Oakleigh provides care and accommodation for up to 50 people who are elderly and are living with dementia. The home, which is set over three floors, is divided into five units; each unit has their own lounge and dining area. Each unit accommodates approximately ten people. On the day of our inspection 46 people were living in the home.
The inspection took place over three days on 23 & 29 January and the 2 February and was unannounced.
The home is run by a registered manager, who was present on the day of the inspection visit. 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 and associated Regulations about how the service is run.
People had different levels of understanding and communication in relation to their Dementia. Staff did not show a level of understanding that people living with dementia have specialist needs. We heard staff talking to people with advanced dementia in a non-dignified way using comments such as, “Good girl.”
Staff did not have written information about risks to people and how to manage these in order to keep people safe. One person had fallen on several occasions and their risk assessment had not been updated since May 2014 to show the persons increased falls, or identified that the person may need to be referred to the falls team. Another person had been diagnosed with epilepsy, but their care plan did not describe guidance to staff on how to manage the risks of this person having a seizure. Risk assessments and care plans did not reflect the individual need of the person and how their dementia and physical needs affected their daily life.
Staff had received training in safeguarding adults and were able to evidence to us they knew the procedures to follow should they have any concerns. One staff said they would report any concerns to the registered manager. They knew of types of abuse and where to find contact numbers and knew about the local safeguarding team.
Staff did not have the specialist training they needed in order to keep up to date with caring for people who live with dementia and responding to their physical health needs. For example; one person with dementia was also registered blind; staff did not understand how to effectively communicate with the person to give a choice and reduce the person’s anxieties.
Staff had not received regular supervision or appraisals. One staff member said; “One staff said they had monthly staff meetings and unit meetings on an ad-hoc basis.”
We identified a need for additional members of staff to be on duty as there were times when we found no staff available to assist people or keep them safe for example from the risks of falls, or to support someone if they became distressed. One visiting healthcare professional said they had noticed the home was sometimes very short staffed, more so at the weekends. Sometimes they arrived to find people not up and dressed. When they asked staff about one person, they were told the person didn’t have visitors at the weekend which made the healthcare professional feel staff prioritised who they got ready first.
Although people told us they were happy living at Oakleigh, we did not observe staff consistently respecting people and treating them as individual’s, focusing on their needs, abilities and achievements. We heard staff ask people constantly about task focused activities e.g. “Would you like a cup of tea, its lunchtime now, come and have your dinner.” We did not observe staff sit and talk to people about their life, how they felt or what they wanted to achieve throughout the day.
Staff did not show an understanding of what people were interested in and what people could still do. We saw some people sitting for long periods of time without supportive interaction from staff. Supportive interactions are relationships and communications that we have with people that are affirming and help promote a person’s sense of self-worth. Best practice guidance shows one-on-one time is very important to having supportive and emotionally worthwhile social interactions.
Activities were limited to people who had capacity to become involved. We did not see any specific activities or pastimes which would be suitable or appropriate to people living with dementia. One staff said there were not enough activities, “They are arranged but never really see them happen.”
The registered manager had taken immediate action to address issues and staff awareness of people’s specific dietary needs, following concerns about the support people needed to eat and drink in relation to special diets such as softened food. However not all people’s care plans correctly identified the support they required for eating and drinking. We observed lunch which was a choice of two main courses and desserts and it looked and smelt appetising.
People were referred to external health professionals when they needed extra support. One person said; “We get visits from a chiropodist and other professionals.”
Care plans did not reflect people’s current needs or individualised choices. They had not been reviewed on a regular basis. One person file stated the mobility assessment and Malnutrition Universal Screening Tool (MUST) were completed 28 January 2015, however, the Waterlow assessment (an assessment that identifies the risk to the person of developing a pressure wound), skin integrity and personal care plan were blank.
Some people were involved with their own plan of care. One person said; “They are very busy but they do speak to me about my care needs.” Other people who lacked capacity had not been involved in their care planning process.
Medicine procedures for the safe administration of medicines were not consistently in place. However we could not identify consistent best practice for the administration and recording of topical creams. Records demonstrating they were applied as prescribed were not up to date.
The legal framework around the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) had not been followed. Staff understood the requirements of the Act and how it affected their work on a day to day basis. One staff said, “MCA and DoLS is when people don’t have the capacity to make choices.” However the registered manager had not completed the necessary MCA two-stage assessment or applications to the local authority as required by the DoLS. This meant people without capacity had not been supported in agreeing to choices made about their care. People at the home were being restricted from leaving and in aspects of their care.
The registered manager did not have a satisfactory system of auditing in place to regularly assess and monitor the quality of the service or manage risks to people in carrying out the regulated activity. We found the registered manager had not assessed incidents and accidents including falls, staff recruitment practices, care and support documentation, and decided if any actions were required to make sure improvements to practice were being made.
Confidential and procedural documents were not stored safely or updated in a timely manner. We saw copies of the homes contingency and emergency plan and the registered manager was able to explain the process in the event of an emergency.
People’s views were obtained by holding residents meetings and sending out an annual satisfaction survey.
The registered manager showed us the complaints log which detailed concerns raised by people or their relative. We saw that the manager had responded to people’s complaints and implemented actions, where necessary. One person said; “I’ve never complained but would do so” and “They would sort out a problem.”
People felt the management of the home was approachable; One person said “X is the manager and seems to be OK, I see them sometimes” and “They seem to manage the home well.” Staff generally said they felt supported; however felt the registered manager could be more visible on a day to day basis. Comments from staff included; “We don’t see the registered manager much, they spend a lot of time in their office.” And “The registered manager spends a lot of time in the office. Occasionally we see the area manager. Generally I feel supported by management.”
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which correspond to regulations of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.