Background to this inspection
Updated
20 July 2015
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.
A comprehensive inspection had been carried out on 8, 10 and 12 May 2015 which had highlighted very serious concerns. Prior to this inspection the Care Quality Commission had received further significant and serious concerns about the care and welfare of the people living at the home.
This inspection took place on 22 May 2015 and was unannounced. The inspection was carried out by 3 adult social care inspectors.
During visits we spoke with 12 people who lived at the home, and 4 members of staff including the manager. We also spoke with six members of agency staff working at the home. We looked around the home, observed practice and looked at records. This included 4 people’s care records and records relating to the management of the service
Updated
20 July 2015
This inspection took place over three days on 8, 10 and 12 May 2015 and was unannounced.
The last full inspection of this service was completed in June 2013 when we found a lack of compliance in several areas. When we followed this up in December 2013 we found the service had achieved compliance.
The inspection was carried out by 5 adult social care inspectors 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. The expert by experience on this occasion had experience in caring for elderly people, particularly those living with dementia.
Since that time the registered manager has left the service and, at the time of our visit a new manager had been in post for two weeks. This person had not yet applied to the Care Quality Commission for registration.
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.
Oxford Grange Care Home provides residential care to a maximum of 43 people some who may be living with dementia. Bedrooms are set over three floors with two communal lounges and two dining rooms on the ground floor.
This inspection found a number of breaches of regulations. These are described below.
There were not enough staff available to meet the needs or maintain the safety of the people living at the home and staff recruitment processes were insufficient. People told us they did not feel safe.
There had been a failure to protect people from harm and to recognise and report when people had been put at risk or had been subject to harmful situations.
Procedures in relation to administration of medicines were not safe.
People were at risk from unsafe moving and handling practices and poor standards in relation to infection control and standards of hygiene.
The above demonstrated breaches in regulations 12, 13 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Staff did not have the skills, training or support they needed to provide safe and effective care.
People living at the home were subject to restrictive practice which had not been identified or managed in line with the Mental Capacity Act (MCA) 2005 and The Deprivation of Liberty Safeguards (DoLS)
People did not receive nutrition and hydration appropriate to their needs and choices. People had lost weight but this had not been recognised.
People did not have their health care needs met.
The environment had not been adapted in any way to support people living with dementia. There was a lack of appropriate equipment and seating to provide people with safety and comfort.
The above demonstrated breaches in regulations 9, 13, 14, 15 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Staff were sometimes kindly in their approach but there was a failure to demonstrate an understanding of people’s needs for dignity and privacy and respect. Systems in the home did not support people’s dignity or well-being. This demonstrated breaches in regulations 10 and 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
People did not receive care that was planned or delivered in a person centred manner and people were not given genuine choices in matters that affected them daily.
There was a lack of regard for people’s social and recreational needs and a lack of opportunity to engage in meaningful activities.
This demonstrated breaches in regulations 9 and 16 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Management of the service was disorganised and chaotic. The manager had been in post for two weeks and there was no evidence of input by the registered provider. Staff lacked leadership and direction. The quality of the service was not monitored to ensure people’s well-being and safety. Records relating to care and to the management of the service were inadequate.
This demonstrated breaches in regulations 17 and 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Due to the concerning nature of some of the observations that the inspectors made during the inspection visits, we deemed it necessary to make safeguarding referrals to the Local Authority for them to be able to investigate this further. Because of these concerns we have continued to liaise closely with both the senior management of the home and our partners to ensure that plans had been put in place to address these concerns.