Charnwood Oaks Nursing Home

Charnwood Oaks Nursing Home is a residential care home providing personal and nursing care to 81older people aged 65 and over at the time of the inspection. The service can support up to 84 people.

The service accommodates people across four separate units, each of which has separate adapted facilities.

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

People were not consistently kept safe. The relevant risk assessments to promote safe care and minimize the risk of catching and spreading infections were not in place. This meant staff did not have information on how to safely provide support to people.

The managers did not always have robust oversight to ensure all areas of safe care and infection prevention and control were monitored.

We have made a recommendation about oversight of safe care and risk assessments.

Staffing had improved at the service. The managers had taken action to address most concerns we found at our last inspection. At this inspection, we found further action was required to continue to improve the service.

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)

The last rating for this service was requires improvement (published 15 September 2021) and there were two breaches of regulation. We served a warning notice and the provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made/sustained, and the provider was still in breach of regulations. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This was a planned inspection as part of CQC’s response to the COVID-19 pandemic we are looking at how services manage infection control and visiting arrangements. During the inspection we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led to check whether the Warning Notice we previously served in relation to Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met / on a specific concern we had about governance and safe care and treatment. The overall rating for the service has not changed following this inspection and remains requires improvement.

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 COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Charnwood Oaks Nursing Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified continued breaches in relation to safe care at this inspection.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Charnwood Oaks Nursing Home is a residential nursing home, it provides nursing and personal care for up to 84 older people living with dementia. At the time of inspection there were 79 people living there.

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

People were not consistently protected from known risks. Not all risk assessments had been completed. We found some equipment was unsafe or not used correctly.

Injuries to people had not consistently been recorded appropriately or followed up. Unexplained injuries were not always investigated to identify a cause and to protect people from abuse.

People were at risk due to concerns with infection, prevention control. Not all staff completed COVID-19 testing regularly. PPE was not consistently worn in line with the providers policies and procedures.

Records of care tasks had not been completed consistently. We found concerns with the recording of repositioning checks to protect people from pressure damage and food charts for people who requires special diets.

Systems and processes required improvement. The provider lacked oversight. Audits completed did not identify the concerns we found with safety, records, equipment and safeguarding people.

The provider had not consistently sought feedback from people, relatives or staff. Trends and patterns had not always been identified to learn lessons and improve the service.

We could not be assured on the staffing levels. Staff and people told us they felt there were not enough staff on each shift. We found a number of unwitnessed falls had occurred.

People were supported by staff who knew them well and who had been recruited safety. Not all staff had received training in dementia, first aid or nutrition.

Medicines were managed well. Administration of medicines were recorded appropriately, and staff had their competencies checked to ensure they had the skills and knowledge to safely administer medicines.

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

The last rating for this service was requires improvement (published 26 November 2019) and there was one breach of regulation. 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 not been made and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to falls management, environmental safety and nutrition. 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 not changed from requires improvement. This is based on the findings at this inspection.

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 COVID-19 and other infection outbreaks effectively.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Charnwood Oaks Nursing Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to record keeping, risk assessment, safe care and oversight at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Charnwood Oaks Nursing Home is a nursing home service, it provides nursing and personal care to older people and people with dementia. At the time of the inspection there were 79 people using the service. The service can support up to 84 people.

Charnwood Oaks Nursing Home provides accommodation across 2 floors in four units, with a lift to the second floor. Rooms have en-suite facilities and there are communal lounges and enclosed communal gardens.

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

The registered manager and provider had not consistently maintained effective oversight of the service around quality and safety. However, they were focused on improving this with some changes made during the inspection.

We found that risks to people from the environment and around their care needs were not consistently considered and people were not always protected from the spread of infection. People told us that they felt safe and we found they were protected from the risk of abuse.

The staff and management team were working in partnership with health care professionals, but some people felt they were not supported to access health care in a timely manner.

The food choices for people on specialist diets was limited. Further development was needed to ensure a dementia friendly environment. The registered manager was working to improve in these areas prior to the inspection. People told us they enjoyed the food and we saw that people were supported to maintain a balanced diet.

Staff were recruited safely, checks on suitability were in place to ensure people were safe. The registered manager had a system in place to monitor staffing levels. We have recommended that this be kept under review to ensure there are enough staff available to meet people’s needs.

People received personalised care from staff that knew them well. However, we have recommended that the provider ensure people from all faiths are supported should they wish to be.

Staff were trained and had the skills and support needed to meet people’s needs. There were regular supervisors and appraisals and staff attended regular meetings to share information and learning.

Medicines were managed safely and given to people by staff who were trained and competent. Medicine records were checked regularly to ensure people were receiving their medicines when they needed them.

Where things had gone wrong the registered manager and provider had been open and transparent in reporting to relevant bodies such as the local authority and CQC. There was evidence of learning from incidents, we saw evidence of staff training and system changes to improve safety for people following incidents.

People's independence was encouraged, they and their families or representatives were included as partners in their care. People and relatives found staff caring and supportive and they had developed good relationships.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection

The last rating for this service was good (published 16 July 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach of regulation in relation to the registered managers and providers oversight of the safety and quality of the service.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Charnwood Oaks is a nursing home that provides accommodation for up to 84 people who require nursing or personal care. At the time of our inspection 84 people were using the service. Charnwood Oaks consists of four care units each with accommodation and communal areas. All bedrooms were en-suite.

The service had a registered manager. 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.’

Care staff and non-care staff, for example cleaners, knew how to identify and report concerns about people’s safety. Staff were suitably deployed to be able to meet the needs of people using the service. People who were assessed to be at risk of displaying behaviour that challenged others were discretely observed to protect them and other people using the service from harm.

People received their medicines at the right times. The provider had safe arrangements for the management and storage of medicines.

People were supported by staff with the right skills and experience. Staff were supported through training and supervision. A new organisational structure at the service meant that staff had easier direct access to senior staff for support.

Staff at all levels understood the relevance of and acted in accordance with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards when they supported people.

People were supported with their nutrition. People with special dietary requirements were supported with their specific needs. People were supported to access health services when they needed to. We saw several records that showed the service engaged with a variety of specialist health services to support people with their health needs.

We observed that staff demonstrated care and compassion in the way they supported people. A reason for this was that the provider had improved the quality of the training and support staff received about how to support people in a caring way.

People using the service and their relatives were involved in making decisions about their care and support. People and relatives we spoke with told us they received information they needed about the service before and after they began to use it.

Staff respected people’s privacy and dignity. They were discrete when they provided care and support. The provider had taken action to reduce the instances of people’s privacy being disturbed by other people walking into their rooms.

People’s care plans were focused on their individual needs. People were supported to maintain their independence and were supported to follow their hobbies and interests. An activities coordinator and care staff organised a range of social activities for people to participate in and people were supported with their interests and hobbies. People using the service and their relatives knew how to raise concerns and their views were acted upon.

The service was organised into near four sections each with a team leader and a senior care worker. The `hotel services’ manager who managed the kitchen, cleaning and laundry services was an integral part of the management team.

People using the service, their relatives and staff were involved in developing the service. The provider acted upon their feedback. The registered manger and senior staff monitored staff care practice. The provider had effective procedures for monitoring the quality of the service which included seeking people’s views about their experience of the service. The registered manager took action to make improvements in areas identified as requiring improvement.

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

Is the service safe?

People we spoke with told us they felt safe at the home. A contributing factor to their feeling safe was that they felt comfortable living at the home. One person described their room "as my little home." People who used the service could summon help in their rooms by using call-alarms. When we looked in people's bedrooms we found that call-alarms were connected and accessible.

We saw that staff treated people with dignity and respect. Staff spoke politely to people and offered encouragement when they supported them. Staff we spoke with, including staff with no care work responsibilities, all knew the forms of abuse recognised in the Health and Social Care Act 2010. Staff knew how to identify and report concerns about people's safety using the provider's whistleblowing procedures. Staff also knew they could contact the relevant agencies.

Care plans we looked at contained risk assessments of things that could potentially harm people. Care plans included plans of how to protect people from risk of falls and risk of injury whilst receiving personal care. Risks associated with people's health had also been assessed.

We had mixed responses from people, relatives and staff about staffing levels. People told us that it sometimes felt to them as if not enough staff were on duty, but none expressed this as a concern. A relative told us that their husband had sometimes been uncomfortable because of delays in staff responding to requests for help. They attributed the delay to there not being enough staff. Staff were split 50 / 50. Half told us they felt enough staff were on duty at all times, but half told us they didn't have time to sit and talk with people which they thought was an important part of supporting people. No person we spoke with said that people were unsafe because of staffing levels.

Senior staff we spoke with understood the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This is legislation that protects vulnerable people who are or may become deprived of their liberty through the use of restraint, restriction of movement and control. Nearly half the staff had received training about MCA and DoLS.

We saw that people's bedrooms and communal areas including the garden were clean and tidy and free of hazards.

Is the service effective?

People's health and care needs were assessed with them or their relatives. Care plans included details of people's needs and information about how they were supported with their needs.

People who used the service told us that they had been well cared for and supported. A relative, referring to the quality of care and support, told us, "Everything is working like clockwork." We compared our observations of how staff supported people with what was in people's care plans and we found that staff supported people in line with their care plans.

Some people who used the service at times displayed challenging behaviour. We heard people repeatedly asking the same questions, often in a very loud tone, over prolonged periods of time. A relative described the situation as "pandemonium." The registered manager described it as "chaotic". After we spoke with staff it became clear that most staff we spoke with felt they had not been trained to deal effectively with the types of situation we witnessed.

The people who used the service were registered with a GP surgery. The provider had arranged regular GP visits so that people's health could be checked.

Is the service caring?

People told us they were well cared for. One person told us they had experienced, "tender love and care" and added, "Even when staff are rushed they don't let you think something is too much trouble." People told us that staff were "kind". Relatives told us that people were treated with dignity and respect. One relative's comments were typical of what others told us. They said, "The staff are very caring. They treat people with dignity and respect."

Staff did not wear name badges. A person who used the service told us, "I don't know staff names. I'd prefer to know their names." A relative told us that they knew the names of senior staff but not other staff. When we spoke with a group of five staff, three told us that they'd prefer to wear name badges.

The provider had taken steps to promote staff awareness and practice of dignity-in-care. The service had staff who acted as `dignity leads' who promoted dignity-in-care amongst staff. The registered manager and senior care workers observed care staff to ensure they treated people with dignity and respect.

People had been supported with their health and nursing needs because the service worked closely with providers of those services. We found that staff monitored people's health and made referrals to the appropriate specialists when required.

People's preferences, interests and diverse needs had been respected. People had been able to attend church services or receive visits from representatives of local churches.

The service had two activities coordinators who arranged activities for groups of people and supported people with individual interests and hobbies. The activities coordinators were further developing a range of activities for people with dementia.

Is the service responsive?

People told us they were well cared for. Records we looked at showed that people had been supported with their personal care, nursing and health needs. People told us that they knew they could make suggestions or raise concerns. Relatives told us they had been involved in decisions about their family member's care. One relative told us, "The home has had it's moments and I've had to bring things up with them, but they were all dealt with."

We found one instance of a care plan that had not been updated to reflect a person's needs, but that was addressed and rectified after we brought it to the registered manager's attention.

Staff told us they regularly read people's care plans to ensure they understood people's changing needs.

Is the service well-led?

The provider had a system for monitoring the quality of service. This included checks of documentation, records and observations of care worker's practice. Staff meetings took place at regular intervals. We saw from records of those meetings that the manager had shared information about the outcome of monitoring activity.

The service had procedures for reporting of accidents and injuries. We saw that reports were reviewed and analysed and that action had been taken to reduce the risk of the same type of accident occurring again. The registered manager regularly sought the views of people who used the service and their relatives. The provider also used a satisfaction survey to obtain people's views.

During this inspection we found that people did not always have their care delivered as planned. Whilst some improvements had been made, the lack of appropriate planning and delivery did not ensure people's safety and welfare.

We saw that appropriate action had been taken when people had been identified to be at risk related to their nutrition.

All new staff completed a three month probationary period with an interim and final supervision before being signed off as competent to fulfil their role.

We asked for and received the corresponding daily records and monitoring checks for four people using the service. We found them to show that, despite people's needs being assessed, the care and treatment was not delivered in accordance with their care plan and in a way that ensured people's safety and welfare.

Staff told us that people who were at risk of malnutrition had food and fluid charts completed for them on a daily basis. We reviewed some of these charts and found there were gaps in the recording of people's food and fluid intake. This meant that people who were at risk of malnutrition had not always had their food and fluid intake appropriately monitored by the service.

One visitor to the service told us: 'The staff do have time to look after my husband. They communicate well me us and always have time to liaise with me.'

Staff told us they were well supported. One member of staff told us: 'The clinical leads are particularly supportive. We have had a difficult time recently and management has changed a lot. I find the present manager very approachable.'

People told us that staff were patient and compassionate when they provided care and support and we observed a number of staff engaged in supporting people, doing so with patience and diligence.

We checked to see that the equipment provided for the benefit of people using the service was fit for purpose and appropriately maintained. We found the provider ensured all such equipment was regularly serviced and maintained in accordance with the manufactures recommendations. We discussed some issues with the manager regarding some types of equipment and they were aware of the issue and had planned a review to ensure all items of equipment are available in sufficient numbers to support people using the service and the staff delivering that support.

The management and staff fully understood the need to keep all aspects of the service under review to ensure all care was planned, delivered and recorded in such a way that best supported the needs of those using the service.

People using the service and their relatives were asked for their views and these were taken into account during the development of people's care plans.

We found the staff to be appropriately trained and supported by the management. The management also ensured people's concerns were listened to and acted upon in a timely manner.