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Inspection carried out on 27 September 2018

During a routine inspection

This inspection took place on 27 September and 1 October 2018 and was unannounced.

Oak Springs is a residential ‘care home’ which provides accommodation and personal care for up to 74 older people, including people living with dementia. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Care is provided over three floors. The service can provide en-suite accommodation. At the time of the inspection 69 people were living at Oak Springs Care Home.

At the time of the inspection there was 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. During the inspection we found the registered manager to be open, transparent and receptive to the feedback provided.

At the last inspection which took place in August 2017 we identified breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Oak Springs was awarded an overall rating of ‘Requires Improvement’. Following the inspection, we asked the registered provider to complete an action plan to tell us what changes they would make and by when. During this inspection, we looked to see if the registered provider had made the necessary improvements.

At the last inspection, we found the registered provider was in breach of regulation in relation to ‘safe care and treatment’ people received. Medication management systems were not followed and the health and safety of people living in the home was being compromised. During this inspection we found that the registered provider was no longer in breach of this regulation in relation to ‘Safe care and treatment’.

At the last inspection, we found the registered provider was in breach of regulation in relation to ‘Good Governance’. The systems which were in place did not effectively monitor and assess the quality and safety of care people received. During this inspection we looked at the governance systems, audits and checks which were in place and found that improvements had been made. Although the registered provider was no longer in breach of regulation in relation to ‘Good governance’ further developments could be made in relation to this area of care.

We have recommended that the registered provider reviews some of the quality assurance systems to further improve the quality and safety of care being provided.

At the last inspection we identified concerns in relation to staffing levels and the deployment of staff. During this inspection the registered manager told us that a monthly dependency assessment tool was completed and analysed. The dependency tool helped to review the dependency support needs of the people who lived at Oak Springs in relation to the levels of staff. Staffing levels were safely managed and people received the level of care and support that was required.

Recruitment was safely managed. People who were employed had undergone the necessary recruitment checks. Pre-employment and Disclosure Barring System checks (DBS) were carried out and appropriate references were sought prior to employment commencing.

Risk assessments were in place for people who lived at Oak Springs. Risk assessments were tailored around the needs of the person, support measures were in place to mitigate risks and assessments were regularly reviewed and updated. Staff were familiar with people’s risks; they received daily updates on people’s health and well-being and if their circumstances had changed.

People were protected from harm and abuse. Staff were familiar with safeguarding

Inspection carried out on 14 August 2017

During a routine inspection

This inspection took place on 14 August 2017 and was unannounced. The service was registered in October 2016. The service was first inspected in February 2017 when a number of breaches of regulation were found. We conducted this inspection to check that the necessary improvements had been made and sustained.

Royal Oak Care Home is a purpose-built home offering personal and nursing care. Including residential, specialist residential dementia care, general nursing care and respite care. Care is provided over three floors. The service can provide en-suite accommodation and care for a maximum of 74 people. At the time of the inspection 41 people were living at Royal Oak Care Home.

There was no registered manager in post. The previous manager had left the service in April 2017. A new manager took up their duties in June 2017 and was in the process of applying to register with the Care Quality Commission.

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.

During the previous inspection we identified a breach of regulation because medicines were not stored or administered safely. On this inspection we saw that the system for recording the administration of records was neither consistent nor robust. People were at risk of running out of medicines. Some medicine storage systems were unsafe. The provider remained in breach of regulation.

At the previous inspection the service was in breach of regulation because some fire doors did not operate correctly which placed people at risk in the event of a fire. As part of this inspection we checked to see if the necessary improvements had been made in accordance with the provider’s action plan. We saw that not all fire doors closed fully on each occasion they were tested. We were particularly concerned about the fire doors leading to the kitchen which were not operating safely at the time of the last inspection. During this inspection we saw that they closed fully on some occasions, but not on others. The provider remained in breach of regulation.

Prior to the inspection we received information of concern that some pre-admission information was not secured before people were admitted. We found that some pre-admission information was missing from care records. This meant that the provider could not make an accurate determination whether Royal Oak Care Home could meet the person’s needs before they arrived.

Regular audits of safety and quality were completed by the manager and clinical staff. Audits had proven effective in identifying some areas of concern and producing action plans to improve performance. However, audit processes had not consistently identified significant issues and had not always resulted in timely action by the provider.

You can see what action we asked the provider to take at the end of the report

Prior to the inspection we received information of concern which alleged that people regularly waited an excessive amount of time to receive care. On the inspection we saw that there were sufficient numbers of staff deployed to meet people’s basic needs for the majority of the time. This was done in accordance with the relevant dependency assessments. However, a number of people required 2:1 support with personal care which left only one member of staff to provide care for the remainder of the people on that unit. We made a recommendation regarding this.

At the inspection in February 2017 we identified a breach of regulation because assessments and care plans were not consistently completed to an acceptable standard. As part of this inspection we checked to see that the necessary improvements had been made and sustained. The service had made and sustained sufficient improvement and was no lo

Inspection carried out on 13 February 2017

During a routine inspection

This inspection took place on 13 February 2017 and was unannounced. The service was registered in October 2016. This was the first comprehensive inspection and was conducted in response to the receipt of concerns relating to safety and care practice.

Royal Oak Care Home is a purpose-built home offering personal and nursing care. Including residential, specialist residential dementia care, general nursing care and respite care. Care is provided over three floors. The service can provide en-suite accommodation and care for a maximum of 74 people. At the time of the inspection 17 people were living at Royal Oak Care Home.

A registered manager was 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.

Prior to the inspection we received information of concern which alleged that medicines were not being managed safely. We wrote to the provider requesting information about these concerns. We looked at the processes for the safe management of medicines within the service and spot-checked medicine administration record (MAR) sheets. We saw evidence that medicines were not always safely administered and recorded. We found a breach of regulation regarding this.

On an escorted tour of the service we were alerted to uneven floors on the first and second stories. There was significant bowing of the floors in a number of areas which created a risk for people, especially those with mobility difficulties.

Prior to the inspection we received information of concern alleging that a fire door did not function properly. We wrote to the provider requesting information about these concerns. As part of this inspection we assessed the functionality of fire doors throughout the service. We saw that two fire doors did not function correctly meaning that they would not be effective in reducing the spread of fire. We found a breach of regulation regarding this.

Prior to the inspection we had received information of concern which alleged that people were not adequately protected from the risk of harassment and poor care. We wrote to the provider requesting information about these concerns. Risk was not consistently and safely managed within the service. Risk assessments lacked detail and the files themselves were not presented in a consistent order which made it more difficult to locate important information.

Some people were not getting care as defined in their care plan. For example, for one person, we saw that they were at risk of weight loss. The care plan stated that the person needed to be weighed weekly. When we checked we saw weight recordings were eleven days apart in one instance and despite this and the family expressing concern, they were not weighed again until two weeks later. We found a breach of regulation regarding this.

Staff told us that they were given informal supervision on a regular basis. However, records relating to formal supervisions indicated that meetings had been held with two members of staff since October 2016. Training was a mixture of e-learning and classroom based activity. Staff were trained in subjects relevant to their roles including; moving and handling, adult safeguarding and first aid. However, the records relating to training were unclear. We made a recommendation regarding this.

Capacity was only assessed on a generic basis with no consideration of people’s capacity to consent to specific aspects of their care. Not all staff had been trained in the Mental Capacity Act 2005 (MCA) as required by the provider. The records that we saw did not clearly demonstrate that the service was operating in accordance with the MCA. We made a recommendation regarding this.

Although the service had been designed to meet the needs of