Oaktree Care Home

Updated 1 December 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

There was a team of three inspectors and an Expert by Experience on the first day. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. The second day was completed by one inspector.

Service and service type

Oaktree 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. Oaktree 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.

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 on both days.

What we did before the inspection

We reviewed information we had received about the service since a new provider took over 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 spoke with ten people who used the service and six relatives about their experience of the care provided. We also spoke with 15 members of staff including the regional operations manager, regional director, registered manager, unit managers, nurses, care, activity and housekeeping staff.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We reviewed a range of records. This included nine people's care records, medication records and food and fluid monitoring charts. We looked at three staff files in relation to recruitment and staff supervision and records relating to the management of the service, including quality assurance audits. After the inspection we sought clarification from the provider to validate our inspection findings.

Updated 1 December 2022

About the service

Oaktree Care Home is registered to provide personal and nursing care for up to 78 people. The service is divided over two separate floors. The ground floor, called Bluebell is for those who require nursing care. The upper floor is dedicated to those people living with dementia and has two units called Primrose and Snowdrop. Snowdrop provides support to people living with dementia but who do not need nursing care. There were 60 people living at Oaktree Care Home when we inspected.

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

At the previous inspection we found there was not enough staff. During this inspection we found there had been some improvements in relation to staffing. However, there was a heavy reliance on agency staff which continued to impact on the delivery of care.

Feedback from people and their relatives said the quality of the care was dependent on who was on duty and whether it was regular staff or agency staff.

People were spending considerable amounts of time in their bedrooms and the only interactions we observed was when staff were supporting people with their personal care or other tasks such as supporting with eating and drinking. Although activities were available daily. People’s feedback was mixed and often people did not know the activities available to them.

There were a number of concerns in respect of the décor of the home including fixtures and fittings. This was shared with the management team. Some work had been completed by day two of the inspection and an action plan had been put in place. The environment in Primrose was not homely and many of the memory boxes outside people's bedrooms were empty. These are important as they help people living with dementia to orientate them to finding their bedroom as well as aid communication with people.

Some of the concerns in relation to the environment was a potential infection control risk. This was due to some areas not being able to be cleaned thoroughly due to surfaces being cracked and split.

Improvements had been made to ensure people at risk of malnutrition were eating and drinking enough. Staff were completing the appropriate records, and this was being monitored by the management team during the daily walk arounds.

People's medicines were managed safely. People had access to health and social care professionals who worked alongside nursing and care team at Oaktree. Feedback from two visiting health professionals was positive.

People were protected against the risks of abuse. Staff had received training in this area and understood their role in reporting. Staff recruitment was safe and ensured people were protected. The registered manager was actively recruiting to the vacant posts and was being supported by the provider’s senior management team.

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.

There were systems in place to monitor the quality of the care and support. The provider regularly visited the service to drive improvements and support the registered manager and the staff.

During our inspection we found improvements were required to the provider’s quality assurance systems as we found concerns with the environment during our inspection.

Rating at last inspection and update

The last rating for this service was Requires improvement (published 12 January 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made to the previous breaches in regulation relating to meeting people’s nutritional needs and staffing. The service remains requires improvement.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well led, which contain those requirements.

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 remained requires improvement. This is based on the findings at this inspection.

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 see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Oaktree Care 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.

At this inspection, we have identified breaches in relation to the environment and the governance arrangements in respect of monitoring the décor and fixture and fittings.

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.