Archived: Little Oaks Residential Care Home

During this inspection we spoke with five staff across the day. We looked at four care plans and spoke with four of the nine people who used the service.

We considered our inspection findings to answer questions we always ask; is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

There were sufficient staff on duty to meet people's needs and we saw that people were regularly monitored for their own safety during the day. During the night when there was reduced staffing we were unable to see from people's records how often staff should monitor them for their safety. Risk assessments were not comprehensive so we were unable to see what the risks were or how the staff were reducing the risk to people. There was no analysis of falls to see if sufficient actions were being taken. This meant we could not be assured that people were always safe.

A record of all visitors entering the service was kept and the front door was locked to prevent unauthorised access. This meant that people were kept safe from unauthorised people entering the service. People were free to move around the service, and we saw people in the garden enjoying the sun. We were told of an incident which potentially could have put staff and people at risk but were unable to see records in the service which related to this incident. This meant we could not be assured that risks to people were managed safely.

Staff received mandatory training to enable them to meet people's needs. However we could not see if all the training was up to date because records were incomplete. Staff training was mainly provided using DVD's and training courses for all mandatory subjects were completed on the same day. This meant that we could not be sure that training had been provided in sufficient depth or that it gave staff sufficient knowledge to meet people's needs safely.

We noted that fire doors were propped open which meant in the event of a fire people would not be safe.

Staff received training in the protection of vulnerable adults and the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This training was periodically updated for staff. People's records showed their capacity had been considered and we saw people had signed to confirm consent for all aspects of their care and treatment.

We could not be sure that appropriate actions were taken in response to events affecting the well-being and, or safety of people who used the service. We saw limited analysis of data and could not see apart from immediate actions what learning had taken place following events. We could not be assured that staff notified CQC of all incidents as outlined in the regulation.

Is the service effective?

We observed the care provided and saw positive interaction between staff and people using the service throughout the day.

People's care was delivered by staff who knew them well and staff provided care in a relaxed, unhurried way. However, care plans were not reviewed regularly and we could not see how care was planned and delivered in a way which was intended to maintain people's safety and well-being so we could not see if care was effective.

Is the service caring?

We saw that staff were kind and caring. They interacted with people regularly and promoted people's independence and emotional well-being. Staff knew a lot about people and chatted to them about what they had been doing and their families. Staff responded appropriately to their needs.

Is the service responsive?

We saw from people's records that staff kept family members informed about changes to their relative's needs. Records showed us that the service had contacted other health care professionals when there was a change in people's health needs.

We saw there was a range of activities for people to do during the day to keep them engaged and active. Activities were provided to meet the needs of individuals and we saw there was some engagement with the local community and community groups. People's records included a life story for each person which helped staff know the person's needs and help them keep connections from the past.

Is the service well led?

There was no registered manager in post on the day of inspection and the service was being sold to a new provider. The provider was not yet registered with CQC. We could see a number of improvements had been made including some refurbishment and redecoration. The service had two experienced deputy managers and staff with a lot of experience. We saw that the service had good staff retention and did not use outside agency staff. This meant staff provided continuity of care to people who used the service.

However staff said there were not always enough staff and concern was expressed over lone working. Staff told us that they had received training but said this was very basic. They said the support they had received varied from staff member to staff member. Staff told us they had clear roles and responsibilities but staff were not able to provide us with all the information we requested. We therefore could not be sure records were in place to support the regulated activity. For example we could not see an analysis of falls, incidents and accidents. We did not see records for specific events that had occurred at the service and we had not been notified of events affecting the well- being and safety of people using the service. Care records did not provide enough information which showed that people were receiving good and effective care.

We could not see if the service had effective quality assurances systems in place to assess the care being provided. Neither were we provided with audits demonstrating the safety and suitability of the home and equipment being used. We found the systems in place to support train and develop staff to ensure they were able to meet people's needs in- effective.

We received some concerns before this inspection about staffing levels and the skills mix of the staff team. .We found it was adequately staffed for the needs of the people using the service. The service was fully occupied and there were three staff on duty providing care. Additional staff included an administrator, cook and the manager supporting care staff. We looked at staffing records and staff support processes and found these to be adequate. Recruitment practices were satisfactory and new staff were supported through an induction process.

We spoke with five people using the service. They all told us they were happy at the service. One person was relaxing in the conservatory and in the afternoon was observed doing some creative work. Another person told us " I am well looked after here, I see my family regularly and the minister visits me."

You can see our judgements on the front page of this report.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place for the storage and management of medicines. Records of the receipt, administration and disposal of medicines were inaccurate. We could not be assured that people received their medicines as prescribed.

Following publication of the report and warning notice the provider sent us two detailed action plans. During the follow up inspection we were satisfied that the service was fully compliant.

We found improvements had been made to people's records about their care and welfare. People were regularly consulted about their needs and staff knew how to support people appropriately to ensure their health and welfare was met.

Clinical waste was stored and disposed off correctly to ensure people were protected from the risk of infection associated with hazardous waste. Other hazards in the premises had been eliminated and the external grounds had been made safe to ensure the safety of staff working at the service and people's safety. People had been assessed to see if they were able to use the stairs/or lift where required. This ensured that people's health and safety was promoted.

The manager had taken necessary steps to meet the regulations and bring about improvements in people's care by reducing risks.

The service was decorated for Christmas and was comfortable and cleaned to a high standard in communal areas.

We inspected the service in September 2012 and identified a number of areas of non compliance. During this inspection we found improvements had been made. More staff had been employed and staff had specific roles for caring, domestic work or catering which meant that staff were not expected to complete duel roles.

Care records were being updated more regularly and accurately reflected people's current needs. People's nutritional needs were being closely monitored and staff had received some basic training in meeting people's basis nutritional needs.

Improvements to the safety of the premises had been carried out, but we identified some further significant concerns during our inspection.