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Oakwood Residential Home Good

Reports


Inspection carried out on 18 April 2018

During a routine inspection

This inspection took place on 18 and 23 April 2018 and was unannounced. The home provides accommodation for up to 28 older people with personal care needs. There were 24 people living at the home when we visited. Accommodation was spread over two floors. There were lounges/dining rooms on the ground floor of the home. There was a garden which was accessible from the ground floor with a patio area.

There was a registered manager at the home. 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.

Oakwood Residential Home 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.

At our last inspection, we rated the service good. At this inspection, we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The provider worked in partnership with other stakeholders and was pro-active in promoting health monitoring and preventative care for people at risk of hospital admission. Staff worked with medical professionals to use tools and assessments this meant that current information about people’s needs could easily be transferred between services.

The registered manager was dedicated to their role and was a prominent presence within the home. Staff were caring and compassionate and understood the importance of treating people with dignity and respect. There were enough suitably skilled and qualified staff to meet people’s needs. The registered manager carried out robust recruitment checks and monitored staff’s performance and behaviour through observation and supervision.

Staff received training which was relevant to their role. Staff had received additional training in end of life care. This helped to ensure that people were treated empathically when receiving care at the end of their life. Staff had also received training in providing effective support around meeting the communication needs of individuals with sensory loss.

Staff understood their responsibilities in keeping people safe from abuse and harm. The registered manager had made appropriate referrals to local safeguarding authorities and had worked in partnership with them to help keep people safe.

People told us they felt safe and comfortable living at Oakwood Residential Home. They told us that there were plenty of activities to keep them occupied and staff were attentive and responsive to their needs. People told us they were involved in making decisions about their care and their independence, preferences and routines had been considered by staff when developing their care plans.

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 registered manager was focussed on making improvements to the home. They had worked to make the environment more homely through a series of renovations. The registered manager also used feedback from people, relatives, and other stakeholders in order to make changes to drive improvements. They were constantly assessing the quality and safety of the service through a series of audits and checks and had formulated an ongoing action plan, which identified how and when key improvements would be made.

Risks to people’s health and wellbeing were assessed, monitored and mitigated. Where people’s health and

Inspection carried out on 21 January 2016

During a routine inspection

This inspection took place on 21 January 2016 and was unannounced. The home provides accommodation and personal care for up to 28 people, including people living with dementia or other mental health needs. There were 22 people living at the home when we visited.

The home is based on two floors with an interconnecting stair lift. Some bedrooms have en-suite facilities and there is a separate bathroom and shower room. There is a large lounge, where activities are held and a dining room where most people eat their meals.

There was a registered manager in place. 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 of the Health and Social Care Act 2008 and associated regulations about how the service is run.

At our previous inspection, on 24 and 27 March 2015, we identified that infection control risks were not being managed safely. We issued a requirement notice and the provider sent us an action plan detailing how they would meet the regulation. At this inspection we found action had been taken and improvements had been made.

The laundry room had been extended and a clear process was in place to reduce the risk of cross contamination. The home was clean and staff followed appropriate infection control practices.

People told us they felt safe at the home. Staff knew how to identify, prevent and report abuse, and the provider responded appropriately to allegations of abuse. Clear systems were in place for managing medicines and people received their medicines when they needed them.

Most risks to people were managed safely, although the risks of one person smoking had not been documented. People were supported to take risks that helped them retain their independence and avoid unnecessary restrictions.

The process used to recruit staff helped make sure that only suitable staff were employed. There were enough staff to meet people’s needs at all times. Staff were suitably trained, were supported appropriately in their work and felt valued.

Staff followed legislation designed to protect people’s rights and liberties. They sought verbal consent from people before providing care and acted in their best interests.

People liked the food and were able to make choices about what they ate. They received appropriate support to eat and drink enough. Appropriate action was taken if people started to lose weight and they were able to access healthcare services when needed.

People were cared for with kindness and consideration. Staff knew people well and build positive relationships with them. People’s privacy and dignity were protected at all times and they were involved in planning their care.

Staff encouraged people to remain as independent as possible and empowered them to make choices about all aspects of their lives. Care plans provided detailed information about how people wished to receive care and support. Staff were responsive to changes in people’s needs and this was reflected in people’s care plans. A range of activities was provided based on people’s individual interests.

The registered manager sought and acted on feedback from people and their families. A suitable complaint procedure was in place and complaints were dealt with promptly.

There was a clear management structure in place and management were supportive of staff. Staff enjoyed working at the home and worked well as a team. There was an open and transparent culture. Staff welcomed visitors and had formed good working relationships with external professionals.

Key aspects of the service were audited regularly to help ensure the service ran well. Where improvements were identified, these were implemented promptly. An effective system was in place to analyse incidents and accidents and learn lessons from them.

Inspection carried out on 24 and 27 March 2015

During a routine inspection

This inspection took place on 24 and 27 March 2015 and was unannounced. The home provides accommodation and personal care for up to 28 people, including people living with dementia or other mental health needs. There were 17 people living at the home when we visited.

At our last inspection, on 24 and 26 June 2014 we identified breaches of 10 regulations relating to: care and welfare; assessing and monitoring the quality of service; safeguarding; infection control; management of medicines; safety and suitability of premises; respecting and involving people; consent to care and treatment; records; and staffing. We set compliance actions and the provider sent us an action plan telling us they would meet the requirements of the regulations by 31 August 2014. In September 2013, we had taken enforcement action and imposed a condition to prevent the service from accepting any new admissions. This condition was still in place at the time of this inspection.

At this inspection, on 24 and 27 March 2015, we found action had been taken. Significant improvements had been made in all areas and the provider was meeting the requirements of all but one of the regulations.

The home is required to have 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. There was no registered manager in place at the time of our inspection. A new manager had been appointed, who was in the process of applying to be registered.

People were satisfied with the cleanliness of the home. However, we found the infection control risks associated with the laundry were not managed effectively and the hand washing sink was not accessible. This put people and staff at risk of infection. Other areas of the home were clean and hygienic.

Improvements to the environment, which the provider told us they would make, had not all been completed. Work to install additional handrails and change the flooring in the lounge and dining room were outstanding. However, some bedrooms and a bathroom had been refurbished and raised flower beds had been built in the garden.

People felt safe and staff knew how to identify, prevent and report abuse. Risks of people falling or developing pressure injuries were managed effectively. Medicines were managed safely, although one medicine that needed to be given before food was often given with or after food, so may not have been effective.

There were enough staff to meet people’s needs and the process used to recruit staff ensured staff were of good character and had the skills and experience to support people appropriately. Staff were well-motivated and received appropriate support and supervision. They were skilled and knowledgeable about the needs of people living with dementia and were suitably trained.

People spoke positively about the quality of the food and received appropriate support to eat and drink. They received fresh, nutritious meals and menus were tailored to people’s individual needs.

Staff sought consent from people before providing care and followed relevant legislation to protect people’s rights and ensure decisions were made in their best interests.

People’s privacy was protected and they were cared for with kindness and compassion. Staff spoke fondly of the people they cared for. People and visitors commented on how quiet and calm the home was and the “family feel” and “happy atmosphere” that had been created.

People (and their families where appropriate) were involved in assessing and planning the care and support they received. They received personalised care from staff who were responsive to their needs. Staff had created a relaxed atmosphere and reduced the levels of anxiety and distress people had previously displayed.

Care plans were comprehensive and were regularly updated when people’s needs changed. People were referred promptly to doctors or specialists when changes in their health were identified. They had access to a range of activities which were adapted to reflect their interests.

People, their families and health care professional recognised and appreciated the improvements that had been made and told us the home was well-led. Staff also praised the management of the home. Their morale had increased and they worked well as a team, which reflected on people and the quality of care they received.

There was an open and transparent culture where visitors were welcomed and good working relationships had been built with external professionals. Care was based on a clear set of values which staff understood and followed in their everyday work.

The quality assurance system used to assess and monitor key aspects of the service, such as care planning, medicines and staff training was effective. When improvements were identified, action plans were developed and monitored to ensure they were completed promptly. Analysis of accidents or incidents was undertaken so lessons could be learnt in order to minimise the likelihood of them reoccurring.

We identified a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds with Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.

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.

Inspection carried out on 23, 24 January 2014

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

At our last inspection on 11, 16 and 19 September 2013, we found the provider was failing to meet the nine essential standards we inspected. We also checked on the warning notices set from our inspection in June and July 2013 and found the provider had not taken adequate action to meet the notices. Following the inspection we took enforcement action and imposed a condition to prevent the provider from accepting any new admissions to the home.

During this inspection we used a variety of methods to help us understand the experience of people using the service. We spoke with eight people, three family members, three external healthcare professionals and observed care and support being delivered. We also 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.

During our SOFI we saw staff interacting positively with people in the lounge. We heard staff using people�s preferred names and speaking with them in a calm and respectful way. Some people told us their needs were met and they were satisfied with the care and support they received. One person said, �They look after me pretty good�. One family member said the care had improved recently and that their relative was �so much better now�. However, two other family members told us they had concerns about the standard of cleanliness at the home and said their relative�s health care needs were not always met.

We looked at 15 care plans and associated records and saw a new format had been developed. However, we found the risks of people falling were not managed effectively and care plans did not contain adequate information about how people�s complex needs would be met. There were inadequate arrangements in place for the provision of meaningful activities or mental stimulation.

We looked at records of safeguarding training which showed all staff had received refresher training. Staff we spoke with knew how to identify and report abuse. However, the service had not complied with a condition attached to an authorisation for deprivation of liberty safeguards (DoLS) in respect of one person. People were not protected from the risk of abuse by other people using the service who posed a risk to them.

The provider had not taken the steps necessary to meet the requirements of the code of practice on the prevention and control of infections. Personal protective equipment, soap and disposable towels were not available in key places, so staff could not follow the home�s procedures.

We looked at 10 bedrooms and found six were not clean. Three bedrooms smelt of urine; three beds were stained with dried urine; and six bedroom carpets were badly stained with dark patches of an unidentified substance. Laundry policies and procedures had not been developed to minimise the risk of cross contamination within the laundry room and staff could not access the hand washing sink.

We looked at a sample of 12 medication administration record (MAR) charts. The arrangements for obtaining medicines were not robust. Appropriate arrangements were not in place to ensure people were able to self-administer inhalers safety. There were inadequate arrangements in place to ensure people received their �as required� medicines safely and consistently.

Inspection carried out on 11, 16, 19 September 2013

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

During our last inspection on 25, 27 June and 1 July 2013, we found the provider was failing to meet essential standards.

We served three Warning Notices on the provider and registered manager in relation to continued non-compliance with regulations regarding the care and welfare of people who use services, cleanliness and infection control and the management of medicines.

We also set compliance actions regarding the safety and suitability of premises, safeguarding people who use services from abuse, requirements relating to workers and assessing and monitoring the quality of service provision.

We conducted a further inspection on the 11, 16 and 19 September 2013 to check the registered persons had taken the appropriate action to meet the requirements. During the inspection we also looked at essential standards relating to staffing and the maintenance of records.

We found improvements had been made to the laundry and a new sluice facility had been created. However, we found none of the essential standards we inspected were being met.

There were inadequate arrangements in place for the safe handling of people�s medicines. Care plans and risk assessments did not reflect the current needs of people, which put them at risk of receiving inadequate care. The care plans had not been reviewed although the needs of people had changed and this may impact on the care they received.

People were not provided with a safe environment to live in. The checks on essential safety equipment had not been carried out. There were inadequate bathing facilities to meet people�s needs. We found the hot water delivery in people�s bedrooms were unsafe and put them at risk of harm.

The recruitment process and staff training were not robust to ensure staff were fit for the job. The staffing levels were decreased at the weekends that may put people at risk of not receiving the care and support they need.

There were some audits being carried out. However these were not robust and did not look at adverse incidents and develop strategies in order to minimise or eliminate risks. There was no action plan developed to show how shortfalls identified through surveys and audits would be addressed.

The management of records was poor and the records for the safe management of the service were not adequately maintained. This puts people at risk to their welfare and safety.

Inspection carried out on 25, 27 June and 1 July 2013

During a routine inspection

To help us to understand people's experiences of the service we spoke with eight people who use the service and we observed the care people were receiving. A person told us they �liked it very much� and were happy and �looked after very well�. They told us they received help and support in a respectful manner. We observed the staff were courteous and respectful when attending and supporting people. People were supported and received adequate diet and fluids that met their needs. A person commented they had �no complaints�.

The care plans and records of care were variable and did not always reflect the current needs of people. We found medicines management was not robust and put people at risk of not receiving their medications safely.

The infection control process did not ensure the risk and spread of infection was adequately managed. People were not provided with adequate facilities to meet all their needs. The recruitment process was not followed to ensure all necessary staff checks were completed. The supervision and support for the staff was not embedded in practice ensuring their practices were monitored.

There was a process to assess the quality of the service provision, however this was not robust and not carried out effectively. The health and safety practices and checks were not adequate. The system to assess the health and safety risk and the environment was lacking and may impact on people.

Inspection carried out on 7 March 2013

During a routine inspection

We spoke with three people living at the service and five members of staff. People told us they were happy at the service. One person told us �the service isn�t at all bad; they�re very good to me� and another told us they had �no complaints�. All were positive about the support they received from staff. One person gestured two thumbs up when asked what they thought of the staff.

The service took steps to ensure people were involved in decisions about their care and support. People�s diversity, values and rights were respected. A member of staff told us that their approach was to �care for people with compassion and respect, and they feel cherished�.

We reviewed care plans, and found issues with completeness and lack of personal information. Plans did not ensure or evidence that everybody�s care and welfare needs were fully met. However, the provider was taking steps to address this and support was observed to be respectful and responsive to people's basic needs.

There were effective procedures and systems in place for the management of medication.

The service had problems maintaining its staffing level. The provider was taking action to address the situation, but at the time of inspection it had yet to be resolved. When the service was understaffed people had to wait longer for support to get up in the morning, and it took longer for staff to respond to call bells.

People were listened to and their comments and complaints were responded to appropriately.

Inspection carried out on 16 November 2011

During a routine inspection

Residents told us that they enjoyed the food, the staff were very good and responsive.

Visitors told us the home was very flexible, looked after their relatives well and that their relatives were happy at the home.

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