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Archived: Oldfield House Residential Care Home Good

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Reports


Inspection carried out on 24 July 2018

During a routine inspection

This inspection took place on 24 and 25 July 2018. The first day was unannounced.

Oldfield House Residential Care Home provides accommodation and personal care for up to 19 people. The home caters for older people, including those living with dementia. The home has bedrooms and bathrooms on both the ground floor and first floor, with three rooms having en-suite bathrooms. On the day of our inspection there were 15 people residing in the service.

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

The service was managed by a registered manager. A registered manager is a person who has registered with the 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.

At our last inspection of 10 and 11 July 2017 we found breaches of Regulations 10, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of privacy and dignity, safe management of medicines and storage of confidential information.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions, is the service safe, Is the service caring, Is the service well-led, to at least good. We checked the action plan had been followed during this inspection and found significant improvements had been made; we have rated this service as Good overall.

The registered manager had considered risks that people presented with. We found risk assessments were in place in relation to skin integrity, mobility, falls and nutrition. These provided guidance to staff on managing risks.

Equipment that was available throughout the service, such as, hoists, stand aids, walking frames and wheelchairs, had been maintained and serviced regularly to ensure they were safe for use.

All the people we spoke with who used the service and staff members, told us there were sufficient staff on duty every day. We observed throughout our inspection that staff were not rushed and had time to sit and chat with people.

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.

Staff told us, and records we looked at showed, that staff undertook an induction when they commenced employment within the service. Training records showed that staff had access to many different courses.

We saw the registered manager worked well with other healthcare professionals and services when people were moving into the home. Records evidenced that GP’s, district nurses, podiatrists and other health care professionals were contacted to meet people’s health care needs.

All the people we spoke with were very complimentary about the meals in the service. We saw people were given plenty of choices over the meals they had. Those who required support with eating their meals were supported in a sensitive manner.

During the inspection, we observed staff interacted with people in a sensitive, respectful and caring manner. We saw staff lowered their tone if they were speaking about a personal issue with someone, would bend down to the same eye level as the person they were speaking to and allowed people the time to express themselves.

Care plans we looked at were person centred. These were detailed to meet people’s needs and to direct staff. We saw people were involved in the development and review of these.

Records we looked at showed that the registered manager continuously sought ways to improve the service.

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Inspection carried out on 10 July 2017

During a routine inspection

We carried out this inspection on the 10 and 11 July 2017. The first day of our inspection was unannounced. We last inspected this service on 12 May 2015 when we rated the service as Good.

Oldfield House is registered to provide accommodation and personal care for 19 older people. On the day of our inspection there were 17 people residing in the service.

At the time of our inspection the service had 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.

During this inspection three breaches of the regulations were found. These were in relation to the unsafe management of medicines, lack of privacy and dignity and failure to keep confidential records in a safe place. You can see what action we told the provider to take at the back of this report. We also made recommendations about infection control.

Most people we spoke with told us they felt safe living at Oldfield House. Two people told us they had concerns regarding a staff member. We discussed this with the registered manager who took immediate action. All staff members had received training in safeguarding and knew their responsibilities.

We reviewed medicines management within the service and found this was not always safe. A number of medicine administration records (MARs) had missing signatures for medicines that should have been administered. This meant we could not be certain that people had received all their medicines. There were no protocols in place for those people prescribed medicines ‘when required’ (PRN). Certain medicines were also not stored correctly.

Risk assessments were in place to keep people safe. We saw risk assessments in place in relation to moving and handling, falls, mobility and pressure ulcers. There was also an environmental risk assessment to ensure all parts of the service were safe. This covered topics such as scalds and burns, trips and falls, needle stick injuries, cleaning products and legionnaire’s disease. All risk assessments were reviewed on a regular basis to ensure they were appropriate.

There were systems in place to prevent the spread of infection. Staff were trained in infection control. The service was clean and tidy and there were no malodours. During our inspection we noted none of the bedrooms had paper towels in for staff when they had undertaken personal care and needed to undertake hand washing. We discussed this with the area manager who felt that this distracted form the personal feeling of people’s bedrooms. We recommended the service seeks guidance from current infection control guidance in relation to this matter.

We looked at the fire safety procedures in the service. We found policies and procedures, risk assessments and personal emergency evacuation plans (PEEP’s) were in place to keep people safe. Fire systems such as alarms, fire fighting equipment and emergency lighting were checked on a regular basis. However, we noted on a number of occasions that a chair was blocking a fire exit. This continued after we had discussed it with the registered manager.

We checked whether the service was working within the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. The registered manager had applied to the relevant supervisory authorities for a DoLS for one person.

Recruitment systems and processes were robust. This ensured only those suitable to work with vulnerable adults were employed by the service.

People’s privacy and dignity was not always respected. On the first day of our inspection a visiting healthcare professional had called to see two people who used the service. We noted they were taken into another service user’s bedroom

Inspection carried out on 19 November 2014

During a routine inspection

We carried out this inspection on 19 November 2014 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the registered provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

The service is registered to provide nursing or personal care for 19 older people. On the day of the inspection 15 people resided at the home. Some people who had lived at the home for some time had developed dementia.

We last inspected this service on 09 April 2013 when we found the registered provider was not meeting Regulation 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 for staffing levels. All other standards were met. However, at a responsive inspection on 19 July 2014 we found the provider had made amendments to the numbers of staff on duty and met the standard.

This inspection was unannounced. During the inspection we spoke with three people who used the service, two relatives, three care staff, the cook and the registered manager.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People who used the service told us they felt safe at Oldfield House. People who used the service said, “The staff sort everything out for me” and “All the staff are good.” A family member told us, “Yes I think my relative is safe, although she has had a couple of falls. She has a mat in her room because she does get up and walk unaided.”

The Mental Capacity Act 2005 (MCA 2005) sets out what must be done to make sure the human rights of people who may lack mental capacity to make decisions are protected. The Deprivation of Liberty Safeguards (DoLS) provides a legal framework to protect people who need to be deprived of their liberty to ensure they receive the care and treatment they need, where there is no less restrictive way of achieving this. The service had policies and procedures to underpin an appropriate response to the MCA 2005 and DoLS and the registered manager and staff expressed a good understanding of processes relating to MCA and DoLS. The registered manager had made applications under the act for people who lacked capacity in line with current guidelines for people who may not realise why they were in a home.

We saw that people who used the service or a family member had signed their consent for staff to administer medication. People received the support they required to take their medicines as prescribed. Staff responsible for administering medicines were regularly assessed to ensure their practice was safe.

Staff received a range of training and told us they were supported so they could deliver effective care. Two members of staff told us, “We have a good staff team. We are very well supported. We are supervised and appraised. I think the training is sufficient to meet the needs of the residents” and “I have had a lot of training. I get very well supported, either formally or informally just chatting about things.”

People who used the service told us, “I’m easy with food, I like prawns and I get them sometimes. There is a menu on the wall but I don’t look at it, I like a surprise”, “If there is nothing I like you only have to ask and they give you a choice”, “Oh yes, it’s good food and there is a choice. The menu is on the wall” and “No bother for staff. They tell me what the menu is and if it’s chips I have something else, I don’t like chips.” People were satisfied with the quality and choice of food.

People’s needs were assessed and regularly reviewed so that staff could deliver personalised care and support. Staff ensured they worked closely with the wider multi-professional care team to ensure people’s needs were met.

Systems were in place to record and review complaints. People were encouraged to express their views about the service they received. Records we looked at indicated people had been satisfied with the way any complaints they had made had been dealt with. The registered manager said she was available regularly to talk to and give them the opportunity to voice their concerns.

People who used the service were supported to take part in individual and group activities both in the home and in the community. These activities were designed to stimulate people and allow people to have access to the community.

Staff told us they enjoyed working at Oldfield House and felt well supported by the registered manager and other staff in the home. People who used the service, staff and family members told us the registered manager was approachable and open to ideas to improve the service.

The registered manager had systems in place to regularly monitor and assess the quality of care provided at this care home. Arrangements were in place to seek and act upon the views and opinions of people who used the service. We looked at the results of a survey sent by the service to families and people who used the service. The results were positive and included comments like, “A friendly, homely care home”, “Clean and comfortable” and “I feel the staff are very good and care for my relative well”.

Inspection carried out on 19 July 2013

During an inspection looking at part of the service

We saw people resting in the communal areas of the home and in the dining room. Two people spoken with told us they were happy with the care and support they received at the home. They told us, �They�re good to us here, I�m very comfortable thank you� and �They take good care of us, I�m alright here�.

We observed three care staff asking people about the way they wanted their care to be delivered. We observed staff supporting and treating people in a kind and respectful manner.

We looked at the staffing rota that was planned four weeks in advance. We saw that as far as possible there was enough staff to meet the needs of people who lived at the home. We noted the staffing levels recorded on the rota matched the number of staff on duty seen during our visit.

We found that improvements had been made to address the shortfalls associated with insufficient staffing levels. These improvements ensured people were safe and their health and safety needs were met by sufficient numbers of appropriate staff.

Inspection carried out on 9 April 2013

During a routine inspection

We spoke with four people who used the service and a relative. They told us they were satisfied with the quality of care and support they received. They told us their needs had been discussed and they had agreed to the support provided.

They told us the care workers provided sensitive and flexible personal care and support and they were well cared for. People made positive comments about the service such as, �They�re good staff here� and �We get good food and they look after us well�.

We looked at the care plans of three people and saw there were procedures in place to ensure their consent was gained in relation to the care provided. A relative spoken with told us, �My husband will have signed the forms for my mother in law�.

People told us they had no concerns about the care being provided and they felt safe and protected from potential harm. A relative spoken with told us, �They�ve been looking after my mother in law for five years. They are patient with her. I have no problems with her care�.

We observed medicines were safely administered during the inspection and medicines procedures were audited on a regular basis.

We noted there were insufficient numbers of staff to meet the needs of the people who use the service at all times. We saw staff were hurried and not immediately available to people when required. This meant there was potential for risks to occur in their absence.

Inspection carried out on 14 May 2012

During a routine inspection

People were satisfied with the service provided. They told us they were agreeable to the treatment and support they were receiving at the home.

People�s care was planned and delivered in accordance with their needs. They told us; The staff are lovely, they do their job right� and �I am happy and comfortable here.�

We found staff had received training on safeguarding vulnerable adults and had access to appropriate policies and procedures. People using the service told us they were able to voice any concerns about the service to a member of staff or the manager and they felt confident appropriate action would be taken. A person told us, �I feel safe living here�.

There were sufficient numbers of staff on duty to meet people's needs. People made complimentary comments about the staff team. They also told us, �The staff are good, they bend over backwards for us� and �If you need help you just press the bell and the staff come quickly�. Also, �It�s smashing here, if there is anything I want or need I ask the manager and if she�s not got it she�ll move heaven and earth to get it for me�.

We saw evidence to demonstrate that people were being consulted about their opinion of the service. They told us they could talk about any issue concerning the home and were confident the manager and staff would listen and act if necessary. We spoke with six people using the service who told us, �My relatives completed a survey for me, it is wonderful here�.

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