Archived: Oxford Grange Care Home

We carried out an unannounced comprehensive inspection of this service on 8, 10 and 12 May 2015. We identified breaches of 10 regulations and said that the service must make immediate improvement. This inspection resulted in an overall rating for the service of ‘Inadequate’.

We received information of concern from the interim manager following the above inspection visits to Oxford Grange. This related to people who lived at the home being put at risk because they were not receiving safe or adequate care and the interim manager told us there had been no improvements to the standard of care. We were told there were conflicts in the temporary leadership of the home.

We undertook a focused inspection on 22 May 2015 to look into these concerns

This report only covers our findings in relation to these areas. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Oxford Grange on our website at www.cqc.org.uk’

This inspection did not change any of the ratings made as a result of our comprehensive inspection on 8, 10 and 12 May 2015.

Oxford Grange provides residential care for up to 43 older people. Nursing care is not provided. At the time of our visit there were 34 people living at the home. There was no registered manager at the home. 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.

When we conduct comprehensive inspections, we report our findings under the five domains: Safe, Effective, Caring, Responsive and Well Led. All our findings from this inspection come within the Safe, Effective and Well Led domains.

We found that although the provider had brought in additional staff from an agency, staff lacked knowledge of people’s needs to safely manage their care.

We saw moving and handling practises that were unsafe and people were at risk of injury.

We saw people with injuries that staff could not clearly explain and which were not documented.

People living in the home were unhappy and distressed and their rights were not being promoted.

People who lived the home were not adequately supported to eat and drink and there was insufficient evidence available to show that all of the people living at the home were receiving a diet suitable to their needs and preferences.

Communication between staff was poor so that essential information about people was not shared in order for their care needs to be met.

Records about people’s care were inadequate; either not in place or incorrectly filled in.

We found that the registered provider had failed to maintain effective leadership within the home and staff lacked direction.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

Ensure that providers found to be providing inadequate care significantly improve

Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

In this inspection we found insufficient improvements and we had further serious concerns. This caused us to take urgent action in line with our enforcement procedures to prevent the provider from operating the service. We have moved to close the service by adopting our proposal to vary the provider’s registration to remove this location.

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.