Archived: Oak Tree Mews

Oak Tree Mews is registered to provide accommodation and personal care to 20 older people. At the time of the inspection eight people lived were receiving care and support.

We found the following examples of good practice.

¿ Relative visiting was being determined through a dynamic COVID-19 risk assessment process. At the time of the inspection relative visiting was not permitted inside the care home. Visiting for exceptional circumstances, such as end of life, had been supported. Window visits had also been postponed during the service’s recent COVID-19 outbreak. The need for these to continue, in one person’s case, had been assessed as necessary and therefore supported. The provider was aware of the government’s guidance, for relative visiting to be supported, and prior to the service’s COVID-19 outbreak, arrangements to enable safe visiting had been in place. Relative visiting would resume when it was assessed as safe to do this.

¿ People were supported to keep in contact with family members and friends through telephone calls and the use of other technology and social media platforms.

¿ Healthcare professionals such as GPs and emergency services personnel had provided support, either by visiting when required or virtually on a regular basis. All other non-essential visits had been prevented during the service’s COVID-19 outbreak. When asked about how they had been looked after during this time, one person told us people had been very well looked after and they personally, had felt very comfortable during this difficult time.

¿ The service followed the government’s guidance on admissions to care homes. At the time of the inspection the service was closed to admissions due to the recent COVID-19 outbreak. All perspective admissions however, were required to have had a negative COVID-19 test result within 24-48 hours prior to admission. Once admitted people were immediately supported to self-isolate in their bedrooms for 14 days to reduce the risk of potential infection spreading.

¿ During the service’s COVID-19 outbreak people were supported to self-isolate in their bedrooms to prevent the spread of infection. A group of staff had moved into the service to ensure people’s care could be maintained and to reduce the risk of the infection spreading in the local community.

¿ Staff were wearing fluid repellent face masks at all times and appropriate personal protective equipment (PPE) when delivering care to people. Staff had worn appropriate PPE during the services COVID-19 outbreak. The provider had ensured adequate supplies of PPE. Relatives visiting for exceptional reasons, were supported to wear appropriate PPE.

¿ Staff continued to monitor people for the signs and symptoms of COVID-19.

¿ Safe waste and laundry management arrangements were in place to help prevent the spread of potential infection.

¿ The provider’s COVID-19 policies and procedures were available to all staff as well as the service’s COVID-19 prevention and outbreak plan. Action had been taken by the provider to ensure staff received effective leadership moving forward.

Further information is in the detailed findings below:

¿ We were informed by staff that the cleaning of people’s bedrooms, when people were self-isolating, was completed ‘when it was possible to do so’. Records relating to the cleaning that took place in these areas at this time were not maintained. The maintenance of cleaning records was addressed by senior managers following this inspection to ensure these were fully completed moving forward. Additional cleaning support and monitoring of cleaning was also organised following this inspection.

¿Additional cleaning of the bedrooms of people who were tested COVID-19 positive had not been completed. Decontamination records for these areas had not been completed and staff were unclear about what decontamination had taken place. The maintenance of decontamination records was addressed by senior managers following this inspection to ensure these were fully completed and recorded in the future.

¿ Although training had been provided to staff, including relevant guidance from the provider, on where staff should take off (doff) their PPE after attending to a positive COVID-19 service user, staff had not followed this in practice. We raised this as a concern following this inspection and recommended that donning and doffing procedures be reviewed with the staff to ensure safe practice was followed in the future. The new home manager reviewed the relevant guidance with staff and confirmed the guidance would be followed moving forward.

¿ Although COVID-19 testing was accessed for people and staff, the relevant guidance provided on this had not been followed correctly and the provider’s protocol for following up tests results not followed. We raised this as a concern following this inspection and signposted the provider to relevant government guidance. The provider took action to ensure this guidance and relevant protocol was followed in the future.

¿ The provider acted quickly to provide the service with further support to ensure its COVID-19 Management Plan and infection, prevention and control policies and procedures were followed and that necessary records are completed.

Oak Tree Mews is residential care home providing personal care to older adults, some of whom are living with dementia. The service can support up to 20 people. Five people lived at the home at the time of our inspection.

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

During our previous inspection we found improvement was needed to ensure tools used to assess people's needs would always be completed appropriately to ensure staff would have accurate information about people's needs. At this inspection we found further improvements in relation to the use of assessment tools had been made and sustained.

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 were safe. Risks to people were assessed, monitored and well managed. A person told us, "I feel very safe here."

Staffing levels met people's personalised care needs. Staff followed good practice guidelines to prevent the spread of infection and gave people their medicines safely. The home was clean and tidy.

People were supported to access health and social care professionals. Dietary needs were assessed, and guidance provided in care plans. People received enough food to eat and drink. People told us they thought the food was excellent.

People received quality care that contributed to their wellbeing. Caring relationships were formed between staff and people due to the approach and continuity of staff. People were treated with dignity and respect.

Staff recognised people as individuals and worked to ensure people felt fulfilled and had access to a range of activities and social stimulation. Staff actively supported people to remain as independent as possible, and to retain their mobility and range of movement.

People’s care plans contained detailed, personalised information that the management team kept under constant review. The registered manager carried out regular checks on the quality and safety of the service and understood their regulatory responsibilities.

People and their relatives gave positive feedback about the service and its managers. Staff were also positive, stating the registered manager was open and supportive.

People's communication needs were identified and planned for. The service had a clear process for managing complaints. People expressed confidence they could raise any issues or concerns and that these would be addressed.

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 (12 June 2018).

Why we inspected

We received concerns in relation to the management of people's care needs (person centred care). As a result, we brought forward our planned comprehensive inspection. Our inspection found that people were in receipt of person centred care, their needs had been assessed and were met by staff who were caring.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

This inspection took place on 1 and 12 April 2018 and was unannounced. Oak Tree Mews accommodates up to 20 people in one adapted building. At the time of our inspection visit there were 15 people using the service.

Oak Tree Mews had 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.

We previously inspected the service in May 2017 and it was rated Requires Improvement. At this inspection we rated the service Good. We found improvements to people’s care plans and the provision of activities had been made. However we found some assessments of people’s needs had not been accurately completed and therefore did not provide staff with the appropriate information to support people. The provider had plans in place to make this improvement.

The service was well led. Quality assurance checks were in place and identified actions to improve the service. Staff and relatives spoke positively about the management team.

People were protected from harm and abuse through the knowledge of staff and management. People were protected from risks in the care home environment. People’s medicines were safely managed. We found the environment of the care home was clean and had been well maintained.

People received support from caring staff who respected their privacy, dignity and the importance of independence. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. There were arrangements in place for people and their representatives to raise concerns about the service.

Further information is in the detailed findings below.

A registered manager was in post at the time of our 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 in the Health and Social Care Act 2008 and associated regulations about how the service is run.

People and their relatives were positive about the care they received. We observed the relationships between staff and people receiving support demonstrated dignity and respect at all times. Staff knew, understood and responded to each person’s needs in a caring and compassionate way. Staff had the knowledge and confidence to identify safeguarding concerns and told us they would act on these concerns to keep people safe.

People told us there was enough staff to meet their needs. Staff rotas confirmed this. Staff carried out additional duties when required. Bank and agency staff were called in if there were any unplanned staff absences. Recruitment checks had been carried out to ensure staff were suitable to work with people. Staff told us they were supported well and had the training and skills they needed to meet people's needs.

Staff had responded quickly when incidents had occurred or people’s needs had changed. However, people’s care records were not consistently completed to reflect their support needs, changes in their well-being, consent to their care or the management of their risks. A range of activities were available for people to access, however some people told us their social and recreational needs were not always met.

The registered manager and the provider’s representatives responded to people concerns and monitored the quality of the care provided, although shortfalls in people’s care planning had not been consistently identified during their auditing process.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Care Quality Commission (Registration) Regulation 2009. You can see what actions we told the provider to take at the back of the full version of this report.

We also found that there was a lack of arrangements in place to protect people from the risk of infection, this included not following up to date guidance and a lack of staff training. At a previous inspection we found issues with the storage of chemicals. We checked and found that action had been taken and chemicals were stored safely. Equipment provided for people using the service was properly maintained.

We looked at staff recruitment and found that required checks had been made before staff started work in the service. Although we did not ask people specific questions about staff recruitment, we did hear positive comments about the staff such as, " they all do the best they can' and "very good indeed, all of them, very helpful".

In this report the name of a registered manager appears who was not in post and not managing the regulatory activity at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time. We have advised the provider of what they need to do to remove the individual's name from our register.

Although people using the service made positive comments about the environment of the home we found some issues with the storage of chemicals that may have put them, staff and visitors at risk.

People told us that there was enough staff for their needs although commented about the current lack of a manager.

People told us they would approach the staff with any complaints. However we found they were unclear where a written complaint would be sent to.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activity at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We have advised the provider of what they need to do to remove the individual's name from our register.