Archived: Oakland Nursing Home

Oakland Nursing Home is a nursing home providing nursing and personal care to up to 27 older people, some of whom have physical disabilities or sensory impairments. At the time of our inspection there were 13 people using the service.

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

The provider had failed to implement effective quality assurance processes. They did not have sufficient oversight of the service being provided.

The provider failed to make required improvements following the last inspection and a number of issues remained at this inspection. The provider had not regularly engaged with people, relatives or the staff team or requested feedback to improve the quality of the service provided.

Risks to people had not been consistently monitored, recorded and action had not always been taken to prevent risks from reoccurring. Equipment and safety checks had not been completed to ensure they remained safe to use.

Safe recruitment processes were not followed. Required pre-employment checks had not always been completed prior to new staff commencing employment.

Medicines had not been stored, recorded or administered appropriately. Not all nursing staff had been observed to ensure they were competent with regards to medicine management.

Records used to monitor people’s health and wellbeing had not been completed consistently. We could not be assured people were receiving sufficient fluids.

People told us they felt safe. Processes had been followed to ensure any concerns related to suspected abuse were appropriately reported.

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

For more details, please see the full report which is on the Care Quality Commission’s (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 13 April 2021) and there were breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about the quality and safety of the service being provided. We also received concerns in relation to the management and provider oversight of the service. A decision was made for us to inspect and examine those risks.

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. Please see the safe and well-led sections of this full report.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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 Oakland Nursing Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to assessing risks, safety of the service, recruitment processes and monitoring systems in place 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 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.

Oakland Nursing Home is a nursing home providing personal and nursing care to up to 27 older people. At the time of this inspection, 20 people were using the service.

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

Risks in relation to the transmission of infections, the environment and risks specific to people’s medical conditions had not always been fully considered or recorded.

Staff had completed medicines training; however, medicine records were not always thoroughly completed. Accidents and incidents had not been fully reviewed to identify any trends.

Systems and processes in place to monitor the quality and safety of the service provided had not always been effective in highlighting shortfalls. Where they had identified issues, timely action had not always been taken to respond. The registered manager had not always taken action to respond to and address any complaints made within the required timescales.

People told us they felt safe. Staff had received safeguarding training and knew the process to follow if they had any concerns. There was enough staff on duty to ensure people’s care and support needs were being met. Staff had been recruited safely and recruitment processes were followed.

The provider and registered manager were responsive to the concerns and shortfalls found at the inspection. The registered manager was new to their role and they were committed to ensuring lessons were learnt when things had gone wrong. They were keen to improve the service.

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 5 February 2019).

Why we inspected

We received concerns in relation to infection control and record keeping. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. 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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to assessing the safety of the service and governance processes in place 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 for 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.

Oakland Nursing Home is a nursing home providing personal and nursing care to 16 older people at the time of the inspection. The service can support up to 27 people in one adapted building.

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

Risks to people were managed to ensure appropriate control measures were in place. Some records had not been updated when changes in the level of risk had occurred. The registered manager took action to address this immediately. Regular checks were in place to ensure equipment remain safe to use.

Good infection prevention and control practices were in place which had been adapted well to respond to increase risks posed by COVID 19. Observations of staffs practice had been completed to ensure government guidance was being followed at all times.

Staff ensured people were provided with a balanced diet. Any concerns in relation to people’s food and fluid intake were appropriately recorded and monitored.

The registered manager had effective systems in place to monitor the quality and safety of the service. Where shortfalls were found, action had been taken. A system of regular reporting had been introduced during COVID 19 to ensure the provider was kept up to date with any concerns or issues.

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 5 February 2019).

Why we inspected

We undertook this targeted inspection to look at specific concerns we had about risk management as well as the providers governance system used to monitor the service provided. This was mainly due to concerns that had been found at the providers other registered locations.

The overall rating for the service has not changed following this targeted inspection and remains good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Oakland Nursing Home accommodates up to 27 people in one adapted building. It is situated in the town of Whitby, close to local amenities and the town centre.

This inspection took place on 3 and 8 January 2019 and was unannounced. At the time of this inspection, 23 people were using the service.

At the last inspection in October 2017 the provider was found to be in breach of two regulations. These were Regulation 17 Good governance and Regulation 18 Staffing.

Following the last inspection, we met with the provider and asked the them 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 effective, is the service caring, is the service responsive, is the service well-led to at least good.

There was a manager in post who had registered with CQC. 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.

Thorough quality assurance systems were now in place and had been effective in identifying and addressing any shortfalls. Clear action plans were in place to evidence action taken to address concerns that had been completed in a timely manner.

There was enough staff on duty to meet people’s needs. Call bells and requests for support were responded to a timely manner by staff who were friendly and approachable. Staff were clearly visible throughout the service.

Safe recruitment processes were in place and had been followed. The registered manager had implemented robust checks to ensure all pre-employment checks were completed before employment commenced. Staff had been provided with an induction to the service and received consistent support through regular one to one and group supervisions. Staff training had been further developed to ensure staff had the skills and knowledge to carry out their role. Medicines had been stored, managed and administered safely.

Risks to people had been assessed and management plans were in place. These had been regularly reviewed and updated when changes occurred. Risk relating to the environment were regularly reviewed and servicing certificates were in place to ensure equipment was safe and well maintained. Recent re-decoration had significantly improved the appearance of the service. Staff followed good infection control practices and the service was clean throughout.

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. People told us they were treated with dignity and respect. Staff addressed people by their preferred names and encouraged them to remain as independent as possible.

There was a range of meals on offer, although some people told us they would like more variety. The registered manager was already taking action at the time of this inspection to address this. People who were at risk of malnutrition were closely monitored to identify any further concerns.

Care plans contained person-centred information and it was clear people were at the heart of the service. Activities were now provided on a daily basis and staff understood the importance of social interaction.

People, relatives and staff spoke positively of the management team and their approach. People had been asked to provide feedback on the service and told us they were confident any concerns they raised would be addressed appropriately.

Oakland Nursing 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.

Oakland Nursing Home can accommodate up to 27 people. At the time of this inspection, 24 people were using the service who had nursing care needs.

There was a registered manager in post who had registered with the Care Quality Commission (CQC) in May 2016. 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 the last comprehensive inspection in August 2015 we found the provider was meeting regulations and awarded a rating of ‘good’. At this inspection, we found some improvements were required and identified breaches in regulation.

The registered manager had not ensured staff had the appropriate skills and knowledge to provide effective care and support to people. Records showed that many staff had training which had expired and no refresher training had been arranged. Staff had not received effective support within their role. Records showed that regular one to one supervisions and appraisals had not taken place.

We judged this to be a breach of regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014.

The registered manager completed monthly audits to monitor the service. However, we found example's where the registered manager's quality assurance systems had not been effective in recognising and rectifying issues. Records of the provider’s audits contained very basic information and evidenced that they did not have robust systems and processes in place to assess and monitor the service.

Where people required support with their medicines, these had been administered as prescribed. Medicines were stored securely. However, assessments had not been completed on staff to ensure they were competent in administering medicines.

We judged this to be a breach of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014.

Safe recruitment procedures were not always followed. Full employment history was not always recorded. We also found that two references were not available for one of the staff files we looked at.

People were confident in approaching staff if they required assistance. However, people were not always supported to communicate effectively and observations showed that people were sometimes left for long periods of time at mealtimes without any interaction. There was a significant lack of activities on offer. Planned activities did not take place and we observed people sat in communal areas with no stimulation other than a television. We have made a recommendation about the lack of activities.

The adaptation and design of the building was not always suitable to meet people’s needs. We found that doors did not always contain appropriate signage.

The provider had a ‘Safeguarding Adults Policy & Procedures’ document which set out the responsibilities of employees. The staff we spoke with were all aware of the different types of abuse and what actions needed to be taken to report any concerns.

Care files contained detailed risk assessments which were specific to each person’s needs. People were kept safe from the risk of emergencies in the home.

New staff had completed an induction when they joined the service.

Care plans contained detailed information to ensure people who were at risk of being malnourished were being monitored. People told us the food provided was satisfactory although the dining experience could be improved. People were clear about how they could get access to their own GP and that staff in the home would arrange this for them.

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.

People spoke positively about the staff and their caring approach.

Care plans were person-centred and focused on the support needs of the individual. Care plans had been reviewed on a monthly basis and updated if needed. Care records evidenced people’s end of life wishes had been discussed and recorded.

The provider had a complaints policy and procedure in place. Feedback from people had been sought through satisfaction surveys, although regular resident meetings had not taken place. People we spoke with were aware of who the registered manager was and spoke positively about their approach.