5 August 2021
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
The inspection was carried out by three inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Tall Oaks Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. The registered manager was not available on the day of our inspection, but the inspection was supported by the deputy manager and members of the provider’s senior leadership team.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During the inspection
We spoke with eight people who used the service and 15 relatives about their experience of the care provided. We spoke with 11 members of staff including the regional support manager, the deputy manager, a care home assistant practitioner, a nurse, care workers and the chef. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
We reviewed a range of records. This included eight people’s care records and multiple medicines records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.
5 August 2021
About the service
Tall Oaks Care Home is a residential care home providing personal and nursing care for 43 people at the time of the inspection. Tall Oaks Care Home can accommodate up to 55 people aged 65 and over across two floors.
People’s experience of using this service and what we found
People’s risks were not always managed safely. Plans in place for people who required support with their nutritional needs were not always monitored, which put people at risk of malnutrition and dehydration.
Lessons were not always learnt, and quality assurance systems were not always effective in identifying the shortfalls in people’s care records. Although people had been referred to other professionals, these were not followed up, which prolonged ineffective care for people.
The majority of 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.
Not all staff had undergone the necessary training, which put people at risk. There were sufficient numbers of staff to meet people’s needs.
The management of medicines had improved since last inspection. However, people had access to fluid thickening powders which could cause harm if ingested.
Infection and prevention control practices were in place and in large were effective in reducing the risk of the spread of infection.
Relatives told us they felt their loved ones were safe and were kept informed of their changing needs by staff who had been safely recruited.
There was a positive culture in the home and staff felt they were supported.
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 25 November 2019) and there was a breach of regulation. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.
The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection although we found improvements had had been made in relation to the management of medicines, the provider remained in breach of regulations.
Why we inspected
We received concerns in relation to people not receiving adequate care and support. As a result, we undertook a focused inspection to review the key questions of safe, effective 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.
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 not changed from 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, effective 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.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Tall Oaks Care Home on our website at www.cqc.org.uk.
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.
We have identified breaches in relation to Regulation 12 (safe care and treatment) and Regulation 17 (governance) at this inspection. Please see the action we have told the provider to take at the end of this report. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.