Background to this inspection
Updated
29 July 2021
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection site visit was carried out by an inspector and a Specialist Nurse Advisor. An Expert by Experience telephoned a sample of relatives, of people who live in the care home, to obtain their feedback. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
The Oaks and Little Oaks is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.
During the inspection
We spoke with seven people who used the service about their experience of the care provided. We spoke with eleven members of staff including the registered manager, regional manager, clinical lead, nurse, senior care workers, care workers, maintenance worker and catering staff.
We reviewed a range of records. This included six people’s care records and multiple medication records. We looked at three staff files in relation to recruitment processes.
After the inspection
The Expert by Experience received feedback from 13 relatives of people who lived in the care home. We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We received feedback from the Local Authority social care commissioners who had recently visited the service.
Updated
29 July 2021
About the service
The Oaks and Little Oaks is a nursing home providing personal and nursing care to 47 people at the time of the inspection. The service can support up to 73 people. The care home accommodates people in two separate wings, each of which has separate adapted facilities. One specialises in providing nursing care and the other provides residential care
People’s experience of using this service and what we found
Accurate, up to date, and complete records were not always in place for people. Although staff understood the care needs of the people they supported, this was not always supported by the provider’s care records and governance systems. The provider’s quality monitoring processes were not always effective and had not identified some of the issues we found during our inspection.
People were supported by staff who they generally knew, and the provider tried to ensure any agency staff used were used regularly so they got to know people’s needs. Some staff pre-employment recruitment check records were not always as complete as they should be.
People were protected from the risk of abuse. Staff had received safeguarding training and knew how to raise concerns when necessary. When incidents occurred, the registered manager reviewed the details so lessons could be learned.
Some staff had not all received the training they required, but the provider had introduced a new system which they said would address that.
People’s bedrooms, the communal lounges and dining rooms were in good condition and hygienic. Other areas of the care home required refurbishment work. Most people told us that the food was nice, and people had a choice in the meals they were offered.
Relatives told us they found the staff, and the registered manager, to be approachable and that they listened to them. The provider had maintained contact with people’s relatives during the COVID-19 pandemic.
People, and their relatives, were regularly asked for feedback on the service by the provider. Action was taken as a result of feedback received.
External professionals told us, although the service had areas which needed to improve, the registered manager had an open and honest approach to making improvements and engaged well with other agencies.
People were supported to have maximum choice and control of their lives and staff supported 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 CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was Good (published 2 November 2019).
Why we inspected
We received concerns in relation to the management of medicines and people’s nursing care needs. As a result, we undertook a focused inspection to review the key questions of Safe, Effective 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 improvements. Please see the Safe, Effective and Well led sections of this full report. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Well-Led section of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Oaks and Little Oaks 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. We have identified breaches in relation to the provider's quality monitoring and governance processes. 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.