Archived: Oakfield House

Oakfield House is a residential care home that accommodates up to 30 older people who maybe living with dementia. At the time of the inspection 24 people living at the service.

What life was like for people using the service:

People told us that they felt safe and that staff met their needs and preferences. People and relatives told us the registered manager was approachable and dealt with any concerns they had promptly. However, the registered manager had not acted to meet the breaches of regulation found at the last inspection. Checks and audits had not been completed to ensure the quality of the service and to make improvements. There continued to be shortfalls in the assessment of potential risks to people’s health and welfare. People and staff told us they had been kept informed by the registered manager of any changes but resident meetings had not been held so that they could give their opinion and make suggestions. The registered manager had not continued to work with other agencies to improve the service or attend forums to keep up to date.

Staff knew people’s needs and preferences, people told us staff supported them in the way they preferred. However, care plans did not always reflect the care given and people’s needs had not been assessed in accordance with national guidance. People could take part in activities they enjoyed, and were encouraged to be as independent as possible and make their own decisions.

Staff monitored people’s health and referred them to health professionals when required. Staff worked with health professionals to support people at the end of their lives. There were sufficient staff to meet people’s needs, who had been recruited safely and received appropriate training for their role.

The service was clean and odour free and had been adapted to meet people’s needs. People told us they received their medicines when they needed them. Staff knew how to report concerns and keep people safe.

More information is in the detailed findings below.

Rating at the last inspection:

Requires Improvement (report published 7 February 2018).

Why we inspected:

This was a planned inspection based on the rating at the last inspection. We found that the service continued to meet the characteristics of Requires Improvement, with the domains of well led now rated Inadequate. The overall rating is now Requires Improvement.

Follow up:

We will work with the provider following this report being published to understand and monitor how they will make changes to ensure the service improves their rating to at least Good.

Oakfield House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Oakfield House is registered to accommodate care and support for up to 30 older people. At the time of the inspection there were 24 people living at the service.

There was a registered manager in post. 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.

We last inspected the service on16 November 2016, the service was rated requires improvement, there were no breaches of regulations at this inspection. Therefore, the provider was not required to provide an action plan to show what they would do and by when to improve the key questions, safe, effective, responsive and well led to at least good. There were no risk assessments in place for potential risks to people’s health and welfare, the principles of the Mental Capacity Act 2005 (MCA) were not always followed. There were no effective audit and quality assurance processes in place. We carried out this inspection to check that improvements had been made. At this inspection we found improvements had not been made and there were two breaches of regulation.

At the last inspection, not all potential risks to people’s health and welfare had been assessed. At this inspection, there were some risk assessments in place; these did not contain detailed guidance for staff to follow to mitigate risks. Environmental risk assessments had been completed, however, the fire risk assessment was not up to date and measures to mitigate risk had not been actioned. We contacted Kent Fire and Rescue following the inspection. Not all checks on the environment had been completed in accordance to best practice, for example, water temperatures in people’s rooms, to reduce the risk of scalding.

People were not consistently protected against the risk of infection. Accidents and incidents had been recorded and action had been taken on an individual level. However, there was no overall analysis to identify patterns and trends and the action needed to reduce the risk of them happening again.

At our last inspection, there was not a comprehensive and effective audit system in place to identify shortfalls in the service and to drive improvement. At this inspection, the registered manager had not taken action and there had been no improvement. The registered manager had not recorded any audits to monitor the quality of the service and identify areas of improvement within the service.

Quality assurance surveys had been sent to people, relatives, staff and stakeholders such as district nurses, responses had been mainly positive. There had been no analysis of the results and no action had been taken to address any concerns. Staff confirmed that they attended staff meetings and were able to make suggestions. The minutes for these meetings had not been recorded and there was no record that the suggestions had been actioned.

It is a legal requirement that a provider’s latest CQC inspection report rating is displayed at the service where a rating has been given. This is so that people, visitors and those seeking information about the service can be informed of our judgments. We found the provider had not conspicuously displayed their rating in the service. The registered manager had not attended forums or engaged with outside agencies to keep their knowledge up to date and had been unaware that they needed to display the rating for the service.

Previously, the principles of the MCA had not always been followed. At this inspection, elements of the MCA were still not being followed. People’s capacity had been assessed in relation to the decision of where they wanted to live but not in relation to their ability to make day to day decisions. Staff confirmed that best interest decision discussions had taken place when making decisions about people’s health and welfare, however, these had not been recorded. Staff sought consent to support people and asked them how they wanted to spend their time or what they wanted to eat and drink.

The registered manager met with people before they moved into the service to check that the staff were able to meet the person’s needs. However, the assessments of people’s health care needs had not been completed in line with guidance. We recommend that the registered manager finds out about how to assess people’s needs in line with current guidance.

Each person had a care plan, but, these did not always contain detailed information about how people liked to be supported. Some information within the care plans was not consistent and there was a risk that staff who did not know the person would not be able to give support in the way the person preferred. People were not consistently asked about their end of life wishes, some people’s wishes had been recorded, but there was a risk that people would not receive care as they prefer.

Staff knew how to recognise signs of discrimination and abuse. They were confident that any concerns would be dealt with appropriately. The registered manager had reported incidents to the local safeguarding team when appropriate.

There were sufficient staff on duty, who had been recruited safely. Staff received one to one supervision. The registered manager had not prioritised training and not all staff had received essential training. However, staff had an understanding of their responsibilities and we observed staff support people safely. People received their medicines safely and when they needed them.

People were supported to eat and drink enough to maintain a balanced diet. Staff referred people to specialist health care professionals such as dieticians when required and followed the advice given. People had access to opticians and chiropodists as needed.

People had the opportunity to take part in activities of their choice. People told us they knew how to complain and that the registered manager dealt with any concerns they had. The registered manager had not recorded when they had dealt with concerns. This was an area for improvement.

People told us that staff treated them with kindness and respect. Staff supported people to be as independent as possible. People’s religious beliefs were recorded and supported by staff. Visitors were able to visit whenever they wanted and were always made to feel welcome.

There was an open and transparent culture within the service. The registered manager was known to people living at the service, people and relatives told us that they were approachable. Staff told us they felt supported by the management team and they could speak to them about any concerns they may have.

Oakfield House is a large converted house that has been adapted to meet the needs of people living at the service.

Services that provide health and social care to people are required to inform CQC of important events that happen in the service. CQC check that appropriate action had been taken. The registered manager had submitted notifications in an appropriate and timely manner and in line with guidance.

At this inspection two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. You can see what action we have asked the provider to take at the end of the report.

This comprehensive inspection took place on 16 November 2016 and was unannounced.

A registered manager was in post at the time of the inspection and had been registered since 2010 under the current legislation. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 knew how to keep people safe and who they could report any incident of harm to. People’s individual care needs were provided by a sufficient number of skilled and competent staff. An effective recruitment process was in place to ensure that staff were suitable to look after people who used the service. People’s medicines were not always stored in a secure manner. Not all risk assessments were in place. This put people at risk of harm.

People’s needs were met and supported by staff who knew the people they cared for well. People were supported to access health care services when required. Staff adhered to the advice healthcare professionals provided.

The CQC is required by law to monitor the Mental Capacity Act 2005 [MCA] and the Deprivation of Liberty Safeguards [DoLS] and to report on what we find. Where appropriate, people’s mental capacity had not been accurately determined. This meant that there was a risk of people being unlawfully deprived of their liberty. The registered Manager was aware of those organisations they needed to contact should any person require restrictions on their liberty. Staff had an awareness of the application of the MCA code of practice.

Not all staff had been provided with updates to their mandatory training. This meant that staff had not been updated on the subjects they had been trained on.

People’s privacy and dignity was provided by staff in a respectful way. People could be involved as much as they wanted in the planning of their care. Advocacy services were available and people had relatives who could also have a say in the way people were looked after.

People were provided with various opportunities to help reduce the risk of social isolation. However, there was limited staff interaction with people other than during the provision of care. People were supported by staff to be as independent as possible.

People’s concerns were acted upon before they became a complaint. People’s concerns were recorded and acted upon promptly.

The registered manager was supported by a head of care, senior care staff, care staff, housekeeping and domestic staff. Staff had regular mentoring, coaching and support from management.

Audits were not as effective as they should have been in identifying issues such as the safety of people’s bed rails and the equipment people used. The identification, monitoring and mitigation of risks had not been effective. This put people at risk of harm. The impact on people’s privacy as a result of surveillance equipment had not been assessed. This had the potential to infringe people’s rights to a private life.

People’s views about the quality of the service had been sought. People, their relatives and staff were able to make suggestions to improve and maintain the quality of the service that was provided.

We spoke to people individually and as a small group. One person said 'It is very well run here, it's a beautiful place.' Another person said 'It is perfectly marvellous, excellent.'

Everyone we spoke with said that the staff were patient and kind. One person said 'You only have to press your buzzer and they are there, the staff are very willing to help.' Another person said 'The staff are lovely, I absolutely cannot fault them' and 'They are very good staff, exceptionally good. The management, from the top down, are good and they (the management) would not accept anything less.'

The home was clean, well maintained and felt homely. People said that they were happy with their bedrooms and with the facilities. One person showed us around and showed us their room. They said their bedroom was cleaned every day and 'was always spotless and beautifully clean'. People told us that the food was very good and that they always had a choice of meals.

People's health and personal care needs were supported and the service worked closely with health and social care professionals to maintain and improve people's health and well-being. People were treated with dignity and respect and the service responded to people's changing needs. People told us that they felt safe.

Checks were made on staff, as part of the recruitment process, to make sure that people were safe and supported by appropriate staff. There were sufficient numbers of staff to meet people's needs. The service was well managed and was safe and well maintained.

Records were organised, up to date and held securely protecting people's confidentiality.

People told us that they felt safe and well looked after. People looked relaxed, comfortable and at ease with each other and staff. One person said 'I don't think I would find a better place. I am glad I'm here, we are well looked after.' Another person said 'It is marvellous here; they know how to look after us. You will not find fault here. I cannot speak highly enough, it is my home.'

People said that the home was clean and that their bedrooms were kept clean. One person said 'It is marvellously clean.' Another person said 'My room feels like home.'

People said that they thought the staff were kind and caring. People said 'The care is absolutely fantastic' and 'The staff are so kind.'

People said that they had enough to do and enjoyed the organised activities. Everyone said that the food was 'very good' and that they always had a choice. One person said 'They always come round and ask us what we want. There is always a choice.'

People's health needs were supported and the service worked closely with health and social care professionals to maintain and improve people's health and well being.