Archived: Oak House Care Home

Oak House Care Home is a residential care home that provides accommodation and nursing or personal care for up to 16 people, many of whom have physical disabilities and are living with dementia. At the time of this inspection, 15 people were living at the service.

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

The risks associated with people’s care was not always undertaken in a safe way. This included the risk of trips and falls and choking. Accidents and incidents were not analysed for trends and themes to prevent further occurrence. The recruitment for staff was not robust. There was information missing around staff’s employment background and there was a lack of required references for the provider to consider the staff suitability for the role.

The provider and registered manager did not have a robust oversight of the care at the service. They had not identified the shortfalls that we had identified at the inspection. People and staff were complimentary about the registered manager and said they felt listened to. People told us they felt safe and that they received their medicines when needed.

Rating at last inspection

The last rating for this service was Good (published 3 May 2019).

Why we inspected

The inspection was prompted in part by concerns we received relating to infection and prevention control practices and safe care and treatment.

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 in relation to risks associated with people’s care, the recruitment of staff and the lack of robust quality assurance. Please see the Safe and Well Led sections of this full report. 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 Oak House Care Home on our website at www.cqc.org.uk.

Enforcement

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

For requirement actions of enforcement which we are able to publish at the time of the report being published. 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The provider had ensured that there was a supply of personal protective equipment (PPE) and staff used this appropriately. Staff had a dedicated changing area with separate access from outside which reduced the risk of infections being brought into the home. Uniforms were only worn at work. Staff had received training in infection control and putting on and taking off PPE safely.

Visitors booked in advance and entered the garden through a side gate. They had their temperature taken and were given PPE. Contact details were taken for track and trace. Visits took place in a gazebo in the garden adhering to social distancing guidelines. The registered manager had provided staff with mobile devices and tablets to assist people with virtual calls to their families when visits were not possible.

The registered manager had carried out risk assessments for people who were in vulnerable groups so that individual risks could be addressed.

Oak House Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Oak House is registered to provide accommodation and personal care for up to 16 people. There were nine people living at the service at the time of our inspection.

People’s experience of using this service:

The safety of the environment had improved since the last inspection. However, improvements were still required to ensure that the surroundings were meeting the needs of people living with dementia. The availability of activities had increased however these could be more meaningful to people to include trips out.

The new manager had implemented positive changes to the service. People and their relatives were engaged more in the delivery of care as the manager proactively sought feedback and acted on this. Staff culture had improved and staff told us that they felt valued and supported. Staff understood the ethos of the service. Audits that took place were used to make improvements to the quality of care.

There were sufficient staff at the service who understood the risks associated with people’s care. Staff were provided with appropriate training and supervision that related to their role. People were supported with their health needs and were provided suitable food and drinks. People were treated with care and consideration by staff and were involved in their day to day care. Care plans contained detailed guidance and staff discussed any changes to people’s care.

Rating at last inspection:

At the last inspection the service was rated Requires Improvement (the report was published on the 13 October 2018).

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received. We wanted to follow up on breaches of regulation that were identified at the previous inspection.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

This inspection site visit took place on 16 August 2018 and was unannounced.

There was no registered manager in post on the day of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. We were supported by the provider on the day of the inspection. The manager that had been recruited at the service had handed their notice in. Instead we were supported by the provider.

At the last inspection in July 2017 we asked the provider to take action to make improvements in relation to the quality assurance and record keeping at the service. We found that these actions had not been completed. At the previous inspection we also made recommendations around how complaints were responded to and staffing levels. We found staff levels had improved however there was still concern around how complaints were recorded and dealt with.

The premises and equipment was not maintained to a safe standard. Audits were not effective in identifying these shortfalls. Risks to people were not managed safely. There was a lack of detailed guidance for staff to assist them to support people. Monitoring tools were not used effectively where people were at risk of malnutrition and dehydration.

Accidents and incidents were not analysed to look for trends. Robust recruitment had not taken place to ensure that appropriate staff were employed.

Staff were not always working within the principles of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). The premises adaptation did not meet the needs of people that were living with dementia.

Before people moved in to the service a full assessment of their needs did not always take place. Care plans were either not in place or did not always include all the necessary information or guidance for staff including end of life care planning. Activities were not always person centred and people did not have appropriate opportunities to go out.

Staff had not always received training or supervision in relation to their role. However, there were aspects of staff practice that was appropriate and in line with correct protocols.

We found that people were not always involved in the planning of their care and did not have choices with day to day care. People did not always receive effective support with their personal hygiene.

Records of complaints were not kept and complaints were not always addressed appropriately. Quality checks that were taking place were not effective and audits did not always identify the shortfalls that we identified. Improvements were not always made as a result of feedback.

Safe levels of staff were maintained, staff protected people from the risk of abuse and there were systems and information in place to keep people safe in the event of an emergency. The management of medicines were safe.

People were offered choices of meals and drinks. People were supported to maintain their health and had access to health care professionals. Information about people’s care was being communicated effectively between staff.

We did see examples of people being treated in a caring and respectful way by staff. People were supported to practice their faith and visitors were always welcome to the service.

Staff told us that they felt supported by the staff team. Where appropriate notifications were sent to the CQC.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Oak House Care Home is a residential care home providing support to up to 16 older people. At the time of our inspection there were 13 people living at the home, some of whom were living with dementia.

There was not a registered manager in post. At the time of inspection, a new manager had been in post for two months and was in the process of registering with us. 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.

At our last inspection we found 5 breaches of regulations. We found problems identified with the home environment were not being addressed, people’s care was not personalised and staff did not protect people’s legal rights. There was a lack of staff training and the provider did not have effective systems in place to maintain accurate records and carry out audits. At this inspection we found that improvements had been implemented to meet the requirements of 4 regulations. However, we did find one continued breach of regulation in relation to record keeping and audits.

There was a continued lack of audits in place to assure the quality of the care that people received. The new manager had started to improve this aspect of the service and introduced a number of new checks on quality. However the provider had failed to make enough improvement in a timely way since the last inspection. We identified some shortfalls that audits could have addressed, such as information missing from one person’s records and concerns with the way medicines were stored.

People had opportunities to be involved in the running of the home. Regular meetings took place and people’s feedback was regularly sought. The provider responded to complaints. However, in one case we identified a complaint could have been responded to better. We recommended that the provider ensures information on how to take complaints further was clear to people.

People’s rights were protected because staff followed the guidance of the Mental Capacity Act (2005). Improvements were made to how the legal process was followed and staff training was refreshed. Staff had received training to support them in their roles. Staff received an induction and training was kept up to date.

Improvements had been made to the home environment. The provider had addressed maintenance issues that we identified at the last inspection, as well as continuing to address any problems they identified through checks. Equipment and utilities at the home were regularly checked and serviced. People were kept safe in the event of a fire because the provider maintained fire equipment and carried out tests and drills to ensure people would be kept safe in an emergency. Systems were in place to ensure the home environment remained clean and the risk of infection being spread through the home was reduced.

People’s care plans had been updated and contained person-centred information. Apart from in one case, staff had all the information that they needed to ensure that people’s needs were met. Regular reviews were undertaken and changes in need were addressed.

The activities at the home had been increased since our last inspection. The manager was in the process of working with people to introduce a new regime of activities, in line with their choices. Risks to people were assessed and plans were in place to reduce any hazards. Where any accidents or incidents had occurred, staff took appropriate actions to keep people safe.

People received their medicines safely. Staff were trained in how to administer medicines and accurate medicines records were kept. Staff worked alongside healthcare professionals to meet people’s needs and we saw evidence of staff making referrals to healthcare professionals where appropriate.

People were supported by kind and committed staff that knew them well. Staff were considerate of people’s needs and involved them in their care. Staff provided care in a way that promoted people’s privacy and dignity. Staff understood their roles in safeguarding people from abuse.

There were appropriate numbers of staff at the home to meet people’s needs. Staffing numbers were based on people’s needs. The provider carried out appropriate checks to ensure that staff were suitable for their roles.

People, relatives and staff spoke positively about the new manager. New systems for communication between staff had been introduced. Staff had regular meetings where they could make suggestions to improve people’s lives.

This was an unannounced inspection which took place on 04 July 2016.

During our inspection the registered manager was present. 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.

Oak House Care Home was last inspected on 23 July 2015 when it was awarded an overall rating of ‘Requires Improvement’. Two breaches were identified in relation to regulation 11 (consent) and regulation 15 (cleanliness). Requirement actions were set and the provider sent us an action plan that stated they would be compliant by 14 September 2015. A recommendation was also made to make the environment more dementia friendly.

At this inspection we found that although some action had been taken this was not enough to meet the requirement actions. In addition, we found there had been a further deterioration in the cleanliness and maintenance of the environment. Most areas of the home required attention and cleaning or repairs. Serious concerns were identified in relation to servicing of hoists, electrical installations, gas facilities and the heating system.

No action had been taken had been taken since our previous inspection to ensure people’s human rights were upheld when they lacked capacity to consent. Mental capacity assessments had not been completed, staff lacked understanding and a DoLS application had been made for a person who had capacity. This was not consistent with the law.

The registered manager and the provider had not ensured that the quality and safety of the service was monitored or that action was taken to improve service delivery.

We took enforcement action against the registered persons and served Warning Notices in response to the above concerns.

Training had been provided but staff did not demonstrate knowledge gained from this and it was not reflected in aspects of their practice. Staff told us that they were happy with the support they received from the registered manager. However, a robust induction and regular, formal supervision was not provided to all staff to help them to understand their roles and to undertake their responsibilities. You can see what action we told the provider to take at the back of the full version of the report.

Staff were not proactive in ensuring people who lived with dementia received stimulation to meet their needs. Care plans did not always reflect the whole person. You can see what action we told the provider to take at the back of the full version of the report.

Accidents and incidents were acted upon and reviewed to prevent or minimise re-occurrence. Risk assessments and care plans were in place that considered potential risks to people. People were supported to access healthcare services and to maintain good health. All apart from one aspect of medicines management was safe.

Everyone said that the registered manager was friendly and approachable. People said they were treated with respect and effort was made to promote their dignity and privacy. However greater effort was needed in this area.

People said that they felt safe, free from harm and would speak to staff if they were worried or unhappy about anything. Staff and the registered manager understood their responsibilities in this area.

People who lived at Oak House Care Home, their relatives and staff told us that there were, on the whole enough staff on duty to support people at the times they wanted or needed. Appropriate recruitment checks were completed to ensure staff were safe to support people.

People said that the food at the home was good. Staff assisted people when needed.

People’s needs were assessed and care given that reflected changes in people’s needs. When recommendations were made by external professionals these were acted upon to ensure people received the care and support they required.

All of the people that we spoke with could not praise the home highly enough. One said 'I'm absolutely over the moon' and another told us 'You've no idea how happy I am she's here.'

The people that we spoke with and their relatives told us that they were fully involved in developing their care plan and that they felt that the staff treated them with respect and encouraged them to be independent.

We observed that the home organised regular activities for the people who lived there and we saw that people were happy and relaxed.

We looked at the staff rota's and saw that there were appropriate numbers of staff on duty each day to attend to the needs of the people who used the service.

The manager told us that each person living in the home was given a Statement of Purpose which gave them details of how to make a complaint should they wish to.