Oak Grange

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.

Oak Grange is a care home providing nursing and personal care and specialises in providing care to people living with dementia. The service can support up to 70 people, at the time of inspection they supported 54 people.

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

We received mixed opinions about staffing levels from relatives. Staff identified increased care needs on one unit and felt staffing needed to be increased. The registered manager took appropriate actions and assured us that staffing levels were increased and felt this was an oversite due to changes in dependencies on the unit not being highlighted.

Staff treated people with kindness, compassion and dignity. People and their families confirmed they were involved in choices and decisions regarding their care and support.

People’s diverse needs were catered for. Care plans were person centred and reflected the needs of each person. Staff were trained in end of life care and received regular training necessary for their role.

Relatives confirmed communication from staff was good and they were always kept up to date regarding their family member.

Complaints were investigated and responded too in a timely manner.

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. People were supported to eat, and drink where needed

There were detailed audits and regular quality checks in place, complete with action plans. The registered manager understood their role and responsibilities and had reported all notifiable incidents to CQC.

Rating at last inspection

This service was last inspected 11 February 2021 and the report published 1 March 2021. This was a targeted inspection and was not rated. The previous inspection 1 May 2019 was published 8 July 2019 and rated good in safe and requires improvement in well led and rated good overall.

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding to test the reliability of our new monitoring approach.

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 found the following examples of good practice.

Relatives spoke positively about their experience of visiting their loved ones and the communication they had received from the service during the pandemic. Relatives comments included, "There's a visiting room. I've been going in at least once a week; sometimes twice. I book it online. When we get there we go to the vestibule, they can see us waiting there. They take our temperatures then walk us round to the visiting room door. They make sure they open the window for ventilation and we use the hand gel." and "We hold power of attorney, they spoke to us about the testing and we made a best interest decision for my relative to have the test; it was the same for the vaccine. They called us up about that and told us what was happening. We have no concerns at this point in time."

The environment was clean and hygienic and increased cleaning schedules to reduce the risks of cross infection were in place. We observed staff wearing the correct personal protective equipment (PPE) and they knew how to dispose of it safely.

People and staff were taking part in regular COVID-19 testing. People were being monitored for symptoms of COVID-19 and people who needed to were supported to isolate in their own rooms. Signage was visible on the bedroom door of any person who was isolating. This meant staff knew before they entered the room what PPE to wear and what enhanced procedures needed to be followed to protect them from risk. Any visitors needing to enter the building, were screened for signs and symptoms of COVID-19, asked to sanitize their hands and provided with PPE before they could enter.

Further information is in the detailed findings below.

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

In response to our findings on the first day of our inspection improvements had been made to the assessment and planning of people’s care. The deputy manager’s working arrangements had been changed to allow them to concentrate wholly on their management and clinical lead responsibilities. The acting manager was aware of their responsibilities and there were arrangements in place for the ongoing monitoring and assessment of the quality of the service people received. The provider was open and transparent and working with other organisations to bring about improvements.

Risks to people had been assessed and planned for. Although the implementation of the learning from some people developing pressure areas had initially been delayed, the provider had since implemented an action plan which had been effective in mitigating risks of other people developing them. There were enough safely recruited staff on duty to meet people’s needs. The service was clean and hygienic, and people received their medicines on time.

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.

At our last inspection in December 2018 and January 2019 we rated the service good. At this inspection we found the evidence continued to support the rating of good.

Why we inspected

We received concerns in relation to the assessment and management of some people’s skin integrity and that some people were being supported to get up very early in the morning. 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.

We have found evidence that the provider needs to make improvements. Please see the Well-Led section of this full report.

The provider had taken steps to effectively mitigate risks to people and to improve the governance systems in place. These improvements need to be sustained and embedded into day to day practice.

The overall rating for the service remains Good. This is based on the findings at this inspection.

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.

Oak Grange is a purpose-built care home which can provide support for up to 70 people with varying levels of need. The home is split into four “communities” over two floors offering support to people with nursing and residential needs. The service also provides support to people living with dementia. At the time of the inspection there were 61 people living in the home.

The service had a registered manager who had been registered with the CQC since February 2016. A registered manager is a person who has registered with the Care Quality Commission 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 our last inspection in March 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of good.

There was person centred information in people’s care plans regarding their “Cultural, spiritual and social values” along with a personal life history of information that the person was happy to share. Staff used this information to start conversations with people to work out what was important to them and plan activities that may interest them and enabled them to carry on following their interests and passions. People had been supported to use their skills and talents and to gain new ones.

The service provided a wide range of activities that empowered people and enabled them to have enriching life experiences and to try new things that they may enjoy. The activities co-ordinators spent time planning and researching how activities could have a positive impact for people. Activities were planned with the aim of enhancing a person’s wellbeing with one of four aims; movement, joy, remembrance and socialising.

People had been enabled to maintain their relationships and make new connections in their community. For example, some people had joined the home’s choir, spent time with a local army regiment, been to religious services in the community, spent time with a local artist, musicians, local students and pupils from local schools. Also, people’s friends and family members were invited to be involved in projects at the home. One person’s family member told us that the activities were, “Amazing and very varied.”

Staff told us that doing this was part of a, “Culture of where people feel loved and valued.” One person’s family member said, “The activities are excellent and add to [name’s] quality of life.”

People and their relatives told us they thought the home was safe. We found the service to be safe. Staff were knowledgeable about safeguarding vulnerable adults. People had risk assessments in place, which assessed their needs and provided guidance for staff on how to meet these needs safely. Any accidents and incidents that happened at the home were recorded and learnt from. The management and administration of people’s medication was safe and the building and the environment of the home was clean, safe and well maintained.

The environment of the home and gardens were pleasant and interesting and met people’s needs. Everybody had access to interesting and pleasant outside space and there were adaptations in place ensuring all areas of the home were accessible.

People were supported with their health care needs and had appropriate care plans and assessments in place to provide guidance for staff to support them to remain healthy. People told us they enjoyed the food provided at the home. People relatives praised the food provided. One relative told us, “They look after [name] she has even put on some weight since she came in.”

People were positive about the quality of care they received. One person told us, “My care is very good.” People’s relatives praised the caring approach of staff members. We witnessed warm, positive interactions between staff and people. Staff supported people in a relaxed and unhurried fashion, giving them their undivided attention. We also saw that staff members were skilled in providing emotional support when people became upset.

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.

There was a very pleasant and friendly atmosphere at the home. People’s relatives thought the leadership and quality of care provided at the home was very good. When we took a tour with the registered manager they knew people’s names and those of their family members and it was clear that she had positive relationships with people.

There was a series of checks and audits that took place at the home to help ensure the accommodation, care and support was safe and of high quality. People told us they felt confident raising concerns saying, “I can’t fault them if I have a problem I speak to someone.” Staff expressed confidence in approaching the manager with any concerns they may have.

Further information is in the detailed findings below.

A registered manager is a person who has registered with the Care Quality Commission 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.

Oak Grange provides care and support to up 70 people with varying levels of need. The service is split into four units which offer support to people with nursing, and residential needs. The service also provides support to some people living with dementia. At the time of the inspection there were 67 people living within the service.

At the last inspection in April 2014 we asked the registered provider to make improvements around the call bell system, and keeping risk assessments up-to-date. At this inspection we found that action had been taken to address these issues.

There were sufficient numbers of staff to meet the needs of people who used the service. The registered manager had recently employed new staff to address a staff shortage. The registered manager had also identified an issue with staff absences and was working to address this through the use of supervision and disciplinary procedures.

People were protected from the risk of abuse. Staff had undertaken training in safeguarding and knew the different types of abuse, and how to go about reporting their concerns. Staff were aware that there was a whistleblowing policy in place, and had access to the registered provider’s safeguarding policy and procedure.

People were supported to take their medication as prescribed. The system in place for administering medication was safe and helped to reduce drug administration errors. Medicines were stored offices which were kept locked when not in use. We looked at a sample of people’s medication and found that the correct quantity was being administered.

Staff had been supported to access training that enabled them to carry out their role effectively. Staff had undertaken training in areas such as infection control, manual handling and the Mental Capacity Act 2005. They had also been supported to access further qualification such as the qualifications credit framework (QCF) at various levels. New staff undertook a period of induction which gave them the opportunity to develop the necessary skills, and ensured that they were suited to the role.

Staff were skilled in their approach to people living with dementia. We saw examples where staff provided high quality care that promoted people’s independence and dignity. Staff treated people with kindness and there were examples which made it apparent that a good rapport had been developed between people and staff. During meal times we found that staff in one of the units spent time talking to people, whereas in another unit there was little social interaction. We discussed our experiences with the registered manager so that she could act upon this.

People told us that they enjoyed the food, and were provided with different options. People with special dietary requirements were provided with appropriate choices and received the correct level of support. Kitchen staff maintained a record of those people who required special diets, and provided the correct quantity to each unit.

Care records were personalised and contained information around a person’s likes, dislikes and preferred daily routines. These also contained up-to-date information around what level of support people required and how staff should meet people’s needs. Staff had a good understanding of those people they were supporting, and we saw that some staff had taken it upon themselves to do further research in an effort to better understand the people’s needs.

There were a range of activities on offer which people told us they enjoyed. These included one-to-one sessions, group activities and days out. There was also a cinema room which was used on a regular basis to show films.

The registered manager and registered provider both completed audits of the service to help maintain standards. These focussed on areas such as accidents and incidents, the environment, and care records. Where issues were identified an action plan was drawn up and these were rectified. We identified that the registered provider had not reported all notifiable incidents to the CQC and we referred them to the guidance.

There were enough skilled and experienced staff to ensure that people's needs could be met and they did not have to wait for attention. People could choose where they wished to have their meals and what they had to eat and drink.

People we spoke with were very happy with the care that they received. One person told us 'I am so pleased that I made the decision to come and live here. I love my bedroom. If you want company it is always there and I have made some new friends.' People told us that they appreciated being able to have a bath or a shower as often as they wished. People told us that they enjoyed the social activities that were provided.