Oak House

Oak House is a 'care home' that provides care and support for a maximum of 26 older people, some of whom may be living with a dementia and/or physical frailty. At the time of the inspection 25 people were living at the service.

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

Although people and relatives were positive about the support provided at Oak House, we found improvements were needed to ensure the safety and quality of the service.

The systems for ensuring medicines were administered safely were ineffective. People did not always receive their ‘as required’ medicines and the necessary protocols were not always in place for staff to follow. Staff did not consistently record when topical medicines had been applied.

Systems and processes to safeguard people were not always effective. Some staff told us they did not feel confident to whistle blow about bullying and poor practice. They had been told they would be reported to safeguarding and lose their jobs if they did so. They told us when they had raised concerns about people’s safety, they had not been acted on. The management team did not always recognise or respond appropriately to incidents of abuse. Safeguarding concerns had not always been raised with the local authority when required.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The provider had failed to submit notifications in line with legal requirements. This included notifying CQC of safeguarding concerns, a serious injury, or when DoLS applications had been authorised.

Quality assurance tools were not effective because they did not identify the concerns we found during this inspection.

A new manager was appointed during the inspection. We discussed our concerns with them and the provider, and they advised us of their plans to address them as a matter of urgency.

Risks to people's health and well-being were assessed and reviewed appropriately. There was clear guidance in place for staff to follow. Staff worked closely with a range of external health professionals to meet people's needs. Measures were in place to prevent the spread of infection, and safety checks on the environment were in place. Incidents and accidents were appropriately recorded and analysed for patterns and trends.

A dynamic and developing activities programme was co-ordinated by committed and passionate staff 7 days a week. This was extremely person centred and tailored to meet people’s individual needs.

Staff received the training and support they needed to do their jobs effectively. They knew people well and were kind and caring. One person told us, “They have so much compassion. The staff are lovely.”

Staff were recruited and selected safely. We saw there were sufficient numbers of staff deployed to meet the needs of the people at the service. We observed, and relatives confirmed, that they were quick to respond when people needed support or were becoming distressed.

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 1 July 2022). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

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Why we inspected

We undertook this focused inspection to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well Led. For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service remains 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, 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 Oak House on our website at www.cqc.org.uk

Enforcement and Recommendations

We have identified breaches in relation to medicines management; safeguarding; consent; governance and notification of incidents.

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.

Oak House is a 'care home' that provides care and support for a maximum of 26 older people, some of whom may be living with a dementia and/or physical frailty. At the time of the inspection 24 people were living at the service.

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

People told us they felt safe. However, improvements were needed in some areas. We could not be assured risks associated with people's needs were consistently assessed and recorded; or accidents and incidents documented fully and followed up. In addition, the quality assurance processes in place were not fully effective which meant these issues had not been identified or addressed in a timely way. The provider had discussed these issues with the registered manager the week before the inspection. Plans were now in place to address them through further training, and increased support and oversight by the provider. These improvements had not yet been actioned and embedded.

People, relatives and staff spoke highly of the management of the service. They told us the provider and registered manager were approachable and supportive, and kept them informed. External professionals were complimentary about how the service worked in partnership with them.

Care plans provided comprehensive information about how people wished to receive care and support. This helped ensure people received personalised care in a way that met their individual needs. There were systems in place to ensure information about any changes in people's needs was shared promptly across the staff team.

People received their medicines safely, and in the way prescribed for them. Staff were recruited safely, and safeguarding processes were in place to help protect people from abuse.

People were supported by sufficient numbers of suitably trained, competent and skilled staff. This meant their healthcare and nutritional needs were met.

People lived in a homely environment which promoted their dignity and wellbeing. Staff were caring and kind and had developed positive and meaningful relationships with people. People were respected, included in decisions, and their privacy and independence promoted. The care provided was sensitive to people's diverse needs. A relative commented, “It’s like a real home. It’s not institutional. All I have experienced is kindness. The staff are really gentle and always calm.”

People enjoyed a range of activities with three activity organisers employed covering seven days a week; a fitness coach; visiting musicians, and pastoral support and holy communion from a local church. The provider planned further analysis to ensure the activities met people’s individual interests and needs. A relative said, “She used to do art and painting. While in the home she has done some lovely pictures which the staff show me. I saw them the other day throwing a ball with a lively gentleman and doing exercises.”

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 18 November 2020 and this is the first inspection.

The last rating for the service under the previous provider was requires improvement, published on 27 April 2019.

Why we inspected

This was a routine, planned 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.

Follow up

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