This inspection took place on 31 July and 01 August 2018 and was unannounced. This is the first inspection we have carried out of this service under its’ current registration with the provider 3A Care (Altrincham). When we last inspected the service in October 2016, the service was being run by a different provider and was rated requires improvement overall. At this inspection we rated the home requires improvement overall, and identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to provision of safe care and treatment. Oldfield Bank Residential Care Home (Oldfield Bank) is a ‘care home’. 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.
Oldfield Bank provides accommodation and personal care for up to 28 older adults, including people living with dementia, in one adapted building. Accommodation is across four floors, with a lift available between floors. The home is located in a residential area of Altrincham, Greater Manchester.
There was a registered manager who had been in post since May 2018, and was registered with the CQC in July 2018. 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.
Some staff had found the change in provider, and changes made to the management team by the new provider difficult to accept. This had resulted in some resistance to change amongst the staff team, although both staff and the registered manager felt this situation was improving.
The home provided accommodation to people staying on a permanent and temporary basis. We found people living at the home on a permanent basis had comprehensive care plans and risk assessments in place. However, we found this was not the case for one person staying on a temporary basis who did not have a complete care plan or risk assessments. We have recommended that the provider reviews how they manage and monitor temporary placements at the home.
There were sufficient numbers of staff to meet the needs of people living at the home. There were times when staff were particularly busy, and when communal areas were unsupervised for short periods of time. However, we did not observe any issues when these instances arose or any significant delays in people receiving the support they needed.
Staff took steps to help ensure risks to people’s health, safety and wellbeing were reduced. This included using sensor mats, providing support and supervision and ensuring people had mobility aids to hand. However, in one instance, a person had a bed sensor mat in place and informed us they had not consented to this. This demonstrated staff did not always balance risk management with people’s rights to make informed decisions effectively. This issue was addressed when we raised it with a manager.
We identified some shortfalls in the safe management of medicines. Medicines were not always stored securely or recorded accurately. For example, we found the door to the treatment room open on one occasion and the keys for the medicines trolley and controlled drugs cupboard were inside the treatment room. Night staff did not administer medicines, and had to contact the on-call staff to administer any ‘when required’ medicines such as pain relief. This could result in potential delays in people receiving their medicines.
The provider was in the process of fitting magnetic locks to stairwell doors at the time of the inspection to help reduce the risk of people injuring themselves who were not able to use the stairs safely without assistance. Required checks and servicing of the premises and equipment had been carried out in most cases. However, we found there was no legionella risk assessment and the passenger lift thorough examination was overdue. Actions were taken during the inspection to address these shortfalls.
We observed that the majority of staff interacted well with people living at the home. Staff acted respectfully and were attentive to people’s needs and comfort. There were some long-standing staff members at the home and only limited use of agency staff. We observed one isolated incident where a staff member started to position a person’s leg to support them to transfer from their chair whilst they were asleep. However, the remainder of interactions we observed were positive and staff communicated well.
Staff encouraged people to retain their independence, and care plans reflected people’s abilities as well as their support needs. Staff told us they would be happy for a friend or family member to live at the home because of the caring nature and commitment of the staff working there.
People told us staff respected their privacy and dignity. However, we also received a comment that there was limited space for people to meet visitors in a quiet or private area other than their bedrooms. The provider was in the process of refurbishing the home and this included plans to create a family/waiting room.
Care plans were person-centred and comprehensive. People told us they had been involved in planning and reviewing their care, and they told us staff acted to meet their preferences.
Staff received regular supervision and a range of relevant training. The registered manager was in the process of reviewing training provision and recognised that improvements could be made in this area. For example, only basic training was provided in relation to dementia care.
Staff worked with other professionals to meet people’s healthcare needs. We received feedback from one healthcare professional who told us staff acted upon the advice they gave in relation to people’s care. The service considered whether people staying at the home short-term may need to be supported to register with a local GP practice on a temporary basis.
We received positive feedback about the food provided. We saw the cook considered people’s dietary requirements and preferences when preparing food.
People told us they would be confident to raise any concerns they might have. We saw that staff had effectively identified and recorded complaints whether written or raised verbally. Complaints had been investigated and responded to appropriately, with actions taken to improve the service when necessary.
The registered manager had introduced a range of audits and checks to help them monitor the quality and safety of the service. However, the checks had not identified the issues we found relating to the safety of the service, nor ensured they had been addressed.
The opinion of people using the service and their representatives had been sought, and feedback provided on how staff had acted upon their views. The service acted upon feedback from relevant others such as the local authority and infection control lead.
Staff told us the new provider was investing in the service, and we saw a refurbishment was underway. The new provider and registered manager had started making a number of improvements. This included installing a new call-bell system, enclosing the garden area, improving care plans and introducing a new electronic care planning and records system, which was due to go live shortly after the inspection.
Staff told us the registered manager was approachable and they felt motivated to provide good quality care. The registered manager had clear plans for how they wanted to work with staff to continue to improve the quality of the service.