Background to this inspection
Updated
9 April 2016
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection took place on 23 February 2016 and was unannounced. The inspection team consisted of two inspectors 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.
On this occasion we did not ask the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. Before the inspection we checked the information that we held about the service and the service provider. We used this information to decide which areas to focus on during our inspection.
During our inspection we spoke with five people, three relatives and seven members of staff. After the inspection we contacted a GP and the local authority, who visit the home on a regular basis. We reviewed a range of records about people’s care and how the service was managed. These included the care records for six people, medicine administration record (MAR) sheets, four staff training, support and employment records, quality assurance audits, incident reports and records relating to the management of the service. We spent time observing care and used the short observational framework for inspection (SOFI), which is a way of observing care to help us understand the experience of people who could not talk with us. We observed care and support in the communal lounges and dining areas during the day. We also spent time observing the lunchtime experience people had and the administering of medicines.
The service was last inspected in June 2014 and no areas of concern were noted.
Updated
9 April 2016
The inspection took place on 23 February 2016 and was unannounced.
Oakhill House Nursing Home provides accommodation for forty-nine older people, living with dementia, who need support with their nursing and personal care needs. On the day of our inspection there were forty-five people living at the home. The home is a large property, spread over two floors, situated in Horsham. There are four communal lounges, two dining rooms and well maintained gardens.
The service had not had a registered manager for six months. 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. A manager had been in post since August 2015.
People’s consent was gained before being supported to take their medicine. There were safe systems in place for the administration of medicines and records showed that people had received these on time. However, there were concerns regarding the procedures for covert medicine administration and the storage and disposal of some medicines. This is an area of concern.
People were supported to maintain their nutrition and hydration. People felt that they had enough food and drink and observations confirmed that drinks and snacks were offered throughout the day. People could choose what they had to eat and drink and felt that the food was good. For people at risk of malnutrition, appropriate measures had been implemented to ensure they received drink supplements. Foods were fortified with cream, milk and cheese to increase their calorie intake.
However, people’s dining experiences varied. Staff supported most people to have a positive dining experience. They were supported in a sensitive and respectful way according to their needs. However, for a minority of people, their dining experience was poor. There was limited interaction from staff and people were not supported to eat and drink in a way that was conducive to them maintaining adequate nutrition and hydration. This is an area in need of improvement.
There were sufficient numbers of staff to ensure people’s needs were met and their safety maintained. Staff had received induction training and had access to ongoing training to ensure their knowledge was current and that they had the relevant skills to meet people’s needs. People were safeguarded from harm. Staff had received training in safeguarding adults at risk, they were aware of the policies and procedures in place in relation to safeguarding and knew how to raise concerns. People felt safe, one person told us “If I wasn’t safe here I wouldn’t tolerate it.”
Risk assessments had been undertaken and were regularly reviewed. They considered people’s physical and clinical needs as well as hazards in the environment and provided guidance to staff. Observations confirmed that staff were aware of risk assessments and supported people in accordance with them. People were encouraged and enabled to take positive risks. People’s independence was not restricted through risk assessments. Observations of people assessed as being at risk of falls showed them to be independently walking around the home. There were low incidences of accidents and incidents, those that had occurred had been recorded and were used to inform practice.
People were asked their consent before being supported with anything. Mental capacity assessments had been undertaken to ensure that for people who lacked capacity appropriate measures had been taken to ensure best interest decisions were made on their behalf.
People had access to relevant health professionals to maintain good health. Records confirmed that external health professionals had been consulted to ensure that they were being provided with safe and effective care. People’s clinical needs were assessed and met. People received good health care to maintain their health and well-being.
People were cared for by staff who knew them and understood their needs and preferences. People told us that they felt well cared for. One person told us “They’re brilliant, so helpful, I can’t fault it.”
People were involved in their care and decisions that related to this. People and relatives were asked their preferences when people first moved into the home. They were provided with an opportunity to share their concerns and make comments about the care they received. Relatives confirmed that they were involved in their loved ones care, felt welcomed when they visited the home and knew who to go to if they had any concerns. The provider welcomed feedback and was continually acting on feedback to drive improvements within the home.
People were treated with dignity and their rights and choices were respected. Observations showed people being treated in a respectful and kind manner. People’s privacy was maintained, when staff offered assistance to people they did this in a discreet and sensitive way. People confirmed that they were treated with dignity and their privacy was maintained.
Staff knew people’s preferences and support was provided to meet people’s needs, preferences and interests. There was a variety of activities that people appeared to enjoy. People were able to make suggestions as to how they wanted to spend their time and these were listened to and acted upon.
There was a homely, friendly and relaxed atmosphere within the home. People were complementary about the leadership and management of the home and observations confirmed that the vision and ethos of the home was embedded in staff’s practice. Staff felt supported by the manager and were able to develop in their roles. There were rigorous quality assurance processes in place that were carried out by the manager and provider to ensure that the quality of care provided, as well as the environment itself, was meeting people’s needs.
We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.