Oaklands

Oaklands care home is a residential care home providing personal and nursing care to up to 53 people aged 65 and over. At the time of the inspection there were 31 people living at the service.

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

When we last visited the service in January 2020, we met a new registered manager. However, when we returned in December 2020, the previous registered manager had left shortly after our inspection, and we were welcomed by another new manager who was in the process of becoming registered with the Commission.

Although the manager had made positive changes since their arrival, these improvements need to be sustained to demonstrate management stability across the service. The feedback we received during our inspection combined a positive view of the new manager, with an anxiety that they would leave.

The manager had started to address the concerns we had raised at our last inspection. They had a practical, person-centred approach which was making a difference to the care people received. Feedback was particularly positive about how well and openly the registered manager was communicating with people, families and staff.

We found care was well-planned and staff minimised risks to people’s safety. The administration of medicines had improved. The care of people at risk of pressures sores had improved.

There were enough staff to keep people safe. The manager was working well with the staff team to improve staff turnover, morale and skills.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. The manager promoted a person-centred approach to managing restrictions resulting from the COVID-19 pandemic. They communicated well with people and families to explain restrictions.

Senior staff carried out regular checks on the quality of care and took action which directly improved care standards.

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

Rating at last inspection

The last rating for this service was inadequate (published 6 March 2020). The service has made improvements and is now rated as requires improvement.

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.

This service has been in Special Measures since May 2020 during this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

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 inadequate 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 Oaklands on our website at www.cqc.org.uk.

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 coronavirus and other infection outbreaks effectively.

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.

Oaklands provides accommodation and personal care for up to 53 older people, some of whom were living with dementia. At the time of our visit 41 people were using the service.

What life is like for people using this service:

We carried out this inspection in response to concerns about people’s health, safety and welfare. At this visit we identified shortfalls that placed people at risk of harm.

Medicines were not managed and administered safely. Where people were frequently asleep at the time of the medicines round, attempts were not always made to administer the medicines at a different time. Where people had missed their medicines for more than three consecutive days, the service had not always raised this with their GP to check whether there would be any adverse effects on their health.

Risks to people were not consistently identified, monitored and managed. For example, care plans did not contain sufficient information for staff to provide care to people. Instances where staff had not followed care plans were not identified and acted upon by the service. A healthcare professional raised concerns with us about the pressure care provided to people.

The quality assurance system in place to monitor the service provided to people had not consistently identified all the shortfalls we found at the inspection. Lessons had not been learned from a previous incident. This meant that action had not been taken to protect people from the risk of potential harm.

People who live at Oaklands have their needs met by sufficient numbers of staff. The service was clean and appropriate infection control procedures were in place.

Following our inspection, we wrote to the service asking them to provide us with information about how they would promptly address our concerns and protect people from harm. They provided information that assured us sufficient measures were in place to protect people whilst improvements could be made.

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):

At the last inspection the service was rated Good. (Report published 26 October 2018)

Why we inspected:

The inspection was prompted in part by notification of a specific incident. Following which a person died after moving from Oaklands to another care home. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about how the service managed and minimised the risk of people developing a pressure ulcer. This inspection examined those risks.

In addition to the above, we received concerns in relation to the care provided to keep people safe and in relation to safe medicines administration. As a result, we undertook a focused inspection 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. This is based on the findings at this inspection.

We found evidence during this inspection that supported the concerns raised with us prior to inspection. Please see the Safe and Well-Led sections of this full report.

Follow up:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Since our last inspection in December 2016, there has been a change of registered manager, however, the people who lived in the service told us that they continued to feel safe and well cared for. There were systems in place which provided guidance for care staff on how to safeguard the people who used the service from the potential risk of abuse. Staff understood their roles and responsibilities in keeping people safe. Risk assessments were still in place to identify how the risks to people were minimised. There continued to be sufficient numbers of trained and well supported staff to keep people safe and to meet their needs. Where people required assistance to take their medicines there were arrangements in place to provide this support.

Both the registered manager and the staff understood their obligations under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The manager knew how to make a referral if required. Meaning that people living in the home were still being supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People’s needs were assessed and the service continued to support people to eat and drink enough to maintain a balanced diet. They were also supported to maintain good health and to have access healthcare services.

We saw many examples of positive and caring interactions between the staff and people living in the service. People were able to express their views and staff listened to what they said and took action to ensure their decisions were acted on. Staff continued to protect people’s privacy and dignity.

People received care that was personalised and responsive to their needs. The service still listened to people’s experiences, concerns and complaints. Staff took steps to investigate complaints and to make any changes needed. People were supported at the end of their lives to have a comfortable, dignified and pain free death.

The registered manager told us that they had been well supported by the organisation while they settled into their position. The people using the service and the staff they managed told us that the registered manager was open, supportive and had good management skills. There were still good systems in place to monitor the quality of service the organisation offered people to ensure it continued to meet their needs.

Further information is in the detailed findings below

The home has had the current registered manager in post since March 2015. A new manager had been appointed as the current registered manager was due to leave the position in the near future. 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.

Staff were aware of safeguarding people from the risk of abuse and they knew how to report concerns to the relevant agencies. They assessed individual risks to people and took action to reduce or remove them. There was adequate servicing and maintenance checks to fire equipment and systems in the home to ensure people’s safety.

People felt safe living at the home and staff supported them in a way that they preferred. There were enough staff available to meet people’s needs and the registered manager took action to obtain additional staff when there were sudden shortages. Recruitment checks for new staff members had been made before new staff members started work to make sure they were safe to work within care.

People received their medicines when they needed them, and staff members who administered medicines had been trained to do this safely. Staff members received other training, which provided them with the skills and knowledge to carry out their roles. Staff received adequate support from the registered manager and senior staff, which they found helpful.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The home was meeting the requirements of DoLS. The registered manager had acted on the requirements of the safeguards to ensure that people were protected. Where someone lacked capacity to make their own decisions, the staff were making these for them in their best interests.

People enjoyed their meals and were able to choose what they ate and drank. They received enough food and drink to meet their needs. Staff members contacted health professionals to make sure people received advice and treatment quickly if needed.

Staff were caring, kind, respectful and courteous. Staff members knew people well, what they liked and how they wanted to be treated. They responded to people’s needs well and support was always available. Care plans contained enough information to support individual people with their needs. People were happy living at the home and staff supported them to be as independent as possible.

A complaints procedure was available and people knew how to and who to go to, to make a complaint. The registered manager was supportive and approachable, and people or other staff members could speak with them at any time.

Good leadership was in place and the registered manager and provider monitored care and other records to assess the risks to people and ensure that these were reduced as much as possible and to improve the quality of the care provided.

As part of this inspection we spoke with five people who used the service and spoke with five family members of people who used the service. There was no registered manager in post so we spoke to the person who was manager pending their registration with us. We also spoke with four other members of staff and the provider's operations manager. We carried out observations of people's care, and reviewed records relating to the management of the service. This included four people's care plans, daily records, some staff records and quality assurance monitoring records.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you wish to see the evidence supporting the summary, please read the full report.

Is it safe?

At the time of our inspection there were insufficient staff to meet people's needs safely and to deliver care which properly matched people's needs. Some staff deployed from housekeeping to caring tasks were not properly trained for the caring role. Staff, visitors and a person who was able to express themselves clearly told us they were concerned there were insufficient staff.

We found that records did not accurately reflect the support people received and, in one case, had omitted significant events affecting the person's safety and wellbeing.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to staffing and record keeping.

The home had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The service had support of regional management for dementia care services who could provide support and advice if restrictions on someone's freedom might be needed for their safety.

Is it effective?

People's health and care needs were assessed, including screening for risks associated with poor nutrition, vulnerability of pressure areas and associated with dementia. However, the care needed to minimise the risks to people was sometimes compromised.

Staff were not appropriately supported to deliver care to people. There was a lack of access to supervision and appraisal to discuss staff roles and development needs. There were gaps in training to ensure staff were up to date in the skills needed to support people effectively.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to supporting staff and the care and welfare of people living in the home.

Is it caring?

People who were able to tell us, said that they felt staff treated them well. One person said, 'They don't lose their temper with people. I couldn't do their job.' However, staff told us they did not always have the time to deliver care to meet needs such as for hair care and nail care. We also observed that staff did not always engage and communicate with people effectively.

Is the service responsive?

We found that people were referred for advice from other health professionals where this was necessary. One person told us that, "They [staff] always get a doctor if I'm not well." We also found that the sample of care plans we examined had been reviewed and updated where necessary so that they reflected people's changing needs.

Is the service well led?

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because their application to cancel their registration had not been completed at the time of our inspection.

The service had a quality monitoring system in place but it was not implemented as the provider intended so that improvements could be made. This shortfall had not been identified. Staff and visitors to the service did not feel that their concerns and comments were always addressed and taken into account in making improvements.

There were checks in place to ensure that the risks to people visiting, living in and working at the home were managed - for example in relation to fire safety and testing for Legionella.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing and monitoring the quality of the service.

One person told us that, "I like living here, it's very nice and I have everything I need." They went on to say that the care staff, "Always ask me if I am Ok and make sure that I don't need anything." Another person we spoke with told us that, "We always have a choice of food, at breakfast dinner and tea time."

People we spoke with told us that the care and support was good and that there were a variety of activities available for them during the day.

Detailed care plans showed staff what the needs of the people who used the service were and how they could be met. However, the recording of how those needs were met was not always consistent.

Staff records showed that recruitment procedures were in place to ensure that people were looked after by staff who had the necessary skills and background and other records we examined were accurate and well maintained.