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Oakwood Residential Home Good

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Inspection report

Date of Inspection: 24, 25, 26 June 2014
Date of Publication: 9 August 2014
Inspection Report published 09 August 2014 PDF

Overview

Inspection carried out on 24, 25, 26 June 2014

During an inspection to make sure that the improvements required had been made

At a previous inspection on 11, 16 and 19 September 2013, we identified the provider was not meeting the requirements of nine regulations. We took enforcement action to prevent the provider admitting any new people to the home.

At the following inspection on 23 and January 2014, we identified the provider was not meeting the requirements of four regulations. We issued warning notices and told the provider to make improvements.

At this inspection, on 24, 25 and 26 June 2014, we found the provider had made improvements but was not meeting the requirements of the regulations.

We considered the evidence we had gathered under the outcomes we inspected. We spoke with nine people who used the service, five family members of people who we were unable to communicate with us due to their mental frailty, seven members of staff, the registered manager and a community healthcare professional. We also looked at 10 care plans and records relating to the management of the service.

We looked at outcomes relating to 11 regulations. We were accompanied by a specialist advisor, a pharmacy inspector and an expert by experience who had experience of people with dementia.

We used the information to answer the five questions we always ask;

� Is the service safe?

� Is the service effective?

� Is the service caring?

� Is the service responsive?

� Is the service well-led?

This is a summary of what we found:

Is the service safe?

We found the service was not safe because people were not protected against the risks associated with medicines. Staff had received training in infection control and appropriate guidance was followed. However, not all people were cared for in a clean environment.

Some areas of the home were in need of decoration and laminate flooring in some communal areas was badly worn. There was a lack of handrails in some communal areas and access to the garden was not safe.

There were not enough qualified, skilled and experienced staff to meet people�s needs. People told us this meant they were sometimes not able to go out on trips or did not always receive certain treatments as frequently as they required.

Arrangements to safeguard people�s property were not effective and there were no arrangements in place to account for the use or disposal of alcohol brought in for people, to ensure it did not go missing. People were, therefore not protected from the risk of abuse.

The provider had a system in place to identify, assess and manage risks to people using the service. However, we found the risks associated with a person who smoked had not been assessed. This put them and others at risk.

Recruitment practices were safe, and pre-employment checks were conducted as required in most cases. There were arrangements in place to deal with foreseeable emergencies. Fire evacuation plans were in place and understood by staff.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The service had policies and procedures in place in relation to DoLS. One person was subject of a DoLS authorisation and we saw they were receiving appropriate monitoring and support.

Is the service effective?

The service was not effective as care plans had not been developed in relation to people�s continence. People�s hydration needs were not monitored effectively. It was, therefore, not possible for staff to easily identify whether people had received sufficient fluids each day.

Staff demonstrated a good understanding of people, including their likes and dislikes. However, we found staff were not aware of key information about the health of three people. Their lack of awareness meant they may not be able to provide safe and appropriate care to these people.

We saw nutrition plans had been completed for each person. These provided catering staff with information about people�s dietary needs and preferences.

Is the service caring?

We found care staff were caring and showed compassion. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We observed positive interactions between people and staff.

People told us they were able to make choices. For example, when they got up, how they spent their day and what activities they took part in. A choice of meals was available each day and people said they could request alternatives if they didn�t like the menu of the day.

We noted the care plan for one person specified their preference for a male care worker. We found only female care staff were employed during the day which meant this preference could not be met.

People�s privacy and dignity was promoted, but was not always respected. We observed staff sometimes knocked before entering people�s bedrooms. However, on two occasions we found staff entered people�s bedrooms without knocking.

Is the service responsive?

We found the service was not always responsive to people�s needs. For example, the care plans for five people stated they lacked mental capacity to make decisions. However, there were no records to show how this related to specific decisions. In two cases we saw consent forms had been signed by relatives to give themselves, or other relatives, permission to access people�s records. This did not comply with relevant legislation.

We found staff lacked knowledge of the Mental Capacity Act, 2005 (MCA) and how to make decisions in people�s best interests. Most staff had not received training in MCA, although we saw this was planned.

People were given appropriate information and support regarding their care or treatment. We saw �service user guides� had been prepared and were available in people�s rooms.

The provider used survey questionnaires to seek people�s views about the service. We looked at the results from the most recent survey, conducted in March 2014. We found they had been analysed and action taken to address concerns. Minutes of residents� meetings showed they provided additional opportunities for people to express their views.

Is the service well-led?

We found not all aspects of the service were well-led. The provider had recently introduced a system of audits to monitor the quality of service provided. However, the system had not had time to become embedded in practice and was not yet working effectively. For example, records confirmed that care plans had been audited monthly, but it was not clear what issues these had identified or what changes had been made.

The provider had not completed an audit of infection control and had not identified the infection control concerns we found during the inspection. Medication audits had also not identified concerns we found during the inspection. Therefore, the audits were not robust.

The provider did not always take account of complaints and comments to improve the service. Family members told us verbal concerns were not always resolved effectively. We found there was no system in place to analyse complaints and identify learning from them.

Records showed most staff had not completed training in dementia or MCA. This meant they may not have the knowledge required to care for people with dementia appropriately.