Oaktree Care Home

Oaktree Care Home is registered to provide personal and nursing care for up to 78 people. The service is divided over two separate floors. The ground floor, called Bluebell is for those who require nursing care. The upper floor is dedicated to those people living with dementia and has two units called Primrose and Snowdrop. Snowdrop provides support to people living with dementia but who do not need nursing care. There were 60 people living at Oaktree Care Home when we inspected.

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

At the previous inspection we found there was not enough staff. During this inspection we found there had been some improvements in relation to staffing. However, there was a heavy reliance on agency staff which continued to impact on the delivery of care.

Feedback from people and their relatives said the quality of the care was dependent on who was on duty and whether it was regular staff or agency staff.

People were spending considerable amounts of time in their bedrooms and the only interactions we observed was when staff were supporting people with their personal care or other tasks such as supporting with eating and drinking. Although activities were available daily. People’s feedback was mixed and often people did not know the activities available to them.

There were a number of concerns in respect of the décor of the home including fixtures and fittings. This was shared with the management team. Some work had been completed by day two of the inspection and an action plan had been put in place. The environment in Primrose was not homely and many of the memory boxes outside people's bedrooms were empty. These are important as they help people living with dementia to orientate them to finding their bedroom as well as aid communication with people.

Some of the concerns in relation to the environment was a potential infection control risk. This was due to some areas not being able to be cleaned thoroughly due to surfaces being cracked and split.

Improvements had been made to ensure people at risk of malnutrition were eating and drinking enough. Staff were completing the appropriate records, and this was being monitored by the management team during the daily walk arounds.

People's medicines were managed safely. People had access to health and social care professionals who worked alongside nursing and care team at Oaktree. Feedback from two visiting health professionals was positive.

People were protected against the risks of abuse. Staff had received training in this area and understood their role in reporting. Staff recruitment was safe and ensured people were protected. The registered manager was actively recruiting to the vacant posts and was being supported by the provider’s senior management team.

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.

There were systems in place to monitor the quality of the care and support. The provider regularly visited the service to drive improvements and support the registered manager and the staff.

During our inspection we found improvements were required to the provider’s quality assurance systems as we found concerns with the environment during our inspection.

Rating at last inspection and update

The last rating for this service was Requires improvement (published 12 January 2022).

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 to the previous breaches in regulation relating to meeting people’s nutritional needs and staffing. The service remains requires improvement.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well led, which contain those requirements.

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 remained 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.

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 Oaktree 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.

At this inspection, we have identified breaches in relation to the environment and the governance arrangements in respect of monitoring the décor and fixture and fittings.

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.

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

Overall feedback, from relatives and people were positive about their experience of the care and support, especially how the staff and manager had managed the pandemic.

As seen at the last inspection, there remained a high use of agency staff, which was having an impact on the delivery of care and staff morale. There were occasions when the home was not staffed according to provider’s staffing tool due to short notice sickness and the agency staff cancelling their shifts. We found a breach in regulation and served a requirement notice in respect of staffing to ensure there were sufficient numbers of suitable and competent and experienced staff.

We could not be assured people at risk were eating and drinking enough. This was because staff were not completing food and fluid charts for those people that had been assessed as being at risk of malnutrition or dehydration.

People’s needs were assessed and planned for. The new provider had introduced their care planning tools. Not all care plans were kept up to date as people’s needs changed. In part this was due to the lack of nurses in Bluebell and the reliance on agency staff.

People’s medicines were managed safely. People had access to health and social care professionals who worked alongside nursing and care team at Oaktree. People were protected from the risk of cross infection and appropriate guidance was followed.

There was a program of activities that people could take part in. People were celebrating the festive season on the day of our visit with a party, including a buffet lunch. External entertainers and the local church had visited the service whilst following government guidance. People were supported to keep in contact with relatives throughout the pandemic such as video and telephone calls and visits.

People were protected against the risks of abuse. Staff had received training in this area and understood their role in reporting. Staff recruitment was safe and ensured people were protected. The registered manager was actively recruiting to the vacant posts.

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.

There were systems in place to monitor the quality of the care and support. The provider regularly visited the service to drive improvements and support the manager and the staff. Improvements were required in respect of the audits improving practice in relation to meeting people’s nutritional needs. This was a breach in regulation.

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 10 April 2019) for the previous provider. The service remains rated requires improvement.

Why we inspected

This was a planned inspection based on the previous rating and change of provider.

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.

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.

Prior to our visit we were informed of the procedures we should expect when visiting, this was the policy for all professionals arriving at the service. Professionals were asked not to visit the service if they displayed any symptoms related to Covid 19.

On our arrival we were greeted by the receptionist and had our temperature taken, we were asked to sanitise our hands and to wear a mask. Everyone visiting provided contact details to support the track and trace system. Visitors were shown to the area of the home they were visiting, by the shortest and most direct route.

We were escorted safely throughout the home, we did not enter people’s bedrooms. We saw staff wearing correct PPE during our visit. The registered manager and nurses completed ‘spot checks’ of the environment. These were completed to check staff understanding and compliance with use of PPE and infection prevention and control practices.

The emotional wellbeing of people and their families had been supported throughout the pandemic. The registered manager and staff ensured contact was maintained through various initiatives. They were sensitive to people’s feelings including anxiety, sadness and loss. It was evident from relatives thank you cards that they were grateful to all staff for the care and attention their loved ones received and for keeping them safe. Written comments included, “Thank you especially for keeping dad, so, so safe and well, we appreciate your dedication”, “Thank you for giving mum a memorable 101st birthday, we know it’s difficult to do ‘ordinary’ in these difficult circumstances” and “Thank you for looking after mum, I know she loves living there and that she is in the best hands”.

Throughout the spring and summer, garden visits were arranged by appointment. Procedures ran smoothly and staff were available if required whilst promoting privacy for people and their relative. As the autumn and winter season had approached, the provider had considered alternative visitor arrangements. An internal pod had been installed which had external access to help reduce entry to other parts of the home and reduce risk. In addition, an outside summer house had been installed and adapted as a ‘safe pod’ Both pods had a clear Perspex screen divider and a hearing loop system was installed to assist communication between people.

All staff recognised their responsibility to protect the people they cared for and how crucial it was that when they were not at work, they respected and followed government guidelines to reduce their own exposure to risks. The registered manager was very proud of all staff and recognised and celebrated their efforts and sacrifices during the pandemic.

People continued to receive prompt medical attention when they became unwell and relationships with health professionals remained strong. When people were admitted to the home, risk assessments were completed, and people were isolated for 14 days. Social distancing was encouraged throughout the home. Where this was not achievable, staff were aware of the need for enhanced cleaning of frequently touched surfaces and people were supported to wash their hands regularly.

There were clear policies, procedures and contingency plans in place. Audits were undertaken, and actions were taken to ensure improvements were made. Staff had received training and regular updates were provided. There was effective, supportive communication between the area manager, registered manager, staff, people using the service and relatives.