Archived: The Oaks and Little Oaks

The Oaks and Little Oaks is a nursing home providing personal and nursing care to 47 people at the time of the inspection. The service can support up to 73 people. The care home accommodates people in two separate wings, each of which has separate adapted facilities. One specialises in providing nursing care and the other provides residential care

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

Accurate, up to date, and complete records were not always in place for people. Although staff understood the care needs of the people they supported, this was not always supported by the provider’s care records and governance systems. The provider’s quality monitoring processes were not always effective and had not identified some of the issues we found during our inspection.

People were supported by staff who they generally knew, and the provider tried to ensure any agency staff used were used regularly so they got to know people’s needs. Some staff pre-employment recruitment check records were not always as complete as they should be.

People were protected from the risk of abuse. Staff had received safeguarding training and knew how to raise concerns when necessary. When incidents occurred, the registered manager reviewed the details so lessons could be learned.

Some staff had not all received the training they required, but the provider had introduced a new system which they said would address that.

People’s bedrooms, the communal lounges and dining rooms were in good condition and hygienic. Other areas of the care home required refurbishment work. Most people told us that the food was nice, and people had a choice in the meals they were offered.

Relatives told us they found the staff, and the registered manager, to be approachable and that they listened to them. The provider had maintained contact with people’s relatives during the COVID-19 pandemic.

People, and their relatives, were regularly asked for feedback on the service by the provider. Action was taken as a result of feedback received.

External professionals told us, although the service had areas which needed to improve, the registered manager had an open and honest approach to making improvements and engaged well with other agencies.

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.

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 2 November 2019).

Why we inspected

We received concerns in relation to the management of medicines and 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. 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 improvements. Please see the Safe, Effective and Well led sections of this full report. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Well-Led section of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Oaks and Little Oaks 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. We have identified breaches in relation to the provider's quality monitoring and governance processes. 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 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.

The Oaks and Little Oaks 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 73 people. The service supports older people, with a mixture of residential, nursing and respite packages.

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

There were enough staff to keep people safe. People and their relatives felt the service was safe. Staff understood how to recognise and report concerns or abuse. People’s needs were assessed, and any risks associated with health conditions documented. These were reviewed regularly with people and relatives and updated when required. Risks associated with the service environment were assessed and mitigated. People received their prescribed medicines safely. People were protected from the risk of infections. Accidents and incidents were reviewed and monitored to identify trends and to prevent reoccurrences.

People and relatives felt staff had the right training to meet their needs. People's needs and choices were assessed in line with current legislation and guidance in a way that helped to prevent discrimination. People were supported to have enough to eat and drink. People and relatives spoke positively about the quality and choices of food and drinks. Staff contacted medical services promptly for advice. The provider had taken steps to ensure the environment was suitable for people's needs. 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 relatives spoke positively about the staff who provided support. People also commented on how well staff knew them and supported them in the ways they preferred. People said they felt involved in making decisions about their care. Staff did not consistently respect people's right to confidentiality, but people said staff always treated them with respect.

People's care plans reflected their needs and they were involved in developing their care plans. People’s communication needs were identified, recorded and highlighted in care plans. The provider employed an activities coordinator, and staff also assisted people to take part in group and individual activities. There was a planned programme of regular activities, but the coordinator also worked with people individually to ensure they had the opportunity to do activities that were meaningful and enjoyable to them. The provider had a system in place to respond to complaints and concerns. People and their relatives were encouraged to talk about their wishes regarding care towards the end of their lives.

People and relatives felt the service was well-led. The registered manager and provider created an open and transparent culture, and clearly understood their roles and responsibilities in relation to managing a registered care home. People said they felt involved in the home and what went on there. Staff understood their roles and were positive about how they were managed.

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 (report published 22 August 2019) and there were multiple breaches of regulations. 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.

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.

We undertook an inspection of The Oaks and Little Oaks on 2 January 2019. The inspection was unannounced. The Oaks and Little Oaks has been registered since September 2011. The service provides accommodation, personal care and support for up to 73 people in Newark. At the time of our inspection, 46 people were using the service. The service is focused on supporting older people, with a mixture of residential, nursing and respite packages.

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.

At the last inspection, on 27 February 2018, we rated the service as ‘Requires Improvement’. During this inspection we again rated the service as ‘Requires Improvement’. We found ongoing concerns about the safety of the service, staffing levels and leadership. This included a breach of regulation 9, regulation 17 and regulation 18 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 version of the report.

There were insufficient staff to meet people’s needs. While staff worked hard to meet people’s needs, the limited number of staff impacted on the responsiveness of the service. This affected the safety of people living at the service. People’s care plans and risk assessments guided staff on how to support people.

We found medicines were managed safely and people received medicines as prescribed. Infection prevention and control procedures were followed. The home was clean. We found that systems and processes were in place to keep people safe from abuse. Lessons were learned when things went wrong.

People were not always supported to have maximum choice and control of their lives. Staff did not support them in the least restrictive way possible; the policies and systems in the service did not support practice. People were not always given adequate support to consume food and fluid. We found relatives sometimes attended to support people when staff were otherwise occupied. This lack of support could put people at risk of malnutrition. The home was not adapted to meet people’s needs as there was little navigation guidance for those that were confused. Staff worked effectively with health and social care professionals. We found that staff had received training and had a good knowledge.

Staff worked hard to meet people’s needs, however the insufficient amount of staff meant staff had little time to talk to people. Care was instead focused on completing tasks quickly to meet people’s needs. Delays in care effected people’s dignity. People’s privacy was respected and staff requested permission before completing tasks. People needed to be more involved with planning and reviewing their care plans.

People’s desired support could not always be responded to due to a lack of staff. There was a lack of activities to keep people engaged and people told us that they felt under stimulated. Formal complaints had been listened too. Further work was required to engage people who could not engage with a formal complaints process. End of life care was supported in a safe and respectful way.

At the time of our inspection there was a registered manager in place. A registered manager is a person who has been registered with the Care Quality Commission (CQC) to manage the service. Like registered providers they are “registered persons”. Registered persons have the legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated regulations about how the service is run.

This is our seventh inspection in nearly two years. The provider has failed to sustain improvements at the service. During this time the service has been assessed as either ‘requires improvement’ or ‘inadequate’. We saw that the registered manager had worked hard to improve the service and people spoke positively of her. However, provider level restrictions for staffing levels restricted further improvements at the service. It has therefore remained rated as ‘requires improvement’. People were given opportunities to feedback and the service worked effectively with other agencies.

A registered manager was in post and they were available during the inspection. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

When we previously visited the service we found them to be in breach of a number of regulations of the Health and Social Care Act 2008 (regulated Activities) Regulations 2014.These related to risk assessments, staffing, dignity and person centred care, complaints and governance of the service. At this inspection we found evidence to show they were no longer in breach of these regulations, and had made significant improvements to the care provided for people. However there were still further improvements to be made at the service.

People felt safe at the service and staff understood their responsibilities in protecting them from potential abuse. Staff had attended safeguarding adults training, could identify the different types of abuse, and knew the procedure for reporting concerns.

The risks to some people’s safety were not always assessed. Risk assessments had not always been completed in areas where people’s safety could be at risk.

Safe procedures for the management of people’s medicines were not always in place.

Staff were recruited in a safe way and there were enough staff to meet people’s needs and to keep them safe. Accidents and incidents were investigated. Assessments of the risks associated with the environment which people lived were carried out and people had personal emergency evacuation plans (PEEPs) in place. Staff had the knowledge and equipment to manage any infection control issues and the cleanliness of the service was maintained.

People were supported by staff who received an induction, were well trained and received regular assessments of their work. People felt staff understood how to support them effectively. The service used nationally recognised tools to assess the needs of people who lived at the service.

People lived in an environment which met their needs and they had access to information in formats which they understood. People’s health and nutritional needs were well managed and staff acted on advice given to them by health professionals to manage people’s health and nutritional needs.

Staff knew how to support people to make decisions and ensure their rights were respected, working in line with the principles of the Mental Capacity Act 2005. 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 support this practice.

People were cared for by staff who showed kindness and consideration of their needs and had knowledge of their preferences and views on their care. They were supported with respect by staff who maintained their privacy and dignity whilst encouraging their independence.

People received individualised care from staff, however there were some aspects of care not clearly documented to give staff the support they needed to provide people with the care they required .

People were supported to take part in a range of social activities and maintain relationships that were important to them. People were comfortable when raising concerns or complaints and felt issues raised were addressed to their satisfaction. People’s wishes in relation to their end of life care were supported with care and empathy.

The service undertook a robust auditing process to maintain the quality of the service. The registered manager worked with people, relatives, staff and external professionals to provide an open and transparent service for the people who lived there.

We carried out an unannounced comprehensive inspection of this service in 16 March 2016 Breaches of legal requirements were found and we took action to ensure the necessary improvements were been made to make sure people received safe care and support. The provider sent us an action plan detailing some of the improvements they intended to make.

At the time of this inspection the service did not have a registered manager in place. The previous registered manger left the service on 9 June 2017. 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 may be left at risk of harm or abuse because there was a risk that the procedures designed to protect them might not be followed. Some risks to people’s health and safety were not being identified and people faced risks in their daily living that could be prevented or reduced.

People were not being provided with their care and support when this was needed by staff on duty. People received their medicines as prescribed but the arrangements for the storage and recording of these needed some improvement.

People were being cared for and supported by some staff who had not kept their training up to date. People’s right to make decisions for themselves may be overlooked as the Metal Capacity Act (2005) was not being correctly followed.

People were not provided with a positive mealtime experience which could affect their nutritional and fluid intake. Staff understood people’s healthcare needs and their role in supporting them with these.

There were times when people were not shown respect and also had their privacy and dignity compromised. More effort could be made to involve people in planning their own care.

People received their care and support in a task oriented manner rather than in a person centred and proactive way. People’s care plans were not always kept up to date and staff rarely referred to these. The system in place for people to raise any complaints was not being followed.

The systems to monitor the quality of the service and identify where improvements were needed were not effective. Quality assurance questionnaires did not capture people’s concerns and dissatisfaction with the service.

“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.

We found a number of 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.

We carried out an unannounced comprehensive inspection of this service on 16 March 2016. Breaches of legal requirements were found. We undertook this focused inspection to check that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Oaks and Little Oaks on our website at www.cqc.org.uk

The service did not have a registered manager in place at the time of our inspection and has not had one since December 2014. The temporary manager told us a new manager has been appointed, who will apply to become the registered manager when they take up their 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.

There were sufficient staff on duty to meet the needs of people who used the service.

Where people lacked capacity to make their own decisions or had restrictions placed on their liberty their rights under the Mental Capacity Act 2015 were respected.

We carried out an unannounced comprehensive inspection of this service on 16 March 2016. Breaches of legal requirements were found. We undertook this focused inspection to check that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk

The service did not have a registered manager in place at the time of our inspection and has not had one since December 2014. The operations manager told us a new manager has been appointed, who will apply to become the registered manager when they take up their 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 supported by staff who understood the risks people could face and were provided with appropriate care that promoted their safety.

People who used the service and care workers were able to express their views about the service which were acted upon. The management team provided leadership that gained the respect of care workers and motivated them as a team. There were systems in place to monitor the quality of the service and make improvements when needed.

The service did not have a registered manager in place at the time of our inspection. The previous registered manager left the service in December 2014. The provider had recruited an acting manager to manage the service who has applied to become the registered manager. 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 and associated Regulations about how the service is run.

People were at risk of experiencing harm because risks were not identified and planned for, or the procedures in place to protect them were not followed. Staff knew where and how to report any incidents of abuse.

People did not always receive care and support to meet their needs because there were insufficient staff to provide this. People could not be assured they would always receive their medicines as prescribed.

People did not always receive the assistance they required to have enough to eat and drink. People were supported by staff who had, or were learning to have, the skills and knowledge to meet their needs. People received support from staff who may not understand their health conditions.

People were at risk of decisions being made on their behalf that they may have been able to make for themselves. Some people had restrictions placed upon them without the required authorisation being obtained.

People were supported by staff who cared about them but did not always care for them in a way that met their individual needs and they could not be confident that action would be taken to promote their dignity.

People did not receive the care they require because this had not been properly planned. People did not receive sufficient opportunities to provide them with social stimulation and companionship.

People did not have confidence that if they had any concerns or complaints these would be acted upon. People did not feel there was an open and inclusive culture at the service and systems to monitor the service were not effectively implemented.

You can see what action we told the provider to take at the back of the full version of the report.

People told us that staff obtained their consent before any interventions were performed. One person told us, 'They ask me about everything and respect my wishes. I could not be better looked after if I were the Queen.' However, people told us they had not seen their care plans and had not signed any agreements about how their care was provided

Suitable and nutritious food and drink was available in sufficient quantities to meet people's individual needs and preferences.

People received their medication when required and the management of medication promoted peoples safety.

People told us they were very satisfied with the staff as they found them to be caring and attentive to their needs but told us there were not always enough staff on duty to meet all needs.

People felt confident in reporting any concerns or complaints to the management team and felt their opinions were valued and respected.

People who used the service told us that they were encouraged to undertake a range of social activities within the home and within the community and felt their social needs were being met.

People told us that they felt safe in the home and felt the staff had the right qualifications, skills and knowledge to perform their duties in a safe manner.

People who used the service were provided with the opportunity to comment on the quality of service provision at residents meetings and were also able to discuss any issues which were important to them with the management team.

We found that the organisation had an effective recruitment process in place which adhered to current legislative requirements. We also found that the support staff had received a training package to ensure they were competent and confident in performing their duties.