Oak House

Updated 8 June 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 was carried out by one inspector and an Expert by Experience. 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

Oak House 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. Oak House is a care home without 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 not a registered manager in post. A new manager had just been recruited and was due to start working at the service.

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. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection

We spoke with 3 people who used the service and 4 relatives about their experience of the care provided. We spoke with or had feedback from 15 members of staff including the assistant manager, cook, provider and activity co-ordinator. We reviewed a range of records. This included multiple care plans, accident and incident records; medicine administration records; and staff recruitment records. 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 received feedback from three professionals who visited the service.

Updated 8 June 2023

About the service

Oak House is a 'care home' that provides care and support for a maximum of 26 older people, some of whom may be living with a dementia and/or physical frailty. At the time of the inspection 25 people were living at the service.

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

Although people and relatives were positive about the support provided at Oak House, we found improvements were needed to ensure the safety and quality of the service.

The systems for ensuring medicines were administered safely were ineffective. People did not always receive their ‘as required’ medicines and the necessary protocols were not always in place for staff to follow. Staff did not consistently record when topical medicines had been applied.

Systems and processes to safeguard people were not always effective. Some staff told us they did not feel confident to whistle blow about bullying and poor practice. They had been told they would be reported to safeguarding and lose their jobs if they did so. They told us when they had raised concerns about people’s safety, they had not been acted on. The management team did not always recognise or respond appropriately to incidents of abuse. Safeguarding concerns had not always been raised with the local authority when required.

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 failed to submit notifications in line with legal requirements. This included notifying CQC of safeguarding concerns, a serious injury, or when DoLS applications had been authorised.

Quality assurance tools were not effective because they did not identify the concerns we found during this inspection.

A new manager was appointed during the inspection. We discussed our concerns with them and the provider, and they advised us of their plans to address them as a matter of urgency.

Risks to people's health and well-being were assessed and reviewed appropriately. There was clear guidance in place for staff to follow. Staff worked closely with a range of external health professionals to meet people's needs. Measures were in place to prevent the spread of infection, and safety checks on the environment were in place. Incidents and accidents were appropriately recorded and analysed for patterns and trends.

A dynamic and developing activities programme was co-ordinated by committed and passionate staff 7 days a week. This was extremely person centred and tailored to meet people’s individual needs.

Staff received the training and support they needed to do their jobs effectively. They knew people well and were kind and caring. One person told us, “They have so much compassion. The staff are lovely.”

Staff were recruited and selected safely. We saw there were sufficient numbers of staff deployed to meet the needs of the people at the service. We observed, and relatives confirmed, that they were quick to respond when people needed support or were becoming distressed.

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 requires improvement (published 1 July 2022). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

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Why we inspected

We undertook this focused inspection to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well Led. For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service remains 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.

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 read the report from our last comprehensive inspection, by selecting the 'all reports' link for Oak House on our website at www.cqc.org.uk

Enforcement and Recommendations

We have identified breaches in relation to medicines management; safeguarding; consent; governance and notification of incidents.

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.