Oakhill House Care Home

Updated 6 August 2022

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 carried out by two inspectors. An Expert by Experience made phone calls to people’s relatives after the inspection. 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

Oakhill House Care home 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. Oakhill House Care home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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.

At the time of our inspection there was not a registered manager in post.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 11 July 2022 and ended on 18 July 2022. We visited the location’s service on 11 July 2022 and 12 July 2022.

What we did before the inspection

We reviewed information we had received from the provider about the incidents and recent issues at the service. 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 spent time with people and observed how staff interacted with people. We spoke with three people that used the service and 11 people’s relatives about the care provided. We spoke to ten members of staff including the provider’s area director, nursing staff, senior carers, carers and the chef. We reviewed seven people’s care plans in relation to people’s care and support needs and multiple medicine records. We reviewed a range of documents relating to the quality and monitoring of the service.

Updated 6 August 2022

About the service

Oakhill House Care Home is a residential care home providing personal and nursing care to up to 49 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 30 people using the service. The home was set over two floors, however the top floor was not in use.

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

People had not always been protected from the risk of harm and abuse. The provider had recently identified safeguarding concerns reported by staff between 2020 and 2021 which had not been investigated at the time of the incidents or reported to the appropriate agencies externally. Once these incidents had been found, investigations and analysis of each incident had been completed as far as possible and measures put into place to minimise the risk to people. Incidents were reported retrospectively to the local authority safeguarding team, CQC, Police and people's relatives.

Risks to people were not always safely managed. The provider had recently found incidents relating to people's safety that had not been investigated or reported. These included incidents of falls, serious injuries and choking events. Although action had been taken in response to finding these incidents, we found that further improvement was needed around managing people's risks. People at risk of choking had not always been safely supported in line with guidance provided by healthcare professionals.

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; the policies and systems in the service did not support this practice. The provider had identified an historic incident in which a person had been unlawfully restrained. This incident had not been reported in a timely way. The provider had investigated the incident and ensured that staff understood their responsibilities around the Mental Capacity Act.

Governance systems had not been effective in identifying recent concerns at the service regarding the reporting of incidents. The provider's response to finding these incidents was not prompt or in line with their safeguarding policy. Some improvements were needed to record keeping to ensure that people at risk of malnutrition, dehydration and skin breakdown were kept safe.

People and their relatives were positive about the support provided by staff at the home. Staff were kind and caring and treated people with dignity and respect. Staff had been safely recruited and trained to support people. People, relatives and staff were given opportunities to feedback on the quality of care at the home. Staff worked with other professionals to provide joined up care for people.

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 03 April 2020).

Why we inspected

We received concerns in relation to safeguarding and safe care and treatment. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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

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, effective 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.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Oakhill House Care 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 safeguarding people from abuse, safe care and treatment and governance.

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.