Archived: Oldbury Grange Nursing Home

The home is an adapted building with purpose-built extensions and accommodation is split into 4 communities over 3 floors. People have access to communal areas and large gardens.

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

People could not be assured that environmental risks at the home would be consistently managed and improvements were needed to ensure that the providers governance systems identified where unsafe conditions existed.

Improvements were needed to how some medicines were stored to maintain people’s safety. People received their medicines considering their preferences and national guideline by trained staff.

People were supported by staff who had been assessed as safe to work with vulnerable adults. People were kept safe from the risk of infection and 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.

The registered manager and staff were clear about their responsibilities. The service worked in partnership with a variety of community professionals to ensure people received any specialist support they needed.

Management sought people's views about the service and used that information to make 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 good (published 8 December 2018).

Why we inspected

The inspection was prompted in part due to concerns received from a family member about the care provided to their relative. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 good to requires improvement. This is based on the findings 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.

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 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 provider's governance and oversight of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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 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.

• People who had tested positive for Covid-19 were supported in a self contained unit and self isolated in line with current guidance. This ensured people were cared for safely who had tested positive for Covid-19 in hospital and needed to transfer to a care home under the Winter Discharge Designation Settings scheme.

• People were supported to communicate with their relatives through regular telephone and video calls. The registered manager held virtual meetings with relatives to provide updates regarding the service.

• People were supported by a cohort of staff that worked solely on the unit where people had tested positive for Covid-19.

• People were supported by staff who were trained in infection prevention and control and wore Personal Protective Equipment (PPE) in line with current guidance.

• People with sensory impairments were supported to communicate through the use of white boards and pictorial cards. Staff wore name badges with their photographs so people could identify them when wearing PPE.

• People were supported in a clean and uncluttered environment. Cleaning schedules were in place in line with current guidance and these were complied with.

• Audit checks were in place that identified any actions related to infection prevention and control and these were addressed in a timely manner.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Further information is in the detailed findings below.

This inspection was carried out on 13 November 2018 and was unannounced. At the time of our inspection there was not a registered manager in post. However, a manager was in post and has applied to the commission for registration. 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. The manager was not present during the inspection. A registered manager from another Morris Care Ltd service was covering whilst they were absent.

At the last inspection 18 November 2015, the service was rated, 'Good'. At this inspection the service remained 'Good'. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People received the medicines they needed safely and staff understood their responsibilities about keeping people safe.

People felt safe at the home and there were enough staff on duty.

The provider had systems, processes and practices to safeguard people from abuse. People were supported by staff to stay safe while their freedom was promoted.

Risks were identified and managed well. Incidents and accidents were analysed to inform practice and make improvements to the service.

The provider completed background checks before new staff were appointed.

The home was clean and fresh and there were arrangements in place to prevent and control infection.

People were provided with enough to eat and drink to maintain a balanced diet.

People had access to healthcare services so that they received on-going healthcare support.

People were supported to have maximum choice and control of their lives and to maintain their independence. Staff supported them in the least restrictive ways possible.

Staff were kind and caring. People's dignity and independence were promoted always and care was taken to ensure people lived in a kind, caring, family atmosphere.

People's consent and choice on how their care was managed was central to how the service was run and what was provided for people. This created a sense of ownership and people considered they were part of the running of the

home.

People had been supported to access activities so they did not feel socially isolated. Information was provided to people in an accessible manner.

The staff recognised the importance of promoting equality and diversity. People's concerns and complaints were listened to and responded to so their quality of care was improved.

There was a positive culture in the service that was focused upon achieving good outcomes for people.

Oldbury Grange Nursing Home provides accommodation and personal care with nursing for up to 63 older people, some of who maybe living with dementia. There were 48 people living in the home on the day of our visit. There is a registered manager in post. At this inspection an interim manager was covering their absence. 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.

People who lived at the home felt safe and secure with staff to support them. People had been assessed before moving to the home so they agreed what they needed help with. Care records contained details of people’s preferences, interests, likes and dislikes.

Staff understood and worked within the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards. Staff were able to demonstrate a good understanding and knowledge of people’s specific support needs, so as to ensure people’s safety and protect their human rights.

Staffing levels and the skill mix of staff were sufficient to meet the people’s needs and to keep them safe. Staff recruitment was thorough with required checks completed prior to staff commencing work.

People had regular routine access to visiting health and social care professionals where necessary. Staff responded to people’s changing health needs and sought the appropriate guidance or care by healthcare professionals. Medication was stored and administered safely.

People were happy with the variety and choice of meals available to them. Regular snacks and drinks were available between meals to ensure people received enough to eat and drink.

People were encouraged and supported to maintain relationships with their friends and family members. Relatives and visitors were always made welcome into the home.

The care records gave staff direction to provide effective care. People were confident that their care was provided in the way they wanted. People knew about their care plan and that staff kept formal records of changes to their care.

Dedicated staff provided group and individual activities and there were opportunities for social stimulation from visiting entertainers. These were well publicised around the home.

A number of audits were in place to monitor quality. The provider acted on any shortfalls identified. Records documented the outcomes in order for staff to reflect and learn from them as part of the overall drive to improve the service.

The provider had an annual survey in place to obtain the views of people who received a service including their relatives. The interim manager spoke to people individually on a daily basis seeking their views about their care. People and their families had the opportunity to attend family meetings so they could share their point of view about the service.

People were receiving their medication late and people who required turning were not being turned at the correct times according to their agreed care plan.

At our August 2013 inspection we found that staffing levels had improved. Recruitment was still on going and staff morale had much improved.

The home was calm and we observed people were settled for the night. Staff were not rushed and attended to people's needs in a timely way.

We did not consult with people who live at Oldbury Grange about their care, this was because people had retired to bed for the night.

We interviewed the night staff and made observations throughout our visit and found most of these concerns, with the exception of poor moving and handling techniques were substantiated.

There were three areas where people lived at Oldbury Grange, these included nursing (Bridgnorth), residential (Oldbury, with high dependency people) and dementia care (Rowan).