Oak Grange

Updated 18 November 2023

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 team included 3 inspectors.

Service and service type

Oak Grange is a ‘care home’. People in care homes receive accommodation and nursing and personal care as a single package under one contractual agreement dependent on their registration with us. Oak Grange is a care home with nursing care. 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 the Care Quality Commission 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 of this information to plan our inspection.

During the inspection

We spoke with 14 people who used the service and 13 family members about their experience of the care provided. We spoke with 23 members of staff including the registered manager, senior regional director, deputy manager, 3 nurses, a health care practitioner a senior care assistant, 8 care staff, 2 administrative assistants, activities lead, a housekeeper, a domestic assistant, the maintenance manager and a chef.

We reviewed a range of records. This included 13 people’s care records and multiple medication records. We looked at 2 staff files in relation to recruitment and staff supervision. We looked at the profiles for 2 agency workers. A variety of records relating to the management of the service, including policies, procedures and audits, were reviewed. We spoke with 3 visiting health and social care professional including a doctor, a district nurse and a community psychiatric nurse.

Updated 18 November 2023

About the service

Oak Grange is a care home providing nursing and personal care specialising in providing care to people living with dementia. The service can support up to 70 people, at the time of inspection they supported 69 people.

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

The service was not well-managed at the time of this inspection. We found improvements were needed to ensure people always received safe, effective, and responsive care that met their needs.

We carried out this inspection because we had received complaints about the standard of care including staffing levels.

We found that staff were not always deployed in sufficient numbers to meet peoples' needs safely and effectively.

Risks to people’s health and welfare were not always identified or managed effectively. Records showed that there was a high incidence of unwitnessed falls. Measures to reduce the risk of falls were not always effective, leaving vulnerable people at risk of injury and harm.

Information to be supplied to the fire service in the event of a fire contained inaccuracies and recommendations detailed in the fire risk assessment had not been sustained.

Systems to safeguard vulnerable people from abuse where not always followed and two care staff spoken with were unclear on the provider’s safeguarding procedures.

People were not always 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 provider was not always working in accordance with The Mental Capacity Act 2005 and had not always applied for Deprivation of Liberty Safeguards in a timely manner.

Managers and staff were not always doing everything reasonably practicable to make sure people who used the service received person centred care and treatment that was appropriate, met their needs and reflected their personal preferences. Personal care records were not always kept up to date and care plans were not always reviewed and revised when peoples’ needs had changed.

Discrepancies in recording of some medicines were identified.

The provider’s quality assurances systems had either not identified the improvements needed at this care home or taken sufficient action in a prompt manner to address the improvements which were needed.

Although there were areas for improvement, most of the people who lived at the home had something positive to say about the staff and the standard of care provided. Nursing and care staff were seen to be kind and caring in their approach. They engaged with people sensitively before providing support and care and they listened and acted on what was said to them.

A visiting doctor told us that managers and staff worked collaboratively with them to ensure people’s health care needs were met. People’s nutritional needs were being met and comments about the standard of food were generally positive.

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

Rating at last inspection and update

The last rating for this service was good (published 11 December 2021). At this inspection we found the provider was in breach of regulations. The service is now rated requires improvement.

Why we inspected

We carried out this inspection because we had received complaints about the standard of care including staffing levels. As a result, we commenced a focused inspection to review the key questions of safe, effective, and well-led only. It became clear during the inspection that improvements were also required in the remaining key questions caring and responsive. We therefore broadened the inspection to include all key questions and in doing so completed a comprehensive inspection of the service.

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, effective, caring, responsive and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Oak Grange on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, consent, staffing, person centred care and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

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 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 request an action plan from the provider to understand what they will do to improve the standards of quality and safety. 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.