Oakwood Care Centre

Oakwood Care Centre is a residential care home providing personal care to 16 people aged 65 and over at the time of the inspection. The service is registered to support up to 18 people in one adapted building.

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

Staff were aware of their responsibilities in safeguarding people from abuse. Risks were well managed. Care records gave clear guidance to staff on what needed to happen to keep people safe, whilst respecting peoples choices. Staff had received training to guide them on managing risks. Health and safety checks in the home had been carried out. There was a programme of regular maintenance to the building and servicing of equipment. Medicines were managed safely. Safe systems of recruitment were in place.

Risks to people who used the service, staff and visitors relating to infection prevention and control, and specifically Covid-19, had been assessed and appropriate action taken. The provider was promoting good infection control and hygiene practices. Staff had received additional training, including handwashing and use of personal protective equipment (PPE).

Since our last comprehensive inspection, a new provider had taken over the service. The provider had good oversight of the service. Systems of daily, weekly and monthly quality assurance checks and audits were in place. The service is required to have a registered manager in place. The location did not have a registered manager. Where satisfactory steps have not been taken to recruit one within a reasonable timescale this can be a limiter on the rating for Well-led. However, the provider had taken satisfactory steps in a timely manner to recruit a new manager, who had started the process of applying to register with CQC.

People told us they were happy living at the home and were treated with respect. Staff knew people well and spoke about people in respectful and caring ways.

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 10 December 2019).

Why we inspected

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 inspection was prompted in part due to concerns we received about management of the service, staffing levels, safeguarding from abuse, management of risks to people, premises repairs and maintenance and manual handling. 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 found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Oakwood 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.

Oakwood Care Centre is a care home providing residential care to 15 people aged 65 and over at the time of the inspection. The service can support up to 18 people.

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

People were safe because potential risks to their health and wellbeing had been mitigated and were managed effectively. They were supported by staff who had been trained to identify and report safeguarding concerns. Staffing levels were good. People were safely supported to take their medicines but we have made recommendations about the recording of thickeners and the safety of one staircase.

People's healthcare needs were monitored. People had access to appropriate support from a variety of health care professionals. People with specialist dietary needs were supported accordingly. 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 and their relatives were positive about the service and said staff were kind and caring. Staff developed caring relationships with people and were sensitive to their individual choices. People were treated with dignity and respect and their right to privacy was upheld. The service could provide people with information about local advocacy services, to ensure they could access support to express their views if they needed to.

People were encouraged and supported to be as socially active as they wished. In addition to group activities, one to one activities were provided. The service had good links with the local community. The provider managed complaints appropriately. People’s future care needs were captured and staff had completed accredited training in end of life care.

There was a positive and open culture. Staff roles and responsibilities were clear. The service worked in partnership with a variety of agencies to ensure people received the support they needed. People were happy with how the service was managed. Staff felt well supported by the management team and held them in high regard.

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 requires improvement (published 20 November 2018) and there was one breach 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 the regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Oakwood Care Centre is situated in Stalybridge, Tameside. The home is registered with CQC for up to 18 people and at the time of the inspection provided care, support and accommodation to 12 people who required personal care without nursing.

We last carried out a comprehensive inspection of this service on 14, 18 and 22 December 2017. At that inspection we found eight breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. The breaches related to safe care and treatment; person-centred care; dignity and respect; consent to care; safeguarding service-users from abuse and improper treatment; receiving and acting on complaints; staffing; fit and proper person employed; and good governance. The service was given an overall rating of 'Inadequate’ and remained in special measures. At this inspection we looked to see if the required improvements had been made. We found that appropriate action had been taken to address the breaches we found at the last inspection and any concerns we found during this inspection were addressed during the inspection. However, we found that more work is required by the provider to ensure the robustness of governance systems to identify issues and ensure timely resolution and sustainability of improvements made. The overall rating for the service at this inspection is ‘Requires Improvement’.

The Service was working closely with the Local Authority Quality Improvement team and the staff and management team were committed to driving improvement. At the time of inspection, the team had already made a positive impact upon the running of the home.

At the time of the inspection the manager had submitted an application with the CQC to become the registered manager for Oakwood Care Centre and this was being processed. 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 had processes in place to manage risks within the home. However appropriate action was not always taken to address these issues. We recommend that the provider review the procedures in place to ensure risk is identified and safely managed.

The recruitment processes were not sufficiently robust to protect people from the risk of staff who are unsuitable to work with vulnerable people. One member of staff had begun working for the service prior to information being received from the Disclosure and Barring Service (DBS). We recommend that the provider review the systems in place for the safe recruitment of staff.

The service had an overview of staff training. Staff were receiving relevant training, competency checks and supervision. However, there were not always staff on duty during the night who could administer ‘when required’ medicines such as pain relief. We recommend the procedures for the safe management of people’s medicines is reviewed to ensure the effectiveness of peoples medicines are optimised through following the recommended guidelines.

The service was maintaining a record of accident and incidents and analysing this information to reduce the potential for reoccurrences.

People could choose what they wanted to eat and the cook knew people, their preferences and nutritional needs well.

The requirements of the Mental Capacity Act 2005 were being met. 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.

Staff were aware of their responsibilities in protecting people from abuse and were able to demonstrate their understanding of the procedure to follow so that people were kept safe.

People’s independence was promoted, they had choices and were treated with dignity and respect by staff.

People were supported by caring staff who knew them and their care needs well.

Care records were detailed and person-centred. They reflected people’s current needs, interests and preferences. A variety of risk assessments were in place to reduce risk and protect people from harm.

Activities were available for people to access within the home and individual hobbies were encouraged.

There was a programme of updating the décor of the home. We recommend that the manager consider best practice guidance with regard to the décor of care homes supporting older adults and people living with dementia.

The service had a complaints procedure and a variety of ways for people, visitors, and health care professionals to share their views and provide feedback on the service. The manager used this information to drive improvements.

The service had up to date policies and procedures in place. These provided information and guidance to staff about the provider’s expectations and good practice.

Everyone we spoke with thought the service was improving and was well managed and spoke positively of the manager. Staff told us they were happy coming to work.

The service had notified CQC of any accidents, serious incidents, and safeguarding allegations as they are required to do. The provider had displayed the CQC rating and report from the last inspection within the home. The provider’s website did not have the rating displayed but did have a link to the report. We spoke with the provider about the requirement to display the rating and following the inspection action was taken to remedy this. We recommended the provider update the website to reflect current circumstances.

Oakwood Care Centre 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.

Oakwood Care Centre is situated in Stalybridge, Tameside. The home is registered with CQC for up to 18 people and at the time of the inspection provided care, support and accommodation to 15 people who required personal care without nursing.

The home is a two storey detached building providing bedrooms and lounge/ dining area on each floor. Communal bathrooms and toilet facilities are available throughout the home. The kitchen is at the rear of the building. The home has a laundry and boiler room located in the basement.

The home was last inspected on 09, 10 and 11 January 2017 when we rated the home as inadequate overall and identified nine breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to; person-centred care, need for consent, safe care and treatment safeguarding service users from abuse and improper treatment, receiving and acting on complaints, good governance, staffing, fit and proper persons employed and notifications of other incidents.

The overall rating for the service was ‘inadequate’ and the home was placed in to special measures.

Services in special measures are kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, are inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we re-inspect it and is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Following the last inspection, we issued warning notices for safe care and treatment and good governance which identified a timeframe that the service needed to be compliant with the regulations by. We also asked the provider to complete an action plan to show what they would do and by when to improve all five of the key questions (safe, effective, caring, responsive and well-led). We also met with the registered provider to discuss the inspection findings and the requirement to improve the overall quality of the care provided at Oakwood Care Centre to at least a rating of ‘Good’.

During this latest inspection we found the necessary improvements had not been made and there were continued systemic failures across the home. The overall rating for this inspection is inadequate which means the service will remain in special measures. You can see what action we told the registered provider to take at the back of the full version of the report. Full information about CQC's regulatory response to the more serious concerns found during inspection is added to reports after any representations and appeals have been concluded.

At the start of the inspection, the service had a registered manager in place who had registered with CQC in October 2017. However, whilst the inspection was underway they were in the process of working their notice and subsequently completed their notice period on 18 December 2017. Following the inspection, CQC received the registered manager’s application to de-register from the service. 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 registered provider had asked the deputy manager to step up to the manager position whilst the registered manager was working their notice and the deputy manager had been managing the service for a week when we undertook our first inspection visit on 14 December 2017. For the purpose of the report, we have referred to them as the manager. The manager told us it was their intention to register with CQC and to become the registered manager but at the time of the inspection they had not commenced the process.

We found the service was not safe. We identified serious concerns regarding the management of environmental risks. There were no window restrictors on windows which posed significant risks to people. We raised this with the registered manager during our second inspection visit and this was addressed whilst we remained on site. We expressed concerns regarding the fire alarm system which had been recommended for replacement during the fire risk assessment conducted in December 2017. Following the inspection, we received an update to inform us that a new system had been installed. Other environmental concerns identified included; dirty water running under open baskets containing clean laundry, clean laundry being stored where staff smoke which was a fire risk and we identified a steep stairwell with only a small bar to prevent people access which was a risk to people’s health and safety.

We found accidents and incidents were recorded but documentation contained limited information to enable analysis to determine trends and prevent re-occurrence.

Medicines were not managed safely. We found sufficient times had not been maintained between doses of medicines as per prescribers and manufacturer’s instructions. At the start of inspection people did not have ‘when needed’ (PRN) protocols or cream charts in pace to support administration and application. We saw these were implemented by our second inspection visit.

Staffing levels were not calculated using a formal calculation based on the needs of people using the service. We observed people were left unattended during the inspection for significant periods of time.

The service was not complying with the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS). Mental Capacity assessments were not conducted. The management had no oversight as to when Deprivation of Liberty Safeguard authorisations had been requested or granted. We found two granted authorisations which had expired and applications had not been re-submitted within required timeframes.

People were supported to have enough to eat and drink but told us choices were limited. We observed people eating their meals on their knees because there were insufficient dining tables and chairs to accommodate all the people living at the home.

We saw people were treated in a caring and respectful manner but noted staff did not engage with people when they had the opportunity. Staff interactions were task focused and when the intervention was completed, staff sat together chatting and didn’t initiate conversation with people living at the home.

The service was unable to demonstrate how people, who used the service, or their representatives, were encouraged to contribute to the planning and reviewing of their care.

We found there were few opportunities to engage in activities and people were seen sitting in the lounges or their bedroom with no meaningful activity or positive interaction taking place. People had expressed in a survey, they would like the opportunity to go on trips but this had not been addressed by the registered provider.

We found there was no effective system in place to monitor and plan improvements to the service provided. A survey had been conducted but this had not been analysed and we found people had made suggestions and requested things but this had not been considered or addressed.

The service was not well led. The registered provider did not demonstrate oversight of the service and did not have a system in place to assess the quality of the service. There were limited audits carried out by the registered manager and when the registered manager had identified areas that needed improvement, the registered provider had not responded or taken action to address these. We found the registered provider made changes and addressed areas of concern whilst we were on site but did not demonstrate sufficient oversight to identify concerns internally or address them without our input.

We inspected Oakwood Care Centre on 9, 10, 11 January 2017 and our visit was unannounced on day one.

This was the service’s first inspection since their registration as a new provider with the commission on 30 September 2015.

Oakwood Care Centre is situated in the Stalybridge area of Tameside. The home provides care, support and accommodation for up to 18 people who require personal care without nursing.

The home is a two storey detached building providing bedrooms, a lounge and small attached dining area on each floor. Communal bathrooms and toilet facilities are available throughout the home. The kitchen is at the rear of the building. The home has a separate laundry area and boiler room located in the cellar.

At the time of our inspection there were 15 people living at Oakwood Care Centre.

The service did not have a manager in place who was registered with CQC. A home 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 had a newly appointed home manager who had been in post for four days at the time of our inspection.

We identified multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We made one recommendation around making the home’s interior decoration more conducive to people living with dementia.

People were supported by staff who were kind and caring. People and their relatives told us they felt people living at the home were well cared for.

Care plans were in place and included information around people’s history, likes and dislikes. However, we found that people, or their representatives, were not regularly involved in deciding or reviewing how their care needs would be met.

We found some people’s documentation to consent to care and treatment had been signed by staff or relatives, who did not have the legal right to provide this consent.

We looked at the safe management and administration of medicines and found medication was not stored correctly and we found minor discrepancies and omissions in medication administration. However, no-one was placed at risk of harm.

Documentation at the home showed us that people received appropriate input from health care professionals, such as district nursing and their general practitioner (GP), to ensure they received the care and support they needed.

One staff member we spoke with understood how to safeguard people and was able to demonstrate their knowledge around safeguarding procedures and how to inform the relevant authorities if they suspected anyone was at risk from harm. However, another staff member we spoke with had not received training and could not demonstrate an understanding of safeguarding adults and the legal safeguards around people’s mental capacity and Deprivation of Liberty Safeguards (DoLS).

During our initial tour of Oakwood Care Centre on the first morning of our inspection, we noted that some areas of the home required cosmetic refurbishment and we identified issues with cleanliness and infection control in a number of areas of the building.

We found that people could not easily call for assistance; a number of call bells in people’s bedrooms were not working and call bells in communal areas were not easily accessible. Therefore, people were not always able to call for assistance when required.

Safety and maintenance checks for building and equipment safety were not in place and we found some necessary safety checks, such as electrical testing and checks for Legionella, were not up to date and placed people at risk. In addition, we found concerns around the fire safety of the building and requested immediate action be taken to ensure the safety of people living at the home. The provider informed us that these had been rectified subsequent to the inspection.

We found that safe recruitment practices were not in place. The provider had not been assured that staff employed at the home had the necessary checks, including police checks, in place to ensure only suitable staff had been employed to work with people who may be vulnerable.

Many staff did not have up-to-date training in place. Several staff were caring for people at the home and had not had any training since commencement of their employment.

We requested that staff, who did not have the required safety checks and training in place, did not care for people unsupervised until the provider could be assured that staff were safe to provide care and support to people living at the home.

Due to our findings on the first day of our inspection, we reported our initial findings to the local authority commissioning team and the provider invoked a temporary, voluntary suspension on new admissions to the home until the issues we had identified had been resolved.

The overall rating for this service is Inadequate and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.