The Oaks Care Home

The Oaks Care Home is a care home providing accommodation and personal and nursing care to up to 45 older people, including people who may live with dementia, or a dementia related condition. At the time of our inspection there were 26 people using the service accommodated in one adapted building.

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

Some improvements had made to the management of risk, but there were still some risks to people’s safety and the management of distressed behaviour.

Improvements had been made to some records, however further improvements were needed. Care plans were not broken down to provide guidance for staff so people received personalised, consistent care for each identified care and support need.

A quality assurance system was in place, to assess the standards of care in the service. Improvements had been made to the running of the service since the last inspection to ensure people received safe care. However, further improvement was needed to ensure people received person-centred care.

There were sufficient staff to support people safely. Care was task-centred rather than person-centred. Due to staff being busy they did not have time to spend with people.

We have made a recommendation about ensuring staffing levels and staff deployment are kept under review so people are kept engaged and stimulated if they choose.

Improvements had been made to medicines management. Staff followed effective processes to assess and provide the support people needed to take their medicines safely. Staff contacted health professionals when people's health needs changed.

A programme of refurbishment was taking place to ensure the environment was safe and comfortable. The standard of hygiene was improving and there was more effective odour control.

We have made a recommendation about continuing the programme of refurbishment in a timely way and to ensure it is enabling to meet 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 had opportunities to give feedback about the service.

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 and update

The last rating for this service was requires improvement (published 30 March 2023) and there were breaches 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 some improvements had been made but the provider remained in breach of some regulations.

At our last inspection we recommended that records contain information, about people’s dietary likes and dislikes, in order to promote their nutrition. At this inspection we found the provider had acted on the recommendation and improvements had been made to people’s nutrition.

The last rating for this service was requires improvement (published 30 March 2023). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We carried out an unannounced focused inspection of this service on 28 February 2023. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, premises and equipment and good governance. We made a recommendation about ensuring records contain information, about people’s dietary likes and dislikes, in order to promote their nutrition.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, effective and well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Oaks on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified continued breaches in relation to safe care and treatment and good governance.

We have made recommendations about staffing levels and staff deployment, timely refurbishment of the environment and environmental design.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The Oaks is a residential care home providing personal and nursing care to up to 45 older people, including people who may live with a dementia. At the time of inspection there were 36 people using the service.

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

The home did not have a registered manager at the time of inspection. The provider was in the process of recruiting a new manager. The home was being overseen by the regional manager with the support of the nurse.

Improvements were required to records to ensure people received safe and effective care. Risks were not always assessed and mitigated to keep people safe. People’s medicines were not always well-managed.

We have made a recommendation that people’s care records should contain information about their food likes/dislikes and dietary preferences.

An infection control system was in place. However, not all areas of the home were well-maintained and there were signs of wear and tear.

The home was not equipped with sufficient furniture for people’s comfort and well-being. The programme of refurbishment needed to continue in a timely manner, ensuring the environment is appropriately designed to meet all people’s needs.

There was a relaxed, welcoming atmosphere at the service. People and relatives were positive about staff and said they were “caring and friendly.” There were sufficient staff to support people. Staff recruitment was carried out safely and effectively. There was evidence of collaborative working and communication with other professionals to help meet 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.

A quality assurance system was in place, but it needed to become more robust to assess the standards of care in the service. We identified shortfalls with medicines management, care records, the environment and infection control. These shortfalls had not all been identified or actioned in a timely manner by the provider’s governance system.

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 good (published 16 July 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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of 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 have approached the provider and requested immediate assurances around their improvement plan. As a result of this an action plan has been produced detailing how they would address the shortfalls identified and work to complete this had begun.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Oaks on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, premises and equipment and good governance at this inspection. We have made a recommendation about ensuring records contain information, about people’s dietary likes and dislikes, in order to promote their nutrition.

Please see the action we have told the provider to take at the end of this report.

Follow up

We have requested 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 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.

• Information, including national guidance was available throughout the home. These resources were used to support staff, people and visitors to understand and follow safe infection control practices. Staff gave positive feedback about how any changes to government guidance were communicated to them.

• Sufficient stocks of personal protective equipment (PPE) were available. Staff had undertaken infection control training and were able to describe the correct sequence of how to put on and take off PPE appropriately.

• Infection control champions were in place and infection control audits were completed. Enhanced cleaning schedules were in place to ensure regularly touched surfaces were cleaned throughout the day.

• People were supported to maintain contact with their friends and family. This included people being supported with window and garden visits. Technology was also used to support people to maintain contact with people who were important to them. This helped minimise the impact of the pandemic on people’s wellbeing. Following the updated government guidance in relation to indoor visits building works had been completed to provide a safe indoor area for visits to take place.

• Systems were in place to support people and staff to maintain social distancing. This included staggered meal times to reduce the number of people in the dining room and environmental changes such as, spacing out furniture to encourage people not to sit too close to each other.

Further information is in the detailed findings below.

People's experience of using this service:

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider is no longer in breach of regulations.

Risk assessments and care plans varied in the amount of detail they contained. The registered manager had identified this and had planned to review all care records.

People who required support with moving and handling did not always have access to their own sling. This was an infection control risk.

People told us they felt safe. The service had established systems in place for reporting and responding to any allegations of abuse. Staff knew how to safeguard people and were confident to raise any concerns.

Medicines were managed safely.

Staff treated people in a dignified manner and people told us staff were caring, supportive and kind.

People had access to health and social care professionals to support them.

Staff told us they were well trained and supported.

The home had a consistent staff team who understood the needs of people well. Staff were recognised for their achievements

Activities were arranged for people that suited their individual interests. Staff supported people to integrate into the local community on outings. Members of the public were invited into the home for events.

The provider and registered manager carried out checks to ensure the service was effectively managed.

People were supported to have maximum choice and control of their lives and staff did support them in the least restrictive way possible; the policies and systems in the service did support this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Why we inspected: This was a planned inspection based on the previous rating.

Rating at the last inspection: The service was rated as requires improvement (the report was published in June 2018).

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

This was the first inspection of the service since it was registered with a new provider.

The Oaks is a care home. People in care homes receive accommodation and nursing or personal care as 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.

The Oaks accommodates a maximum of 45 older people, including people who live with dementia or a dementia related condition, in one adapted building. At the time of inspection 33 people were using the service.

A manager was in post who had applied to become registered with CQC. Since the inspection they have become registered with the 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.

At this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to regulation 18 and 17 with regards to staffing levels and governance. You can see what action we told the provider to take at the back of the full version of this report.

Changes had been made to the environment. Some areas had been refurbished. However, not all areas of the home were clean and well maintained for the comfort of people who used the service. The home was not designed to promote the orientation and independence of people who lived with dementia, although plans were in place to address this. We have made a recommendation that the environment should be designed according to best practice guidelines for people who live with dementia.

Improvements were needed to improve staff understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves. People were not always supported to have maximum choice and control of their lives and they were not always supported in the least restrictive way possible, the policies and systems in the service supported this practice.

We have made a recommendation that staff receive training about person-centred care in order to ensure people receive individualised care and support.

We considered that staff deployment and staffing levels needed to be kept under review to ensure people’s needs were met in a safe, effective and timely way. Care was at times task centred rather than person-centred. There were limited opportunities for activities for some people to keep them engaged and stimulated.

Risk assessments were in place and they accurately identified current risks to people as well as ways for staff to minimise or appropriately manage those risks. Care was provided with kindness and people’s privacy and dignity were respected.

Systems were in place for people to receive their medicines in a safe way. People had access to health care professionals to make sure they received appropriate care and treatment. People received a varied and balanced diet to meet their nutritional needs. However, we considered improvements were required to consultation and the involvement of people who lived with dementia.

Staff knew people’s care and support requirements. However, record keeping required improvement to ensure it reflected the care provided by staff. A complaints procedure was available. People had access to an advocate if required.

Staff and relatives said the management team were approachable. Communication was effective to ensure staff and relatives were kept up to date about any changes in people’s care and support needs and the running of the service.

The home had a quality assurance programme to check the quality of care provided. However, the systems used to assess the quality of the service had not identified the issues that we found during the inspection with regard to staffing levels, environmental design, infection control, person-centred care and record keeping.