Oaklands Nursing and Residential Home

Oaklands Nursing and Residential Home is a residential care home providing personal and nursing care to up to 44 people. The service provides support to older people and people living with a dementia across a two-storey building. At the time of our inspection there were 41 people using the service.

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

Medicines were not always managed safely and in line with prescribers’ directions. System were not robust enough to identify and reduce risk. Individual risk assessments were not always detailed enough or in place. People felt safe in the service. Staff were recruited safely and knew how to report and recognise safeguarding concerns. There were sufficient staffing levels in the service to meet people’s needs, although people told us that at times, they felt there were not enough staff. The service had recently been separated into units and staff told us that this has helped to organise shifts and response times. Infection prevention and control measures were in place and being followed.

Staff were not consistently receiving training in key areas. We recommended that training compliance levels were improved. Supervisions were occurring. People’s diet and nutritional needs were met, and they told us they enjoyed the meals. The provider worked in partnership with other agencies to maintain people’s health and wellbeing.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

People’s individuality was being respected. People were being treated with dignity and respect and had choices over their care. People and relatives told us they felt supported and were involved in meetings at the service.

People were supported to have person centred care. We made a recommendation about people and their families being involved in the care planning processes. Activities were being offered at the service and processes and systems were in place to respond to complaints. End of life care was being considered and planned for.

Systems and processes were not always effective to oversee and manage risk in the service. The views of people, families, staff and professionals were being sought and analysed. Staff and residents’ meetings were regularly occurring. Staff and people felt the home was well managed and the new manager was bringing positive change. The manager and provider were aware of their duty of candour responsibilities and had taken appropriate steps to register the new manager at the service.

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 the service under the previous provider was good published on 28 December 2018.

Why we inspected

This inspection was prompted by a review of the information we held about this 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 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.

The provider has taken immediate action address the issues identified and provided an action plan.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Oaklands Nursing and Residential home on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 safe medicine management, the management of risks within the environment and individual risk assessments, and the operation and oversight of the service at this inspection. We have also made recommendations on improving training compliance and ensuring people and relatives are involved in care planning.

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.

We found the following examples of good practice.

¿ There was a separate unit identified as a designated care setting in response to the Winter Plan for people discharged from hospital with a positive Covid-19 status. Access to this first floor unit was separate to the main entrance of the home via stairs or a stairlift.

¿ There were effective infection prevention and control (IPC) policies in place. Clear procedures and risk assessments had been developed to maintain good practice in relation to infection control and to provide safe care. Staff had received updated training on IPC and the use of personal protective equipment, (PPE). Agency staff had also received additional training from the management team to ensure their infection control knowledge and practice followed the provider’s policies.

¿ Stocks of PPE exceeded current government guidance levels. PPE stations had been established throughout the unit to help ensure staff had access to it when required. The provider had commissioned a clinical waste contractor to ensure safe disposal of PPE and other waste.

¿ Staffing of the unit had been arranged to ensure they worked there exclusively. Staffing included a nurse, care staff and housekeeping staff. The numbers of staff would be adjusted according to occupancy.

¿ Food and drink would be delivered directly to people in their rooms. Disposable crockery and cutlery had been provided.

¿ The unit was clean and tidy. Some minor refurbishments had been completed, this included a new clinic room for the safe storage of medicines and equipment.

¿ The provider had developed a discharge procedure to help ensure people could return to their homes in a safe and timely way.

We were assured this service met good infection prevention and control guidelines as required of a designated scheme.

Further information is in the detailed findings below.

We found the following examples of good practice.

There were clear infection prevention and control procedures which were understood and followed by staff. All staff were trained in the use of personal protective equipment (PPE), handwashing techniques and participated in the testing programme. During our visit, the staff were wearing appropriate PPE and plentiful supplies were available around the home.

There was a good standard of cleanliness in all areas seen. Additional housekeeping staff had been employed and the frequency of cleaning had been increased. There were effective policies, procedures and risk assessments in place to maintain good practice in relation to infection control and to provide safe and kind care.

The provider’s infection prevention and control policies and procedures were up to date and a monthly audit had been carried out. A Covid-19 Response Plan and business contingency plan were in place and had been followed. The management team were working closely with the local authority and clinical commissioning group and other partners including the community nurses.

Visiting was subject to government restrictions. However, people were supported to maintain contact with their relatives in different ways including window visits and telephone calls. A warm and safe area was available in the garden for relatives to visit their family members, for when visiting restrictions were eased. There were procedures in place for essential visitors, which included temperature and health checks.

The atmosphere in the home was settled and calm and staff were attentive and caring towards people. People were occupied with watching TV, reading books and newspapers and spending time talking to others or staff. Other people preferred to stay in their bedrooms.

We were assured this service met good infection prevention and control guidelines.

Further information is in the detailed findings below.