Okeley Care Home

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

People and their relatives were very positive about using the service and feedback from them was good.

Suitable arrangements were in place to keep people safe. Policies and procedures were followed by staff to safeguard people and staff understood these procedures. Risks to people were identified and managed to prevent people from receiving unsafe care and support.

Medicine arrangements ensured people received their medicines as prescribed. People were protected by the provider's arrangements for the prevention and control of infection.

There were enough staff to meet people’s needs. Staff were recruited safely. Suitable checks were undertaken to ensure the right staff were employed to care for people. Arrangements were in place for learning and making improvements.

Suitable arrangements were in place for staff to receive a robust induction, appropriate training, and regular supervision. People’s dining experience was positive, and their nutrition and hydration needs were met. The service ensured people received appropriate healthcare support from healthcare services. The service worked together with professionals and other organisations to ensure people received coordinated care and support.

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 were treated with care, kindness, dignity, and respect. People received care and support that met their needs and preferences. Staff had a good knowledge and understanding of people's specific care and support needs, how they wished to be cared for and supported. The rapport between staff and people using the service was positive.

People had a personalised care plan describing their specific needs, wishes and preferences. Activities and events were provided to meet people’s social and leisure needs and to reduce isolation. Systems were in place to ensure people were cared for at the end of their life.

Complaints were investigated and managed. People were involved in the development of the service. Robust arrangements were in place for the oversight of the service and to monitor the quality of the service provided.

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.

An inspection took place in February 2019 and found the service to be requires improvement in all key questions. The provider completed an action plan after this inspection to show what they would do and by when to improve.

We returned in November 2020 and found the key question of safe to be good and key question of well led to be requires improvement.

The last rating for this service was requires improvement (published 17 December 2020). At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last two inspections.

The overall rating for the service has changed from requires improvement to good 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 read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Okeley Care Home on our website at www.cqc.org.uk.

Okeley care home is a residential care home providing personal and nursing care to up to 84 people aged 65 and over. At the time of the inspection there were 74 people living at the service, the majority of them were living with dementia.

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

When we last visited the service in February 2019, we met a new registered manager who told us about the improvements they were making. However, when we returned in November 2020, the previous registered manager had left, and we were welcomed by another new manager who was in the process of becoming registered with the Commission.

Although the registered manager had made positive changes since their arrival, these improvements need to be sustained to demonstrate management stability across the service. The feedback we received during our inspection combined a positive view of the new manager, with an anxiety that they would leave.

The manager had started to address the concerns we had raised at our last inspection. They had a practical, person-centred approach which was making a difference to the care people received. Feedback was particularly positive about how well and openly the registered manager was communicating with people, families and staff.

We found care was well-planned and staff minimised risks to people’s safety. The administration of medicines had improved. Risk from the spread of infection was well managed.

There were enough staff to keep people safe. The manager was working well with the staff team to improve staff turnover, morale and skills.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. The manager promoted a person-centred approach to managing restrictions resulting from the COVID-19 pandemic. They communicated well with people and families to explain restrictions.

Senior staff carried out regular checks on the quality of care and took action which directly improved care standards.

For more details, please see the full report which is on the CQC at www.cqc.org.uk.

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 8 April 2019). The service remains rated requires improvement. This service has been rated requires improvement.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. We also met with the provider and the former registered manager to discuss their action plan. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We received concerns that the provider did not have effective systems in place to keep people safe. We also had concerns about the high turnover of registered managers within the provider’s services. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at 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 coronavirus and other infection outbreaks effectively.

We considered how well the provider had responded to the concerns and breaches found at the previous inspection. The overall rating for the service remains requires improvement. This is based on the findings at this inspection.

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

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.

People’s experience of using this service: People told us that they felt safe, however we found medicines were not always being managed safely and we identified shortfalls in how risks were responded to and monitored. People told us they sometimes had to wait for support and we found there were not sufficient numbers of staff deployed to meet people’s needs. We observed staff were rushed at times and made observations where this had impacted on people’s dignity. We also found improvements were needed to care plans and activities. The auditing and governance at the service had not proactively identified and addressed all the issues found at this inspection.

People spoke positively about the food that was provided for them and we saw evidence of their involvement in this. Whilst care planning was not always consistent, we did see examples that were personalised and where people’s individual needs and preferences had been responded to. People spoke positively about the staff and we also observed good practice from staff in response to needs relating to people’s dementia.

There had been two changes in management since our last inspection which had led to inconsistent leadership. There was a new manager in post who shared their ideas and vision for the service with us. They had started to implement some new practice with a focus on people’s dignity and promoting independence. Staff told us they felt supported and we saw evidence that staff had received training and support for their roles.

Rating at last inspection: Good. Our last inspection was carried out in March 2016 where the service was rated as good and there were no breaches of the legal requirements.

Why we inspected: This was a planned inspection to check if the service was continuing to meet the characteristics of a good rating and to check all legal requirements were still being met.

Enforcement: Action we told provider to take (refer to end of full report)

Follow up: The provider will share an action plan with CQC and we will continue to monitor the service. We will return in line with our policy to check that the concerns we identified have been addressed and that the legal requirements are met.

The inspection took place on 23 March 2016 and was unannounced.

Okeley Care Centre provides accommodation and personal care for up to 84 older people who may also have dementia. Care is provided on three floors with different units on each floor. The layout of the home means that people can walk around each unit without encountering barriers, or locked doors. At the time of our visit there were 82 people living in the service.

The service had 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.

People were safe because staff supported them to understand how to keep safe and staff knew how to manage risk effectively. There were appropriate arrangements in place for medication to be stored and administered safely, and there were sufficient numbers of care staff with the correct skills and knowledge to safely meet people’s needs.

The Care Quality Commission monitors the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and are required to report on what we find. The MCA sets out what must be done to make sure the human rights of people who may lack mental capacity to make decisions are protected. The DoLS are a code of practice to supplement the main MCA code of practice. Relevant professionals had undertaken appropriate mental capacity assessments and best interest decisions. This ensured that the decision was taken in accordance with the Mental Capacity Act.

People’s care plans were individual and contained information about people’s needs, likes and dislikes and their ability to make decisions.

People had access to healthcare professionals. A choice of food and drink was available that reflected their nutritional needs, and took into account their personal lifestyle preferences or health care needs.

Staff had good relationships with people who used the service and were attentive to their needs. People’s privacy and dignity was respected at all times.

People were encouraged to follow their interests and hobbies. They were supported to keep in contact with their family and friends.

There was a strong management team who encouraged an open culture and who led by example. Staff morale was high and they felt that their views were valued.

The management team had systems in place to monitor the quality and safety of the service provided, and to drive improvements where this was required.

We spoke with eight people who lived at the home. One person said to us: "I have no complaints; the staff are so kind all the time." Another person said: "I don't think they could do it any better." Two people told us how they had made friends with each other since coming to live at the home. We were not able to speak with some of the other people due to their communication needs. We observed the care and attention these people received from staff. All of the interactions we saw were appropriate, warm, respectful and friendly. People were treated in a way which sought to preserve their dignity.

The accommodation was designed to meet the needs of the people living there, was suited to caring for people with limited mobility and was properly maintained. The home was warm, clean and was personalised to the people who lived there.

We saw that people's support plans and risk assessments reflected their needs and were up to date. Staff we spoke with were aware of the contents of the care plans, which enabled them to deliver safe care in line with those plans. The provider had systems in place that ensured the safe receipt, storage, administration and recording of medicines. Staff recruitment systems were robust.