The Oaks

Updated 11 January 2024

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 team consisted of 2 inspectors, a medicines inspector, a nurse specialist advisor and 2 Experts 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.

Service and service type

The Oaks 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. The Oaks 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 general manager who was in the process of applying to be registered. We have since been informed the general manager has resigned from their post.

Notice of inspection

The first day of the inspection was unannounced. The provider knew we would be returning to continue the inspection on subsequent days.

What we did before the inspection

We used the information the provider sent us in the Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We reviewed the most recent Healthwatch report for the service. 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 all this information to plan our inspection.

During the inspection

We looked at a range of records including 20 people’s medicine and care records and 6 staff files in relation to recruitment, induction and supervision. We also looked at training records and records related to the management of the service which included, accident and incidents, complaints and quality assurance records and audits.

We spoke with 10 people and 5 relatives of people receiving care to get their views of the service provided. We also spoke with 13 members of staff including 4 health care assistants, 4 nurses/unit managers, the chef, the activities coordinator, the general home manager, the deputy manager, the regional manager and the clinical project manager. After the inspection we sent feedback questionnaires to staff to get their experience of working at the service. We received 5 responses. We also made calls to a further 10 relatives of people receiving care.

Updated 11 January 2024

About the service

The Oaks is a residential care home providing personal and nursing care to up to 113 people. The service provides support to older people, people living with dementia and people with mental health needs. At the time of our inspection there were 90 people using the service.

People’s experience of the service and what we found

People were placed at undue risk of harm. Many people were unable to easily call staff for assistance when they needed it. Risk management plans were not always followed correctly to mitigate the risk of harm of skin breakdown. People's medicines were not managed safely. The service did not always follow good infection control procedures. There were maintenance issues of the building that had not been resolved or made safe.

People's hydration needs were not always met and the risk of dehydration was not properly mitigated. The risks associated with health conditions were not always assessed and care plans lacked sufficient guidance for staff. Staff did not receive the necessary training they needed to meet all the needs of people using the service. The building was not designed or adapted to fully meet the needs of people with dementia.

Due to the issues we found with the delivery of person-centred care we could not be assured people were always supported to have maximum choice and control of their lives.

Not everyone received a kind and caring service. We observed some poor, uncaring interactions between people and staff. People’s dignity was not always maintained. Mealtimes were not well organised to ensure they were a calm and pleasurable experience. Food choices were not always presented in a way that would ensure people with cognitive decline could have as much choice and control as possible. We received mixed feedback from people and their relatives about the care they received.

Care plans did not contain sufficient information about people’s personal history, interests or hobbies. People were not always provided with adequate stimulation and activities. People were not always supported to plan their end of life wishes. The provider was following their complaints process when people raised concerns about the quality of the care they received.

The provider had made some improvements to the service but further improvements were needed to ensure people received a safe and effective service. The provider did not always carry out investigations when things went wrong and lessons were not always learnt from previous incidents. There were a wide range of quality assurance checks taking place but many of these had not been effective and had not resolved issues in a timely manner. In general staff were positive about the culture of the organisation and were happy with the support they received from the senior managers. However, feedback indicated not all members of staff were working to ensure people always received high standards of care. The provider acknowledged the issues we identified during the inspection and started making improvements immediately after the inspection.

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 the service under the previous provider was Good (published on 18 November 2020).

Why we inspected

The inspection was prompted in part due to concerns we received about safe care and treatment, the management of medicines and person-centred care. A decision was made for us to inspect and examine those risks. As this is the first inspection of the service under the new provider we carried out a comprehensive inspection.

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

Enforcement

We have identified breaches in relation to nutrition and hydration, person-centred care, safe care and treatment, staff training and good governance.

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

Follow Up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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.