Oakbank Care Home

Oakbank Care provides personal and nursing care for up to 55 people, some of whom are living with dementia. At the time of our inspection there were 41 people using the service. Nursing care is delivered on the ground floor, with residential care upstairs. The care home benefits from large grounds and a garden space to rear.

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

Safeguarding systems, policies and procedures helped protect people from avoidable harm. Staff were recruited safely. People told us they felt safe and happy at the service. Medicines were safely managed. Risk to people were mitigated and assessments were reviewed regularly by the nursing and management teams.

People were supported by a well-trained and knowledgeable staff team. People were supported to access external health care professionals, to ensure their needs were met. 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. Peoples nutritional needs were met, and people told us they enjoyed the food at the home.

Staff promoted individual’s dignity and privacy. Staff supported people in a person-centred way and knew people well, to enable them to provide individualised support. The service provided a range of activities based on people’s individual needs and abilities. People were supported with end of life care by suitably trained staff.

The registered manager had audit systems in place to maintain standards in the service. People and staff told us the registered manager was available, approachable and dealt with concerns if raised.

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 13th May 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

Follow up

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

Oakbank Care Home is registered with the Care Quality Commission (CQC) to accommodate a maximum of 55 people. 50 people aged 65 years and over used the service at the time of this inspection, some of whom lived with a diagnosis of dementia.

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

Systems and processes which sought to safeguard people from the risk of abuse were in place. Staff we spoke with knew how to recognise and respond to potential signs of abuse and were aware of local safeguarding procedures. Throughout the inspection, including when we visited unannounced out of hours, people who used the service appeared relaxed, well cared for and were happy to speak with members of the inspection team. We found no evidence of systemic safeguarding issues within Oakbank.

The necessary safety checks had been completed before staff started working in the home. Staff completed a full induction. The provider had systems in place to monitor staffing levels. Staffing level assessments were used and reviewed monthly, or when people's needs changed. Accidents, incidents and untoward events were reported and recorded appropriately. Processes were in place to analyse and identify any trends.

Systems for audit, quality assurance and questioning of practice were operated effectively. Provider oversight had been enhanced through recent investment in a new quality assurance tool. The provider and registered manager fully understood. their regulatory responsibilities.

Why we inspected

CQC have introduced targeted inspections to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in response to concerns received about safeguarding. A decision was made for us to inspect and examine those risks.

We also 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 coronavirus and other infection outbreaks effectively

Rating at last inspection

The last rating for this service was good (published 24 February 2021).

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

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.

Oakbank Care Home is a care home providing personal and nursing care to 42 people aged 65 and over at the time of the inspection. The service can support up to 55 people.

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

People were supported safely. Risks were identified, recorded, mitigated and reviewed. Staff were aware of the risks people presented. Accidents and incidents were recorded and reviewed. Further analysis of accidents and incidents had enabled the provider to implement further systems to support people at high risk of falls. Staff were recruited safely, and agency workers received a full induction to the service and were informed of people’s needs and risks. Staffing levels were sufficient. The health and safety of the home was continually monitored.

Staff had been provided further on ongoing training to manage risks which had seen a reduction in falls at the home. Staff said the period of change since the last inspection had been positive and felt well supported by the management of the home. There had been an improvement to governance systems at the home which had enabled the provider to highlight, improve and implement action plans. A deputy manager had been employed to support the registered manager and staff felt this had been a positive addition to the team. The senior management team were actively involved with the day to day management of the home.

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 12 August 2020) and there were multiple 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.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

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

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.

Oakbank Care Home is a care home providing personal and nursing care to 39 people aged 65 and over at the time of the inspection. The home can support up to 55 people across two floors. The ground floor supports people with nursing care needs and the first floor supports people with residential care needs.

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

Risks to people were not robustly assessed, mitigated and reviewed. Staff did not have clear direction of how to manage the risks people presented, which put people at risk of harm or injury. People were using equipment without being safely assessed to do so. Risk assessments did not accurately capture people’s needs and were not always incorporated into care plans. Some care plans were not descriptive of people’s current needs and did not give the guidance to support people effectively.

Staff could not always describe how to support people safely. Agency workers were used across the home, but they did not always receive a robust induction or the opportunities to learn about people’s care and support needs. Personal Emergency Evacuation Plans (PEEPs) needed further work to be reflective of people’s moving and handling needs.

There had been no learning from previous falls in the home that had led to injury. Audits to monitor care plans and risk assessments did not identify the concerns we found where the assessments lacked person-centred detail or areas for improvement.

There was a lack of clinical oversight at the home and there had been no deputy manager in post for over a year. The registered manager told us it was sometimes difficult to keep on top of things and additional support had been sourced from a compliance manager prior to the inspection.

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 6 July 2019).

Why we inspected

The inspection was prompted in part by notifications of death and specific incident. Following which people using the service died or sustained a serious injury.

These incidents are subject to investigation. As a result, this inspection did not examine the circumstances of those incidents.

The information CQC received about the incidents indicated concerns about the management of falls. This inspection examined those risks and a focused inspection was undertaken to review the key questions of safe and well-led only.

We reviewed the information we held about the service. 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.

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 improvement. Please see safe and well-led sections of the report.

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

Following the inspection, we sent a Letter of Intent to the provider to seek assurances on the concerns we raised. The provider provided a response which assured us of the actions in place to improve the management of risks to people.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Oakbank Care Home 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 monitor the service.

We found breaches in Regulation 9 (Person-centred care), Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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 from the provider detailing 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.

People’s experience of using this service:

Emergency evacuation procedures were not robust to enable people to be safely evacuated.

Temperature checks were not in place to ensure medicines stored in a medicines trolley on the first floor were at the correct temperature. All other medicines across the home were stored at the appropriate temperature and checks were in place.

Staffing levels were satisfactory and permanent staff members were now in post at the home.

People felt safe while living at the home. Family members also confirmed this.

People were supported to eat a healthy and nutritious diet. People were monitored for weight loss or gain and appropriate action taken.

People received support from health professionals in a timely manner.

The home ensured it followed the principles of the Mental Capacity Act.

We observed caring and kind interactions from the staff to people living at the home. People and their families were complimentary about the staff team.

Care plans were detailed and regularly reviewed and captured people’s personal preferences.

Activities were varied but were not available every day.

End of life care was planned and recorded for most people. Staff could describe what plans were in place for each individual.

Audits were in place to monitor and improve the service, however, they did not identify concerns with safe emergency evacuation and storage of medicines. We made a recommendation for the provider to review this.

Staff felt well supported by the registered manager. People and their families told us the registered manager was approachable.

The registered manager and provider were aware of their responsibilities under their registration.

Rating at last inspection: The rating of this service at the last inspection was good. The report was published on 9 November 2017.

Why we inspected: The inspection was brought forward due to concerns about staffing levels.

Enforcement We found two breaches of the Health and Social Care Act 2018 (Regulated Activities) Regulations 2014. More information can be found at the end of this report.

Follow up: We will work with the provider following this report to understand how they will make changes to ensure the service improves their rating to at least good.

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

Oakbank Care Home is owned by Unity Homes Limited and is in the Harpurhey area of Manchester. Local shops and amenities are within easy walking distance of the home. The home is registered to provide accommodation for up to 58 people including those who need nursing care. On the day of the inspection there were 44 people using the service.

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.

There were sufficient numbers of staff on duty on the day of the inspection to adequately meet the needs of the people who used the service. Staff recruitment was robust and staff files included relevant documentation.

There was an appropriate safeguarding policy and procedure in place. Staff demonstrated an understanding of the procedure and had undertaken training in safeguarding.

There was a health and safety policy and procedure and staff undertook training in infection control. General and individual risk assessments were in place to help ensure people’s safety.

The service had an appropriate medicines policy in place medicines systems were robust.

The induction process was robust, mandatory training was undertaken and there were ample training opportunities for staff.

The environment was pleasant and well appointed. There were no unpleasant odours detected within the home and there was some signage to help people orientate around the home.

The food was plentiful and nutritious and there were ample choices. The mealtime experience could have been enhanced with more conversation and interaction.

The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS).

People who used the service felt the care was good and staff were kind and caring. We observed staff interactions and saw they offered care with compassion and respect.

Privacy and dignity were maintained by staff knocking on people’s bedroom doors and waiting to be invited in. All rooms were single occupancy and people were able to spend time in their rooms if they wished to have some privacy.

People who used the service and their relatives, where appropriate, were involved with care planning and reviews of care. There were regular scheduled meetings for relatives and friends to attend.

People who used the service that we spoke with felt they were listened to. Care files included information about people’s backgrounds, interests, significant events and things that were important to them. We saw evidence of regular care file audits, with actions to address any shortfalls.

Activities included arm chair exercises, table top games, film afternoons, shopping trips, arts and crafts, sewing, relaxation hand and arm care, dominoes and card games and one to one chats with people.

Questionnaires were completed regularly throughout the year by people who used the service, relatives and professionals. Recent questionnaires completed by people who used the service were positive

There was an appropriate complaints policy which was displayed within the home. There had been six complaints or concerns recorded for 2017 and these had been responded to and actions taken. A number of compliments had been received by the service.

Staff we spoke with felt supported and said management were approachable. Staff supervision sessions and appraisals were undertaken regularly to help ensure staff were supported.

There were systems in place for monitoring and assessing the service and a number of audits were completed regularly. The registered manager had oversight of all incidents at the home.

Results of questionnaires were analysed and actions taken to address any suggestions or concerns raised. Residents’ and relatives’ meetings were held regularly and feedback from these meetings was also used to drive improvement.

We inspected the service on the 11, 12 and 15 April 2016. Oakbank Care Home is owned by Unity Homes Limited and is in the Harpurhey area of Manchester. The home is registered to provide accommodation for up to 55 people including those who need nursing care. The home has two floors and has gardens at the rear of the home. Car parking is at the front of the home.

At the time of the inspection there had been no Registered Manager in post who was registered with the Care Quality Commission (CQC) since 2012. This was due to person who was in the process of being registered as manager, going off on long term sick. However, the current manager was in the process of registering with CQC. 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 did not speak with the manager until the third day as they were not present due to planned leave.

Care records contained person centred information to guide staff on the care people needed and had agreed to. However, these were not always reviewed and updated when changes occurred. We saw a variety of health assessments were in place to ensure referrals to other health professionals were made as appropriate.

Staff we spoke with were knowledgeable of the needs and preferences of the people they cared for. We spoke with people who lived at the home and their relatives. We were told they were happy with the service the home provided. Comments we received included; “Oh I’m well looked after here I can assure you” and “Staff are great.”

Our observations during the inspection showed us that people were not always supported by sufficient numbers of staff. Staff recruitment was not safe as the service had failed to carry out all the required checks on staff to ensure they are safe to work with vulnerable adults. Staff we spoke with confirmed they attended training and development activities to maintain their skills and that further training was planned. We also viewed documentation that showed us there were recruitment processes in place and staff confirmed these had been carried out when they had been employed.

During the inspection we saw staff were attentive and patient when supporting people and people were encouraged to eat and drink to meet their needs. However, staff were task focused at times due to staffing levels and the needs of people. We observed people being offered a limited choice and if people required assistance to eat their meal, this was done in a dignified manner.

We saw that there were procedures in place to instruct staff in the action to take if they were concerned that someone was at risk of harm and abuse and the staff we spoke with were knowledgeable of these procedures.

We discussed the quality assurance systems in place with operations director and the manager of the home. We were told audits of accidents, incidents and falls were carried out and these were investigated by the manager to ensure risks were identified and improvements made.

We identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.

We looked at the care records for four people living at Oakbank. We found that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

The home had a safeguarding adults procedure that complied with all of the relevant legislation and good practice guidelines. Staff understood their responsibilities to protect people from harm.

A robust staff recruitment process was in place, which helped to ensure that people were supported by staff members who were suitable for their required roles. From the staff records we looked at we were able to see that the staff currently working for the home had been appointed correctly.

The provider had an effective system to regularly assess and monitor the quality of service that people receive. The quality of the service was monitored through monthly internal audits and included monthly service user feedback questionnaires.

We saw records that showed people were asked to give consent and had signed to confirm they agreed with their care plans. People we spoke with said they understood their care plans and that staff had explained things to them in detail.

We found that all of the records we reviewed were comprehensive, accurate, up to date and had been regularly reviewed.

People were protected against the risks associated with medicines because there were appropriate arrangements in place to manage medicines.

We looked at the staffing levels, for both day and night staff, and saw there were systems in place to ensure the staffing levels were adjusted according to occupancy and dependency levels of the people using the service. Staff talked positively about their work.

People told us they thought that staff were knowledgeable regarding their individual care needs. They said they were treated well and their experiences in the home were positive. Five people told us that if they had a complaint they would talk to the staff and they said they were confident any issues would be dealt with properly.