Archived: The Oaks

The Oaks is a large nursing home which accommodates up to 113 older people living with dementia or mental health needs across six units.

We found the following examples of good practice.

¿ There were effective systems in place to manage the spread of inspection. Visitor's temperatures were checked on arrival, and all visitors were asked to complete a screening questionnaire to ensure they were safe to enter the service.

¿ Risks relating to COVID-19 had been fully assessed and action taken to mitigate them where possible.

¿ Staff wore appropriate PPE and some chairs had been removed from communal lounges to encourage people to adhere to government guidance on social distancing.

¿ The service was clean and appropriate cleaning products were used.

Further information is in the detailed findings below.

The Oaks is a large nursing home which accommodates up to 113 older people living with dementia or mental health needs across six units. At the time of our inspection there were 78 people living at the home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. There was a manager in post at the time of our inspection and they were in the process of registering with the CQC to become the registered manager for the service. 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 this inspection we found the service had continued to make required improvements and demonstrated that they met the regulations and fundamental standards.

Risks to people were assessed, recorded and managed safely by staff. Medicines were managed, administered and stored safely. People were protected from the risk of abuse, because staff were aware of the types of abuse and the action to take. There were systems in place to ensure people were protected from the risk of infection and the home environment appeared clean and well maintained. Accidents and incidents were recorded and acted on appropriately. There were safe staff recruitment practices in place and appropriate numbers of staff to meet people’s needs.

There were systems in place to ensure staff were inducted into the service appropriately. Staff received training, supervision and appraisals. Staff were aware of the importance of seeking consent and acted in accordance with the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. This provides protection for people who do not have capacity to make decisions for themselves. People’s nutritional needs and preferences were met. People had access to health and social care professionals when required and staff worked well with health and social care professionals to meet people’s needs.

People told us staff treated them well and respected their privacy and dignity. People’s diverse needs were met and staff were committed to supporting people to meet their needs with regard to their disability, race, religion, sexual orientation and gender. People were involved in making decisions about their care. There was a range of activities available to meet people’s interests. The service provided care and support to people at the end of their lives. People’s needs were reviewed and monitored on a regular basis. People were provided with information on how to make a complaint. There were effective systems in place to monitor the quality of the service provided. People’s views about the service were sought and considered. People, their relatives and staff spoke positively of the management at the home.

We undertook this focused inspection to check that the provider met legal requirements. This report only covers our findings in relation to some of the breaches identified at our last inspection and in the warning notice. You can read the report from our last comprehensive inspection, by selecting the link for The Oaks on our website at www.cqc.org.uk.

The Oaks is a large nursing home which accommodates up to 113 older people with dementia or mental health needs across six units. At the time of our inspection there were 87 people living at the home. There was a registered manager, however the provider advised us that they had tendered their resignation and were not actively managing the service. The provider was in the process of recruiting a new manager to run the home and had made temporary arrangements to support staff until a new manager was recruited. 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 this focused inspection on 6 July 2017 we found that the provider had addressed the breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and were compliant with the warning notice we served. There were newly implemented systems in place to assess, monitor and mitigate the risks relating to the health, safety and welfare of people using the service, to assess monitor and improve the quality and safety of the service and to ensure contemporaneous records were kept relating to the health, safety and welfare of people using the service. However the ratings for the key questions safe, effective and well led at this inspection remain ‘Requires Improvement’ at this time as systems and processes that had been implemented had not been operational for a sufficient amount of time for us to be sure of consistent and sustained good practice and to achieve the rating of good.

The Oaks is a large nursing home which accommodates up to 113 older people with dementia or mental health needs across six units. At the time of our inspection there were 83 people living at the home. 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.

At this inspection we found the provider had met the breach of regulation in relation to assessing people’s capacity in line with the Mental Capacity Act 2005 and continued improvements were on going. However, whilst we found that the provider had made improvements to the specific area identified; at this inspection we found new breaches of regulations. We found failures to operate effective systems to assess, monitor and mitigate the risks relating to the health, safety and welfare of people using the service and to effectively operate systems to assess monitor and improve the quality and safety of the service. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

People’s risk assessments were not always completed appropriately and were not always reviewed on a regular basis in line with the provider's policy to ensure they remained up to date and reflective of people’s needs and risks. There were failings in ensuring there were effective systems in place to assess, review, monitor and improve the quality and safety of the service, maintain accurate complete and contemporaneous records and to mitigate risks relating to the health, safety and welfare of people using the service.

Medicines were managed, administered and stored safely. There were arrangements in place to deal with foreseeable emergencies and there were safeguarding adult’s policies and procedures in place. There were appropriate numbers of staff to meet people’s needs.

Staff new to the home were inducted into the service appropriately and staff received training, supervision and appraisals. There were systems in place which ensured the service complied with the Mental Capacity Act 2005 (MCA 2005). This provides protection for people who do not have capacity to make decisions for themselves. People’s nutritional needs and preferences were met; however some people’s meal time experience required some improvement. People had access to health and social care professionals when required.

People told us they were treated with kindness and respect. Staff were knowledgeable about people's needs with regards to their disability, race, religion, sexual orientation and gender and supported people appropriately to meet their identified needs and wishes. People were provided with information on how to make a complaint and told us the registered manager and staff were approachable. People using the service and their relatives were asked for their views about the service.

The Oaks is a nursing home which can accommodate up to 113 older people with dementia or mental health needs across six units. At the time of our inspection there were 90 people living at the home. There was a registered manager in place who had started to work as manager at the home just prior to the last inspection in March 2015. 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 this inspection we found a breach of regulation where people may lack capacity to make a particular decision; records showed their capacity was not separately assessed for each decision. You can see the action we have asked the provider to take at the back of the full version of this report. People were asked for their consent before they were provided with care or support. Applications for Deprivation of Liberty Safeguards authorisations had been appropriately made in line with current guidance.

We found improvements had been made in relation to medicines which were now safely and consistently managed across the home. Considerable improvements had been made to the environment to make it more suitable for people living with dementia. People and their relatives told us they felt safe at the service. Staff understood signs of abuse or neglect and knew how to report concerns. Individual risks to people were identified and monitored. There were processes in place to manage emergencies. The premises and equipment including emergency equipment were routinely checked, serviced and maintained. Recruitment checks were in place before staff started work to reduce the risk of unsuitable staff being employed. There were enough suitably qualified staff to meet people’s needs. We observed that no one was waiting for care and support throughout the day and call bells were answered promptly.

People and their relatives told us staff were kind and helpful. People were not rushed and their privacy and dignity was respected. People’s end of life care was sensitively and appropriately managed. Staff received supervision, appraisal and suitable training across a range of areas and told us they felt supported to enable them to carry out their role.

People had plenty to eat and drink and were encouraged to be independent or supported, where needed, at their own pace. The home worked with a wide range of health and social care professionals to meet people’s health needs. People’s needs were assessed to ensure they could be safely met. Care and support was planned to meet their individualised needs. There was a regular activities programme, which had been extended to include a wider range of opportunities for stimulation and interaction. Further improvements in the range of activities offered were being introduced.

People, their relatives, staff and health professionals told us the service was well led. The management team looked for ways to constantly improve the service. The views of people at the service, relatives, staff and visiting professionals were sought and used to make improvements. Complaints were responded to in line with the provider’s policy. People knew how and where to complain if they had a problem. There were systems in place to monitor the quality of the service and issues identified were acted on.

We checked whether the provider had made improvements since our previous inspection in relation to staff training, supervision and appraisal, and with record keeping. At our inspection on 05 March 2014 we found the provider had made most of the improvements that were required. We found staff mandatory training was up to date for the majority of staff, and that although supervision sessions did not meet the provider's required frequency, most staff had been adequately supervised and supported. We found the provider had appraised the majority of staff and we saw confirmation that the remaining staff appraisals were planned. We found the majority of people's care records reflected their needs and had been adequately maintained. People's records in most cases evidenced the care they received. We found the security of people's care records had improved.

We found people or their relatives were involved in decisions relating to their care, and people were invited to make choices. People's privacy and dignity was respected. We found people's care needs had been regularly re-assessed and care plans reflected people's current needs. The provider had assessed the risks to people and had ensured that people were provided with care and support which reduced the risks to them. We found the provider had made improvements to the premises to ensure people lived in a suitable environment. Not all staff had received the provider's required level of training, supervision or appraisal. People's care records did not always adequately evidence the care that people received and management records were not always sufficient to monitor training or supervision uptake.

We checked medication practice including administration, recording, storage and disposal and found that improvements had been made. For example, staff training had been held, and the provider had checked its medication practice more frequently. The sample of medicines we checked found showed medication knowledge and practice at the home had improved. We checked the provider's quality assurance systems and also found improvements had been made. Several checks took place to ensure a quality service was provided and where weaknesses were identified, improvements were implemented.

We were unable to speak to most people who used the service due to communication difficulties. However, we observed that people received minimal staff interaction and little stimulation. People's families we spoke with were complimentary of the service. One person told us the staff were very good and they were kept informed about their family member's condition. In one person's recent care review their family member commented "staff look after X very well and they do what they can". One person who used the service told us they were happy and staff provided them with support to continue to walk.

We found people's care needs were assessed and in general people's care needs were met. However we found some risk assessments were not in place and people were afforded little stimulation or activities throughout the day. We found improvements had been made in relation to our previous medication issues, but we found medication processes were still insufficient in areas. Quality assurance improvements had not been made. The provider was unable to demonstrate that the required maintenance and refurbishment would be carried out to make the premises a more suitable environment for people live in.