Oakview Care Home

Oakview Care Home is a ‘care home’ providing personal and nursing care. Oakview Care Home accommodates 97 people in 1 building across 4 separate units, each of which have separate adapted facilities. Two of the units specialises in providing personal and nursing care to people living with dementia. At the time of our inspection there were 90 people using the service.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Right Support:

People had not always had all of the risks associated with their care assessed or mitigated. Care plans needed further information about how to reduce risks in people’s care. Fire safety risks and people’s health conditions needed to be fully considered.

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

People received their prescribed medicines. However, guidance on the use of people’s ‘as and when’ (PRN) medicines needed to be improved.

Staff demonstrated understanding and knowledge of people’s individual needs, including their healthcare needs.

Right Care:

Staff demonstrated knowledge and understanding of how to recognise and report abuse. Records showed staff had received adequate training.

There were enough staff to meet people’s needs. People were treated with dignity and respect.

Right Culture:

Systems in place to review the quality and safety of the service were not always effective. We identified care records were not always reflective of people’s needs and risks and lacked information regarding people’s health and care needs. The provider’s management of fire safety risks to people needed to improve.

Systems were in place to ensure people, staff and relatives could feedback on the care delivery; evidence showed this was acted upon.

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 good published 01 April 2021.

Why we inspected

The inspection was prompted in part due to concerns received about risk management, incidents of a safeguarding nature and governance. A decision was made for us to inspect and examine those risks.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. 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 inspection reports and timeline’ link for Oakview Care Home on our website at www.cqc.org.uk

Enforcement

We have identified breaches in relation to risk management and good governance at this inspection. 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.

We found the following examples of good practice:

The provider was following best practice guidelines in ensuring visitors to the home did not introduce or spread COVID-19. Due to the layout of the building, in order to reduce the amount of visitors entering through the main entrance, a separate entrance was also being used for easier access to specific areas of the home and to minimise the risk of spreading infection.

Staff were adhering to Personal Protective Equipment (PPE) guidelines and extra PPE locations had been set up on each corridor. Where social distancing could not be maintained, staff took extra precautions through the use of PPE and handwashing to minimise the spread of infection.

The provider had ensured that all staff had received a personal COVID-19 risk assessment and conversations about their wellbeing were held regularly .

The care home has continued to allow visitors to enter the premises, however strict guidelines were adhered too. Visitors have to use the appropriate PPE and specific areas had been set up for people to see their visitors.

At the last inspection, the service was rated Good. At this inspection we found the service remained good.

People told us they received safe care, relatives who we spoke with told us staff were trained to support their family members in a way which kept them safe. Staff demonstrated good knowledge in how they were to protect people from harm. We found staff understood and recognised the signs of abuse and knew how to report this. The registered manager had identified potential risks to people and had put plans in place to support staff to reduce the risk to people without taking away people’s right to make decisions about their care. People and relatives told us the registered manager ensured there were enough staff to support their care needs. People were supported with their medicines in a safe way. Staff followed appropriate guidelines to reduce the risk of infection. Accidents and incidents were investigated and action taken to reduce the risk of further harm.

People received care and support which met their needs and preferences and was in line with their consent and agreement, and staff understood the importance of this. Staff received regular training which was relevant to the people they cared for. We found people were supported to eat a healthy diet which was tailored to their individual preferences. Staff worked with external healthcare professionals and where necessary followed their guidance and advice about how to support the person in the right way. 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 support this practice.

People’s views and decisions they had made about their care were listened to and staff acted upon these in a dignified and respectful way. Staff worked as a team to ensure people were supported with respect and their dignity maintained. Relatives felt the staff team treated their family members in a kind and friendly way, which was done so respectfully. People benefitted from the staff using different approaches and communication equipment to support them to make choices and be involved in their care decisions as much as possible.

People were involved in the planning and ongoing reviews of their care. People were supported to maintain their hobbies and interests. Staff recognised if people’s healthcare needs changed, and responded to these in a timely way. The registered manager had provided people with information around how to raise a complaint should they need to. People and relatives we spoke with knew who they could speak with to raise any concerns. People and relatives felt listened to where they had raised a concern. The registered manager had received some complaints and had taken action to address these and share the learning with the staff team to improve practice. People and their families were supported by staff that were compassionate and knowledgeable to meet their end of life needs.

People and their relatives felt involved in the way the service was run. They felt they had the opportunity to share their views and discuss aspects of the service. Staff felt supported by the registered manager to carry out their roles and responsibilities effectively, through training and daily contact. Staff felt involved in the service and felt able to influence their ideas in the way in which the service was run. People, relatives and staff felt the registered manager was approachable and listened to them. We found checks the registered manager completed on the service focused upon the experiences of people.

Further information is in the detailed findings below.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found-

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic.

There were enough staff on duty to meet the needs of the people living at the home and members of the management team were available to support staff on the units. .

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We found that proper policies and procedures were in place and the manager demonstrated a good level of awareness of this area.

We carried out this inspection because we had received comments expressing the view that unsafe care had been provided to one person. In addition to carrying out this visit, we referred the comments to the local authority, who has responsibility for investigating safeguarding concerns. At the time of writing this report, the local authority had not completed their investigation.

Is the service effective?

People told us that they were happy with the care that had been delivered and their needs had been met. It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well. One person told us. "We are lucky to be here.'

Staff had received relevant training to meet the needs of the people living at the home.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people.

People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this. One person told us 'They are friendly and gentle with us'. A healthcare professional who visits the home told us, 'the nurses listen and I find them knowledgeable'they follow what they are expected to do.'

Is the service responsive?

People's needs had been assessed before they moved into the home.

Records and people's comments confirmed that people's preferences, interests, aspirations and diverse needs had been recorded. Care and support had been provided in accordance with people's wishes.

People had access to a range of activities and had been supported to maintain relationships with their friends and relatives.

Is the service well-led?

There were good systems for quality assurance.

People in the home and their relatives had completed customer satisfaction surveys and had opportunities to attend regular feedback meetings. The manager demonstrated that changes which had been made as a result of comments from people living in the home and their relatives.

Staff, relatives and people living in the home told us that the managers were accessible and took account of their comments.

The manager and senior staff demonstrated a good level of awareness about the performance of the home and the plans for the future.

We found that people's needs were assessed and their care and treatment was delivered in a safe way, according to their needs and preferences.

There were suitable arrangements for making sure that people were provided with adequate nutrition and hydration.

There were sufficient numbers of staff with appropriate experience and qualifications to meet people's needs.

There were good arrangements for assessing the quality of care provided and for identifying areas for possible improvement. These included asking people and their representatives about the quality of care they received. These systems had been used to identify a need for improvement in the quality of activities for people and for a more formal system for staff development.

The records were well maintained and stored in a secure way.

We received comments from several relatives and fifteen people who lived in the home. Most were positive and included, 'It's a very nice place to be in. The staff are warm and friendly, helping us as much as they can. They never shout or raise their voices to me.' One person said, 'This home is lovely to live in, and the staff are very good and kind to me.' A relative told us, 'Overall it's a good home and it's getting better.' We received a minority of negative comments about specific events and we passed these to the manager for investigation and action.

Most people who used the service were not able to tell us about the care they received due to their health needs. We therefore used a number of different methods to help us to understand their experiences.

We spoke with the relatives of six people who used the service and two visiting healthcare professionals. Overall the comments we received about the service were positive. One relative told us 'I'm very satisfied with care.' Another relative said, 'The staff have got patience.'

We also spent time observing care being given. We found there had been improvements in the care people received since our previous visit. Interactions between staff and the people who used the service were positive. People received their medicines as prescribed and staff were following appropriate infection control practices.

We found improvements had been made to support people's nutritional needs and in the maintenance of people's care records. However we still had some minor concerns about people's meal time experience and the quality of people's care records.

The report refers to two managers. Mr James Parkes has been the registered manager since February 2012. The previous manager has not yet applied to be de-registered.