The Oaks Care Home

The Oaks Care Home is a residential care home providing personal care and accommodation in one adapted building for up to 33 people. At the time of our inspection there were 20 people using the service, all of whom were over the age of 65 and some of which were living with dementia.

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

Since the last inspection there had been a number of improvements made to the service. These improvements had resulted in safer care being provided to people living at The Oaks Care Home.

People and relatives told us they felt safe and were happy with the care. They confirmed staff were kind and caring, and we observed positive interactions between staff and people.

People's care plans and risk assessments contained consistent and detailed information in relation to people's needs and how these should be managed. People's health needs and wellbeing were monitored in line with the information highlighted in their care plans and risk assessments.

People were protected from avoidable harm and individual, environmental and infection control risks were managed appropriately. People received their prescribed medicines as required. There were safe arrangements in place for obtaining, storing and disposing of medicines.

Recruitment practices were effective, and people and relatives told us there were enough staff to meet the needs of the people living at the home.

Although we identified actions had been taken to help ensure the service was working within the principles of the MCA, we noted some work was still required. However, we were assured 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 were supported to access appropriate healthcare services when required. Health and social care professionals commented on the improvements in the service over the last two months. They spoke positively about the services ability to manage people's health needs and request support in a timely way.

Staff had received appropriate training and support to enable them to carry out their role safely. They felt well supported by the management team.

The service worked in partnership with other agencies to aid joined up, person centred care provision. Effective and robust quality assurance systems had been developed and implemented to continually assess, monitor and improve the quality of care people received.

The management team were open, approachable and supportive. Everyone was confident they would take actions to address any concerns promptly.

People, relatives and staff were positive about the service and the support they received from the management team and providers. People and staff felt there had been improvements in all aspects of the service since the last inspection.

The management team were open and transparent. They understood their regulatory responsibilities. There were effective governance systems in place to identify concerns in the service and drive improvement.

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 9 December 2022) and there were multiple breaches of regulations identified. The service was placed in special measures and the provider was issued warning notices telling them they must make improvements and send us an action plan stating how this would be achieved within our timescales.

During this inspection the provider demonstrated that improvements had been made and no breach of regulations were identified. 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

We undertook this focused inspection and reviewed the key questions of safe, effective and well-led only. This inspection was completed to ensure that the Warning Notices we previously served to the service in relation to, Regulation 13 (safeguarding), Regulation 12 (safe care and treatment) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, had been met.

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 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.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Oaks Care Home 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.

The Oaks Care Home is a residential care home providing personal care and accommodation in one adapted building for up to 33 people. At the time of our inspection there were 30 people using the service, all of who were over the age of 65 and some of which were living with dementia.

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

Although people told us they felt safe we found that not all people’s care plans, and risk assessments contained detailed information and clear guidance to staff about how people’s needs should be met to mitigate risks. Therefore, we could not be assured people were being provided with safe care and treatment.

We could not be assured people were protected from abuse. The management team and staff lacked knowledge and understanding of what constituted safeguarding and effective processes for investigating safeguarding incidents were not followed.

Although there was processes in place to monitor incidents, accidents and near misses we could not be assured action to address issues was always taken when needed.

We observed sufficient numbers of staff available to meet people's needs in a person centred and timely way, however, staff recruitment systems were not followed robustly to help ensure only suitable staff were employed.

We could not be assured 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.

Not all staff had received specific essential training and training had not always been received or renewed in a timely way.

People told us they were supported to access healthcare services when required. However, information relating to people's health needs was not always clearly documented within people's care plans and staff lacked understanding and awareness of these.

People received enough to eat and drink and told us they enjoyed the food.

Quality and safety monitoring systems were not adequate, and we found there was a lack of governance processes and systems in place to help ensure the safe running of the service. Without these systems, the provider and registered manager could not be proactive in identifying issues and concerns in a timely way and acting on these.

Environmental risks had been considered and acted on where required. Infection, prevention and control processes and up to date policies were in place. The provider, management and staff adhered to the latest government guidance in relation to infection, prevention and control.

People and relatives were happy with the care provided and spoke positively about the staff and running of the service. We observed some positive interactions between people and staff.

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 3 May 2018).

Why we inspected

The inspection was prompted in part due to concerns received about, staffing levels, lack of staff training, environmental issues and poor management and leadership. 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.

We have found evidence that the provider needs to make improvements. The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

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

Enforcement and Recommendations

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 seven breaches in relation to safe care and treatment, safeguarding, recruitment, staffing, consent, good governance and failure to notify 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.

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.

We found the following examples of good practice.

¿ Visitors were received in a safe and appropriate manner. Upon entry to the service visitors' temperatures were checked and contact details recorded for track and trace purposes. Signs were in place requesting staff and visitors adhere to government guidance with respect to personal protective equipment (PPE) and to be mindful about the potential to bring Covid-19 into the service.

¿ PPE was supplied to visitors at reception. Staff were observed wearing appropriate PPE during our visit and had received training in its use.

¿ At the time of the inspection relatives were not permitted to visit due to a Covid -19 outbreak, though the provider had previously arranged visits for relatives and had facilitated garden visits with social distancing in place, the provider had a visiting unit in the garden with floor to ceiling screening. The provider hoped to restore these visits when deemed safe to do so. People were able to communicate with family through alternative means such as video calls.

¿ People were tested every 28 days and staff were tested every week for Covid-19 and the provider supported them should they test positive for Covid-19. The provider worked with people and their relatives to maximise the uptake in testing and overcome people refusing tests. New admissions were supported in line with best practice guidance and the provider was able to support people in isolation.

¿ Cleaning schedules had been increased and additional audits had been implemented to monitor cleanliness and staff compliance with the provider's infection control policy.

¿ The registered manager had systems to ensure there was clear oversight in relation to infection prevention and control. There were comprehensive infection control audits and cleaning schedules in place to ensure the home remained clean.

Further information is in the detailed findings below.

The building work, commented on at the time of the last inspection had been completed and the new premises registered with the Commission. The home can now accommodate up to 33 older people. At the time of this inspection there were 20 people living at the home. The Oaks 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 .

Since the last inspection the provider had appointed a new 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.

Following the last inspection the provider completed an action plan, as requested, to show what they would do and by when to improve. All the improvements made are detailed within this report.

The new management team provided better leadership and had made significant improvements.

People were kept safe as the provider had taken appropriate steps and had good systems in place to protect people. The registered manager had informed us through required notifications and had also made relevant referrals to the local authority for any safeguarding concerns. Staff had received training in safeguarding.

People’s needs had been assessed with plans to mitigate risks that may be involved in the delivery of care. These were now up to date and accurate. The premises had also been assessed and made as safe as possible for people.

Accidents and incidents were recorded, monitored and action taken if necessary.

Staff were recruited in line with robust policies and all the necessary checks had been carried out.

There were good systems to make sure medicines were administered as prescribed.

There were enough staff to meet the needs of people accommodated.

Staff were now trained to a higher standard with all core training undertaken and a system to make sure staffs’ training was kept up to date. The staff team were therefore able to deliver care in line with best practice.

People had up to date comprehensive care plans in place so that staff could refer to these and deliver consistent care. The care we observed was consistent with people’s plans and people received a personalised service.

The service was now compliant with the Mental Capacity Act 2005 (MCA). People were supported to make decisions. Where they did not have capacity for specific decisions, the home followed the requirements and principles of the MCA in arriving at ‘best interest’ decisions on their behalf. There were also robust systems to make sure that people were only deprived of their liberty in accordance with the Act, and that any conditions of that deprivation were applied.

Staff were now better supported though indirect and formal supervision as well as having access to on call managers. This is ensured staff were motivated, trained to a high standard and able to work effectively with people living at the home.

The home worked collaboratively with health services and social care services in meeting people’s health needs.

People were provided with a good standard of food with their having choice of what they wanted to eat and their individual needs catered for.

Staff were kind, caring and compassionate in their interactions with people and very knowledgeable about their histories likes and dislikes.

Activities were provided to keep people occupied and stimulated.

Complaints were responded to and the procedure was well publicised.

Wishes and preferences for end of life care needs were assessed and plans put in place to meet these.

There were auditing and monitoring systems being followed seeking overall improvement.

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.

Staff understood the principles of keeping people safe, but in practice these had not been followed. We found serious injuries had not been reported to external bodies or investigated by the registered manager meaning people may not have been safeguarded from potential abuse. Some people had relevant risk assessments in place to meet their needs, but for some people relevant risk assessments were not up to date. This meant there may have been risks associated with people’s care which staff were not aware of. Staffing levels had not been planned to meet the needs of people, but these were increased following the inspection. There was a training programme in place for staff but this did not cover all the areas needed, which meant staff did not always have the knowledge to meet people’s needs. Recruitment checks had been completed before staff started work to ensure the safety of people. Medicines were administered and stored safely.

Staff had a basic knowledge of the Mental Capacity Act 2005 but this had not been properly followed or put into practice. This meant people did not have their mental capacity assessed and restrictions had been placed on people without their agreement or being in their best interests as authorised by proper processes. People enjoyed their meals and were offered a choice at meal times. People were supported to access a range of health professionals.

People did not always have their needs planned in a personalised way which reflected their choices and preferences had been considered. This meant staff may not always have the best information on how to meet an individual’s needs and preferences. People felt confident they could make a complaint and it would be responded to. Complaints were logged and there were recordings of investigations into complaints.

People felt the staff were caring and kind. However the lack of staff available and their lack of training in areas meant they did not always respond to people in the most appropriate manner. The home did not always have an open culture where staff felt they could raise concerns and they would be listened to. Staff felt supported by the registered manager. Records were not always accurately maintained and there was not an effective quality audit process in place. Notifications were not being submitted as required.

We found breaches in 7 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Registration Regulation 2009. You can see what action we told the provider to take at the back of the full version of the report.

The registered manager, assistant manager and director were present for the inspection.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service caring?

Is the service effective?

Is the service responsive?

Is the service well led?

This is a summary of what we found

Is the service safe?

People told us they felt safe because 'There's always someone around.' A relative said, 'No-one is left unattended.'

Staff told us the service was safe because there was a high staff ratio which meant they had time to get to know people well and gain their trust. They said this meant people living in the home could talk to them about things that were worrying them.

The home had appropriate procedures in place to support people who could not make decisions about their care and treatment. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw the home had made applications for DoLS and were waiting for the local authority to inform them of their decisions at the time of our inspection.

We found that the home had suitable procedures in place to protect people against the risks associated with medicines.

Is the service caring?

People who lived in the home said the staff were caring and they felt well looked after.

Staff spoke about people in a caring and respectful manner. They knew people well and treated them as individuals. One told us, 'It's so refreshing to be somewhere where everyone wants the best for residents.' When asked if they would recommend the home to a loved one, the staff and people we spoke with told us they would.

Is the service effective?

The service is effective because people were involved in their care planning and their individual needs were recorded in their care plans. We saw examples of how people's needs were met and this was confirmed to us by the people we spoke with.

Is the service responsive?

We saw the home responded to people's individual needs and preferences. We saw that action was taken if people's needs changed or their health deteriorated. There was evidence that the home responded to concerns and was committed to improving the service.

Is the service well led?

The management team were very open about the improvements they had made and their plans to continue to improve the service they offered. People we spoke with said they thought the service was well led. Staff spoke highly of the management team as did the relatives we spoke with.

There was limited communication with people because of their care needs. Consequently, we used our SOFI (Short Observational Framework for Inspection) tool to help us see what people's experiences at mealtimes were. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time and whether they have positive experiences. This included looking at the support that is given to them by the staff. We spent 35 minutes observing people and staff together at the lunch time meal. We saw people had positive experiences. Staff were observed to help people who needed it. People were offered choices of food.

We looked at care records for people. We saw people's needs were assessed with care plans for needs such as personal care, continence care and mobility. We noted some of the care procedures being followed did not link with any instructions in care plans.

Relatives told us they considered the home provided a good standard of care. Comment was made by relatives and a health and social care professional that the home's standards have improved. An example was given by two relatives of the introduction of an activities programme for people.

Records showed the home consulted people and their relatives about their care. For those people unable to consent to care the home had not assessed mental capacity as required by the Mental Capacity Act 2005. In addition, 'best interests decisions' were not completed or recorded.

We found the home made safeguarding referrals to the local authority when this was appropriate. The local authority told us the home worked with them regarding any safety issues for people.

We found the home was sufficiently staffed. Staff told us they felt supported in their work and received regular supervision.

The home sought the views of people and their relatives about the service it provided. The home's management took action regarding staff performance issues. Records showed the home had looked into incidents and complaints.

Comments from people living in the home who expressed their views included. 'If you have to be in a place, this is a good place to be, the staff are good and they sort out any problems you have.' Another person said. 'The people here are kind, my husband can visit whenever he wants and there is very nice food but not many activities'.

All of the relatives that were spoken with said that they felt positive about the home and said that people were treated with dignity and respect. We were told. 'We are kept informed of any changes to our relative's care and their doctors and other professionals involved are called as appropriate'.

Staff we spoke to knew how to support people and how to meet their needs.

Policies, procedures and staff training was in place to support people to keep safe and report any identified concerns.

Recruitment procedures were in place to make sure that people received care from suitable, skilled and knowledgeable staff.