Oaklands Residential Care Home

Oaklands is a residential care home providing accommodation and personal care to 22 people in one adapted building at the time of the inspection. The service can support up to 25 people.

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

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.

The service provided safe care to people. A person commented, “I feel really safe here, the staff look after me.” A relative commented, “Mum is definitely kept safe, I have no concerns.” Staff demonstrated an understanding of what might constitute abuse and knew how to report any concerns they might have.

People’s individual risks were identified, and risk assessment reviews were carried out to identify ways to keep people safe. Medicines were managed as necessary. Effective infection control measures were in place. The principles of the Mental Capacity Act were adhered to when necessary. Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them.

There were effective staff recruitment and selection processes in place. People confirmed that staffing arrangements met their needs. There were enough staff to support people and the staff worked well as a team.

Staff relationships with people were caring and supportive. Staff provided care that was kind and compassionate. People commented, “The staff are lovely. I am happy here” and “They (staff) are really kind and caring.” Relatives commented, “The staff are super, they really are lovely. The staff are so patient. Mum is like a new woman since she moved to Oaklands, she is even walking again!” and “When we visited, a carer was gently stroking mums’ hair, which she likes because she was feeling distressed. The staff are so attentive.”

Staff spoke positively about communication and how the registered managers worked well with them and encouraged their professional development.

A number of methods were used to assess the quality and safety of the service people received. The service made continuous improvements in response to their findings.

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 11 June 2021) 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 the service follows best practice guidance in developing PRN protocols for individuals who may be prescribed PRN medicines. At this inspection, the provider had made improvements.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 27 November 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, fit and proper persons employed and good governance.

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. We have also reported on the Key Question Caring.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings 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.

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

Oaklands is a residential care home providing personal and nursing care to 18 people aged 65 and over at the time of the inspection. The service can support up to 25 people. The service has accommodation on two floors with access via a stair lift to the first floor. Most bedrooms and communal space is on the ground floor. Most people living at the service are living with dementia.

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

People and staff had not been fully protected from the risk of infection due to not having the right personal protective equipment (PPE) available for particular situations. Once we pointed this serious error out the providers acted to rectify this and now have the right PPE in place.

One professional gave the following feedback “The provider has been slow to provide the numbers of positive cases, we know they are under pressure due to so many staff testing positive but we are required to have this information to help inform the over all picture of covid outbreaks.”

Some improvements were needed to how clinical waste of PPE was being disposed of. Bins in the sluice room did not have lids. Bins in areas for where PPE would be removed such as entrance and exit of home were small and meant they would need repeatedly emptying. Some documentation needed updating and clarifying. For example the infection diseases policy did not mention or signpost staff to anything about covid 19. The pandemic emergency plan stated systems would be set up and roles allocated but did not give any detail about who would be responsible for what. People’s personal evacuation plans had been photocopied many times and were not easy to read. They did not include details of what equipment each person might need to assist them in an evacuation.’

Recruitment processes were not robust and did not ensure staff were checked for their suitability to work with vulnerable people before they commenced employment.

The quality assurance systems did not identify the risks we highlighted during this inspection.

People said they were happy and being well cared for. One person said “Its very good here. We get plenty to eat and it’s a nice place.”

We observed people being cared for and supported by kind and compassionate staff. For example one staff member went out of their way to obtain a phone number one person was concerned about getting.

People were being offered a choice of drinks and snacks throughout the day.

Medicines were being safely managed.

We made one good practice recommendation in respect of medicines.

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 27 September 2018)

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 about infection control as there had been a large outbreak of covid 19 positive cases. Where a service has more than a 30% outbreak, we have made an operational decision to inspect to check on infection control.

We inspected and found there was a concern with infection control and the use of appropriate PPE, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

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

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 good to requires improvement. 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 Oakland 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 have identified breaches in relation to the lack of appropriate PPE equipment, infection control processes and recruitment at this inspection.

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

We brought this comprehensive inspection forward as we had received concerns about the environment and aspects of the care delivered to people, including staff’s approach. We did not find evidence that people’s needs were not being met. We received consistently positive feedback about staff’s approach and behaviour. Work had been undertaken to improve aspects of the environment, including new water pipes.

Oaklands Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Oaklands offers care and support for up to 25 older people. At the time of the inspection there were 25 people living at the service. Some people were living with dementia. The service uses a detached house over two floors with a stair lift to provide access to the upper floor.

We last inspected the service on 17 October 2017. Following that inspection, the service was rated ‘requires improvement’. This was because systems for the management of medicines were not always safe and the provider’s quality assurance arrangements had failed to address the known shortfalls. The service had also received a one-star rating by the Food Standards Agency and had been told to carry our immediate improvements to the kitchen to meet the requirements.

At this inspection we found significant improvements had been made. A new electronic medicines system was in use which significantly reduced errors. A new kitchen had been fitted since the last inspection and the Food Standards Agency officer confirmed the kitchen was refitted to a high standard. The service was waiting for a new Food Standards Agency rating.

There was a registered manager in post. 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.

Medicines management had improved with the introduction of a electronic system, which had reduced errors significantly. However, during the inspection the ambulance service raised a safeguarding alert as during a night visit to the service, staff on duty had not been trained to administer medicines. We have recommended that a trained and competent member of staff is on duty at all times to administer medicines safely. The registered manager had plans in place to ensure staff were trained by the end of August 2018.

Staff received appropriate training for their roles. However formal supervision of staff had lapsed. We have recommended that formal staff supervision is reinstated in order to ensure staff have the appropriate support.

The staff team were exceptionally caring. People, their relatives and health care professionals were extremely complimentary about the care and support provided at the service. Comments included, “They’re nice people and kind. They go beyond the expected and make our lives meaningful”; “It’s very nice. The staff are exceptional…” and “They are very loving towards her and tactile which is what she likes. They’ve made a home for her rather than her being in a home. In a word, fantastic”. Staff provided sensitive, compassionate care and responded very promptly to people’s needs. They understood each individual’s diverse needs and ensured they met them. People were treated with dignity and respect by staff who promoted their independence and choice. People and their relatives were involved in the planning of care and support.

People who used the service were safe as the provider managed the risks to their safety and provided staff with training and support to recognise and act on any potential abuse. Comments included, “It’s like a permanent holiday here. We’re not responsible for anything. People are gracious and nice”. A relative said, “It gives me peace of mind knowing that I could leave her here for a day or a week and I don’t worry, because the care is the same…. It’s absolutely fabulous here.”

There were sufficient staff available to ensure people’s wellbeing and safety. Appropriate recruitment and selection processes were in place which ensured new staff were suitable to work with people living in the service.

Accidents and incidents were audited to identify any trends or re-occurrences. The service worked in partnership with other professionals and had been responsive in referring people to other services when there were concerns about their health.

The home was clean and free from odours throughout. Maintenance checks were regularly completed on the building and equipment.

People’s right to make decisions about their care was respected and those people, who lacked capacity to make their own decisions, had been appropriately supported under the principles of the Mental Capacity Act 2005.

People enjoyed the food and were supported to maintain a healthy diet and fluid intake. Staff were aware of peoples’ dietary needs and preferences.

A variety of opportunities were provided for people to enable them to enjoy meaningful social interaction and reduce potential risks of social isolation.

The registered manager and provider were approachable. Clear information about how to make a complaint was available for people. People, their relatives and staff felt any concerns would be taken seriously and acted on.

The provider had quality assurance processes in place, which helped to maintain standards and drive improvement. People who lived at the service, relatives, professionals and staff said the service was well managed. Staff were aware of their roles and responsibilities and were well supported.

Oaklands is a care home which offers care and support for up to 25 predominantly older people. At the time of the inspection there were 23 people living at the service. Some of these people were living with dementia. The service uses a detatched house over two floors with a stair lift to provide access to the upper floor.

Systems for the management and administration of medicines were not robust. We found it was not always possible to establish if people had received their medicine as prescribed. There were many gaps in the Medicine Administration Record (MAR) where it could not be established if doses of prescribed medicines had been given. We checked these gaps in the blister packs and found some medicine doses had been given, but not signed for. Tablets remained in the blister packs for some people but the MAR had been signed to indicate the medicine had been given. Entries on the MAR recorded that a person was asleep and their medicine was not given. Two people had not been given five doses of their prescribed medicines over a period of two weeks either due to being asleep , refusing or having been missed by staff. One person had their pain relieving patch changed 24 hours later than indicated on the MAR. The service was not carrying out regular audits of their medicine records and had not identified the errors found at this inspection.

The premises were regularly checked and maintained. However, a recent Food Standards Agency had given the kitchen at the service only a one star rating. This was due to the kitchen needing immediate necessary work to meet the standards required. The provider showed us the plans for the new kitchen installation which was due to start in the next few weeks.

We walked around the service which was comfortable and personalised to reflect people’s individual tastes. People were treated with kindness, compassion and respect.

Staff were supported by a system of induction training, supervision and appraisals. The service had addressed the concern found at the last inspection. Staff t records clearly stated when each member of staff had begun their induction. Staff files contained all the necessary checks such as references and Disclosure and Barring service checks.

People were supported by staff who knew how to recognise abuse and how to respond to concerns. Staff received training relevant for their role and there were good opportunities for on-going training and support and development. More specialised training specific to the needs of people using the service was being provided such as skin care and diabetes care. Staff meetings were held regularly. These allowed staff to air any concerns or suggestions they had regarding the running of the service.

The service had identified the minimum numbers of staff required to meet people’s needs and these were being met. The service did not use any agency staff and covered any staff absence from existing staff resources.

People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. The principles of the Deprivation of Liberty Safeguards were understood and applied correctly.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy.

The service was in the process of changing the flooring to some bedrooms at the time of this inspection. There was some pictorial signage around the service which helped meet the needs of people living with dementia to orientate themselves.

Care plans had recently been transferred to an electronic system. This work was not entirely complete at the time of this inspection, and the paper files were still in use for some information. Care staff used hand held devices to record all care and support provided. Information on people’s care needs was well organised and contained accurate and up to date information. Care planning was reviewed regularly and people’s changing needs recorded. People, and where appropriate, relatives were included in the reviews. Risks in relation to people’s daily life were assessed and planned for to minimise the risk of harm.

People had access to meaningful activities. A member of the care staff took the lead in activity provision. They arranged regular events for people. These included visiting musicians, animals bought in to the service for people to enjoy and regular events that bought the local community and school children in to the service. There were many photographs throughout the service showing people enjoying various activities.

The registered manager was supported by the provider and a team of motivated staff. The staff team were happy and committed to constantly improving the service.

There was a breach of the regulations found at this inspection. You can see the action we have told the provider to take at the end of this report.

Is the service safe?

Is the service caring?

Is the service effective?

Is the service responsive?

Is the service well led?

This is a summary of what we found.

On the day of our inspection there were 24 people living at Oaklands, although two were in hospital. The summary is based on conversations with six people living at the service, two relatives, five staff, four visiting health or social care professionals, the registered manager and provider. We looked at records of people's care and quality monitoring systems used with the home. We also spent time observing how care and support was being delivered to people. Following the inspection we spoke with the community nurse team who make regular visits to the home.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found the service was safe because usually there were enough staff in place to meet people's identified needs. We did find some weekends were short by one staff member, but heard this was due to staff sickness rather than there not being enough staff rostered on. We have asked the providers to monitor this carefully as the manager and head of care were not usually on duty at the weekends, so there was no additional back up support except in an emergency, which could impact on timeliness of people's needs being met.

We saw care was being well planned and where people's needs had increased a GP or other healthcare professionals were consulted. One social care professional commented on how the service had improved it's record keeping to make sure people's weight and other aspects of their care were being closely monitored.

We found people were being cared for in an environment which was clean and safe. One person had raised an issue of the water in an ensuite sink being too hot. The provider was addressing this. There were quality monitoring checks made to ensure the environment and equipment were fit for purpose.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Whilst no applications have needed to be submitted, we heard from the manager how she had referred some people for assessment of this safeguard. We also heard from staff about training they had completed or were booked on which covered how these safeguards applied to people to protect their rights.

Is the service effective.

The service was effective. People who were able to give their views about their experience said they were happy at the home. Comments included ''We are very well looked after''. Another person told us ''I would prefer to be in my own home, but this is not a bad place, the staff look after us well.''

When we spoke with staff, they were able to show an good understanding of people's needs and preferred routines. Our observations of how care and support was being delivered supported this. This showed the staff had the right knowledge and skills to provide effective care and support to people.

Is the service caring?

The service was caring. We saw people were supported by staff in a kind and respectful way. For example, when one person expressed dissatisfaction with their lunch option, the care staff showed patience and brought in other options for them to consider. We saw staff worked with people at a pace which suited their needs, for example when supporting people to move safely from the lounge to the dining area. A visiting relative told us ''I visited most days and know the staff are very good here.''

Is the service responsive?

We saw the service was responsive. People's needs had been assessed before moving into the home and their care plan was reviewed regularly to ensure all needs were being monitored and met. Plans included key questions about people's life history as well as their known likes and dislikes. This helped staff to deliver care in a more person centred way.

We saw some activities were organised such as therapy dog visiting, music and local school children visits. We heard other activities were usually carried out in the afternoons, including bingo, quizzes and hand massages. This showed the service were responding to people's emotional well-being.

Is the service well-led?

We found the service was being well-led. We heard from staff how they were having regular staff meetings as well as one to one supervisions about tehir work. Staff we spoke with felt their opinion was listened to. People who lived at the home told us they could talk over any concerns with staff. We also saw people and their families had been asked to complete questionnaires about all aspects of their care. The provider has not yet collated all the results, but planned to do this and action any suggestions. They also planned to ask people living at the home, and their relatives for suggestions about how they could improve their menu choices. This showed the provider used people's views to improve the quality of the service provided.

We looked at the care plan records and daily notes of four people. We spoke with five staff and we observed people having their lunch. We spoke to two people who were at risk of being nutritionally compromised and had lost weight, but who were able to give us a clear picture of their experiences of living at Oaklands and explain what staff had been doing to help them improve their appetite. We heard the service had introduced new menus with more choice. This included providing fresh fruit snacks and smoothies for afternoon snacks. One person said ''They are always offering me food and drinks, they really take care of me.''

We saw records of people's food and fluid intake had improved and where people were at risk of poor nutritional intake, referrals had been made to their GP. This meant people were protected by accurate records.

We spent time talking to people at the home, we also observed care and support being delivered. People who were able to give a view about their experience of living at Oaklands were positive about the care and support provided. Comments included ''I have no complaints, staff are all very good, otherwise I would tell you.'' ''Oh yes, it's very good here, the staff are all lovely, but I still want to go home.'' We observed care and support being provided in a kind and respectful way. One visiting relative told us they had no concerns about the care of their relative.

We saw that whilst care and support had been well planned, the risk assessment for good nutritional intake had not always triggered the need to monitor food and fluid intake more closely, and we have said this needs to improve. Menus were being revised to include more fresh fruit and other options for main meals.

Staff told us they were well trained and supported and they demonstrated they understood the needs and wishes of people they cared for. Staffing levels were sufficient for the number and needs of the people who lived at the home, but need to be kept under review to reflect the dependency levels of people at the home as these change.