Oakland (Rochdale)

Oakland (Rochdale) is a purpose-built residential care home providing accommodation and personal care for up to 40 people aged 65 and over, some of whom live with dementia. At the time of inspection 38 people were living at the home.

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

People felt safe living at Oakland (Rochdale) and spoke positively about the care and support they received. Relatives echoed this view, reporting no concerns with the safety and quality of care. We found enough staff were deployed to meet people’s needs and keep them safe. Staff knew how to identify and report safeguarding concerns. Accidents, incidents and falls had been documented consistently, with records detailing actions taken and lessons learned. The home was clean with effective cleaning and infection control processes in place. On the first day of our inspection additional deep cleaning was being carried out, in response to a recent infection control audit by the local authority.

Staff received training, supervision and support which allowed them to complete their roles safely and effectively. 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’s healthcare needs were being met with any referrals to professionals being made timely.

People and relatives were happy with the care provider at Oakland (Rochdale). Staff were described as kind, caring and helpful. One relative stated, “They are so caring, I can’t fault them at all.” People told us they were treated with dignity and respect, were encouraged to make choices about their care and daily routine and maintain their independence.

Care plans explained to staff what people’s needs were and how they wanted to be supported. Peoples’ social and recreational needs were met through an activities programme, though people’s feedback on the consistency of activities varied. The complaints process was displayed around the home and people told us they knew how to complain, though all but one person had not needed to.

People, relatives and staff spoke positively about the home and how it was run. Their views were sought through meetings and annual surveys. The registered manager was reported to be approachable and supportive. A range of systems and processes were used to monitor the quality of the service provided. Action plans were created to help drive improvements.

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 the service was good (published 8 November 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

Robust procedures were in place before any person was allowed access into the care home.

The provider had recently updated its Infection Prevention and Control (IPC) staff competency assessment framework. Records indicated Oakland (Rochdale) had achieved 96% compliance.

Two members of staff took a lead role in championing good IPC practice across the home.

Individual risk assessments had been completed to ensure that wherever possible, people’s rights and freedoms were respected and valued.

Those with Essential Care Giver status continued to have unrestricted access into the care home. This also included visiting access to those people who were very unwell and/or nearing the end of life.

Whilst outbreak restrictions were in place, YouTube broadcasts were utilised which meant entertainment and exercise classes could continue. These events were ‘live’ and interactive which meant people were able to fully participate.

Oakland Care Home is a residential care home providing personal care for up to 35 people aged 65 and over in one adapted building. There were 35 people accommodated at the home at the time of the inspection.

We found the following examples of good practice

•Temperatures were taken on entry and a care home visiting form was completed to screen for symptoms prior to entry. This included contact details for "test and trace," should there be a necessity to do so. The visiting policy and restrictions had been discussed with people, their families and friends.

• Although local restrictions were in place at the time of the inspection, alternative measures such as video calls, emails and letters were utilised to update and maintain contact with family and friends.

• The provider complied with shielding and social distancing rules. People who had returned from hospital were risk assessed and their immediate care and support followed government guidance. This included people having to isolate in their bedrooms.

•We observed clear signage and procedures regarding isolation when people were re-admitted back to the home from hospital settings and staff were trained on how to keep people safe from the risk of infection. Personal protective equipment (PPE) was used effectively to safeguard staff and people using the service and national guidance was implemented.

• Risk management strategies were thorough. We saw evidence of risk assessments for people at high risk. Measures were in place to reduce the risks to people's health and safety.

• We observed the home looked clean and hygienic. Staff told us high touch areas such as handles, and switches received additional cleaning daily. Environmental, coronavirus and infection control policies, procedures and audits were in place to ensure infection prevention procedures were robust.

Further information is in the detailed findings below.

This inspection took place on 25 and 27 September 2018. Our visit on 25 September was unannounced. The home is registered with CQC to provide nursing and personal care for up to 40 older people. At the time of our inspection there were 39 people living at the home. Accommodation is provided over two floors, with capacity for 18 people in a dementia unit on the ground floor, and 22 people in the residential unit on the first floor.

We last inspected this service in August 2017 when we found the registered provider was in breach of Regulations 9, 10, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because people were unable to pursue their individual hobbies and interests; their personal care needs were not always attended to, there were insufficient staff to meet people’s needs safely and the overall governance of the service had not been effective in improving the service. After our last inspection the provider sent us an action plan telling us how they would improve the service. These improvements had been effective, and we found the provider was now compliant with the regulations and consistently meeting people's needs.

The service had a registered manager who had been appointed immediately prior to our last inspection. They have completed the registration process and registered as the manager with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 told us they felt safe at Oakland. Risk assessments identified and monitored individual and environmental risks and the registered manager conducted a daily walk around of the property to identify any maintenance issues or other concerns which were reported for repair. People told us, and we saw that staff took appropriate precautions when delivering care and the staff we spoke with understood their roles and responsibility to safeguard vulnerable people. They had a good understanding of safeguarding issues, and there was a system in place to report any suspicion of abuse.

Most of the people who used the service were unable to consent to their care and treatment, but the people supporting them at Oakland understood issues around capacity, and offered meaningful choices in a way people understood. Where people were unable to consent, the appropriate deprivation of liberty authorisations had been sought.

At our last inspection we found that there were not always enough staff to safely meet the needs of people who lived at Oakland. We found at this inspection that the service had developed a dependency chart to determine the right level of staff. There were sufficient staff on duty to attend to people’s needs and provide care and support in a timely and respectful way. They were well trained and had access to refresher training to ensure that their knowledge was up to date and in line with current best practice. The service made appropriate checks during the recruitment process to ensure that new staff had the right attributes and character to work with vulnerable people. All new staff received a full induction and systems were in place to provide one to one supervision for all the people who worked at Oakland.

We saw that care staff knew the people they supported and staff told us that they felt comfortable working on either the residential or the dementia unit. Care plans reflected people’s needs and interventions were kind, patient and timely. People had call bells to summon assistance if needed; we heard when these were triggered that their needs were quickly attended to. The staff we spoke with could tell us about the needs, wishes and characteristics of the people they supported and spoke about them in a caring manner. They showed a genuine caring attitude. Dignity, respect and personal choice was acknowledged, and people felt involved in their care.

There were systems in place to ensure that medicines were well managed. These included attention to people’s skin integrity; records and charts gave very clear instruction to staff who applied creams and ointments.

The home was clean. Staff were mindful of their need to maintain a good level of hygiene and appropriate procedures were in place to prevent and control infection.

At the last inspection we found that care records did not always document people’s hobbies and interests and that staff rarely had to spend with people meaning that they had little to do. Since that inspection the service had increased the staff ratio and appointed an activity coordinator. This had led to an improvement in activities and people were more stimulated.

We saw that attention was paid to people’s general health, with regular liaison with doctors, district nurses and other health and social care professionals. Dental and optical appointments were made as necessary. Similarly, staff were attentive to what people ate and drank. Care records indicated any dietary requirements, and showed liaison with dieticians and Speech and Language therapists to ensure that people ate the correct foods in the way that would minimise risk, for example, of choking.

We saw that systems to monitor the quality of the service provided had improved since or last inspection. To help ensure people received effective care checks were undertaken on the running of the home and there were opportunities for people to comment on the facilities and the quality of the care provided. Records showed that systems to manage complaints, incidents and accidents were managed well and measures put in place so that they were less likely to reoccur.

The inspection took place on 2 August 2017 and was unannounced.

There had not been a registered manager at this service for a period of three months. However, a new manager had been appointed and had started the registration process. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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.

At this inspection, we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to person-centred care; dignity and respect and staffing. You can see what action we asked the provider to take at the end of this report.

Staffing levels were not sufficient to meet the needs of people. People had to wait for assistance with their personal care and continence needs, and were reluctant to ask for help because of this.

Staff were under pressure in their roles, which meant some interactions with people were abrupt.

People were sometimes placed in undignified situations and were not always treated with respect. People and relatives had voiced dissatisfaction about the lack of dignity afforded to people.

People could not enjoy their individual hobbies and interests, which led to feelings of boredom. Although people had life history care plans in place regarding their interests, not all had been completed.

Although there was a system for responding to complaints, not all complaints had been investigated fully.

The home had been through a period of managerial instability, which meant not all the issues identified at this inspection had been acted on. Staff morale had been low, and staff absence high.

People were supported to maintain their health. People's individual dietary needs were catered for , and people received assistance with their eating and drinking needs. People enjoyed choice and variety of meals and drinks.

The new manager had identified areas of improvement for the home and had started to instigate positive changes.

The service were last inspected in July 2014 when the service met all the regulations we inspected.

We undertook this inspection on 20 and 21July 2016. This comprehensive inspection was unannounced and conducted by one inspector.

The service had a 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff we spoke with were aware of how to protect vulnerable people and had safeguarding policies and procedures to guide them which included the contact details of the local authority to report to.

Recruitment procedures were robust and ensured new staff should be safe to work with vulnerable adults.

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

The administration of medicines was safe. Staff had been trained in the administration of medicines and had up to date policies and procedures to follow. Their competency was checked regularly.

People who used the service told us the food was good. We observed one mealtime which was a social occasion with staff talking to people and encouraging them to take a good diet.

We also saw that people were offered fluids regularly and during hot weather ice creams.

Electrical and gas appliances were serviced regularly. Each person had a personal emergency evacuation plan (PEEP) and there was a business plan for any unforeseen emergencies. There were regular fire alarm tests and staff fire safety training to help protect the health and welfare of people.

There were systems in place to prevent the spread of infection. Staff were trained in infection control and provided with the necessary equipment and hand washing facilities to help protect their health and welfare.

Most staff had been trained in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The registered manager was aware of her responsibilities of how to apply for any best interest decisions under the Mental Capacity Act (2005) and followed the correct procedures using independent professionals.

New staff received induction training to provide them with the skills to care for people. Staff files and the training matrix showed staff had undertaken sufficient training to meet the needs of people and they were supervised regularly to check their competence. Supervision sessions also gave staff the opportunity to discuss their work and ask for any training they felt necessary.

We observed there were good interactions between staff and people who used the service. People told us staff were kind, knowledgeable and caring.

We saw that the quality of care plans gave staff sufficient information to look after people accommodated at the care home and they were regularly reviewed. Plans of care contained people’s personal preferences so they could be treated as individuals.

There was a record kept of any complaints and we saw the manager took action to investigate any concerns, incidents or accidents to reach satisfactory outcomes. There had not been any complaints since the last inspection.

Staff, people who used the service and family members all told us managers were approachable and supportive.

Staff meetings gave staff the opportunity to be involved in the running of the home and discuss their training needs.

The manager conducted sufficient audits to ensure the quality of the service provided was maintained or improved.

The environment was maintained at a good level and homely in character. We saw there was a maintenance person to repair any faulty items of equipment.

People who used the service and their relatives were asked about their views of the service and action was taken to make any improvements suggested.

There were sufficient activities to provide people with stimulation if they wished to join in.

Below is a summary of what we found. The summary is based on speaking with people who used the service, the staff who supported them and from looking at records.

Is the service safe?

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. All members of staff had been trained to understand when an application should be made, and how to submit one.

The relative of one person said, 'They are so good with my husband, the staff are really helpful and they make me feel very welcome. I feel he is in a safe environment.'

Members of staff had received training in the management of medication and knew how to safely give medicines to people who used the service.

Is the service effective?

People's health and care needs were assessed with them if possible, or their relatives and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. Care plans were reviewed regularly and amended to reflect people's changing needs. The relative of one person said, 'I've seen the care plan, they've just been updating it. They involve me at every stage whatever's going on.'

We found that people's weight and appetite was monitored. When any problems were identified advice was sought from the doctor and dietician. All the people we asked told us that the meals were good. One person said, 'The food is good, if you don't like what's on the menu you don't have to have it, they get you something else.'

There was a rolling programme of training in place so that all members of staff were kept up to date with current practice.

Is the service caring?

We saw that care workers were attentive to people's needs and offered appropriate encouragement and assistance when necessary. One person said, 'We are certainly looked after.' The relative of one person told us they were very happy with the care provided and said, 'The staff are superb.'

People who used the service and their relatives were given the opportunity to regularly complete satisfaction questionnaires. These were evaluated at the company's head office in order to identify any areas for improvement.

Is the service responsive?

The activities coordinator told us that activities were organised daily and included, arts and crafts, baking, table tennis, gardening, ball games and individual activities for people with a dementia. People were taken out for pub lunches, trips to Blackpool and a museum where reminiscence was encouraged. One person said, 'There's plenty to do.' The relative of one person said, 'The activities person is brilliant, she took mum out for lunch yesterday.'

All the people we spoke told us they were happy with care provided at the home but would speak to the manager if they had any concerns.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

There were systems in place for assessing and monitoring the quality of the service provided. We saw that audits completed regularly by the manager covered all aspects of the service provided.

Members of staff had regular supervision meetings and an annual appraisal with their line manager. The two care workers we asked said they found these meetings helpful and supportive and gave them the opportunity to discuss issues relating to their work including training.

The visitors told us that they had been involved in the care plans for their family members and had been asked for consent where appropriate. The people using the service told us they felt they were being looked after properly.

Some people expressed concerns that during some busy times they felt there were not always enough staff on duty but overall there were sufficient staff.

One relative told us, 'It is absolutely excellent, the staff are kind, supportive and brilliant'. Another relative said, 'Everything is alright, there is nothing to worry about'.

People's care records were kept secure and contained enough information to show how they were to be supported and cared for. They also showed that people gave consent to their care and treatment.

Systems were in place to protect people who lacked the capacity to make decisions about their own care and support.

All the people we spoke with felt that the environment was suitable for the delivery of care. One visitor told us that they had enjoyed decorating the room for their relative and had support from the home. Another visitor told us that they enjoyed being with their relative but felt that sometimes the temperature was cold for their relative.

Both visitors confirmed staff asked their relatives for verbal consent before providing treatment and personal care. However, both visitors told us that they were not involved in the regular reviews of the care plans.

Neither visitor had any concern in relation to the wellbeing or safeguarding of their relatives. The person living at the home said 'I feel safe living at the home.'

The visitors we spoke with told us they felt there were enough staff around to assist their relatives and other people. They told us that they had no concerns about the care they received and would speak to the manager if they had any concerns or complaints.