Oakridge House Care Home with Nursing

Oakridge House Care Home with Nursing provides accommodation for persons who require nursing or personal care for up to 91 people. The service supports people under and over 65 years, and people living with dementia. At the time of our inspection there were 79 people using the service.

Accommodation was provided on two floors accessed by stairs and lifts. The home is divided into residential and nursing households. There are various units within the home including a short stay unit. This was for people living in the community who needed additional care to prevent unnecessary admissions to hospital. People moved into the unit to receive care and support from various healthcare professionals to help them improve their independence.

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

At our last inspection we found there were areas which we identified as needing improvement. At this inspection we found all required improvements had been carried out and sustained.

People were kept safe from avoidable harm as risks to people’s safety were identified and guidance put in place. Risk management plans were reviewed regularly and when any needs changed. Staff had been given training on safeguarding and understood what they needed to report. Systems were in place to make sure any concerns were reported to local safeguarding teams.

People were living in a building that had regular checks for maintenance and safety. Health and safety systems were robust and included checks of equipment being used. Fire systems were also checked and there was a clear process for emergency evacuation which staff were aware of. Incidents and accidents were recorded and reviewed, and action taken to prevent reoccurrence. The home was clean and had good infection prevention and control procedures in place.

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. People and relatives had opportunities for engaging and sharing their views, results were shared and visible on notice boards. People could have visitors when they wished.

People had enough staff to support them safely. The home had no challenges with recruitment and did not use agency staff. Staff had been recruited safely and received training for their roles. Staff told us they felt very well supported by management teams and were able to share their ideas for improvements. There were regular staff meetings with minutes kept. Those we spoke with all said they would recommend the home as a good place to work.

Quality monitoring systems had improved, and the provider had installed an electronic system to improve oversight. Regular audits took place which helped to improve quality and safety, and these were carried out by different staff. The registered manager told us she tried to involve staff in quality monitoring as much as possible as this gave different views and improved oversight.

People, relatives, and staff all told us the service was well managed. There was a registered manager in post who had been at the service for many years. There was a good staffing structure in place and the registered manager had good support in her role.

Staff worked in partnership with a range of local professionals. The local GP visited the home at least weekly and spent most of the day visiting people and reviewing health needs. Communication was good and we observed staff working well as a team.

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 requires improvement (published 18 June 2021).

Why we inspected

This inspection was prompted by a review of the information we held about this service. 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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Oakridge House Care Home with Nursing is a care home service which also provides nursing care to 58 people aged 65 and over at the time of the inspection. The service can support up to 91 people. The service supports older people who may have a physical disability, sensory impairment or who are living with dementia.

Oakridge House is a two-storey building. The home is comprised of two units; one for residential and one for nursing care. The units are further divided into areas.

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

People using the service were not always safe as the service had not regularly assessed and put in place measures to reduce risks to their health, safety and wellbeing. Staff were not always up to date in safeguarding and safety related training.

Recruitment processes needed to be more robust to ensure staff were fit to work in the care industry.

Generally, medicines were administered by competent staff but the recording of medication was not always clear or accurate.

We identified records were not always up to date, complete or accurate and systems to review the quality of the service did not always identify areas of improvement.

There were systems in place to monitor and improve the service, however these required further improvements. This was because incidents were not always followed up or had lessons learned and there was not a proper oversight of training. The registered manager had worked on the above during and after the inspection, and recognised that improvement was needed.

Staff understood signs of possible abuse to people and how to raise concerns internally if needed. Staff appeared to have a suitable understanding of people’s needs around mealtimes with people supported to eat and drink enough.

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

Rating at last inspection

The last rating for this service was good (published 20 September 2018).

Why we inspected

The inspection was prompted in part by a report from the coroner raising concerns about practises at Oakridge House. The information CQC received indicated concerns about the management of falls, staffing and training. We also received concerns about risk management and handling complaints. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

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 from good 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 Oakridge House Care Home with Nursing on our website at www.cqc.org.uk.

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.

Oakridge House Care Home with Nursing is a care home service which also provides nursing care. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided. Both were looked at during this inspection.

Oakridge house is registered to provide nursing and residential care for up to 91 people who have a range of needs including diabetes, dementia and epilepsy.

At the time of our inspection 91 people were living at Oakridge House. Oakridge House is a two storey building set in secure grounds on the outskirts of Basingstoke. The home comprised two units; one for residential and one for nursing care. The units are further divided into areas. Each nursing area is managed by a registered nurse and includes a dining room with basic kitchen facilities as well as a lounge and quiet seating areas. There is a central, secure garden with seating and raised planting areas which are accessible to people living in the home.

The service was last inspected in July 2017 and was rated as ‘Requires Improvement’ overall. This was due to staff not taking appropriate steps to ensure people’s safety and wellbeing, ineffective systems to support staff in giving people maximum choice and control over their lives, incomplete documentation relating to the care people received, and quality assurance systems which were not always effective in identifying risks.

The provider had not ensured effective systems were in place to make sure they assessed and monitored the quality of the service provided. This was a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

At this inspection we found the provider had made the required improvements so that they were no longer in breach of this regulation.

The home had a registered manager in post. 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.

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

Effective systems and processes were in place to protect people from harm and abuse. Staff had completed safeguarding training and were knowledgeable about actions to take if they suspected abuse. The provider deployed sufficient numbers of staff to meet people's needs and keep them safe.

The provider used safe recruitment processes to ensure only staff who were suitable to work in a care setting were employed. Medicines were stored, recorded and administered safely and people were protected from the spread of infection.

People received care from skilled, knowledgeable staff who had been appropriately trained. Staff were supported with regular supervision and training to help develop their knowledge.

Staff were aware of the legal protections in place to protect people who lacked mental capacity to make decisions about their care and support.

People were supported to maintain a balanced diet. Snacks and drinks were available at all times and risk assessments were in place for those at risk of malnutrition and dehydration. People were supported to access care from appropriate health professionals.

Staff had developed bonds with the people they supported and knew them well. Staff encouraged people to communicate their needs and protected their privacy, dignity and independence.

Care plans were written in partnership with people and their families or legally appointed representatives where appropriate.

There were procedures in place for investigating complaints. These were responded to promptly.

Plans were in place for delivering end of life care for people. Staff had undertaken end of life care training and an end of life register was used to assist staff in monitoring people if they needed end of life care.

The registered manager had a vision to provide care which met people’s individual needs. This was shared by the staff team.

Effective systems were in place to monitor quality and safety within the service. Incidents were reflected upon to improve care for people. The provider used different methods to engage staff, people and the public in the service and actively sought feedback about the care provided in order to improve care for people

The provider worked effectively with health and social care professionals to meet people’s needs.

Oakridge House Care Home with Nursing (Oakridge House) is a home which provides nursing and residential care for up to 91 people who have a range of needs, including those living with dementia, epilepsy and diabetes and those receiving end of life care. The home also offers a discharge to assessment unit for 10 people. This unit is for people who require a period of short term care treatment and support upon their discharge from hospital. This placement is to ensure people are able to meet their own needs safely before moving home or seeking additional support in another social care setting. At the time of our inspection 87 people were living at Oakridge House.

Oakridge House is a large two storey building set in secure grounds on the outskirts of Basingstoke town centre. The home comprises of three distinct units, residential, nursing and discharge to assessment. Each unit includes communal areas such as dining rooms with basic kitchen facilities including a microwave, fridge and food storage and preparation areas with access to a lounge and quiet seating areas. There is a secure garden which sits in the middle of the units with seating and raised planting areas to ensure accessibility by people living at the home. This report will refer to all three units collectively as ‘the home’ throughout this report where not individually specified.

The home has a registered manager in post. 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.

People using the service told us they felt safe. Staff understood risks to people’s health and wellbeing however we did not see this guidance was always documented. Where risks to people’s health and wellbeing were known staff did not always take steps to ensure these risks were minimised appropriately.

People told us they sometimes had to wait to receive care however; we could see people were supported by sufficient numbers of staff to meet their needs. The provider was able to adapt their staffing levels appropriately when required in order to meet changes in people’s needs.

People were not always supported to have maximum choice and control of their lives. Staff supported people in the least restrictive way possible however the systems in the service did not support this practice.

Where people lacked the capacity to make specific decisions for themselves that actions taken on their behalf were always in their best interests.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which apply to care homes. The registered manager showed an understanding of what constituted a deprivation of a person's liberty and was able to discuss the processes required in order to ensure people were not deprived of their liberty without legal authority.

Documentation relating to the completion of care were not always completed fully to demonstrate people received the care they required to maintain their health and wellbeing.

People were not always provided with the opportunity to participate in activities allowing them to live interesting and fulfilling lives. During the inspection the registered manager launched a new initiative that people would receive a minimum of 10 minutes of staff members time each day however, time was required to see if this practice was effective and embedded in working practices.

People were not always supported to eat and drink safely whilst maintaining their dignity and independence.

Quality assurance processes in place were not always effective in identifying the issues identified during this inspection. Where action had been identified as necessary the provider’s action plan had not been regularly updated to show where improvements had been made and where additional action was identified as required.

We saw that people were able to choose their meals and were offered alternative meal choices where required. Most people's food and drink preferences were documented in their care plans and were understood by staff. People were supported to eat and drink enough to maintain a balanced diet.

Recruitment procedures were fully completed to ensure people were protected from the employment of unsuitable staff.

People received their medicines safely, staff had received the appropriate training to enable them to complete their role safely and medicines were stored, administered, disposed of and documented appropriately.

Contingency plans were in place to ensure the safe delivery of people's care in the event of adverse situations such as a fire, flood or utilities loss. These were easily accessible to staff and emergency personnel such as the fire service, if required to ensure people received continuity of care in the event of an on-going adverse situation which meant the home was uninhabitable.

People told us that care was delivered by kind and caring staff who sought to meet their needs and ensure they were happy. We saw that people had friendly and relaxed relationships with staff who would stop and speak with them when moving around the home.

People’s health needs were met as the staff and registered manager promptly engaged with other healthcare agencies and professionals to ensure people’s identified health care needs were met and to maintain people’s safety and welfare.

People received care which was regularly reviewed to ensure it contained the most current guidance for staff on how to effectively meet people’s needs. Care plans and risk assessments were reviewed monthly to ensure they remained accurate to enable staff to meet people’s needs.

People knew how to complain and told us they would do so if required. Procedures were in place for the registered manager to monitor, investigate and respond to complaints in an effective way. People, relatives and staff were encouraged to provide feedback on the quality of the service during regular meetings with staff and the registered manager.

People and staff told us registered manager provided positive leadership and fulfilled a number of the requirements associated with their role as a registered manager.

The registered manager had informed the CQC of notifiable incidents which occurred at the service allowing the CQC to monitor that appropriate action was taken to keep people safe.

The provider’s values and peoples ‘Charter of Rights’ were provided to people and known by staff. Staff understood these and relatives told us these standards were evidenced in the way that care was delivered.

The registered manager and staff promoted a culture which focused on being open, honest and delivering care which was highly individualised, respected people’s dignity and provided people with the opportunity to fulfil their potential.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see what action we have told the provider to take at the end of the full version of this report.

We carried out an unannounced comprehensive inspection of this service on 16 and 17 December 2014 where one regulatory breach was identified. Following this inspection the provider wrote to us to say what they would do to meet these legal requirements. During the inspection we checked whether the provider had completed their action plan to address the concerns we had found. The provider had made the required improvements to address the original concerns; however at this inspection we identified some other improvements were required.

Oakridge House Care Home with Nursing is a home which provides nursing and residential care for up to 91 people who have a range of needs, including those living with dementia, epilepsy and diabetes and those receiving end of life care. This also included a discharge to assessment unit for 10 people. This unit is for people who require a period of short term care treatment and support upon their discharge from hospital. This placement is to ensure people are able to meet their own needs safely before moving home or seeking additional support in another social care setting. At the time of our inspection 91 people were living in the home.

Oakridge House is a large two storey building set in secure grounds on the outskirts of Basingstoke town centre. The home comprises of three distinct units, residential, nursing and discharge to assessment. Each unit includes communal areas such as dining rooms with basic kitchen facilities including microwave, fridge and food storage and preparation areas with access to a lounge and quiet seating areas. There is a secure garden which sits in the middle of the units with seating and raised planting areas to ensure accessibility by people living at the home. This report will refer to all three units collectively as ‘the home’ throughout this report where not individually specified.

The home has a registered manager in post. 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.

Our inspection of December 2014 found that the planning and delivery of care did not ensure the welfare and safety or people using the service as care plans and records did not always reflect people’s current needs. At this inspection we found that improvements had been made and all the areas identified had been appropriately addressed. Care plans contained suitable guidance to allow staff to care for people in a safe and effective way including updating people’s care plans regularly to ensure they reflected people’s changing needs.

Relatives of people using the service told us they felt their family members were cared for safely. Staff understood and followed the provider’s guidance to enable them to recognise and address any safeguarding concerns about people.

People’s safety was promoted because risks that may cause them harm had been identified and guidance provided to manage these appropriately. People were assisted by staff who encouraged them to remain independent. Appropriate risk assessments were in place to keep people safe.

Robust recruitment procedures were in place to protect people from unsuitable staff. New staff induction training was followed by staff spending a period of time working with experienced colleagues to ensure they had the skills required to support people safely.

Contingency plans were in place to ensure the safe delivery of care in the event of adverse situations such as a loss of accommodation as a result of fire or floor. Fire drills were documented, known by staff and practiced to ensure people were kept safe.

People were protected from the unsafe administration of medicines. Nurses and staff responsible for administering medicines had received training and were subject to competency assessments to ensure people’s medicines were administered, stored and disposed of correctly.

People received sufficient food and drink to maintain their health and wellbeing however they were not always supported in a timely fashion during meal times. Meal times could take place over an extended period of time with some people not receiving the care they required as detailed in their support plan to enable them to eat in a timely way. The registered manager was aware of this and had taken action to recruit general assistants to support people at meal times. More time was needed to ensure these improvements were fully implemented and sustained.

People were supported by staff who had received an effective induction and period of support from more experienced members of staff. This enabled them to acquire the skills and confidence to deliver safe effective care. Regular supervisions ensured that staff were able to express any concerns they had about their role or ask any questions and they felt supported as a result.

People were supported by staff to make their own decisions. Staff were able to demonstrate that they complied with the requirements of the Mental Capacity Act 2005 when supporting people. This involved making decisions on behalf of people who lacked the capacity to make a specific decision for themselves. Documentation showed people’s decisions to receive care had been appropriately assessed, respected and documented.

The staff and registered manager promptly engaged with other healthcare agencies and professionals to ensure people’s identified health care needs were met promptly and to maintain people’s safety and welfare.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications had been submitted to the supervisory body to ensure that people were not being unlawfully restricted.

Staff demonstrated they knew and understood the needs of the people they were supporting. People told us they were happy with the care provided. The registered manager and staff were able to identify and discuss the importance of maintaining people’s respect and privacy at all times.

People had care plans which were personalised to their needs and wishes. They contained detailed information to assist staff to provide care in a manner that respected each person’s individual requirements. Relatives told us and records showed that they were encouraged to be involved at the care planning stage, during regular reviews and when their family members’ health needs changed.

The provider sought to engage people in meaningful activities however there were insufficient activities hours available and provided to ensure that people receiving support in their rooms always received one to one interaction from activities staff. Staff understood the importance of preventing people suffering from isolation and ensured that they offered companionship where possible. The registered manager recognised the need for more personalised interaction with people in their rooms and was due to introduce more sensory based activities specifically catering for people unable or unwilling to participate in group activities. More time was needed to ensure that this planned improvement would be fully implemented and sustained.

People knew how to complain and told us they would do so if required. Procedures were in place for the registered manager to monitor, investigate and respond to complaints in an effective way. People, relatives and staff were encouraged to provide feedback on the quality of the service during regular meetings and participation in customer survey questionnaires.

The provider’s values were provided to people in their service guides and known by staff. Staff demonstrated they knew these standards and we could see these standards were evidenced in the way care was delivered.

The registered manager and staff promoted a culture which focused on providing care in the way that staff would wish to receive care themselves. The registered manager provided strong leadership and fulfilled the requirements of their role as a registered manager. The registered manager had informed the CQC of notifiable incidents which occurred at the service allowing the CQC to monitor that appropriate action was taken to keep people safe. Quality assurance processes were in place to ensure that people, staff and relatives could provide feedback on the quality of the service provided. People were assisted by staff who were encouraged to raise concerns with the registered manager.

We spoke with 12 people who use the service, three relatives, the manager and two deputy managers and 10 staff. We looked at care and treatment records for nine people who use the service.

We considered our inspection findings to answer questions we always ask;

' 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?

There were enough qualified, skilled and experienced staff to meet people's needs. Records of accidents or incidents were reviewed regularly by the provider and monitored for any trends and triggers, to reduce the risk of reoccurrence.

However, people were not protected from the risk of infection because appropriate guidance was not always followed. People were not always cared for in a clean, hygienic environment.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. This procedure is to ensure that an individual's liberty is restricted only when it is in their best interests and there is no other way to take care of that person safely. Since the last inspection two new applications had been submitted. Proper policies and procedures were in place and had been followed. Relevant staff had been trained to understand when an application should be made, and how to submit one. The manager was aware of recent changes to the legislation and was awaiting further guidance from the provider organisation.

Is the service effective?

Care and treatment was not always effectively planned and delivered in a way that met all people's health and welfare needs. In particular, people we spoke with commented about a lack of mental stimulation.

One person who uses the service said 'Sometimes the staff have time to talk to me, they are very busy. 'I would like to go into the garden. I never can, I sit here'. Two other people commented about going outside. One told us 'I would like to sit in the garden. I am not able to though'. Another said 'I feel safe here I think. I have no memory. I never go in the garden. I think I might like it'.

Another person who lives in the home told us 'The only trouble is there is nothing to do all day'. They remarked 'Sometimes the staff have time to chat, they are busy'. A relative told us 'There is no stimulation for my mother. She is now getting that she can't be bothered to do anything. She just sits in her chair all day. She has not got dementia; there is just nothing for her to do'.

People were not always supported to be able to eat and drink sufficient amounts to meet their needs. The dining experience did not contribute toward encouraging people to enjoy their meals. There was not an effective system to regularly assess and monitor the quality of service that people receive.

Is the service caring?

We observed staff providing care and support in a friendly and respectful way. One person who uses the service told us 'I am well looked after and the staff treat me kindly'. Another person who lives in the home told us 'I am well looked after here and the staff are OK. There is no ill treatment here'. A relative told us 'I love this home, it is calm and the carers are all very caring. They nip in and out to speak to my mum'. They also commented 'There is a nice atmosphere here' and 'The carers all know us by name. I would be happy to live here if I had to'.

Is the service responsive?

The care plans included detailed information about peoples' health care and clinical needs. This supported staff to monitor peoples' well-being over time, supporting a responsive and preventative approach to the management of conditions. Information in the care plans included records of liaison with other health and social care professionals and involvement of people's families.

Is the service well led?

On the day of the inspection it was not possible to see, from the evidence provided, how the management was monitoring, reviewing and planning the service and its development in relation to specific areas of care practice.

There was a lack of evidence to show that people who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. Care staff we spoke with said there were no regular meetings and they did not receive regular one-to-one supervision.

We also received positive feedback about the leadership in the home. Two members of staff said if they had any issues they would raise them with the manager. They said they felt they would be listened to and any concerns would be taken seriously. Another member of staff told us it was a 'Well-organised home. Another said the service had 'Good relationships with families'.

We spoke with four people who lived at Oakridge House. They all told us they were happy. One person said 'I have absolutely no complaints about the staff or the care and support they give me.' Another said 'It has taken me a little while to adjust because it's not the same as living at home, but the staff are great. We have a laugh and joke and that makes my day.' They also said 'the staff listen to me and I am involved in making decisions.'

Care plans were complete and up to date. We noted that they reflected the care and support that we observed. Staff told us each person's key worker was responsible for making sure their care and support plan was correct and regularly reviewed. One staff member said 'it's a system that works well and really lets us get to know people'

We saw that, where completed, care plans were personalised, detailed and relevant. However, three of the five care plans that we looked at had missing information. This meant there was a risk that people would not receive appropriate care.

People were offered a choice of suitable and nutritious food and drink. Where appropriate they were supported to be able to eat and drink sufficient amounts to meet their needs. All the people we spoke with told us there was enough food and they were generally complimentary about the variety and quality.

There were sufficient, trained and experienced staff on duty. People we spoke with said 'the staff are great' and 'the carers are very good, they work very hard'.

The provider had a system in place to record and process complaints. Complaints people made were responded to appropriately.