Archived: The Oaks Private Residential Home

This was an unannounced inspection that took place on 16 November 2016. There were 20 people using the service at the time of the inspection.

There was a registered manager in post at the time of the inspection. 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.

At the inspection on 12 April 2016 we found nine breaches of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to: safe care and treatment, person centred care, safeguarding service users from abuse and improper treatment, privacy and dignity, meeting nutritional and hydration needs, premises and equipment, complaints, good governance and staffing. The home was rated as ‘Inadequate’ overall and in four of the five domains inspected. As a result of our findings the home was placed in special measures which meant they would be kept under review.

At our inspection on 16 November 2016 we found that significant improvements had been made and that the breaches from the previous inspection had been actioned and addressed.

The recruitment process was satisfactory to help ensure suitable staff were employed at the service.

Appropriate policies were in place with regard to safeguarding and whistle blowing. Staff had received training in safeguarding and those we spoke with were aware of the issues and confident of the reporting procedure.

The induction programme helped ensure new employees were equipped with the skills, knowledge and competence to work at the home. Training was on-going and mandatory training was refreshed regularly.

People’s nutritional and hydration needs were assessed and recorded appropriately. Special diets were adhered to by the chef and people were given choice with regard to meals.

People we spoke with felt the care was good and staff were kind and caring. We observed good interactions between staff and people who used the service throughout the day. People who used the service and their families were involved in discussions about the delivery of their care. Staff respected people’s dignity and privacy.

People who were nearing the end of their lives were cared for, as far as possible, in accordance with their wishes.

Care files we looked at evidenced that care was delivered in a person centred way, taking into account people’s preferences, likes and dislikes. People we spoke with said staff responded quickly to call alarms.

There was a programme of activities at the home and people were encouraged to participate if wish to. Someone to one interaction were undertaken with people who were unable to participate in group activities. A residents/relative committee had been formed to help plan and delivery activities.

The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA). Deprivation of Liberty Safeguards (DoLS) authorisations were in place where required and staff were aware of the implications of these.

Medication systems were robust and medicines were managed safely at the service.

Individual and general risk assessments were in place. Equipment was fit for purpose and was regularly serviced and maintained to ensure it was in good working order.

There was an appropriate complaints policy and this was displayed throughout the home. Concerns were responded to in a timely and appropriate manner and the service had received a number of compliments and thank you cards.

People told us the staff and management were approachable. Staff felt the manager was supportive towards them. Staff were receiving staff supervisions.

We saw evidence of regular checks and audits that took place at the service to help ensure continual improvement with regard to care delivery.

This was an unannounced inspection that took place on 12 April 2016. There were 25 people using the service at the time of the inspection. We last inspected the home on 24 July 2014 and found the service was meeting four of the five regulations that we reviewed. One of the regulations relating to cleanliness and infection control was not met. We revisited the home on 02 March 2015 and found this regulation had now been met.

At the inspection on 12 April 2016 we found ten breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to: safe care and treatment, person centred care, safeguarding service users from abuse and improper treatment, privacy and dignity, meeting nutritional and hydration needs, premises and equipment, complaints, good governance and staffing

There was a registered manager in post at the time of the inspection. 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.

On arrival at the home, the senior in charge to the shift was unsure of the numbers of people living in the home.

Staff spoken with did not have a clear understanding of the whistle-blowing procedures and were unsure of what to do if they if they suspected any abuse or neglect of people who used the service.

We found that people were not cared for by sufficient numbers of suitably skilled and experienced staff. Staff had not undertaken up to date training and support to enable them to do their job effectively and care for people safely.

We observed that people’s dignity was not always respected.

We found the systems for managing medicines were unsafe and that people were not receiving their medicines in a timely manner as prescribed. For some people the risk identified placed them at risk of significant harm.

The care records were not person- centred and did not contain sufficient information to guide staff on the care and support that people required. We found gaps in the care files where reviews should have been completed.

The service was not meeting the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). People were not supported to make choices and decisions.

Systems used to monitor training and the delivery of supervisions were out of date. The training matrix showed that there were gaps in mandatory training. New staff had not completed a staff induction programme as required.

Staffing levels were not satisfactory to meet the needs and preferences of people who used the service. Staffing levels were defined by the number of people living in the home and not by the levels of dependency.

People who used the service were not provided with adequate nutrition and hydration to meet their needs. The chef had no menus to work with and meals were planned around what food was available in home. The timing of meals should be reviewed as all the people who used the service were offered breakfast at 10.00. This meant that people who were early risers had to wait for their breakfast.

We saw that the activities were limited and the activity coordinator was deployed to other caring tasks.

Not all areas of the home were clean and well maintained. We observed areas of poor infection control and a lack staff hygiene which could increase the risk of cross infection to people who used the service.

Systems were not in place to effectively assess and monitor the quality of the service provided.

Relatives spoken with were happy with the care and support their relatives received.

We look at staff recruitment files and found these to be satisfactory. Appropriate checks were in place to help ensure that staff were suitable to work with vulnerable people.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin

the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

We are considering our enforcement actions in relation to the regulatory breaches identified. We will report further when any enforcement action is concluded.

After our inspection of 23 July the provider wrote to us to say what they would do to meet legal requirements and improve practice in relation to infection control procedures. We undertook an unannounced focused inspection on 2 March 2015 to check that they had followed their plan and to confirm they now met legal requirements.

We found that the provider had followed their plan and that staff were aware of how to minimise the risk of cross infection to people who lived at the home. They were able to demonstrate that guidance in relation to substances hazardous to health was being followed and that internal audits of cleaning across the home were being completed by the manager. This meant the home was compliant with essential standards.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found-

Is the service safe?

During our inspection, we saw the environment was clean and safe. However, we found examples of poor practice related to infection control procedures. Several staff members were observed at lunch time serving food without wearing protective clothing. The cook did not wear protective clothing when preparing food for people who used the service. We observed several staff members who entered the kitchen without protective clothing. This was despite a clear sign being displayed on the kitchen door instructing people not to enter without putting protective clothing on first. This practice presented a clear risk to the health and safety of people who used the service.

Deprivation of Liberty Safeguards (DoLS) become important when a person is judged to lack the capacity to make an informed decision related to their care and treatment. The provider told us an application for a DoLS was made in May 2014. We found all the required paperwork had been completed appropriately and the Care Quality Commission (CQC) had been notified as required.

Is the service effective?

People who used the service had their care needs assessed with them. However, we did not see any signatures or consent forms for the provision of care within their care plans. This would have confirmed a person`s involvement in developing their individual care plans.

People`s mobility and other care needs were taken into account in relation to signage and building adaptation. This helped ensure people could move around the care home freely and safely.

Is the service caring?

We spent time in communal areas and saw staff caring for people in a patient and unhurried manner. We saw one person who used the service needed assistance eating their lunch and a staff member supported them at all times. This helped ensure the person received their nutritional requirement.

We spoke to three people who used the service and one told us, "This is the place to be. Brilliant." Another person told us, "I have no complaints at all. We are well looked after." One family member who was visiting told us, "You always get a nice welcome when you come in."

Is the service responsive?

Several people who used the service needed a visit from a medical practitioner. We saw and heard the manager contacting the respective professionals to make arrangements to attend the care home. This helped ensure the health and welfare of people.

A complaints procedure was in place at the care home which people were aware of. One person told us, "Yes. If I had any problems I know exactly who to see." A family member told us, "I know I could talk to any of the staff if there was anything wrong."

Is the service well-led?

We saw there were procedures in place that monitored the quality of care and support provided to people who used the service. Regular internal and external pharmacy checks were completed and there were bi-monthly audits of individual care plans.

We were told staff and resident meetings were not held on a regular basis. Satisfaction surveys were not routinely carried out for people to express their views on the quality of service. We were told staff supervisions were behind schedule. Staff appraisals had not been undertaken. This showed the provider did not systematically ensure people who used the service and staff members were provided with the opportunity to provide feedback. Consequently, their knowledge and experience had not been taken into account.

The people we spoke with told us that they were happy living at the home and that staff were helpful. One person told us 'The staff are all good. I get on well with them all.'

We inspected the home in January 2013 and again on two dates in May 2013. At these inspections we found that the service was not meeting the standards required relating to supporting workers. We found that people were at risk of unsafe or inappropriate care because staff had not received appropriate training, supervision and appraisal.

After our inspection in May 2013, the provider wrote to us and told us about the changes that had made and those that they were planning to make. When we visited in July 2013, we found that many improvements had been made and the provider was now meeting this standard. The staff we spoke with told us that they felt supported in their role and had no concerns the way that they were managed. The people living at the home told us that they had no concerns about the staff or their care at the home. One person told us 'staff are belting (good).' Another person said 'I get on well with the staff. They always seem organised and know what they are doing.'

Since our last inspection we found that improvements had been made with record keeping and maintenance issues. At this inspection we looked at the care and welfare of people using the service; the protection of vulnerable adults; the management of medicines; staffing levels and quality monitoring systems. We found that the service was meeting these standards.

We also looked at the recruitment process in place and found that it did not sufficiently protect people using the service.

At our inspection in January we found that there were not appropriate arrangements in place to ensure that all staff were appropriately trained and supervised. At this inspection we found that the required standard was still not being met. We have asked the provider to take action about this.

We issued compliance actions regarding the concerns regarding the safety and suitability if the premises; staff support and training and the completion of people's records. We generally use compliance actions in response to breaches of the regulations with a minor impact on people, or where the impact is moderate but it's happened for the first time. An additional inspection will take place to follow up on the compliance actions that were issued for these three outcomes.

We found that the issues we highlighted within the warning notice had been addressed. We met with the provider to obtain further assurance that he would keep an overview of the quality of the service provided in order that the recent improvements were continued and were maintained. We found our discussions were positive and we were provided with appropriate assurance.

We found that people living at the home had been asked for their feedback on the quality of the service. Comments included 'Staff are always very helpful' and 'Lighting is poor in the car park. We would welcome spotlights with sensors.'

We were concerned about maintenance within the home. For example there was a wrinkled carpet on a staircase landing; there was stained flooring; there were gaps between flooring and skirting boards in bathrooms and toilets and a loose banister rail.

The staff members we spoke with were happy working there. When we checked records we were concerned that there were important areas where a significant number of staff had not received training.

We found that there was a lack of quality monitoring within the home. Actions taken as a result of accident and incident monitoring were not formally recorded and this made it difficult for us to confirm that appropriate actions had been taken and completed.

We checked four sets of care records and found that information was not always recorded in sufficient detail and they were not always updated in a timely manner.