Oak Cottage

Updated 29 February 2024

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 Health and Social Care Act 2008.

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 was undertaken by an adult social care inspector.

Service and service type

Oak Cottage is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with CQC to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

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. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with the registered manager, senior care assistant and 2 support workers. We spoke with 2 people who lived in the home and a relative about their experience of the care provided. We reviewed a range of records. This included 3 people's care records and medication records. We looked at records in relation to safe recruitment and a variety of records relating to the management of the service.

After the inspection visit.

We continued to seek clarification from the provider to validate evidence. We continue to review evidence in relation to people’s care, and the management of the service. We discussed our concerns about the service with both the registered manager and the nominated individual for the service (who has responsibility for supervising the regulated activity).

Updated 29 February 2024

About the service

Oak Cottage provides accommodation and personal care for a maximum of seven people with complex needs. The accommodation consists of six self-contained flats with a shared kitchen and lounge and a separate self-contained apartment to the rear of the main building.

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

Right Care

People’s needs and risks were not adequately assessed or managed to mitigate the risk of avoidable harm. Staff lacked clear information about people’s needs and risks. Some of the support provided was not always well planned to ensure that people’s emotional wellbeing was supported appropriately.

Medication management was unsafe. There were no effective systems in place to account for medicines administered to people. This meant it was impossible to tell if the balance of medicines in the home was correct and people had been given the medicines they needed. Medicines were not always stored at a safe temperature and there was a lack of safety checks around the competency of staff to administer injectable medicines.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. People’s consent was not sought in line with the principles of the Mental Capacity Act 2005.

The checks in place to prevent legionella bacteria developing in the home’s water supply were not completed properly to mitigate risks. Other aspects of maintenance were also not completed in a timely manner. A smoking shelter situated in the garden area was in poor repair and not fit for purpose.

Accident, incidents and safeguarding events were recorded and reported. However safeguarding risks were not always safely assessed or managed. Sometimes the response to people’s emotional distress was not carried out in such a way as to de-escalate distress and any impact on the person’s mental wellbeing.

Improvements were needed with regards to the recruitment of staff. Agency and bank staff covered gaps in the rota but not some did not have staff profiles in place to show what training, skills and competencies they had.

Right Support

Everyone living in the home was funded for a certain amount of one to one support hours, but the system in place for to monitor how this was delivered was unclear.

The home was satisfactorily clean, and people were supported with daily living tasks as required. People told us they liked living in the home and that staff supported them. One person told us “Staff are good, firm but fair”. A relative told us the staff were kind and that they communicated with them well.

Staff spoke warmly about the people they supported and had a good understanding of the social activities people liked to do and how people liked to spend their time. During our inspection we saw that people were supported to access activities in the community and do the things they enjoyed. This helped reduce social isolation. People were supported to maintain good family relationships and relatives visited the home without restriction. This was good practice.

Right Culture

The systems in place to assess the quality and safety of the service including service culture were not robust. They had not identified most of the concerns we found during the inspection. Managerial oversight by the manager and the provider was ineffective. This placed people at risk of avoidable harm as risks to their health, safety and welfare were not safely managed.

The culture of the home was for the most part relaxed but there were aspects of service culture that were appeared institutional. There were certain routines and language used by staff that appeared restrictive. Changes to people care were not always adequately planned for to mitigate the impact on people's wellbeing and to ensure positive outcomes were achieved. We spoke with the manager and nominated individual about this.

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

Rating at last inspection and update )

The last rating for this service was good (published August 2017. At this inspection, we found that the quality and safety of the service had significantly declined. Breaches of the regulations were found, resulting in a rating of inadequate for both safe and well-led. At this inspection, breaches of regulations 11 (Need for Consent); 12 (safe care and treatment); 17 (Good governance) were identified.

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

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Why we inspected

The inspection was prompted in part due to concerns received regarding the quality of care. A decision was made for us to inspect and examine those risks and review the previous rating. 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.

Enforcement

We have identified breaches in relation to the safety of people’s care, the implementation of the mental capacity act, deprivation of liberty safeguards and the management and governance of the service.

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.

Follow up

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.