Oakwood House Residential and Nursing Home

Oakwood House is a purpose-built residential care home providing personal and nursing care for up to 24 people. There were 23 people living in the service on the day of our inspection visit as one person was in hospital.

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

People living in the service were supported in a clean and safe environment. There were sufficient suitably trained staff to provide safe care and support. Staff were aware of their responsibilities regarding safeguarding and safeguarding concerns were dealt with appropriately. Medicines were managed safely, and people received their medicines as prescribed. There were appropriate infection control measures in place which had been enhanced in response to the COVID pandemic. Where things went wrong incidents were investigated and lessons learnt.

Since our previous inspection in October 2019 care plans had been rewritten and contained sufficient information for staff to provide effective care and support. We fed back to the registered manager areas for further development including more detailed moving and handling plans specifically for those exhibiting distressed behaviour. The registered manager had already identified some of the concerns raised and was taking action.

People received enough to eat and drink. Where required support was requested from appropriate health care professionals. However, we found that the meal time experience could be improved to ensure people received their choice of food and enjoyed the mealtime experience.

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.

The service worked well with other healthcare professionals and was working on developing these relationships further.

We received positive feedback from relatives regarding the way care and support was provided to people. We observed mainly caring and respectful interactions between people and staff.

People were supported, as far as possible during the COVID pandemic, to access the local community and engage in meaningful activities. They were supported to maintain contact with family and friends by video calls. Visits from family were taking place in the service garden.

Since our previous inspection new audits and quality assurance measures have been put in place. These had resulted in significant improvements to the quality of the service provided. These now need to become embedded to ensure improvements continue and is sustained.

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 Inadequate (published 12 November 2019) and there were multiple 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 improvements had been made and the provider was no longer in breach of regulations

This service has been in Special Measures since November 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

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.

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

People were not protected in a safe environment. The premises were unclean and were not maintained to a standard which ensured people living at Oakwood House Residential and nursing home were safe. We identified risk in the environment which had not been recognised or addressed by staff or the management.

Medicines were not administered safely. Where medicines needed to be administered at specific times, or with specific gaps between administration, we were not assured that this was done.

The service did not employ sufficient suitably trained and experienced staff to ensure the smooth and effective management of the service. Staff were not up to date with training to ensure they were aware of best practice.

While relatives told us that they believed their relative was safe living at the service, incidents were not always appropriately recorded.

Staff did not always ensure people’s privacy and dignity were respected. Staff did not engage with people to ensure they were not socially isolated.

Systems and processes designed to identify shortfalls and to improve the quality of care were not effective. Our two previous inspections have rated the service as Requires Improvement and the service is now rated Inadequate. We are therefore concerned about the overall governance of the service.

Care records did not always provide sufficient detail to guide staff on how to look after people.

People were not 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 support did not support best practice.

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 27 February 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. The service has deteriorated to Inadequate and further breaches of regulation have been identified. The service has been rated as Requires Improvement at the two previous inspections.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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

Medicines were not managed and administered safely. Medicines were not always available when required and people did not always receive their medicines as prescribed.

Care plans did not always contain information as to how risk was managed and where this was in place it was sometimes contradictory putting people at risk of receiving unsafe care. Since our previous inspection in August 2019 some improvements had been made to the maintenance of the premises, particularly around cleanliness. However further improvements were still needed to ensure people’s safety.

After our inspection we met with the provider to discuss improvements they planned to make to the management of the service following our inspection in August 2019 and this inspection to ensure improvements to safety and the management of risks at the service. Whilst they were able to tell us about changes they had made to the senior management team and plans they had in place to make improvements there were no specific time scales for improvements. Actions had not been prioritised to mitigate the more serious risk identified.

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 Inadequate (published 1 October 2019) and there were multiple breaches of regulation. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to the management of medicines, staffing and how people’s care needs were met. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection. The overall rating for the service has not changed from Inadequate. We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.

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 Oakwood Residential and Nursing Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to premises safety, medicines and the overall management at this inspection.

Please see the action we have told the provider to take at the end of this report. 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 request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Oakwood House Residential and Nursing Home 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.

Oakwood House Residential and Nursing Home accommodates 24 people across three separate units on two floors. On the day of our inspection there were 22 people lived in the service. 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection in April 2018 we rated Oakwood House overall as requires improvement. This was because quality assurance systems and processes were not in place to ensure that people received good quality, safe care. Following that inspection, we asked the provider to complete an action plan to show what they would do and by when to improve all of the key questions to at least good. At this inspection in January 2019 we found that the actions plan had not been fully implemented and have identified breaches of three regulations. Quality assurance and monitoring processes put in place by the provider had failed to ensure that the service improved from the previous rating of requires improvement.

There was not an open culture within the service. Communication between the management team was poor with misunderstandings leading to the provision of poor care and support.

People were not supported in a safe environment. We identified trip hazards in the service and some cupboards in the communal areas were chipped with the chipboard under the laminate exposed. The seal in several windows had been removed. Hazard tape had been applied to prevent drafts but this was coming off. When we brought this to the attention of the facilities manager some repairs were made.

The environment had a pleasant homely feel but was not always managed to ensure people were comfortable.

Hand washing facilities did not comply with current guidance. Towelling hand towels were being used in some communal toilets which presented an infection control risk. We brought this to the attention of the registered manager on the first day of the inspection but they were still being used on our return inspection visit.

Not all risks were assessed and managed effectively. Where precautionary measures had been put in place these were not always followed. Care plans were not always up to date with people’s support needs. Care plans did not demonstrate people had been involved in their review. They did contain information regarding people’s likes and dislikes.

Staff provided a range of activities. However, these were limited due to poor communication between the service and the provider as to how these should be financed

Medicines were managed safely.

There were sufficient staff to support people safely. Management did not ensure that staff had the skills and time to recognise when and how to give compassionate support. Staff training was not up to date. Staff had not always been given training to use equipment effectively.

People’s nutritional needs were assessed and monitored. People told us the food was good. We observed the lunch time meal which had a convivial atmosphere.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Relatives told us they felt welcomed into the service.

The inspection took place on 8 November and 10 November 2017. The first day of the inspection was unannounced. Oakwood House Residential and Nursing Home accommodates 24 people in one adapted building. At the time of our inspection, there were 24 people living at the service.

There was a registered manager in post. They were registered in June 2017 but had managed the service since December 2016. This was their first post as a manager, although they had worked in the service previously as the deputy 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Oakwood House Residential and Nursing Home is an established care home and was recently registered with the Care Quality Commission on 10 October 2017. However, the change in registration was the result of changes within the provider’s organisation. The only change was to the provider’s name. There were no other changes to the service. The management and staff team remained the same. However, this was the first comprehensive inspection under this registration and as such they had not yet received a CQC rating.

At this inspection, we found systems for monitoring quality and auditing the service had not always been effective. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014: Good governance.

The service was not always safe, the building was poorly maintained and health and safety checks had not been carried out as they should have been, meaning that some safety certificates had been allowed to lapse. Arrangements have been put in place to ensure this is rectified as soon as possible. This was a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014: Premises and equipment.

Mainly because of the poor maintenance of the building and some of the equipment, there were some infection control issues that needed attention. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014: Safe care and treatment.

People did not always receive person centred care. People’s individual needs were not always identified. People's privacy was not always respected. Personal information was not always stored securely and staff discussed people’s personal needs within hearing of other people. This was a breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014: Dignity and respect.

People told us that they enjoyed their food; it was well cooked and plentiful. However, their mealtime experience would have benefited from staff being more attentive and concentrating on supporting people to eat their meals without talking over people to other staff members. This is an area requiring improvement.

Not all the staff were sufficiently trained to support people and keep them safe. There was a low percentage of staff training in some areas and some essential training had not been put in place. This is an area requiring improvement.

People were not always supported by staff who were kind and caring towards people and upheld their privacy and dignity at all times. We saw some examples of poor practice in this area. This is an area requiring improvement.

Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk of harm or if they needed to report any suspected abuse.

Some systems were in place to identify risks and protect people from harm. Care records contained guidance and information to staff on how to support people safely and mitigate risks. Risk assessments were in place and reviewed monthly. Where someone was identified as being at risk, actions were identified on how to reduce the risk and referrals were made to health professionals as required. Records were detailed and referred to actions taken following accidents and incidents.

There were sufficient numbers of staff to meet people's needs. Staff recruitment procedures ensured only those staff suitable to work in a care setting were employed. Newly appointed staff received an induction to prepare them for their work.

Policies and procedures were in place to ensure the safe ordering, administration, storage and disposal of medicines. Medicines were managed, stored, given to people as prescribed and disposed of safely.

People's capacity to consent to care was properly considered and the home worked in accordance with current legislation relating to the Mental Capacity Act 2005 and the Deprivation of Liberties Safeguards. This included training for all staff on both subjects. Throughout our inspection, we saw that people who used the service were able to express their views and make decisions about their care and support. We observed staff seeking consent to help people with their needs.

People's health care needs were assessed, monitored and recorded. Referrals for assessment and treatment were made when needed and people received regular health checks. People’s rooms were decorated in line with their personal preferences.

You can see what action we told the provider to take at the back of the full version of the report.