Archived: High View Oast Care Home

High View Oast is a nursing home providing personal and nursing care to 22 people aged 65 and over at the time of the inspection. The service can support up to 33 people.

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

There had been change of provider and a number of changes to the management team since the last inspection and this had resulted in staff feeling unsettled. Although the new provider had made positive changes to the service these had yet to be embedded into the culture and the provider acknowledged there was more work to do. The provider and manager were accessible and open to people’s views. Surveys had been completed and actions taken to address shortfalls. Regular audits were completed. Regular visits to the service and weekly reports enabled the provider to have oversight of the service.

Staff told us they felt they would benefit from more training and more regular supervisions. There was a new training plan place and supervisions were being planned. People’s health care needs were managed well and the manager had begun working closely with the local GP to improve people’s access to health professionals. Some people had hospital passports which they could give to hospital staff to explain their needs and preferences, however, this was not in place for everyone. People had access to food and drinks which met their needs and where necessary their intake was monitored and actions taken when required. 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.

People’s care plans were now more consistent and gave detailed guidance for staff about their needs and how they preferred to be supported. People’s end of life care plans would benefit from more detail about what makes them feel comfortable and reassured. People could take part in a range of activities; however this could be expanded. An activities co-ordinator had recently been employed to improve this. Complaints were dealt with in line with the providers policy. However, the complaints policy and other documents were only available in normal or large print. No other options were available to make information accessible to people.

People told us that staff were kind, caring and respected their wishes. Staff knew people well and used that knowledge to engage with people and reassure them. Relatives told us they were always made welcome and kept informed about any changes in their loved ones needs. People were encouraged to be independent and their dignity and privacy was respected.

People told us they felt safe at the service. Staff understood their responsibilities in relation to safeguarding people form abuse. Risks had been assessed and guidance was in place to minimise risk without restricting people. Staffing levels were appropriate to meet people’s needs and staff had been recruited using safe practices. People’s medicines were managed safely and in the way they preferred. Infection control measures were taken by staff and the service was clean. Accidents and incidents were reviewed for learning and actions were taken to reduce the risk of reoccurrence.

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 07 July 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. This is the fifth time the service has been rated inadequate or requires improvement.

Why we inspected

This was a planned inspection based on the previous rating.

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.

High View Oast 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. High View Oast accommodates up to 33 people in one adapted building. At the time of the inspection 24 people were living at the service.

The service had a registered manager in post, the registered manager had started working at the service after the previous inspection. A registered manager is a person who is registered with the Care Quality Commission (CQC) 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.

We last inspected High View Oast in March 2017 when one continued breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was identified. We issued a requirement notice relating to safe care and treatment: the unsafe management of medicines.

At our last inspection, the service was rated ‘Requires Improvement’. We asked the provider to complete an action plan to show how they would meet the regulatory requirements. At this inspection, the continued breach of regulation had been met, medicines were now managed safely. However, two new breaches of regulations were identified. This is therefore the third time the service has been rated ‘Requires Improvement.’ There had been lots of different managers over the past three years. The service was now more stable with a registered manager, some of the issues we identified had already been identified and were being addressed. Staff morale had improved but there was still a way to go which the registered manager recognised.

The service had been rated inadequate or requires improvement at the previous three inspections. The provider had not ensured that any improvements made had been embedded into the culture of the service. The day to day management of the service had been inconsistent over the past three years and the provider had not ensured consistent oversight of the service to meet the regulations.

Potential risks to people’s health and welfare had been identified but had not been consistently assessed. Staff did not have detailed guidance to mitigate risks in respect of people that displayed behaviours that may challenge. When people had displayed behaviours that may be challenging, staff completed behaviour charts and incident reports. This information had not been analysed to identify any patterns, trends or triggers to people’s behaviour and to develop a behaviour support plan. The registered manager told us they had discussed with the local safeguarding team, incidents where other people were at risk from people’s behaviour but this had not been recorded. Staff understood their responsibility to report any safeguarding concerns they may have.

Each person had a care plan that covered all aspects of their care including cultural needs, mental and physical health. These plans varied in detail about people’s choices and preferences, and how they liked their support to be provided. Some care plans did not reflect the care that was being provided. Staff knew people well and described how they supported people and their choices and preferences.

Checks and audits were completed on the quality of the service by the provider and the registered manager. The provider had identified some shortfalls in the care plans and risk assessments and detailed what action needed to be taken. However, there were no action plans detailing who was responsible for the action and when the action had to be completed by. There was no record that checks had been completed to confirm the action had been taken. The registered manager had not identified any shortfalls in their audits. The audits were not effective as they had not identified the shortfalls found at this inspection.

Checks had been completed on the environment and equipment to keep people safe. Environmental risk assessments had been completed and action had been taken to mitigate risks to people. Each person had a personal emergency evacuation plan, these gave details of the persons physical and communication needs to support them to be evacuated safely.

People were supported to express their views about their care; however, this was not always available in different formats to assist people’s understanding. The service was now supporting people living with dementia. There was limited pictorial signage to help people understand where they were or where different parts of the service were. The registered manager agreed these were areas for improvement. The building had been adapted to meet people’s needs and people had access to outdoor space. The service was clean and odour free.

Medicines were managed safely and people received them when needed. There were sufficient staff to meet people’s needs and staff had been recruited safely. Staff received regular supervision and appraisals to discuss their practice and development. Staff had received training appropriate to their role.

People were supported to eat and drink enough to maintain a healthy diet. People were encouraged to lead as healthy a life as possible. Staff monitored people’s health and referred them to specialist healthcare professionals when needed and staff followed the advice given. People had access to health professionals such as opticians when required. People were asked their end of life wishes and these were recorded when people wanted to discuss them. People’s needs were assessed before they moved into the service using recognised tools in line with current practice.

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.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager had a system in place to track and monitor applications and authorisations.

The provider had a complaints policy and complaints had been investigated in line with the provider’s policy.

People were treated with dignity and respect. People were supported to be as independent as possible. People had the opportunity to take part in activities and create links with the community.

People, relatives and staff were encouraged to express their views about the service. The provider and registered manager’s vision for the service was for people to be as independent as possible and for them to feel happy and contented. Staff shared the vision of the care they wanted to provide.

The registered manager attended meetings and forums to keep their knowledge up to date. Additional links to the community were being developed. The registered manager worked with other agencies such as the local commissioning group.

Services that provide health and social care to people are required to inform CQC of important events that happen in the service. This meant we could check that appropriate action had been taken. The registered manager had informed CQC of important events in a timely manner as required.

It is a legal requirement that a provider’s latest CQC report rating is displayed at the service where a rating is given. This is so that people, visitors and those seeking information about the service can be informed of our judgements. We found the provider had conspicuously displayed their rating on a notice board in the entrance hall and on their website.

At this inspection breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. You can see what action we have asked the provider to take at the end of the report.

High View Oast Nursing Home is a converted Oast house, and is nursing home for up to 33 people. The bedrooms are situated on both ground floor and first floor, and consist of a mixture of single and double rooms. There is a lift providing access between floors. The communal accommodation is situated on the ground floor and consists of two interlinking lounge areas, a dining room, a small quiet lounge, and a porch area. On the day of the inspection there were 16 people living at the service.

There was no registered manager in post. The service had an interim manager who had been managing the service since September 2016. A new manager had been appointed but was not due to start at the service until April 2017. 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 and associated Regulations about how the service is run. We were supported by the interim manager, the regional manager, and the quality manager.

We last inspected this service in September 2016. We found significant shortfalls in the service. The provider did not have sufficient guidance for staff to follow to show how risks were mitigated when moving people, supporting people with their behaviour and health care needs. Staff had not ensured the proper and safe management of medicines. Safeguarding alerts had not been raised with the local safeguarding team. Staff were not deployed in sufficient numbers. Staff were not suitably qualified, competent, skilled and experienced to meet people's needs. Authorisations to deprive people of their liberty in line with the Mental Capacity Act had not been made. Care plans were not person centred or regularly updated when people's needs changed. The registered provider had failed to take appropriate action to mitigate risks and improve the quality and safety of services. They had failed to seek and act on feedback from relevant people, on the service provided to continually evaluate and improve the service. Records could not be found, were not clear and completed accurately.

We took enforcement action and required the provider to make improvements. This service had been placed in special measures. Services that are in special measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. The provider sent us information and records about actions taken to make improvements following our previous inspection.

At this inspection we found that significant improvements had been made. There was, however, one continued breach in the regulations in the safe management of medicines and further improvements were needed in moving and handling risks assessments, details in care plans of what people could do for themselves and to eliminate an odour on the second floor of the premises.

People’s medicines were not well managed, stored and recorded accurately. Some people had not received the medicines they needed.

Although staff were observed moving people safely, some risk assessments to support people with their mobility did not have sufficient information to guide staff how to move people consistently and safely.

Checks had been carried out on the service, to ensure the premises was safe and environmental risk assessments were in place. However, on the second floor, improvements were needed to ensure that the service was free from offensive odours.

Emergency procedures were in place and the service had a business continuity plan. There was a ‘grab file’ which was available in case of an emergency such as a fire, and each person had a personal emergency evacuation plan in place. Regular fire drills for all staff had been carried out apart from one week when the staff member responsible had been on annual leave. The interim manager told us that this would be addressed and an additional staff member would be identified to cover this duty.

Risk assessments to show staff how to positively support people with behaviour that challenged now had detailed information about what may be triggering this behaviour and how to reduce the risk of this happening again. Accidents and incidents had been investigated and analysed to ensure action was being taken to reduce the risks of further events.

Staff had been trained protect people from harm, and were aware of the service’s whistle-blowing policy. They knew how to raise any concerns with the interim manager, or with outside agencies if required. Systems were in place to ensure that people's finances were protected. There were clear systems in place to record and receipt any monies spent which were regularly audited.

Staffing levels had been reviewed to ensure that there was enough staff deployed in the service to meet people’s care and support needs. Staff had been recruited safely.

Staff had completed training including competency training to help them carry out their roles effectively. All staff had received regular supervision, including clinical supervision for the registered nurses. Staff told us they felt supported and were confident to raise issues in their supervision or at the regular staff meetings.

The interim manager and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) and people’s mental capacity to consent to care or treatment had been assessed and recorded. People were supported by their relatives to be involved in planning their care and to make decisions about their daily lives.

People’s health care needs were monitored and when required health care professionals were involved in their care. Staff were familiar with people’s likes and dislikes, and supported people with their daily routines.

People told us they enjoyed the food and a varied menu was provided to ensure people received a nutritious diet. Records showed that people were assessed to make sure they received a healthy diet to ensure their nutritional needs were met.

People told us that their privacy and dignity was maintained and they were treated with kindness and respect. Staff greeted people as they went about their duties and people were offered choices about their daily routines, and where they wanted to sit or what they wanted to eat.

People’s care plans had been reviewed and contained detailed information of how they would like their care to be provided. The plans were more personalised but further detail was required to show what people could do for themselves, and how they were being encouraged to remain as independent as possible. Staff were able to describe in detail how they supported people to remain independent but this was not always reflected in the care plans.

Staff told us that the ten minute meetings each day had improved communication and ensured that all staff were as aware of people’s changing needs and what was going on in the service that day.

There was a new activities co-ordinator who encouraged and supported people to maintain their hobbies and interests. People were enjoying the singing during the afternoon, smiling and singing along with the songs. The co-ordinator talked about involving all staff with the ongoing activities plan to promote a family atmosphere in the service.

People and relatives felt confident that any concerns raised would be listened to and acted on. All complaints had been recorded and responded to appropriately.

People had opportunities to provide feedback about the service provided. Quality assurance surveys were sent out annually directly from the organisation’s head office. Although other stakeholders and visiting professionals had been sent surveys no one had responded. People and relatives could view the outcome of the survey on the notice board. Resident meetings were held regularly and minutes taken, relatives who could not attend were sent the minutes to keep them up to date with the service.

The systems in place to review the quality of all aspects of the service had been reviewed and they were now working effectively. There were now regular checks and audits in place to make sure that any issues were picked up and actioned to address shortfalls and continually improve the service.

People, relatives and staff felt the service was well led, and the interim manager had made ‘huge’ improvements in the service. Staff told us they were valued and the interim manager listened to them and their opinions were taken into consideration.

Record keeping had significantly improved. The records were now very organised, including the audits, staff records, care plans and relevant documentation. All records requested at the inspection were provided promptly and were in good order.

The provider had ensured that the published rating from the previous inspection was on display.

As this service is no longer rated as inadequate, it will be taken out of special measures. We acknowledge that this is an improving service however there was one continued breach in the regulations to ensure that people receive their medicines safely. The interim manager took immediate action to ensure the person was safe when this was raised and an investigation is on-going. We will continue to monitor High View Oast to check that improvements continue and are sustained.

High View Oast Nursing Home is a converted Oast house, and is nursing home for up to 33 people. The bedrooms are situated on both ground floor and first floor, and consist of a mixture of single and double rooms. There is a lift providing access between floors. The communal accommodation is situated on the ground floor and consists of two interlinking lounge areas, a dining room, a small quiet lounge, and a porch area. On the day of the inspection there were 22 people living at the service.

There was no registered manager in post. The service had an interim manager who had left on 16 September 2016. A new interim manager was due to start on 26 September 2016. The regional manager told us they planned to work at the service until a permanent manager had been appointed. 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 and associated Regulations about how the service is run. We were supported by the regional manager, the quality manager and deputy manager.

At our previous inspection on 21 September 2015 the service was rated as ‘requires improvement’. At that time areas for improvement had been identified by the management team and action plans were in place to address the shortfalls. However, at this inspection we found the required improvements had not been made and additional shortfalls in the service were identified, as detailed in this report.

Although people told us they felt safe living at the service, people were not fully protected from harm or abuse. The management team had failed to report incidents of alleged abuse by staff to people to the local safeguarding authority, in line with safeguarding protocols.

Risk assessments to show staff how to support people positively when their behaviour were not detailed enough. There was no information on what may be the trigger to this behaviour and how to reduce the risk of this happening again. Measures were not in place to reduce the risks and keep people as safe as possible. Some risk assessments to support people with their mobility did not have sufficient information to guide staff how to move people consistently and safely.

Accidents and incidents were recorded but lacked detail, and these were not analysed so action could be taken to reduce the risk of further events.

There was not enough staff on duty to ensure people’s needs were fully met. On the day of the inspection the deputy manager confirmed that staffing levels were not up to the preferred levels due to staff sickness. Recruitment procedures had not been followed to ensure staff had been recruited safely.

People were at risk of harm as they were not always receiving their prescribed medicines. The storage room for medicines was not maintained at the correct temperature to ensure the medicines were safe to use.

Checks on the equipment and the environment were carried out, but staff could not find the environmental risk assessments. The service had a ‘grab file’ which was available in case of an emergency such as a fire, and each person had a personal emergency evacuation plan in place. Regular fire drills had been carried out.

The training programme had not ensured that all staff had received the training and training updates they needed to carry out their roles safely.

During the last inspection in September 2015 it was noted that not all staff had received a yearly appraisal to discuss their training and development needs and the programme of staff supervision was not up to date. There was an action plan in place to address these shortfalls, but at that time of this inspection there remained staff who had not had a one to one meeting with their line manager or received an annual appraisal.

Meetings were held with the nursing staff, and care staff to encourage them to voice their opinions of the service and discuss any issues; however minutes of the senior staff meeting were not available at the time of the inspection.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. One application to deprive a person of their liberty (DoLS) had been processed through the local authority and granted. Staff did not have a clear understanding regarding DoLS as there were people living with dementia who lacked capacity, and who needed constant supervision and were unable to leave the service. No DoLs applications had been made in these cases.

People’s privacy and dignity was not always upheld. At times people had to wait to be supported with their personal care until early afternoon, whilst others had to wait to be supported with their mobility.

People’s care plans varied in detail and they were not always personalised. The plans contained out of date information which did not give staff clear guidance to ensure people were receiving care in line with their current needs. Monthly care plan reviews were carried out but the main care plans were not always updated with full details of people’s current needs.

Staff told us that they sometimes found it hard to keep up with people’s changing needs as there was only a staff handover between nurses and they did not attend. There was a ten minute meeting each day but this happened at 11am and staff thought this was too late as they needed to know if people’s needs had changed before they went on the shift first thing in the morning. This situation had resulted in poor communication and there had been instances when staff were not aware of people passing away or those who required to attend hospital appointments.

There were two activities co-ordinators who encouraged and supported people to maintain their hobbies and interests. They provided group and individual activities to each person living at High View Oast. People and relatives told us they enjoyed the activities and they had really improved.

Staff greeted people as they went about their duties and people were offered choices about their daily routines, and what they wished to eat. People were encouraged to remain independent as possible and do things for themselves.

The complaints procedure was on display to show people the process of how to complain. The process to respond to complaints had not been followed to ensure that people were responded to within the agreed timescales.

People had opportunities to provide feedback about the service provided. Quality assurance surveys were sent out annually directly from the organisation’s head office. Results had been received in June 2016 but there was no evidence to confirm that people had been advised of the results or what action was needed to improve the service. At the previous inspection in September 2015 we noted that feedback from other stakeholders, staff and visiting professionals had not been gathered to ensure continuous improvement of the service, based on everyone’s views. This had not changed at the time of this inspection.

There were systems in place to review the quality of all aspects of the service but these were not effective. The service had received a ‘mock inspection’ from a quality assurance provider in May 2016 and an action plan was put in place to improve the service. However, not all of the shortfalls identified were included in the action plan, and there remained many areas of concern which had not been addressed and improved.

Staff said they did not feel the service was well led as the management was unstable and different managers and senior staff had left the service in last few months. They told us they did not always feel they were listened to and their opinions taken into consideration.

During the previous inspection in September 2015 it was noted that records about people’s end of life wishes had not always been completed, and there was a lack of people’s personal life histories. At this inspection life histories had been completed and end of life records were in place however, people’s records lacked accuracy and were not always updated and fully completed. Other records, such as the emergency plan, and environmental risk assessments, could not be found.

People were supported by their relatives to be involved in planning their care and to make decisions about their daily lives. People told us they enjoyed the food and they had choices. Records showed that people were assessed to make sure they received a healthy diet to ensure their nutritional needs were met. There were four weekly menus in place but no evidence to show that people had been involved in planning the menus.

People’s physical and mental health was monitored and people were supported to see healthcare professionals. People and relatives told us the staff were kind and respected their privacy and dignity. Staff were familiar with people’s likes and dislikes, and supported people with their daily routines.

Staff had been trained in safeguarding adults, and were aware of the service’s whistle-blowing policy. They knew how to raise any concerns with the manager, or with outside agencies if required. The provider had ensured that the published rating from the previous inspection was on display.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's re

We looked at the care records of four people who used the service. We saw that each person had a set of care records that were up to date and person centred.

We found that people could choose what they wanted to eat and drink. One person told us “I get to choose what I would like to eat and if I change my mind they always make me something else. They really are very good”. We observed staff assisting people at mealtimes. We saw that staff engaged positively with people.

We looked at the recruitment records and spoke with staff. We found that there were effective recruitment and selection processes in place to ensure that the staff were suitable for the role.

People told us that they felt safe and well looked after. They said that the staff were kind and caring. People said “Oh, they (the staff) are very kind” and “I really enjoy it here. They are all very good” and “I have enjoyed myself here and feel much better for being here.”

People said they could talk about any problems to the manager and to the staff. People said that they would be listened to and any problem would be sorted out. Everyone we spoke with said they had no complaints about the service.

People said that the home was clean and that their bedrooms were kept clean. People said that they were happy with their bedrooms. People told us that the food was good and said “There are two or three choices at lunchtime and there is always a salad. They come round mid morning and tell us what there is and we choose.”

People’s health needs were supported and the service worked closely with health and social care professionals to maintain and improve people’s health and well being.