Background to this inspection
Updated
16 June 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was conducted by one inspector. An Expert by Experience made calls to people and relatives following the site visit, to ask their views on the service provided. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Oakland Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Oakland Nursing Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
This service 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. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was not a registered manager in post. An interim manager had recently been appointed. They are referred to as ‘the manager’ throughout this report.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We used information gathered as part of monitoring activity that took place on 20 October 2021 to help plan the inspection and inform our judgements. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spent time observing staff interactions with people. We conducted a tour of the service and looked in people’s bedrooms as well as communal spaces. We spoke with four members of staff including the new manager, a nurse and two care staff.
We reviewed a range of records. This included five people's care records and multiple medication records. We looked at two staff files in relation to recruitment. A variety of records relating to the management of the service were also reviewed.
After the inspection
Following the inspection site visit an Expert by Experience contacted six people who used the service and four relatives via telephone to ask their views on the service provided. We contacted the nominated individual via email to request records that were not available in the service and to validate evidence we found. The nominated individual is responsible for supervising the management of the service on behalf of the provider.
Updated
16 June 2022
About the service
Oakland Nursing Home is a nursing home providing nursing and personal care to up to 27 older people, some of whom have physical disabilities or sensory impairments. At the time of our inspection there were 13 people using the service.
People’s experience of using this service and what we found
The provider had failed to implement effective quality assurance processes. They did not have sufficient oversight of the service being provided.
The provider failed to make required improvements following the last inspection and a number of issues remained at this inspection. The provider had not regularly engaged with people, relatives or the staff team or requested feedback to improve the quality of the service provided.
Risks to people had not been consistently monitored, recorded and action had not always been taken to prevent risks from reoccurring. Equipment and safety checks had not been completed to ensure they remained safe to use.
Safe recruitment processes were not followed. Required pre-employment checks had not always been completed prior to new staff commencing employment.
Medicines had not been stored, recorded or administered appropriately. Not all nursing staff had been observed to ensure they were competent with regards to medicine management.
Records used to monitor people’s health and wellbeing had not been completed consistently. We could not be assured people were receiving sufficient fluids.
People told us they felt safe. Processes had been followed to ensure any concerns related to suspected abuse were appropriately reported.
People were supported to have maximum choice and control of their lives and staff them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
For more details, please see the full report which is on the Care Quality Commission’s (CQC) website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 13 April 2021) and there were breaches of regulations. 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 the provider remained in breach of regulations.
The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.
Why we inspected
The inspection was prompted in part due to concerns received about the quality and safety of the service being provided. We also received concerns in relation to the management and provider oversight of the service. A decision was made for us to inspect and examine those risks.
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.
We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Oakland Nursing Home on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.
We have identified breaches in relation to assessing risks, safety of the service, recruitment processes and monitoring systems in place 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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.