they previously breached has in the main been implemented. The manager agreed to address issues surrounding consent and catheter care as a matter of priority.

People were encouraged to provide feedback on their experience of the service to monitor the quality of service provided. The manager has introduced a regular programme of resident meetings. Annual customer surveys were conducted with people. The service was open and transparent regarding concerns raised and actions taken.

The six people we spoke with told us staffing levels had improved since our last visit. One person said 'everything is wonderful the staff are really good. There is an occasional day when they are short.' Another person told us 'sometimes it seems ages we have to wait for attention. They do their best.' The third person we spoke with said staffing levels had improved we were told 'sometimes we have to wait. At night they are pretty good.'

The registered nurse (RN), one senior and two care assistants said there had been improvements in staffing levels. One member of staff said 'staffing levels are ok. They try and cover sickness but it's harder when staff go off sick.' We were told it was difficult to cover for staff that had rung in sick unexpectedly just before their shift began. Another member of staff said 'staffing levels are much better. There is usually two staff on each floor and more staff are being interviewed to increase the staffing levels.'

When shifts needed cover existing and agency staff were used. The rota in place showed the manager took steps to maintain staffing levels. We saw bank and agency staff were used to cover shifts.

Systems to monitor staff performance were in place to ensure they were competent to meet people's needs. The matrix in place showed staff had an appraisal and individual supervision in January 2014.

During this inspection we found improvements had been made. We spoke with five people and six relatives. One person told us 'I like it all.' We observed staff spoke kindly with people and were busy throughout the providing care and support.

We looked around all areas of the home and at equipment to check for cleanliness and how infection control was being managed. We observed communal areas and people's bedrooms were clean and tidy. The manager told us new cleaning equipment had been purchased and showed us records of cleaning audits.

During this inspection we found the numbers of people living at the home had increased and staffing levels had remained the same. People told us they often had to wait for care and relatives told us they did not think there were enough staff to meet people's needs.

People and their relatives said they were satisfied with the care provided. We observed staff were caring and patient. We saw those care plans and risk assessments which were in place were reviewed regularly and were updated when people's needs changed. Some care records did not have plans to support all care needs. Care plans did not contain appropriate detail to enable staff to provide safe, effective care .

Staff were knowledgeable about their role and responsibilities with regards to infection control. We found some areas of the home had not been cleaned effectively. People's equipment was not clean.

Relatives told us staff contacted visiting health care professionals promptly when they had concerns about a person's health. Staff maintained appropriate records of health professional visits.

There were not enough qualified, skilled and experienced staff to meet people's needs.