Oakleigh Lodge Residential Home

Oakleigh Lodge Residential Home is a residential 'care home' for up to 15 older people, some of whom are living with dementia. At the time of the inspection there were 10 people living in the home.

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

At the last inspection in February 2020, we identified a number of breaches of regulations. These were in relation to Regulation 12 (Safe Care and Treatment), Regulation 17 (Good Governance) and Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we found improvements had been made. The provider, registered manager and staff worked hard to ensure the appropriate actions have been taken to provide good and safe practice. These improvements will need further time to be fully introduced and embedded into every day practice.

Since the previous inspection, the COVID-19 pandemic had begun. The service had an appropriate and up to date infection prevention and control policy in place to help keep people safe. This included increased cleaning and ensured adequate supplies of personal protective equipment (PPE) were available. Staff completed additional training in relation to COVID-19.

People were protected from the risks of harm, abuse or discrimination because staff had received appropriate training and knew what actions to take if they identified concerns. Staffing levels had been increased and there were enough staff working to provide the support people needed. Risk assessments provided some guidance for staff about individual and environmental risks. People received their medicines safely in line with their wishes. People felt safe living at Oakleigh Lodge. One person told us, “I’m very happy here, I’m perfectly safe and well cared for.”

Quality assurance systems had been developed and improved. This included audits of medicines, care plans, and health and safety. Both the registered manager and the provider had oversight of these processes to ensure issues were identified and acted upon in order to drive improvement in 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 22 April 2020). There were breaches of regulations. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 17 February 2020. Breaches of legal requirements were found and three Warning Notices were served in relation to Regulation 12 (Safe care and treatment), Regulation 17 (Good governance) and Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this focused inspection to confirm the provider now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has not changed following this focused inspection and remains requires improvement.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Oakleigh Lodge Residential Home 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.

Oakleigh Lodge Residential Home is situated in Hove, East Sussex. It is a residential ‘care home’ for up to 15 older people some of whom are living with dementia. At the time of the inspection there were 14 people living in the home.

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

Risks were not well-managed, and some people had been exposed to increased risk of harm. There was a lack of oversight of risks to some people’s care. Insufficient guidance was provided to staff to inform them of some people’s needs. Medicines management was not always safe. Staffing levels at night were not safe and were not aligned to people’s assessed levels of need. There were concerns about some people’s safety and being provided with effective care due to some staff’s lack of training. Fire safety had not always been considered and this increased the risk that people would be exposed to risk of harm. We made three safeguarding referrals as well as a referral to East Sussex Fire and Rescue Service following the inspection.

There was a lack of oversight and the provider had not made enough improvement since the last inspection to ensure the quality of care met people’s needs. Quality assurance systems were not always effective and had failed to identify the shortfalls found at the inspection.

People were not always supported to have maximum choice and control of their lives and staff had not always supported them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

We recommended the provider sought further guidance in relation to the mental capacity act and associated codes of practice to ensure people were effectively supported with decisions when they had a condition that had the potential to affect their decision-making abilities.

Plans were in place to further involve people in the planning of their care and ongoing decisions that related to it to ensure that staff were provided with clear, accurate and relevant guidance to help ensure people’s care was responsive.

We recommended that the provider ensured that accessible information was considered for all people's needs.

People were happy and told us they liked living at the home. Staff were kind, caring and compassionate and people told us they were fond of the staff. People were treated with respect and their privacy and dignity was maintained. Independence was promoted, and people were encouraged and able to continue to retain their skills.

Staff ensured people were treated as individuals and had considered and acknowledged their life histories, backgrounds and preferences. People told us there was enough to do to occupy their time and they enjoyed the support provided by staff and external entertainers. People were able to make suggestions and raise concerns and complaints and these were welcomed and learned from to ensure changes were made. People told us they were confident that staff would contact external healthcare professionals if they were unwell.

Following the inspection, once concerns were made known to the manager and provider they took immediate action to improve the quality of care to ensure people’s safety.

Rating at last inspection and update

The last rating for this home was Requires Improvement. (Published 19 February 2019). There was a breach of regulation in relation to the leadership and management of the home. At this inspection, not enough improvement had been made and the provider was still in breach of regulation. The home remains rated Requires Improvement and has now been rated Requires Improvement at the last three consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a continued breach in relation to the leadership and management of the home. We found two new breaches in relation to people’s safety and staffing. Please see the action we have told the provider to take at the end of this report.

Follow-up

We will continue to monitor the intelligence we receive about this home. We will request an action plan from the provider to understand what they will do to improve the standards of safety and governance. We plan to inspect in line with our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

Oakleigh Lodge Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Oakleigh Lodge Residential Home is registered to provide care and accommodation for 15 older persons with physical care needs. There were 14 people living at the service on the day of our inspection.

People’s experience of using this service:

Since the previous inspection, significant improvements in relation to the environment and the care provided have been made and people and staff were complimentary about the service. However, we identified that further development was required in relation to systems of quality monitoring and governance. We could not see that any harm had come to people due to these systems of monitoring not being in place. Additionally, it was acknowledged that the acting manager of the service began to implement the required systems of audit straight away. However, providers must have systems and processes established and operated effectively to assess, monitor and improve the quality and safety of the services provided.

Medicines were managed in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored and administered appropriately. However, the provider did not carry out routine audits of medicines and we found large quantities of out of date prescribed fortifying drinks stored in the medicines fridge and another fridge at the service.

Systems were in place for the recording of incidents and accidents. However, incidents and accidents were not monitored and analysed over time for any emerging trends and themes, or to identify how improvements to the service could be made.

People were cared for in a clean and hygienic environment. However, appropriate procedures for infection control were not in place. The provider did not carry out routine audits of infection control procedures.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service. However, some staff had not received training in topics that the provider considered mandatory, and refresher training for staff had not routinely gone ahead.

There was no 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. Day to day management of the service was carried out by senior staff and an acting manager. We were told that the acting manager was intending to register with the CQC, however at the time of our inspection, no application had been received.

When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector.

Risks associated with people’s care, the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

People were being supported to make decisions in their best interests. The acting manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

On the day of our inspection there were sufficient staff to support people. People felt well looked after and supported. We observed friendly relationships had developed between people and staff. People were treated with dignity and respect, and they were encouraged to be as independent as possible.

People chose how to spend their day and they took part in activities. They enjoyed the activities, which included, arts and crafts and visits from external entertainers. People were also encouraged to stay in touch with their families and receive visitors.

Healthcare was accessible for people and appointments were made for regular check-ups as needed. Care plans described people’s preferences and needs, including their communication needs. People’s end of life care was discussed and planned and their wishes had been respected.

Staff were knowledgeable and trained in safeguarding adults and knew what action they should take if they suspected abuse was taking place. Staff had a good understanding of equality, diversity and human rights. People’s care was enhanced by adaptations made to the service.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank.

People were encouraged to express their views. People said they felt listened to and any concerns or issues they raised were addressed. Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ management approach, where the management team was always available to discuss suggestions and address problems or concerns. Staff had received supervision meetings with their manager and formal personal development plans.

Rating at last inspection: Requires Improvement (report published 11 January 2018).

Why we inspected: We previously inspected Oakleigh Lodge Residential Home on 1 and 3 November 2017 and found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take action to make improvements. Two of these actions have been completed and the provider was now meeting legal requirements in these areas. However, at this inspection, we found a continued breach of the Regulations and areas of practice that needed improvement.

Follow up: We will be in contact with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good.

Oakleigh Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Oakleigh Lodge is a residential care home that provides personal care and support for up to 15 adults over 65 years of age, some of who are living with dementia. There were 12 people living at the home during the inspection. Accommodation was provided in a residential area of Hove. The home had a communal lounge and dining area and a garden accessible to people at the rear.

There was 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.

At the last inspection in June 2015, the service was rated overall as Good. We found no breaches of the regulations at this time. However we recommended the provider took steps to ensure the ongoing upkeep and safety of premises through the implementation of regular maintenance processes. This was because the upkeep of the home was not safely maintained. Audits of maintenance and the environment had not identified the need to complete monthly tasks relating to this area. We found at this inspection these concerns had not been acted upon.

The registered manager said the owners had previously been very active at the service, undertaking quality monitoring checks and redecoration. They explained that owing to personal reasons they had needed to delegate responsibilities to a family member. This process had not been completely transferred which meant that regular environmental and compliance monitoring had stopped. However the registered manager had continued to focus on the care deliver at the service to ensure people received good care.

People were not always protected from unsafe and unsuitable premises. The provider’s quality assurance systems did not effectively assess and monitor the quality and safety of the service. The systems in place were not effective to monitor health and safety at the service. The provider had not completed any environmental risk assessments to ensure the environment was safe. Therefore they had not identified areas of concern which we found at our visit. These were fire safety risks, poor cleanliness of the kitchen, a hot surface and a hot water tap in a communal bathroom which exceeded the recommended temperature. The provider took action during and after the inspection to resolve these concerns and also undertook an environmental risk assessment to ensure there were no further concerns.

Risk assessments had not been completed to assess the potential risk to people of falling out of windows on the first floor. The registered manager assessed the risks following our discussions and during the inspection they had window restrictors fitted to seven windows on the first floor.

The main communal area was in a poor state of decoration, poorly lit, cluttered, had a fish tank with stagnant water and also contained the manager’s office. The conservatory leading off of this area was being used to store unused furniture, televisions and fridges being used for holding food for the kitchen. This meant it was not a safe or pleasant environment for people to spend time in. The provider told us after the inspection that they had taken action and cleared the conservatory, moved the fish tank and was looking to have the lounge redecoration finished.

People were not supported by staff who had the required recruitment checks in place. Staff received an induction and were knowledgeable about the signs of abuse and how to report concerns. Staff had received training and developed skills and knowledge to meet people’s needs.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS provide legal protection for those vulnerable people who are, or may become, deprived of their liberty. They had made applications for people to be deprived of their liberty to the local authority DoLS team. However where people lacked capacity, mental capacity assessments had not been completed in line with the MCA. The registered manager showed us an MCA assessment document and said they would undertake the assessments where required.

Staff recorded accidents promptly in the accident book and the actions they had taken at the time. The registered manager reviewed all accidents and incidents each day as part of their duties to identify trends about, time of day/night and the frequency of accidents. However there was no system to monitor the number of incidents and falls people had, to look at trends and themes.

The provider had a written complaints policy and procedure which did not accurately guide people to the correct external organisations. The registered manager said they would amend the procedure to guide people to the appropriate external bodies.

Risk assessments were undertaken for people to ensure their health needs were identified. Care plans reflected people’s needs and gave staff clear guidance about how to support them safely. Care plans were person centred and where able people and their families had been involved in their development and ongoing reviews. Staff were very good at ensuring people were able were involved in making decisions and planning their own care on a day to day basis. People were referred promptly to health care services when required and received on-going healthcare support.

Medicines were safely managed and procedures were in place to ensure people received their medicines as prescribed.

There were adequate staffing levels to meet people’s needs. The provider had reduced the staff level at night to one care worker. They had consulted with staff and considered the assessed needs of people and said they would increase the staff level if needed. We identified one issue which we discussed with the management team regarding this. The registered manager undertook shifts and stepped in to fill staffing gaps. They were actively recruiting to three staff vacancies.

People received person centred care. Staff knew people well, understood their needs and cared for them as individuals. People were relaxed and comfortable with staff that supported them. Staff were discreet when supporting people with personal care, respected people’s choices and acted in accordance with the person’s wishes.

Staff relationships with people were caring and supportive. They delivered care that was kind and compassionate. People said staff treated them with dignity and respect at all times in a caring and compassionate way.

People’s views and suggestions were taken into account to improve the service. Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them.

People were supported to follow their interests and take part in social activities. The registered manager was very keen for people to take part in activities and had regular activities available for people to attend as they chose. The registered manager was working with people to engage in activities to avoid social isolation.

People were supported to eat and drink enough and maintain a balanced diet. People and relatives were positive about the food at the service. People were seen to be enjoying the food they received during the inspection.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 related to safe care and treatment; safeguarding service users from abuse and improper treatment; staffing and good governance.

People were assessed and care was planned and delivered to meet their individual needs in a way that reflected their preferences. One person told us, 'I get all the help I need. I think I'm lucky to be here.' A visiting community health care assistant said, 'The people always seem very happy and well looked after.'

People were given a choice of varied and nutritious food and drink, and their nutritional state was monitored. One person said, 'There are lots of things I don't eat. They give you what you can eat and what you like.' Another commented, 'The food is good here, I love the cooking.'

People received their medicines when they needed them. Medicines were stored securely and accurate records were kept. One person told us that the manager, 'Is very efficient where medicines are concerned.'

We found the premises were fit for purpose, safe, secure and well maintained.

There was a complaints policy and people knew who to contact if they wanted to raise a concern. One person told us, 'If I've anything to say, I say it to their faces. You can always raise issues here.'