Archived: Oakleigh House Nursing Home

Updated 11 October 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection was prompted in part by a notification we received from the local authority that the registered provider did not provide qualified nursing staff over a 24-hour period.

This inspection took place on 21, 25 & 26 June 2018. Our visit on 21 June 2018 was unannounced. We gave the registered provider notice on 21 June 2018, that we will visit the service again on 25 & 26 June 2018.

On 21 June 2018 the inspection was carried out by one adult social care inspector and one expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses nursing and dementia care. On 25 & 26 June 2018 the inspection was carried out by one adult social care inspector.

Due to the change of the planned comprehensive inspection, the provider was not able to complete a Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. Before the inspection we reviewed all the information we held. This included previous inspection reports and notifications the provider is required to send to us.

During our visit we spoke with the manager, the office administrator, three registered nurses (one permanently employed and two agency nurses), two senior care workers and two support workers. We spoke with four people who used the service, five relatives and one visiting friend.

We looked around the building including bedrooms and all the communal areas.

We examined care records for seven people using the service. We sampled medicines administration records including storage of controlled drugs, the recruitment, supervision and training records for seven staff and records in relation to quality assurance and management of the home.

Updated 11 October 2018

This inspection took place on 21, 25 and 26 June 2018. We arrived on the 21 June 2018 early in the morning and did not announce our inspection. We told the registered provider that we would need to visit again on 25 and 26 June 2018.

During our previous inspection on 14 & 15 June 2017 we rated Oakleigh House Nursing Home as ‘Requires Improvement’ and found five breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. We found that the premises and equipment used was not secure, clean and suitable for carrying out the regulated activities, Regulation 15 premises and equipment. We found that people who used the service were not always protected from detecting and controlling the spread of infection, Regulation 12 safe care and treatment. We found that the treatment and care provided did not always reflect peoples assessed needs, Regulation 9 person-centred care. We found that the registered person failed to have an effective system in place to monitor and assess the quality of care and make improvements because of these quality assurance measures, Regulation 17 good governance. We found that treatment and care was not always provided in a safe way and the registered provider did not take reasonable steps to mitigate such risks, we served a warning notice for Regulation 12 safe care and treatment.

Following our comprehensive inspection in June 2017, the service submitted an action plan detailing how they would improve to ensure they met the needs of the people they were supporting and the legal requirements.

We undertook a focused inspection on 3 October 2017 to assess the breach of regulation 12 in relation to inadequate risk assessments to ensure people were safe from receiving inappropriate care. At this focused inspection, we found that the service had followed their plan and legal requirements had been met. We found that risk assessments were in place for areas such as pressure ulcers, falls, epilepsy and diabetes. There were measures in place to give guidance to staff on how to manage risks. There was evidence the risk assessments were reviewed regularly to ensure they remained relevant and reflective of people's needs.

Oakleigh House Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Oakleigh House Nursing home is registered to provide accommodation and nursing care to maximum of 20 people. At the time of this inspection 17 people were living at the home.

At the time of our inspection there was no manager registered with the CQC. The registered manager left in November 2017. A registered manager is a person who has registered with the CQC to manage the service. Like registered services, 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. The home was managed by one of the company directors, who was not a registered nurse.

During our inspection we had some concerns about the fire safety at Oakleigh House Nursing Home. We shared our concerns with the London Fire and Planning Authority (LFEPA). The LFEPA is the regulator for fire safety in non-domestic premises, such as care homes. The LFEPA visited Oakleigh House Nursing Home on 2 July 2018 and issued Oakleigh House Nursing Home with an enforcement notice. In the response to this enforcement notice the registered provider decided to initiate the closure of Oakleigh House Nursing Home. We received written confirmation from the registered provider that on 20 July 2018 all people using the service had moved to alternative accommodation and that the home was planning to close.

We found that while people’s risks had been assessed, guidance to mitigate such risks had not been followed by staff and outside clinical support was not always obtained to mitigate and respond and reduce such risk. Staffing deployed by the home did not always suitably meet the needs of the people who used the service, due to staff not always having the appropriate qualifications in providing nursing care to people. The service did not follow their own medicines procedure, by not always providing qualified registered nurses to administer medicines which meant safe medicines administration procedures were not complied with. The service did not always respond to and meet people’s health and medical needs appropriately with people’s health care and medical needs. The service did not always seek medical advice to ensure peoples medical needs were met holistically.

People’s dietary needs had been met, however people had to wait long periods of time if they required assistance to eat and food was not always given to people at a suitable temperature. People’s care was not always dignified. They had to wait long periods of time to be supported and on occasions were not always dressed appropriately. We saw that care record plans were in place; however, these had not been updated frequently to respond appropriately to people’s changing needs. People were offered a limited choice of activities, tailored to their individual needs. Quality assurance systems were not always effective and the quality of care was not monitored effectively to ensure improvements could be made in a timely manner. The lack of consistent leadership and clinical guidance contributed to the shortfalls highlighted in this report.

Staff employed had been checked and vetted to ensure that they were suitable to work with people who used the service. Appropriate infection control procedures were adhered to, to minimise the risk of spreading infections.

New prospective people using the service or their relatives contributed to the pre-assessment process, however the records viewed lacked detail. Care workers had access to training and induction and had received supervisions. However, we found that not all staff had received up to date and current dementia training and most staff only had one planned supervision in 2018. Since our last inspection the service had started to redecorate the environment and the communal areas as well as the private areas of the home were now suitable to meet people’s needs. The service worked within the principles of the Mental Capacity Act 2005 and appropriate Deprivation of Liberty Safeguards were sought to not deprive people who used the service of their liberty. However, we found that do not attempt to resuscitate orders were not stored appropriately.

People who used the service and relatives could contribute to the care provided. However, the information provided was not accessible to all people who used the service due to their communication needs.

People who used the service and relatives could voice concerns in relation to the treatment or care provided and most people were satisfied with the action taken by Oakleigh House Nursing Home. During this inspection none of the people were provided with end of live care.

The registered provider service was meeting the conditions of their registration. They were submitting notifications in line with legal requirements. People who used the service and relatives were given some opportunities to contribute to the running of the home.

We found five breaches of regulations and rated this service as inadequate. Normally, when services are rated inadequate they are placed into special measures. This did not happen and we did not take out more serious enforcement action, because the provider cancelled their registration to carry out the regulated activities and Oakleigh House Nursing Home closed on 20 July 2018. You can see what action we told the provider to take at the back of the full version of the report.