Oaklands Nursing Home

Oaklands Nursing Home is a care home providing personal and nursing care for up to 50 older people in one adapted building. At the time of our inspection there were 46 people using the service.

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

Medicines were managed safely. Infection prevention and control processes protected people from the risk of infections. People told us they felt safe. The staff team were consistent and had a good understanding of how to care for people who lived at the service. Risks to people were assessed and measures were put in place to reduce them.

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.

There were systems to identify when people needed safeguarding and staff understood their responsibilities to keep people safe.

Staff received regular training and supervision. They told us they felt supported. People were supported to maintain their health and well-being. They were encouraged to maintain a balanced diet and their nutritional needs were met. The environment was adapted to meet people's needs and staff supported people to access health services where needed.

Safety checks of the premises and equipment had been undertaken. All areas of the service were clean and well maintained. People had personal emergency evacuation plans (PEEPs) in place.

There were improved governance systems in place. Effective systems were used to monitor the quality and standard of the service and to have oversight of risks of people's care and support. People and staff were positive about the management of the home.

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 20 September 2021) and there were 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.

Why we inspected

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

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The provider had developed policies and procedures to mitigate any risks relating to the COVID-19 pandemic. These were clear to follow and regularly updated.

Staff had access to the personal protective equipment (PPE) they needed and there were PPE ‘stations’ situated at regular points around the home. Signage was visible on the bedroom doors of people who were isolating following a positive test result for COVID-19. This was helpful in informing staff before entry to ensure the appropriate PPE was being worn and any enhanced procedures were being followed.

Routine COVID-19 testing was in place for people living at Oaklands Nursing Home, staff and visitors.

People were supported to keep in touch with their families and friends. Visiting arrangements were in line with current government guidance.

Oaklands Nursing Home is a residential care home providing personal and nursing care to 37 people aged 65 and over at the time of the inspection. The service can support up to 50 people. Oaklands accommodates people within a three-story building with access to all levels being provided by a passenger lift.

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

Some working practices placed people at risk of harm. Risk assessments, care plans and care monitoring documentation did not always accurately reflect care needs. The provider lacked effective systems to identify the shortfalls we found.

The provider and registered manager had also failed to ensure appropriate consent was obtained from people about important health decisions which affected them. This meant people were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. The policies and systems in the service did not support this practice.

Although we found improvements were needed, people did tell us they liked living at Oaklands Nursing Home and felt they received good care. People told us they felt safe and could speak to the staff and registered manager if they had any concerns. People also spoke positively about the meals they were provided with and could make choices about where to take their meals and spend their time generally within the service.

Staff were safely recruited and inducted. There were enough staff available to respond to people when they needed care. We observed staff treat people with respect and demonstrated they knew people well. People confirmed they were supported to access healthcare services when they needed it and relatives felt well informed about their loved one’s day to day care.

The service was clean, and people were encouraged to personalise their own bedrooms in a way they chose.

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

Rating at last inspection

The last rating for this service was good (published 16 February 2019).

Why we inspected

We received concerns in relation to the safe management of people’s nursing care needs. As a result, we undertook a focused inspection to review the key questions of safe, effective 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 COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the Safe, Effective and Well-Led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

The provider has taken action to mitigate some of the risks we identified and has shared an action plan setting out how they would address the issues we found during the inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Oaklands 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 to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the safe assessment and management of risks to people, seeking appropriate consent and ensuring records are accurate with an effective system of management oversight of the quality of care being provided to people 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 for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

¿ Visitors were asked to complete a health screening form. Personal protective equipment (PPE) was available for visitors along with access to handwashing facilities and hand sanitiser.

¿ People and staff were taking part in regular COVID-19 testing.

¿ People had individual care plans in place that reflected their visiting arrangements and how they kept in touch with loved ones.

¿ Staff had received training in infection prevention and control, COVID-19, handwashing and the wearing of PPE.

¿ The service had increased cleaning of the service to reduce the risks of cross infection.

¿ Staff had access to PPE and wore it appropriately.

¿ Staff had been kept informed of how to work safely throughout the pandemic and were confident in supporting people with a COVID-19 positive diagnosis.

¿ Clear processes were in place for the management of people with a COVID-19 positive diagnosis. The provider was following national guidelines.

Further information is in the detailed findings below.

Oaklands nursing home is a care home. People in care homes receive accommodation and nursing or personal care as a single package and one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

Oaklands is located in Littleton on the outskirts of Chester. The home is a three-story building with access to all levels being provided by a passenger lift. There are 45 bedrooms; most have ensuite facilities. The home can provide care for up to 50 people. At the time of our inspection there were 31 people living at Oaklands.

There was no registered manager in post at the time of our inspection, however the acting manager was in the process of registering with the Care Quality Commission. The new manager had commenced in post during October 2018. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection in April 2018 the service was rated as requires improvement. We recommended that improvements be made to the management of ‘as required’ medicines and that governance processes continued to be developed and improved.

Improvements had been made with the management of medicines and PRN ‘as required’ medicines protocols were now in place. Medicines were ordered, stored, administered and disposed of in accordance with best practice guidelines. The registered provider had medicines policies and procedures in place. Medicine administration records (MARs) were fully completed and regularly audited for accuracy. Staff that administered medicines had all received training and had their competency regularly assessed.

Improvements had been made to the governance systems undertaken by the registered provider at the home. Quality assurance systems were in place that were consistently completed. Areas for development and improvement had been identified and action taken to complete these. Accidents and incidents were analysed to identify trends and patterns within the home.

Safe and robust recruitment practices were in place and sufficient staff were employed to meet the assessed needs of the people living at the home. All staff had completed an induction at the start of their employment and undertaken shadow shifts. Staff completed mandatory training required for their role and undertook regular refresher updates. Staff told us they felt supported and that they attended regular team meetings and daily handovers.

Staff had all undertaken safeguarding training and felt confident that they knew what to do if they had any concerns regarding the people they supported. The registered provider had safeguarding policies and procedures in place staff knew how to access.

People were assessed before they moved into the home and this information was used to produce detailed risk assessments and person-centred care plans. These documents included clear guidance for staff to follow to meet people’s individual needs. People’s needs that related to age, disability, religion or other protected characteristics considered throughout the assessment and care planning process. Care plans and risk assessments reviewed and updated regularly.

People had their dietary needs assessed and reviewed regularly. Guidance was developed and used by staff to support people with their individual needs. Staff were participating in a hydration project which had shown positive results for people supported. People spoke positively about the food and drink.

We observed positive interactions between people and the staff that supported them. People told us that staff respected their privacy and promoted their independence where possible. We saw staff demonstrate kindness and were caring in their interactions with people. Activities were available for people to participate in.

The Care Quality Commission is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 and report on what we find. We saw that the registered provider had guidance available for staff in relation to the MCA. Staff had undertaken basic training and demonstrated understanding of this. The registered provider had made appropriate applications for the Deprivation of Liberty Safeguards (DoLS). Care records reviewed included mental capacity assessments and best interest meetings.

Oaklands was well maintained and all equipment was regularly serviced. Health and safety checks were regularly and consistently undertaken at the home. Fire safety checks were clearly documented. Improvements had been made to the environment and further improvements were planned.

The registered provider had displayed their ratings from the previous inspection in line with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This unannounced focused inspection took place on 4 and 17 April 2018.

Oaklands nursing 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, and both were looked at during this inspection.

Oaklands is located in Littleton on the outskirts of Chester. The home is a three storey building with access to all levels being provided by passenger lift. There are 45 bedrooms; most have en-suite facilities. The home can provide care for up to 50 people. At the time of our inspection there were 32 people living at Oaklands.

There was no registered manager in post at the time of our inspection however the acting manager was in the process of registering with the Care Quality Commission.

During the previous inspection we found that staff did not carry out appropriate checks on visitors to the service to ensure that people were safe. During this inspection we found improvements had been made; we were greeted at the front door by a member of staff before being allowed to enter the main building.

During the previous inspection we found there was a lack of effective systems and processes in place to monitor and improve the quality of the service. During this inspection we found that improvements had been made and the manager was in the process of implementing new systems and processes to monitor and improve the quality of the service.

Prior to the inspection we received information of concern in relation to staffing levels; during this inspection we found that sufficient staffing levels were deployed to meet the needs of people living in Oaklands.

Medicines were stored securely, however medicine administration was not always accurately recorded.

Risk assessments were in place for people living at Oaklands; the manager told us that not all risk assessments accurately reflected people’s individual risks. However, this was being looked at as a priority.

Supplementary records were being used by staff to record daily information such as food and fluid intake, night safety checks and repositioning charts.

Each person living in Oaklands had a Personal Emergency Evacuation Plan (PEEP) that was accurate and reviewed regularly.

Accidents and incidents were reported and recorded accurately by staff.

There were no concerns regarding the safety and cleanliness of the environment; regular safety checks were completed.

Staff had received training in areas such as infection control and manual handling; the service had recently delivered practical training in relation to manual handling.

Staff and people living in Oaklands spoke positively about the current management team and the improvements that had been made.

Staff had access to policies and procedures for the service to assist them to follow legislation and best practice.

The management team were very responsive during the inspection and able to provide information on request.

The manager and registered provider showed a desire to improve on the quality of the service being provided for people living in Oaklands.

Oaklands nursing home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Oaklands is located in Littleton on the outskirts of Chester. The home is a three storey building with access to all levels being provided by a passenger lift. There are 45 bedrooms; most have en-suite facilities. The home can provide care for up to 50 people.

The service has had a registered manager in post since April 2015. 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.

The service has not been previously inspected by Care Quality Commission under the new inspection methodology. During this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see the action we have told the provider to take at the end of the report.

Appropriate checks on visitors to the service were not always completed by staff to ensure people were safe in their home environment. We raised concerns to the management team regarding the safety and security of the building and asked them to address this with immediate effect.

Quality assurance systems in place were not always effective. Action plans had not always been put in place to address the improvements needed. There was a lack of management oversight to ensure that checks were carried out as required across the different areas of the service.

Supplementary records were not properly maintained to make sure they were accurate and fully complete. Care plans were not always personalised.

The management of medicines was safe. Records we viewed were completed appropriately and people told us they had received good support to take their prescribed medications. However, the registered provider’s medication audit required improving. The audit did not clearly identify what actions had been taken to improve practice when medicines errors had occurred.

People told us and observations showed that they were offered choices at mealtimes and a variety or regular snacks and drinks throughout our visits. However, further improvements were required to improve the mealtime experience for people living at the service. We have made a recommendation to the registered provider.

Improvements were required in relation to the management of rotas. The registered provider’s recruitment procedures were followed appropriately. All staff were subject to a range of checks to ensure that they were suitable and safe to work with vulnerable people.

Regular supervisions and team meetings had been recently re-introduced and staff confirmed that communication had started to improve at the service. People were supported by staff who had received appropriate training. All staff received training to enable them to fulfil their roles which included essential subjects such as moving and handling, safeguarding people and medication training.

Risk assessments were completed for each person supported, and identified any risks to their health and safety. Assessments provided information to guide staff on how to minimise risks to people and themselves when providing care and support.

Staff worked well with external health and social care professionals to make sure people received the care and support they needed. People were referred onto the appropriate service when concerns about their health or wellbeing were noted. Staff spoke kindly to people and respected their privacy and dignity. Staff knew people well and had a caring approach.

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.

All staff had completed safeguarding adults training and were able to describe different ways that people may experience abuse. Staff and managers had a good understanding of the procedures they were required to follow to ensure people protected from the risk of abuse. However, staff understanding of how to raise concerns through whistleblowing and who to contact was varied.

The management and oversight of accident and incidents was good. The registered manager evidenced where trends and patterns had been established and actions taken to mitigate any further risks to people supported.

There was an effective complaints system in place. People and staff knew who to raise concerns with and there was clear line of accountability amongst senior staff.