Archived: Oldfield House Residential Care Home

Oldfield House Residential Care Home provides accommodation and personal care for up to 19 people. The home caters for older people, including those living with dementia. The home has bedrooms and bathrooms on both the ground floor and first floor, with three rooms having en-suite bathrooms. On the day of our inspection there were 15 people residing in the service.

Oldfield House Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service was managed by a registered manager. A registered manager is a person who has registered with the 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.

At our last inspection of 10 and 11 July 2017 we found breaches of Regulations 10, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of privacy and dignity, safe management of medicines and storage of confidential information.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions, is the service safe, Is the service caring, Is the service well-led, to at least good. We checked the action plan had been followed during this inspection and found significant improvements had been made; we have rated this service as Good overall.

The registered manager had considered risks that people presented with. We found risk assessments were in place in relation to skin integrity, mobility, falls and nutrition. These provided guidance to staff on managing risks.

Equipment that was available throughout the service, such as, hoists, stand aids, walking frames and wheelchairs, had been maintained and serviced regularly to ensure they were safe for use.

All the people we spoke with who used the service and staff members, told us there were sufficient staff on duty every day. We observed throughout our inspection that staff were not rushed and had time to sit and chat with people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff told us, and records we looked at showed, that staff undertook an induction when they commenced employment within the service. Training records showed that staff had access to many different courses.

We saw the registered manager worked well with other healthcare professionals and services when people were moving into the home. Records evidenced that GP’s, district nurses, podiatrists and other health care professionals were contacted to meet people’s health care needs.

All the people we spoke with were very complimentary about the meals in the service. We saw people were given plenty of choices over the meals they had. Those who required support with eating their meals were supported in a sensitive manner.

During the inspection, we observed staff interacted with people in a sensitive, respectful and caring manner. We saw staff lowered their tone if they were speaking about a personal issue with someone, would bend down to the same eye level as the person they were speaking to and allowed people the time to express themselves.

Care plans we looked at were person centred. These were detailed to meet people’s needs and to direct staff. We saw people were involved in the development and review of these.

Records we looked at showed that the registered manager continuously sought ways to improve the service.

Policies and procedures were in place to guide staff in their roles. We saw these had been reviewed and necessary updates made.

Oldfield House is registered to provide accommodation and personal care for 19 older people. On the day of our inspection there were 17 people residing in the service.

At the time of our inspection the service had a registered manager in post. 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.

During this inspection three breaches of the regulations were found. These were in relation to the unsafe management of medicines, lack of privacy and dignity and failure to keep confidential records in a safe place. You can see what action we told the provider to take at the back of this report. We also made recommendations about infection control.

Most people we spoke with told us they felt safe living at Oldfield House. Two people told us they had concerns regarding a staff member. We discussed this with the registered manager who took immediate action. All staff members had received training in safeguarding and knew their responsibilities.

We reviewed medicines management within the service and found this was not always safe. A number of medicine administration records (MARs) had missing signatures for medicines that should have been administered. This meant we could not be certain that people had received all their medicines. There were no protocols in place for those people prescribed medicines ‘when required’ (PRN). Certain medicines were also not stored correctly.

Risk assessments were in place to keep people safe. We saw risk assessments in place in relation to moving and handling, falls, mobility and pressure ulcers. There was also an environmental risk assessment to ensure all parts of the service were safe. This covered topics such as scalds and burns, trips and falls, needle stick injuries, cleaning products and legionnaire’s disease. All risk assessments were reviewed on a regular basis to ensure they were appropriate.

There were systems in place to prevent the spread of infection. Staff were trained in infection control. The service was clean and tidy and there were no malodours. During our inspection we noted none of the bedrooms had paper towels in for staff when they had undertaken personal care and needed to undertake hand washing. We discussed this with the area manager who felt that this distracted form the personal feeling of people’s bedrooms. We recommended the service seeks guidance from current infection control guidance in relation to this matter.

We looked at the fire safety procedures in the service. We found policies and procedures, risk assessments and personal emergency evacuation plans (PEEP’s) were in place to keep people safe. Fire systems such as alarms, fire fighting equipment and emergency lighting were checked on a regular basis. However, we noted on a number of occasions that a chair was blocking a fire exit. This continued after we had discussed it with the registered manager.

We checked whether the service was working within the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. The registered manager had applied to the relevant supervisory authorities for a DoLS for one person.

Recruitment systems and processes were robust. This ensured only those suitable to work with vulnerable adults were employed by the service.

People’s privacy and dignity was not always respected. On the first day of our inspection a visiting healthcare professional had called to see two people who used the service. We noted they were taken into another service user’s bedroom for these appointments, rather than to the bedroom of each person being seen.

Care records containing personal and confidential information were not stored securely and anyone was able to access them.

We observed positive interactions from all staff members on duty on both days of our inspection. Staff members explained options and offered choices using appropriate communication skills. People appeared comfortable and confident around the staff. We saw people laughing and smiling with staff members.

Records we looked at showed that prior to moving into Oldfield House, a pre-admission assessment was undertaken. This provided the registered manager and staff with the information required to assess if Oldfield House could meet the needs of people being referred to the service prior to them moving in.

People were given the information on how to complain with the details of other organisations if they wished to go outside of the service. The complaints procedure was displayed in the entrance of the service for visitors to see.

Staff and people who used the service all told us managers were approachable and supportive. The registered manager told us they received support from the area manager.

Meetings and supervisions with staff gave them the opportunity to be involved in the running of the home and discuss their training needs.

The registered manager conducted sufficient audits to ensure the quality of the service provided was maintained or improved.

The service asked people who used the service, family members and professionals for their views and responded to them to help improve the service.

We observed three care staff asking people about the way they wanted their care to be delivered. We observed staff supporting and treating people in a kind and respectful manner.

We looked at the staffing rota that was planned four weeks in advance. We saw that as far as possible there was enough staff to meet the needs of people who lived at the home. We noted the staffing levels recorded on the rota matched the number of staff on duty seen during our visit.

We found that improvements had been made to address the shortfalls associated with insufficient staffing levels. These improvements ensured people were safe and their health and safety needs were met by sufficient numbers of appropriate staff.

They told us the care workers provided sensitive and flexible personal care and support and they were well cared for. People made positive comments about the service such as, 'They're good staff here' and 'We get good food and they look after us well'.

We looked at the care plans of three people and saw there were procedures in place to ensure their consent was gained in relation to the care provided. A relative spoken with told us, 'My husband will have signed the forms for my mother in law'.

People told us they had no concerns about the care being provided and they felt safe and protected from potential harm. A relative spoken with told us, 'They've been looking after my mother in law for five years. They are patient with her. I have no problems with her care'.

We observed medicines were safely administered during the inspection and medicines procedures were audited on a regular basis.

We noted there were insufficient numbers of staff to meet the needs of the people who use the service at all times. We saw staff were hurried and not immediately available to people when required. This meant there was potential for risks to occur in their absence.