The Oaks Care Home

The Oaks Care Home is registered to provide accommodation, personal and nursing care for up to 61 people who may have a physical disability, living with dementia, or requiring end of life care. At the time of our inspection 48 people lived at the service.

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

Improvements were needed in the management of medicines to reduce the risk of errors being made, and to ensure all people receive their medicines as prescribed.

Staff were not always following safe infection control processes. Improvements were needed to ensure all areas of the service and equipment used were kept clean and hygienic.

Governance systems were not robust enough to ensure shortfalls were independently identified and addressed.

People told us they felt safe living in the service and if they had any concerns knew to who to talk to. One person said, “I like it here…I feel very safe,” and told us if they had a concern they would, “Speak to the nurse or [manager].”

Feedback from people living in the service, their relatives and staff identified at times the provider’s staffing levels were not being maintained. This impacted on staff being able to spend time talking with people. The manager was aware how a high level of sickness would affect maintaining the planned staffing levels and was taking action to address it.

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. However, if staffing levels are not maintained, this could have an impact on people’s choice, and being able to take part in activities.

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 good (published 24 January 2018).

Why we inspected

We received concerns in relation to the management of medicines and governance of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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.

You can see what action we have asked the provider to take at the end of this full report.

The provider responded immediately during and after the inspection, carrying out a full medicines audit and producing an action plan to address concerns.

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

Enforcement

We have identified breaches in relation to medicines management and quality assurances systems at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

National guidance was being followed to ensure staff and people living in the service were regularly tested for COVID-19. This included the quick tests, where results were known within 30 minutes and used for visiting relatives.

Booked visits were being accommodated in the ‘visiting pod’, and systems were in place to accommodate indoor visits, in line with government guidelines from the 8 March 2021.

Staff had been trained and followed safe practice in the wearing of personal protective equipment (PPE).

Along with official posters to alert people how to wear face masks correctly, a poster of a dog also showing how the mask should be worn, caught people’s attention and provided a good talking point. Where staff noted visitors wearing black face masks caused anxiety to people living with dementia, the visitors were asked to change to a light-coloured face mask.

People had received their first COVID-19 vaccination. The service was working closely with the local authority, Public Health England, and the Clinical Commissioning Group (CCG) infection control team to ensure their infection control practice was safe.

The ‘Bug news’, an informative monthly newsletter provided by the local CCG infection control leads, kept staff updated on best practice and new guidance.

We carried out this unannounced inspection on 28 November 2017 to see if the provider had made the necessary improvements to the service. We saw that improvements had been made to ensure people were kept safe from the risk of infection, records were more consistent, people had more opportunities for leisure activities and improvements had been embedded in practice. All of the key questions were rated as ‘Good’ and the service received a rating of 'Good' overall.

The Oaks is a ‘care 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.

The care home was registered to provide a service to up to 61 people in one building on two separate floors. These included people with a physical disability, those living with dementia and people receiving end of life care.

However, after the recent refurbishment people were accommodated only on the ground floor until further refurbishment was undertaken. At the time of the inspection, there were 32 people being supported by the service.

A registered manager was 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.

There were systems in place to safeguard people from avoidable harm and staff knew how to report any concerns. The risk assessments undertaken provided staff with the necessary information and guidance on how risks to people could be minimised. The service regularly reviewed their staffing arrangements to ensure there were sufficient staff available to support people safely.

Recruitment processes were in place for the safe employment of staff. People’s medicines were managed and administered as prescribed and infection control procedures were followed in order to keep people safe and well. Systems were in place to learn from incidents and accidents and to improve the service as a result.

An organised programme of induction, training, supervision and appraisals for staff were in place. Staff had the knowledge and skills to care for people effectively. They understood their roles and responsibilities to seek people’s consent prior to care being provided.

People were supported to have a choice of food and drink and to have a balanced and varied diet. The registered manager and staff ensured access to healthcare services were readily available to people and worked with a range of health professionals to implement care and support plans.

People’s needs were met by the design and decoration of the premises. They had been involved in the recent refurbishment and could access all areas including the grounds.

Systems were in place to ensure that people’s rights were respected and protected under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Where people did not have capacity to consent to their care or make decisions about their lives, this was managed in line with the requirements of the MCA.

Staff were respectful and compassionate towards people ensuring their privacy and dignity was valued. People were supported in a person centred way by staff who understood their roles and responsibilities. People's independence and choice were encouraged and promoted by staff.

People received personalised care that was responsive to their needs. Care plans were individual and detailed people’s history, preferences and wishes. An effective complaints procedure was in place and had been implemented appropriately by the registered manager. People and their families were well supported by caring staff at their end of their life.

There was a positive, open and inclusive culture at the service. The service was well led and managed. Resources were available to support and develop the service and people, their families and staff were actively involved. Systems were in place to monitor all aspects of the quality of the service. There were opportunities to learn and develop new and innovative ideas in partnership with other agencies.

During an earlier inspection in December 2015 we identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was placed into Special Measures and we imposed a condition on their registration to not admit any further people into the service. We told the provider to take urgent action and kept the service under review, with the expectation that significant improvements would have been made within a six month timeframe.

At our inspection in June 2016 we found that robust and sustainable audit and monitoring systems were still not in place to ensure that the quality of care was consistently assessed, monitored and improved. The provider had failed to recognise and identify significant failings impacting on the quality of service provision, and risks to people. We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of Regulation 9 Person centred care, Regulation 10 Dignity and Respect, Regulation 12 Safe care and treatment, Regulation 14 Meeting nutritional and hydration needs, Regulation 16 Receiving and acting on complaints, Regulation 17 Good governance, Regulation 18 Staffing and Regulation 19 Fit and proper person’s employed.

You can read the reports from our last comprehensive inspections, by selecting the 'all reports' link for The Oaks Care Home on our website at www.cqc.org.uk.

The provider had acted on our concerns and at this inspection we found that there was a positive, open and inclusive culture in the service. There had been significant progress made in making the required improvements, however there were some aspects of the service provision where further work was needed to ensure that safe and responsive care was delivered at all times.

The Oaks Care Home provides care for up to 61 people who are elderly and frail with complex needs that may include nursing and/or dementia related needs. On the day of our inspection there were 25 people living at the service.

There was currently no registered manager but an interim manager was 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.

Improvements were still needed to protect people from the risk of infection. Some staff were observed providing care without using the appropriate personal protective equipment such as gloves and aprons.

Although significant progress had been made with the care plans we found that records were not always consistent. However, care plans were now person centred and reflected the care and support that each person required and preferred to meet their assessed needs.

People generally felt that there were sufficient numbers of staff to care and support people according to their needs. People and their families were positive about the care they received from staff who respected their privacy, dignity and independence.

Staff demonstrated a knowledge and understanding of people’s preferred routines, likes and dislikes and what mattered to them. Staff were being encouraged and supported to have a greater understanding of how they could ensure a holistic approach to people’s care. They had completed additional training to equip them with a greater awareness and understanding with regards to supporting people living with dementia.

There were improvements in the provision of activities. There were times when the opportunities for social interaction were more limited but this was being addressed with the introduction of an additional activities co-ordinator and the provision of further areas where people could meet together once the refurbishment work was complete.

There had been significant improvements in the way the kitchen was managed and monitored. There were also improvements in catheter and pressure care.

People presented as relaxed and at ease in their surroundings and told us that they felt safe. Staff knew how to minimise risks and provide people with safe care. Procedures were in place which safeguarded the people who used the service from the potential risk of abuse. People knew how to raise concerns and were confident that any concerns would be listened and responded to.

Suitable arrangements were in place for the management of medicines and staff had been trained to administer medicines safely. However, additional work was needed to ensure that there was clear guidance for staff relating to medicines to be administered ‘as required.’

Staff understood the importance of gaining people’s consent to the support they were providing. The management team and staff understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People’s nutritional needs were assessed and professional advice and support was obtained for people when needed. They were supported to maintain good health and had access to appropriate services which ensured they received ongoing healthcare support.

At our last two inspections we found widespread and significant shortfalls in the way the service was led. The provider had acted on our concerns and at this inspection we found that there was a positive, open and inclusive culture in the service. A comprehensive improvement plan together with a robust quality assurance system meant that shortfalls were being identified, addressed and used as an opportunity to drive continuous improvement

Although significant progress had been made in improving the service it was not possible for the provider to fully demonstrate the impact of the changes because of the short time they had been implemented for. The provider now needs to demonstrate that the improvements will be sustained and embedded in practice so that people can be confident they are receiving safe, effective and responsive care.

During our inspection in December 2015 we identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was placed into Special Measures and we imposed a condition on their registration to not admit any further people into the service. We told the provider to take urgent action to address and improve staffing levels, medicine management, infection control practices, cleanliness and hygiene, governance and management systems. We received an action plan from the provider and we have kept the service under review, with the expectation that significant improvement to have been made within a six month timeframe.

Despite assurances given by the provider and management following our previous inspection, at this inspection we found that robust and sustainable audit and monitoring systems were still not in place to ensure that the quality of care was consistently assessed, monitored and improved. The provider had failed to recognise and identify significant failings impacting on the quality of service provision, and risks to people.

The Oaks Care Home provides care for up to 61 people who are elderly and frail with complex needs that may include nursing and/or dementia related needs. On the day of our inspection there were 32 people living at the service.

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.

The overall governance and oversight was not robust enough to ensure that all areas of the service were working well and improving. Where actions had been taken to improve there was no effective system in place to ensure those actions were being implemented and sustained. People continued to be at risk of infection, poor moving and handling, poor pressure relieving management and poor record keeping. Staff did not have the resources, including effective training, to support them to provide high quality care.

Care was not personalised and delivered in a planned and consistent way. The needs of people living with dementia were not considered and staff were not aware or understood how dementia affected those individuals in their day to day living. Staff had also not had training to help them understand other health needs of people for example, diabetes.

We found that there continued to be poor standards of cleanliness and infection control. The kitchen and kitchen equipment were unclean and unhygienic, and people were at risk from the unsafe management of food.

Recruitment processes were not robust and operated effectively to ensure newly recruited staff were suitable for the role.

Since our last inspection action had been taken to address significant shortfalls in medicine management however further improvement was needed to ensure people received their prescribed medicines at the right time and ensure the correct period of time between doses.

There was a lack of oversight from all levels of management and quality assurance systems were not effective. This meant improvements identified in their action plan were either not being properly implemented or sustained. Resulting in continued non-compliance with regulations and poor outcomes for people.

This is the second time the service has been found to be Inadequate overall and continues to be in Special Measures, The Commission is considering its enforcement powers.

We looked at care records and found that people had appropriate assessments and were cared for according to their needs. We saw that there was enough equipment to promote people's independence and comfort. We found that systems were in place to ensure the service was being maintained.

Staff told us that they received training and support to ensure that they had the skills, experience and knowledge to carry out their roles.

One person stated that "they enjoyed playing dominoes with the staff."

We inspected six regulations and found that the service was meeting the personal, emotional and healthcare needs of the people using the service. We found that the environment was maintained safely and that all health and safety checks were up to date

Three people told us they were pleased with the choice of menus available. At lunchtime we carried out a short observational framework inspection (SOFI). We found that people were appropriately supported with their meals in a timely and respectful manner and were provided with at least three choices. The catering staff spoke with people to see if they had enjoyed their meal and to also listen to any ideas people had about the meals.

We found that all mandatory training was up to date.