Oriel Care Home

Oriel Care Home is a residential care home providing accommodation and personal care to up to 33 people. The service provides support to older adults, people living with dementia and people with mental health needs. At the time of our inspection there were 32 people using the service. The home is separated into 3 areas. One smaller building which accommodates 4 people, and a larger building separated into 2 areas. Each area has its own lounge and dining room.

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

Some staff had not practiced fire evacuation drills and did not know the emergency evacuation procedure. A lack of analysis of incidents for people experiencing distress linked to their mental health meant they were at risk of not receiving appropriate and effective care. People told us they felt safe. The home was clean and clutter free.

People gave mixed views about their meals, some felt they were not very varied, some were happy with their food. Some staff had not completed mandatory training which could impact on their ability to provide safe effective care.

Some records relating to people showing distress and confusion were not very caring. They showed a lack of understanding by some staff of how people’s conditions affected them. We did also see examples of kind and caring staff interactions. Relatives spoke positively about the staff team.

Relatives gave mixed views on whether there were enough events and activities to stimulate people. Some felt their loved ones seemed to have a lack of activities to occupy their time, others felt there was enough for them to do. Staff would have benefited from more guidance in some cases to support people with mental health needs and those living with dementia.

Systems to monitor the safety and effectiveness of care had not identified a number of the concerns we found during inspection. Relatives told us they felt consulted and involved in decisions about people’s care. Staff told us they felt supported by the management team.

People were not always supported to have maximum choice and control of their lives and staff did not always 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.

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 21 August 2021)

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risks for people experiencing distress. This inspection examined those risks.

We found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

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 have identified a breach in relation to how the quality and safety of care is monitored at this inspection.

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

Oriel Care Home is a residential care home providing personal to 32 people aged 65 and over at the time of the inspection. The service can support up to 33 people across three separate buildings on one site.

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

People were supported by staff who understood the signs of abuse and actions they should take to keep people safe. Staff knew the risks to people’s safety and how these risks should be managed. There were enough staff available to meet people’s needs. Medicines were managed in a safe way and work was underway to improve guidance for staff on ‘as and when required’ medicines should be given. There were infection prevention systems in place to reduce the risks associated with COVID-19.

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 had their dietary needs met by kitchen staff who knew their needs. People had access to healthcare support when required. The environment met people’s needs, although further work was being undertaken to make outdoor spaces more accessible.

People and staff spoke positively about the leadership at the service. There were systems in place to monitor the quality of care provided and this had identified where records required further detail. People had been given opportunity to feedback on the quality of the service and this feedback had been acted upon.

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 28 March 2020).

Why we inspected

We received concerns in relation to the management of falls and compliance with the Mental Capacity Act 2005. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, effective and well-led sections of this full report.

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

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.

We found the following examples of good practice.

Residents meetings enabled people to communicate directly to the management team and provider. Meetings were completed in a socially distanced manner and families were invited to join the meetings remotely.

The provider set up a closed social media page for staff and relatives to share pictures and communicate with relatives. People were supported to maintain contact with their family members through phone and video calls.

Activities were promoted to maintain peoples physical and mental wellbeing. The activities co-ordinator had made changes to activities in order to promote social distancing. For example, a live video call with a local theatre group production was arranged.

The provider developed a COVID19 staff survey. This provided staff with an additional way to communicate whether they felt supported and if there was anything more the management team could do to support them.

Staff wore personal protective equipment in line with government guidance and attended training on infection prevention and control to minimise the risk of infection.

Further information is in the detailed findings below.

Oriel Care Home 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 service can support up to 33 people in one adapted building over two floors. On the day of the inspection there were 28 people living at the home.

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

We saw good interaction with between staff and people using the service, showing care, compassion and kindness.

Appropriate forms of communication to meet people’s individual needs were available including large print documents and white boards. People were supported by staff who knew them and their needs well. There were sufficient staff members employed by the service to support service users.

We saw staff have received training in line with the needs of people using the service and the care certificate.

People's needs were assessed, care plans and risk assessments were in place to support their needs.

Staff were aware of people's dietary needs and the risks associated with this. 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.

Staff worked with external health and social care professionals and ensured people were

supported to access these services when they needed them to maintain their health and wellbeing.

Accidents and incidents were monitored, and appropriate actions taken to reduce the risk of further occurrences. Staff knew people well and had received training on how to protect them from the risk of abuse. The medication systems in place helped to reduce the risk of errors. We found people were safe at the home.

People's needs were reviewed when their needs changed, and care plans updated accordingly.

The service seeks feedback from people using the service and families about the service.

We saw complaints which were received, were investigated and responded to in a timely way.

Staff were positive about the new management team and told us they felt listened to and supported by them and the provider.

There are audits in place and we were told about plans to continue to develop and improve the service.

The registered manager and nominated individual knew people's needs well and worked closely with the team to drive improvements.

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 04 March 2019).

Why we inspected

The inspection was a planned comprehensive inspection based on the registration.

Please see the findings in this full report.

Oriel Care Home 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.

Oriel care home accommodates 33 people and has adapted facilities. There were 28 people living at the home, at the time of this inspection. The service has a registered manager, who was present during our inspection. A registered manager is a person who has registered with the CQC 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.

This was the first inspection and rating of this service, since it was taken over by a new provider in January 2018.

The service has been rated as requires improvement.

We found areas of service provision where the provider was in breach of regulations. The providers systems for governance were not effective in identifying and addressing risks to people and needed improvement. We found that care was not always delivered safely. You can see what action we told the provider to take at the back of the full version of this report.

Risk assessments were in place for each person. These did not effectively identify, assess or mitigate risks to people, to ensure effective safe care. People had suffered multiple falls, in some cases resulting in serious injury. The registered manager did not recognise or consider the potential for raising safe guarding concerns or following the duty of candour regulations, regarding these serious injuries.

Staff were recruited safely and new staff completed induction training. There was a training plan in place for all mandatory safety training. Staff had received training in how to safeguard people from abuse. Staff received supervision and attended staff meetings on a regular basis. We found that issues raised by staff were not always effectively dealt with, this meant that safeguarding was not as effective as it could have been.

We found that the safe evacuation of the home was compromised. Emergency evacuation routes were found to be blocked and one emergency exit door was found securely bolted. We spoke with the provider about this, who took immediate action to remove bolts from doors and to remove obstructions from the evacuation routes. We also informed the West Midlands Fire Service, who undertook an inspection of the home.

We saw medication being safely administered, however we found medications were not safely stored. During this inspection we found that storage temperatures were too high, which could make medication less effective or unsafe. We also found some medications were left unsupervised, this is an unsafe practice and poses a risk to people in the home.

People told us they were happy with the care they received. Staff used support plans to ensure people were effectively cared for. Support plans were regularly reviewed and updated. We noticed that where accidents had taken place, these were detailed in support plans as an event, however preventative strategies were not recorded. People told us that the staff were caring, compassionate, attentive to their needs, patient, very nice, very good, pleasant, and helpful. During our observations we saw people sitting, in silence, for long periods of time without any interaction or meaningful activity.

People were supported to have enough to eat and drink. People told us they enjoyed their meals. Meals were well presented and nutritious. People were not provided with snacks and refreshments to help themselves to during the day or evening although snacks refreshments were available if requested. The Hagley dining area provided a poor environment, with some people isolated from the general meal time experience, with their backs to the main area and facing the wall.

There was a lack of direction signage making it difficult for people to navigate around the home independently. Communal seating areas did not enable people to chat with each other. People spent long periods of time in silence and asleep and peoples comfort needs, such as foot stools, were not always considered.

The registered manager was not using a dependency tool to determine staffing levels. We have concerns over the staffing levels at night. We found that there was not enough staff to answer people’s alarm calls in a prompt way. We found that night staff helped people out of bed in the morning. Staff told us that due to the number of staff available, some people were assisted to wash and dress as early as 5am.

There was an ongoing programme of activities within the home. Local school children had visited people. People and school children were writing to each other. Some people attended local functions. Some people told us they felt bored during the day. It was the providers policy that the televisions were not in use in the communal areas until the evening.

The providers governance system and processes, to monitor the quality of care and the safety of the premises, were not effective. Audits had not identified areas for improvement, even when these were clearly known to the registered manager. The registered manager did not always respond to those raising concerns about the service. When people experienced serious injuries, the provider and registered manager were not fully undertaking their duty of candour responsibilities.