Archived: Oakleigh House Nursing Home

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.

At our last comprehensive inspection on 15 and 16 June 2017 we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the service did not have detailed risk assessments and risk management plans for people who used the service. We served a waring notice to the provider.

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 this focused inspection on 3 October 2017 to check that the service had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to this focussed inspection which looked at whether the service was 'safe'. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Oakleigh House Nursing Home on our website at www.cqc.org.uk.

There was a registered manager in post who was present throughout the inspection. 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 this focused inspection, we found that the provider had followed their plan and legal requirements had been met.

We found that risk assessments were now 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.

The home had also been recently adapted to meet the needs of people with mobility difficulties. Mobility aids were in also place for people.

During our last inspection in September 2015 the provider met all legal requirements and was overall rated good.

Oakleigh House Nursing Home is a registered to provide accommodation and nursing care to 20 older people. Some people have dementia and mental health problems. The home is located in a residential area in Hatch End, North West London.

A manager is registered with the Care Quality Commission (CQC). 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.

External and internal checks to help to maintain the safety of the building were not always carried out and we found that the premises were not always safely maintained. No window restrictors were fitted to one room on the second floor. Sharps were not disposed of in a timely manner. Carpets mainly on the ground floor were uneven and loose and lighting was not always maintained. Adaptations to support people to walk safely and independently were not in place throughout the home. Risks to people who used the service in relation to the treatment or care were not always assessed and managed appropriately.

People who used the service were safe from bullying and harassment as appropriate systems were in place to ensure people were protected from abuse.

Sufficient staff were deployed to meet people’s needs and they were suitably vetted and checked to ensure they were permitted to work with vulnerable people.

Medicines were managed safely and people were confident that they received their medicines as prescribed.

The environment was dated and was not decorated regularly, this resulted in carpets being very dirty and worn, curtains in people’s rooms not hung properly and some en-suite showers in people’s rooms not working properly or not working at all.

Care workers had access to a range of training and received appropriate support from their manager to ensure they had the skills and knowledge to meet people’s needs.

People who lacked capacity to make some decisions in relation to their treatment or care had their capacity assessed and appropriate safeguards had been put into place.

People who used the service were provided with nutritious and well balanced meals and had access to drinks and snacks at any time during the day.

The service ensured that people’s health care needs were met and appropriate support was sought from health care professionals if required.

People told us that they felt comfortable in the presence of care workers and were well cared for and their privacy and dignity was respected.

Care plans were in place and specific to the person, however care plans did not always reflect people’s needs and lacked detail to ensure people’s needs could be met holistically.

People were offered a range of activities which met their needs.

Appropriate procedures were in place for people to make complaints or raise concerns. Over the past 12 months the service received six complaints which had been dealt with appropriately.

Quality assurance systems were not always effective and quality of care was not monitored to ensure improvements can be made in a timely manner.

The staff worked well together as a team, with a positive and compassionate attitude.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are currently considering what action to take. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We found that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. All care plans had current assessments for the person's health needs, including the risk of falls, pressure care and mobility. We saw that people's wound management plans were accurate and reflected current guidance.

People's medicines were managed to ensure they received the correct medicines at the right time, in the manner prescribed by their doctors. We found that records were maintained accurately and consistently.

People were generally satisfied with the care and support they received in the home. Their relatives were also content that they were being cared for and treated appropriately. We however, found that people's needs were not always assessed in a timely manner to ensure their needs were identified and for care plans and risk assessments to be developed to address their needs.

We found that the service provided equipment to ensure people received the appropriate treatment when they had pressure ulcers. On a few occasions, people who had pressure ulcers were seated for more than two hours. This could prevent current pressure ulcers from healing or put people at risk of developing new pressure ulcers.

People were supported with their healthcare needs and referred to healthcare professionals according to their needs. However, we found that the arrangements to manage their medicines were not effective to protect them against risks associated with medicines.

Records were not always kept accurately to demonstrate that people received safe and appropriate care. For example fluid balance and turning charts were not completed in a consistent manner to confirm that people were receiving safe and appropriate care.