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Oakleigh Lodge Residential Home Requires improvement

We are carrying out a review of quality at Oakleigh Lodge Residential Home. We will publish a report when our review is complete. Find out more about our inspection reports.

Reports


Inspection carried out on 17 February 2020

During a routine inspection

About the service

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

Inspection carried out on 21 January 2019

During a routine inspection

About the service:

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 activitie

Inspection carried out on 1 November 2017

During a routine inspection

This unannounced comprehensive inspection took place on 1 and 3 November 2017.

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. Staf

Inspection carried out on 17 & 18 June 2015

During a routine inspection

The inspection was carried out over two days on 17 & 18 June 2015 and was unannounced on the first day. 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. The oldest person at the home was aged 102 years. At the time of our inspection the home was full.

Accommodation was provided in a residential area of Hove. The home had a communal lounge and dining area and an attractive and fully accessible garden.

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.

Upkeep of some areas of the home and gardens was not maintained. This was reflected in the feedback we received from some people, and included this comment, “This isn’t the smartest place but the care is good. I have recommended this place to a friend but they weren’t happy with the environment but I think the care is excellent.” We have made a recommendation about the regular on-going maintenance and safety of the premises.

Audits of cleaning had not identified the failure to complete tasks relating to the upkeep of the environment and maintenance around the home. We have identified this as an area of practice that required improvement.

Improvements were required for opportunities for people to engage with meaningful activities. People were generally positive about the opportunities for social engagement and the activities offered though we also heard that people would welcome more opportunities in this area. For example, one person told us, “I so love the art classes and would like it more often. It’s only one hour each fortnight and it goes so quickly but then things do when you’re enjoying yourself.” The registered manager acknowledged further work was required to ensure people were stimulated and kept occupied. We have identified this as an area of practice that required improvement.

There was guidance for staff on actions to take to minimise risks to people and provide appropriate and individualised care to people. Care plans and risk assessments included people’s assessed level of care needs, action for staff to follow and outcomes to be achieved. People’s medicines were stored safely and in line with regulations. People received their medicines on time and safely.

People spoke positively of the home and commented they felt safe. Our own observations and the records we looked at reflected the positive comments people made. People were happy and relaxed with staff. They said they felt safe. We heard different views about whether there were sufficient staff to care for them. Overall there were sufficient numbers of suitable staff to keep people safe. One person told us, “Do you know, I have a great feeling of safety here. I couldn’t be in better hands”.

People felt well looked after and cared for and were encouraged to be as independent as possible. We observed friendly and genuine relationships had developed between people and staff. One person told us, “They treat you well here, it’s a home from home.” A visitor told us, “Fantastic, we know mum is safe and happy.”

When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work with people who required care. Staff were knowledgeable and trained in safeguarding and what action they should take if they suspected abuse was taking place.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the registered manager understood when an application should be made and how to submit one. Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests.

Accidents and incidents were recorded appropriately and steps taken by the home to minimise the risk of similar events happening in the future. Emergency procedures were in place in the event of fire.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, such as dementia and end of life care. Staff had received both one to one supervision meetings with the registered manager and annual appraisals were in place.

People were encouraged and supported to eat and drink well. One person said, “The food is home-made and good. I went off my food before I came here but I’ve picked up now and I’ve had two sweets today so I feel much better”. There was a daily choice of meals and people were able to give feedback and have choice in what they ate and drank. Special dietary requirements were met. People’s weight was monitored, with their permission. Health care was accessible for people and appointments were made for regular check-ups as needed.

People were encouraged to express their views and completed surveys, and feedback received showed people were satisfied with the care they received. People and their relatives said staff were friendly and helpful. People also said they felt listened to and any concerns or issues they raised were addressed. One person said, “If there is anything wrong, they sort it out quickly”.

Staff were asked for their opinions on the home and whether they were happy in their work. They felt supported within their roles and described an ‘open door’ approach from the registered manager. The management were always available to discuss suggestions and address problems or concerns.

Inspection carried out on 30 September 2013

During a routine inspection

We spoke with four people who used the service and a relative. We also spoke with the registered manager, a care worker, the cook and a visiting community health care assistant.

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.�

Inspection carried out on 18 May 2012

During an inspection in response to concerns

People living in the home had been invited to complete a quality assurance questionnaire by the provider in 2011, and thirteen completed survey forms were returned and were available to read. These informed the provider that all of respondents stated yes that they felt the home was a good place to live. Additionall comments recorded included, �very much,� �warm and comfortable good place to be living in,� � always been happy here,� and �good twenty-four hour care.�

Relatives and visitors had been invited to complete a quality assurance questionnaire by the provider in February 2012, and five completed survey forms were returned and were available to read. These informed the provider that all of respondents stated that they were satisfied that people received a good standard of care. Additionall comments recorded were, �mum seems very happy here and is well looked after and cared for,� � we know that mum is well cared for,� and she is very happy and well cared for.�

There were fourteen people resident in the home at the time of our visit. We spoke to seven people using the service and a visiting relative who told us that they were very happy with the care provided to their relative.

People expressed their views and were involved in making decisions about their care and treatment.

Peoples� needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

Peoples� care was provided by care workers that understood their care needs.

People knew who to talk to if they had any concerns.

We spoke to the registered manager, the administrative assistant and two care workers who told us that they were happy working in the home, that the team worked well together and that they had received the training and supervision they needed to meet individual people�s care needs.

Reports under our old system of regulation (including those from before CQC was created)