Archived: Great Oaks

Great Oaks is a purpose-built home in a residential area of Bournemouth. It is registered to provide care, treatment, and support for up to 80 older people some who were living with dementia. The home is split over three floors which are accessible by stairs or a lift. There were 61 people living at Great Oaks at the time of inspection.

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

Developments and changes to the leadership of the home had strengthened oversight. This meant the service was safe. Improvements had been made in various areas of the home but specifically with auditing, monitoring, provider oversight and recruitment processes. Since our last inspection the home had improved in areas such as, infection prevention and control, medicines management, staff morale and team working. The registered manager continued to work with the service and external health and social care professionals on communication channels.

Improvements to the assessment of mental capacity meant people were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

At our last inspection we made a recommendation about recruitment procedures. There had been enough improvement and recruitment practices were safe. There were enough staff on duty and recruitment was ongoing.

People told us they were happy living at Great Oaks. Staff understood how to recognise and raise concerns. There was confidence in the management of the home to follow up concerns and make the necessary referrals to keep people safe. People had risk assessments in place for all their care and support needs. Utilities and equipment safety checks were in place to ensure people lived in a safe environment, this included robust fire safety procedures. Accidents and incidents were recorded and analysed to identify trends and themes with a view to preventing reoccurrence.

People had access to medical services as needed and the home worked with external professionals. People and their relatives were involved and felt able to raise their concerns if needed. People’s needs and abilities were assessed before they moved into the home to ensure staff could meet them.

Staff felt supported and the management teams focus was to continually improve staff morale and team working. Staff were proud to work at Great Oaks and improvements to the home overall were clear during this inspection.

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 (published 4 July 2022) and there was a breach of regulation about the management oversight of the home. We also made a recommendation about the providers recruitment processes. 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 improvements had been made and the provider was no longer in breach of regulation and had acted on the recommendation made.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 9, 10 and 11 May 2022. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the management oversight and governance processes.

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 changed from requires improvement to good. 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 Great Oaks on our website at www.cqc.org.uk.

Follow up

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

Great Oaks is a purpose-built home in a residential area of Bournemouth. It is registered to provide care, treatment and support for up to 80 older people some whom were living with dementia. The home is split over three floors which are accessible by stairs or a lift. There were 64 people receiving a service at the time of inspection.

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

Improvements were needed to the governance systems within the service. The systems for monitoring and checking the home operates in a safe way were not effective. The service did not actively seek feedback from others in order to drive improvements within the service. Staff did not always feel appreciated, valued and listened to.

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

People did not always have the necessary legal authorisations to be living at the home, this meant that some people were being deprived of their liberty, unlawfully. The manager made the applications immediately during the inspection.

The service had a recruitment process in place, but this had not always been followed. We have made a recommendation about recruitment practices within the home.

Medicines were not always managed safely as monitoring checks had not been carried out as planned. Infection control procedures were not robust in preventing avoidable infections within the home.

Staff did not always feel supported and supervisions did not take place as planned. Staff received training to carry out their role and the service was improving staff training for all staff.

People had enough to eat and drink and received health care as required. Specialist support was sought in a timely manner and their instructions carried out by staff who communicated changes throughout various channels. Improvements had been made to the décor and design of the home, with more planned for the future.

The provider was responsive to address the shortfalls found within this inspection and took immediate measures together with long term planning actions.

People and their relatives told us they felt safe at Great Oaks. We received compliments about the staff team. Staff were proud to work with people who lived at Great Oaks and their focus was to help them live a good life. Safeguarding was managed within the home. Staff had received training and knew how to report any concerns they had. Accidents and incidents were analysed and learning shared.

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 14 May 2021).

Why we inspected

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

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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 and will take further action if needed.

We have identified a breach in relation to the management and oversight of the home at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

There were safe practices in place for welcoming visitors to the home. These included rapid COVID-19 testing, temperature checks, hand sanitising, symptom and health checks. Health professionals provided evidence of vaccination. Records of mandatory staff vaccinations were maintained. Staff were testing for COVID-19 at the frequency as set in the government guidance. This included ‘essential care givers’ who were also part of the same testing regime as staff. Essential care givers was a role introduced in government guidance for visiting people in care homes, often family members, they support people in addition to the care and support they receive from the home.

Supplies of Personal Protective Equipment (PPE) were in good supply and we observed staff compliance in this area. People told us they were happy and we overheard staff supporting people to wash their hands. Where a person was undergoing a period of isolation we noted individual PPE stations outside their room, this contributed to keeping staff and people safe.

The home was visibly clean, tidy and free from clutter. The manager told us an additional staff member had been employed to join the housekeeping team. This meant that high use areas such as kitchenette areas could be deep cleaned on a weekly basis. Staff had training in infection prevention and control and were shown how to put on and take off PPE correctly.

Great Oaks had supported people to maintain relationships with their loved ones throughout the COVID-19 pandemic. The creation of a visitors pod with protective screens and comfortable surroundings, video calls and nominating visitors has been important to them. The home had contingency plans in place to manage outbreaks effectively. The provider had a infection prevention control policy in place and undertook regular audits of the cleanliness within the home.

Great Oaks is a purpose-built home in a residential area of Bournemouth. It is registered to provide care, treatment and support for up to 80 older people some whom were living with dementia. The home is split over three floors which are accessible by stairs or a lift. There were 66 people receiving a service at the time of inspection.

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

Improvements had been made in the reporting of concerns and in the management systems within the home and had been sustained following our last inspection. There was enough staff on duty, however, we received some mixed views about staffing levels. There was an ongoing recruitment campaign and agency staff hours has reduced, the registered manager said they were continuing to work on staffing levels and skill mix across the home.

People told us they were happy living at Great Oaks. Staff thought the home was safe and people had a good quality of life. Staff understood how to recognise signs of abuse and who to report concerns to; they felt confident in the registered manager.

Medicines were managed safely, and staff received training and had their competency assessed. The home was clean and tidy and enhanced cleaning schedules contributed to keeping people and staff safe. Staff wore Personal Protective Equipment (PPE) correctly and in line with current government guidance. Good practice guidance informed the home’s procedures and the registered manager kept up to date.

Risk assessments were in place to keep people safe and staff were aware of the risks people faced and how to minimise or eliminate them.

Quality assurance systems were in place, working efficiently and embedded within the home. Staff told us that the home was organised, and they were clear on their role and responsibilities, they felt appreciated.

We received many positive comments about the registered manager and clinical lead and staff told us they were happy and felt supported. The home was supported by the provider, director of care and clinical operations manager. They told us they were committed to the continual improvement of Great Oaks.

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 requires improvement (published 24 December 2019).

Why we inspected

This was a focused inspection to see if improvements found in the previous inspection were embedded and could be sustained.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The overall rating for the service has changed from requires improvement to good. This is based on the findings at this 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.

The service is registered to accommodate up to 80 people and provides care, treatment and support for older people, some whom were living with dementia. The service is split over three floors which were all accessible by stairs or a lift. There were 60 people using the service at time of inspection.

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

The provider, registered manager, deputy manager and staff had worked to improve the service to ensure it was effectively managed, and people were protected from harm and abuse. There were improved systems in place to ensure safeguarding concerns were identified and reported. Keeping people safe was discussed daily and within every meeting held with staff. Staff understood how to recognise abuse and who to report it to.

The provider and registered manager’s oversight of the service had improved since the last inspection, and systems had been established to ensure shortfalls were identified and actions taken where necessary. Staff told us they understood the importance of the monitoring systems and were confident it had improved within the home. Further improvements to these systems were planned.

Rating at last inspection and update

The last rating for this service was requires improvement (published 24 December 2019) when we identified three breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Following our last inspection, we served a warning notice on the provider and the registered manager. We required them to be compliant with Regulations 13 (Safeguarding) and 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 by 27 December 2019.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 13 and regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC are currently trialling targeted inspections, to measure their effectiveness in following up on a Warning Notice or other specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

The service is registered to accommodate up to 80 people and provides care, treatment and support for older people, some whom were living with dementia. The service is split over three floors which were all accessible by stairs or a lift. There were 60 people using the service at time of inspection.

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

People were not always protected from harm and abuse as safeguarding concerns had not been identified by management staff and referrals were not always made to the local authority.

There was a quality assurance and auditing process in place but they were not always effective. Audits had not identified safeguarding concerns within people’s records. Staff had received safeguarding training but had not always reported their concerns.

The service had not notified the CQC of all incidents that took place within the service as legally required.

The provider wrote to us following the last inspection to tell us how they would ensure they met the regulations. We found that some of these actions had not been carried out as stated in the plan.

There had been improvements made to the management of medicines and staff support systems. Staff told us they were proud to work for Great Oaks.

People and their relatives told us staff were kind and caring and they were happy living at the service.

People had access to a varied diet and healthcare services as required.

There were enough staff on duty. The service completed a dependency tool to support their staffing levels. Staff were recruited safely, and the necessary checks were carried out before they started work.

The service involved people, relatives and staff in the service by holding meetings and sending questionnaires.

The service worked well in partnership with others and continued to build community links.

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 requires improvement (published 10 October 2018). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

Enforcement

We have identified breaches in relation to keeping people safe from abuse and harm, management oversight and notifying CQC of events within the service.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

This unannounced comprehensive inspection took place on 14 and 15 June 2018. This was the service's first inspection since registering in June 2017.

Great Oaks is registered to provide accommodation, nursing care and support for up to 80 people. At the time of the inspection there were 36 people living at the home. The home provides accommodation over three floors. Bedrooms had en-suite toilet and shower facilities and communal areas included small kitchenettes, dining rooms, lounges and separate quiet rooms for people who wished to spend time quietly. There were also specialist bathrooms and an easily accessible garden. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

There was a registered manager employed at the service. 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.

Medicines were not always stored and managed safely. Medicine fridges had been running for 48 hours at temperatures outside of their safe range and although staff were aware this had happened, action had not been taken to address the error and make medicines safe. Inconsistencies were identified in the management of fluid thickening agents and medicine administration records including topical cream administration records were not completed consistently.

These shortfalls were a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Staff were aware of what constituted abuse and the actions they should take if they suspected abuse. Relevant checks were undertaken before new staff started working at the service which ensured they were safe to work with vulnerable adults.

Staff had the right skills and training to support people appropriately. Staff had completed or were in the process of completing The Care Certificate, which is a nationally recognised set of standards for health and social care workers. The provider ran a detailed training programme for all staff, which staff told us they found useful and effective.

People and staff consistently told us there were not enough staff on shifts to care for them appropriately. The registered manager confirmed they were in the process of recruiting further staff for an additional position that would increase the staffing levels.

Staff told us they felt overwhelmed and felt the use of supervision meetings were used in a negative way. They said the management team did not listen to them and felt they did not receive effective support.

Supervision meetings for staff were not completed consistently. This area for improvement had been identified by the provider who told us a revised schedule of supervisions would be put in place.

People's care records were not consistently completed. Records had omissions, some had inaccurate information recorded and were illegible.

These shortfalls were a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Pre-admission assessments were completed prior to people moving into the home. People’s risks were assessed and plans developed to ensure care was provided safely. Accidents and incidents were monitored to ensure any trends were identified to enable action to be taken to safeguard people.

People were referred to health care professionals as required. If people needed additional equipment to help them mobilise and keep them safe and comfortable this was readily available.

The manager was aware of their responsibilities regarding the Deprivation of Liberty Safeguards (DoLS). These safeguards aim to protect people living in care homes and hospitals from being inappropriately deprived of their liberty. These safeguards can only be used when there is no other way of supporting a person safely. Staff understood the Mental Capacity Act 2005 (2005) and how it applied to their work.

Staff knew people well and cared for them with warmth and compassion. We observed staff supported people in a friendly and caring way and treated people with dignity and respect. People had their privacy respected.

People had positive meal time experiences and enjoyed nutritious, appetising meals. People were offered choice for their meals and told us they really enjoyed the food they were offered.

There was a range of meaningful activities for people to participate in if they wished.

The systems in place at the home had not identified the shortfalls we found during our inspection in relation to medicine management and record keeping. This led to a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There were plans in place for the provider to form active links with the local community.

There were effective systems in place to ensure the safety and maintenance of the premises.

You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.