Archived: Oakhill House Care Home

Oakhill House Nursing Home provides accommodation for forty-nine older people, living with dementia, who need support with their nursing and personal care needs. On the day of our inspection there were forty-five people living at the home. The home is a large property, spread over two floors, situated in Horsham. There are four communal lounges, two dining rooms and well maintained gardens.

The service had not had a registered manager for six months. 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 had been in post since August 2015.

People’s consent was gained before being supported to take their medicine. There were safe systems in place for the administration of medicines and records showed that people had received these on time. However, there were concerns regarding the procedures for covert medicine administration and the storage and disposal of some medicines. This is an area of concern.

People were supported to maintain their nutrition and hydration. People felt that they had enough food and drink and observations confirmed that drinks and snacks were offered throughout the day. People could choose what they had to eat and drink and felt that the food was good. For people at risk of malnutrition, appropriate measures had been implemented to ensure they received drink supplements. Foods were fortified with cream, milk and cheese to increase their calorie intake.

However, people’s dining experiences varied. Staff supported most people to have a positive dining experience. They were supported in a sensitive and respectful way according to their needs. However, for a minority of people, their dining experience was poor. There was limited interaction from staff and people were not supported to eat and drink in a way that was conducive to them maintaining adequate nutrition and hydration. This is an area in need of improvement.

There were sufficient numbers of staff to ensure people’s needs were met and their safety maintained. Staff had received induction training and had access to ongoing training to ensure their knowledge was current and that they had the relevant skills to meet people’s needs. People were safeguarded from harm. Staff had received training in safeguarding adults at risk, they were aware of the policies and procedures in place in relation to safeguarding and knew how to raise concerns. People felt safe, one person told us “If I wasn’t safe here I wouldn’t tolerate it.”

Risk assessments had been undertaken and were regularly reviewed. They considered people’s physical and clinical needs as well as hazards in the environment and provided guidance to staff. Observations confirmed that staff were aware of risk assessments and supported people in accordance with them. People were encouraged and enabled to take positive risks. People’s independence was not restricted through risk assessments. Observations of people assessed as being at risk of falls showed them to be independently walking around the home. There were low incidences of accidents and incidents, those that had occurred had been recorded and were used to inform practice.

People were asked their consent before being supported with anything. Mental capacity assessments had been undertaken to ensure that for people who lacked capacity appropriate measures had been taken to ensure best interest decisions were made on their behalf.

People had access to relevant health professionals to maintain good health. Records confirmed that external health professionals had been consulted to ensure that they were being provided with safe and effective care. People’s clinical needs were assessed and met. People received good health care to maintain their health and well-being.

People were cared for by staff who knew them and understood their needs and preferences. People told us that they felt well cared for. One person told us “They’re brilliant, so helpful, I can’t fault it.”

People were involved in their care and decisions that related to this. People and relatives were asked their preferences when people first moved into the home. They were provided with an opportunity to share their concerns and make comments about the care they received. Relatives confirmed that they were involved in their loved ones care, felt welcomed when they visited the home and knew who to go to if they had any concerns. The provider welcomed feedback and was continually acting on feedback to drive improvements within the home.

People were treated with dignity and their rights and choices were respected. Observations showed people being treated in a respectful and kind manner. People’s privacy was maintained, when staff offered assistance to people they did this in a discreet and sensitive way. People confirmed that they were treated with dignity and their privacy was maintained.

Staff knew people’s preferences and support was provided to meet people’s needs, preferences and interests. There was a variety of activities that people appeared to enjoy. People were able to make suggestions as to how they wanted to spend their time and these were listened to and acted upon.

There was a homely, friendly and relaxed atmosphere within the home. People were complementary about the leadership and management of the home and observations confirmed that the vision and ethos of the home was embedded in staff’s practice. Staff felt supported by the manager and were able to develop in their roles. There were rigorous quality assurance processes in place that were carried out by the manager and provider to ensure that the quality of care provided, as well as the environment itself, was meeting people’s needs.

We found a breach 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 the report.

This summary is based on our observations during the inspection, discussions with 11 people, six relatives, the deputy manager, two nurses, three senior carers, one carer, the activities coordinator and the chef on duty. The manager was not present on the day of our visit. We also reviewed records relating to the management of the service and four people's care and health records. As some people could not talk with us about their experiences of living at the service we spent time observing how they were cared for and treated by staff. We observed interactions between staff and people who lived at the service for three hours during the morning and lunchtime period.

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

Is the service safe?

There were enough suitably qualified and experienced staff on duty to meet people's needs. Staff that we spoke with told us that there were enough staff and that they were able to spend social time with people. We observed that staff responded quickly to meet people's needs and ensure their safety.

People's care records were up to date and reviewed on a monthly basis. In general records were accurate and fit for purpose. Where we noted omissions these were quickly rectified.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Since our last visit one application had been made. The deputy manager demonstrated knowledge of their responsibilities in respect of this.

Is the service effective?

We found that people's care plans were detailed and that they had been reviewed on at least a monthly basis. This ensured that the care provided was in line with their individual needs and preferences. One relative told us, 'I'm very happy with everything, the staff are all excellent'.

As many of the people living at the service were unable to speak directly of their experience, we spent time observing the care and support that they received. Staff demonstrated skill and experience when supporting people. People that we spoke with told us, 'I'm very happy here' and 'The staff are all lovely, they help you'.

People were supported to eat and drink enough to meet their needs. There was a varied menu and the service had clear information on people's dietary preferences. We observed that people were given time to enjoy their food. Where people were at risk of malnutrition, the service had clear procedures in place to ensure that action was taken. This included referrals to other healthcare professionals such as the GP or Speech and Language Therapist.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were patient and gave encouragement when supporting people. We spoke with 11 people. They were all satisfied with the care that they received. They told us they were able to do things at their own pace and were not rushed. Our observations confirmed this. One person told us, 'It's very nice and the people are very nice'. A member of staff said, 'I just see them as my Mum'. Relatives shared, 'The residents are treated as people who matter' and, 'The carers are angels, all kind without exception'.

Is the service responsive?

People told us that they were able to raise suggestions or concerns and that they were regularly consulted about changes in the service. Relatives told us that they were kept informed and updated if there were any issues or concerns regarding the health of their family member. One relative said, 'When I asked a question about whether X had had a specific treatment, they were able to confirm straightaway that this had been done'. We found that the service listened and responded to questions and feedback received from people, their representatives and from staff.

Is the service well-led?

Since our last visit improvements had been made in the way the service reviewed people's care needs. We found that people's needs were assessed on a regular basis and that monitoring records were generally up to date.

Systems were in place to make sure that the manager and staff learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve.

We spoke with eight relatives. They too were satisfied with the care provided. One said, 'In his world he is very happy, this place is as near perfect as it can be'. Another told us, 'You can touch the compassion; they are so friendly and flexible'. There was a folder of compliments sent to the home. One read, 'I was always impressed by the calmness of the staff when I visited and the time they gave to the patients, often holding hands and giving them lovely smiles'.

We spoke with six members of staff. They spoke enthusiastically about their work in the home. One said, 'I love it'. Another told us, 'It's challenging and it is fun'.

Most of the people living at the home had dementia care needs, which meant they might have had difficulty describing their experiences of the service. We gathered evidence by spending time watching how people spent their time, the support they got from staff and whether or not they had positive experiences.

We found that the home was clean and bright and that people looked well cared for. Staff were welcoming and we saw that they supported people with kindness and respect. People's rights with regard to consent were being promoted by the service and staff understood how people's capacity should be considered. People told us that they could approach staff or the manager if they were unhappy or had ideas to discuss.

We found, however, that people's needs were not regularly assessed and that sometimes care and treatment was not delivered in line with their individual care plan. This placed them at risk of receiving care or treatment that was inappropriate or unsafe.

People were pre-assessed before admission to the home and the appropriate resources were identified and made available to meet their needs. We observed equipment designed that met people's needs were readily available.

During the visit we observed staff engaged in a warm and supportive manner to people. We observed that visitors enjoyed a warm relationship with staff.

A relative told us they were pleased by the numerous visual images and pictures that decorated the walls of the home. We observed photographs of people and staff out on outings in the community.

We found people were protected from the risk of abuse as staff were trained in safeguarding. Staff were knowledgeable and knew how to raise a safeguarding alert if there were concerns.

We found staff were trained in areas such as dementia which provided information for them to perform their roles safely.

The provider had a system in place to monitor and assess the quality of the service they delivered.

People at Oakhill were allowed to keep their pets when they moved into the home