Oakham Grange

Updated 9 August 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

The inspection was carried out by 2 inspectors, a pharmacy specialist, and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Service and service type

Oakham Grange is a 'care home'. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Oakham Grange is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. There was a home manager who was in the process of submitting their registered manager application.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 3 people and observed staff engagement with people to support us to understand people’s experience of care. We spoke with 8 family members for their experience of the care their family member received. We spoke with 12 staff; this included the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We also spoke with the home manager, head of quality and compliance, the clinical lead, two nurses, the chef, a domestic, 2 team leaders, a support worker, and an agency worker.

We reviewed a range of records. This included 11 care records, 3 staff files in relation to recruitment and supervision and multiple medication records. We looked at a variety of records relating to the management of the service, including audits and checks, staff training, meeting records, staff deployment and incident management.

Updated 9 August 2023

About the service

Oakham Grange is a care home with nursing. Accommodation is over three floors. All rooms are en-suite and there are a range of accessible communal areas internally and externally. The service can accommodate up to 68 people, some of whom are living with dementia. At the time of our inspection 50 people were using the service.

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

The provider had made improvements in all areas of the service, and this was ongoing. To ensure new and improved systems and processes were fully effective and safe, further time was required for these to become fully embedded and sustained.

This inspection identified further improvements were required in governance procedures such as monitoring processes. Record keeping in particular was identified to be inconsistent and needing strengthening.

People were protected as far as possible from abuse and avoidable harm. Whilst improvements had been made to the reporting of safeguarding incidents to the local authority safeguarding team, an incident was found not to have been reported. The provider was completing an investigation to understand what went wrong.

People’s risks associated with their care and treatment needs had been reviewed and guidance for staff improved upon. This was an area of continued improvement.

Staff deployment had increased. Additional nursing staff were on duty day and night and new unit clinical service mangers had been appointed and due to commence shortly.

Clinical competency assessments had been completed by nursing staff and additional training provided for all care and nursing staff and this was ongoing. People felt permanent staff were competent and understood their health conditions and care needs.

People described staff as caring and kind. Staff had been recruited safely and received ongoing opportunities to review their work, training, and development needs. Staff were positive about the improvements being made at the service and felt better supported and valued.

Medicines management had improved and was ongoing. The systems and processes that monitored medicines however, needed further improvement.

Lessons learnt processes had been further developed and action had been taken and was ongoing to ensure learning opportunities were robust and effective.

Infection prevention and control best practice guidance was followed. The service was clean and hygienic.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way. Improvements were ongoing in relation to the assessment process of people's mental capacity. Mental capacity assessments and best interest decisions for people who lacked capacity to consent had been completed.

Recognised assessment tools were used to assess and monitor health care needs. Further improvements were identified in relation to weight monitoring and action was being taken.

People’s dietary needs and preferences were known and understood, food and fluid were monitored to ensure people received sufficient to eat and drink. Improvements had been made and were ongoing in response to concerns raised by people about meal choices.

Staff worked with external health and social care professionals, to support people to achieve positive outcomes in their ongoing care and treatment needs.

The environment was adapted to meet people’s needs and was comfortable, spacious, and pleasant.

People and staff were positive about the new manager, they were described as being supportive, approachable, and knowledgeable. Senior management, leadership and oversight had increased and senior staff were present daily at the service. The management team were open and honest, they recognised further improvements were required at the service. An ongoing improvement and action plan were in place.

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 rated inspection for this service was inadequate (published 5 July 2023). Breaches in regulations relating to safe care and treatment, staffing, safeguarding, consent, and governance were identified. The provider completed an action plan after the inspection to show what they would do and by when to improve and meet the breaches in regulation related to safeguarding and consent. Warning Notices were served for the breaches relating to safe care and treatment, staffing and governance.

At this inspection we found enough improvements had been made in relation to some breaches in regulation. However, the provider remained in breach of 1 regulation relating to governance.

This service has been in Special Measures since the last inspection. 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 inspection was carried out to follow up on action we told the provider to take at the last inspection. The overall rating for the service has changed from inadequate to requires improvement based on the findings of 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.

Please see the safe, effective, and well-led sections of this full report. You can read the report from our last inspection, by selecting the 'all reports' link for Oakham Grange 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.