Archived: Oakendale Residential Care Home

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 also carried out to follow up on breaches of regulations which we identified at our last inspection in June 2015 and in response to heightened concerns from the Local Authority Safeguarding team.

At our last inspection, in June 2015, we found the provider was in breach of legal requirements relating to staffing, safe care and treatment, consent, meeting nutritional and hydration needs, premises and equipment, person-centred care, good governance, safeguarding service users from abuse and improper treatment and statutory notifications.

During this inspection we found that although the provider had begun to make improvements in some areas, they were not yet meeting legal requirements.

Oakendale Residential Care Home is a small care home which is registered to provide 24 hour care to up to fifteen older people. The home is a converted large domestic property, split over three floors. The home has been fitted with a lift and stair lift to reach the upper levels.

The home had a registered manager. 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.

The provider had not ensured that sufficient numbers of suitably qualified, competent, skilled and experienced persons were deployed at all times. This was in breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Recruitment procedures had not been operated effectively to ensure persons employed at the service were of good character and had the qualifications, competences, skills and experience necessary to carry out their role. This was in breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The service had not established, and operated effectively, systems for the proper and safe management of medicines. This was in breach of Regulation 12 (2) (g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The registered person had not ensured risks to the health and safety of people were properly assessed and they had not done all that was reasonably practicable to mitigate any such risks. This was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The registered person had not maintained an accurate, complete and contemporaneous record in respect of each service user, including a record of the care and treatment provided and of decisions taken in relation to the care and treatment provided. This was in breach of Regulation 17 (2) (c) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider had not ensured staff had received such appropriate support, training, professional development, supervision and appraisal as was necessary to enable them to carry out the duties they were employed to perform. This was in breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The service was not working within the principals of the Mental Capacity Act 2005. Additionally, the service had not sought and recorded people's consent to care and treatment. This was in Breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The nutritional and hydration needs of service users were not being met. This was in breach of Regulation 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There was very little evidence to show that people or those close to them, where appropriate, had any input into the care planning process. This meant people's views and opinions were not taken into account when their needs were assessed, or when their care was planned and delivered. This was in breach of Regulation 9 (3) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People were not treated with dignity and respect. This was in Breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The service did not demonstrate good management and leadership at all levels. The systems designed to assess, monitor and improve the quality of the service provided were not being operated effectively. This was in breach of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

The service had not submitted statutory notifications, as required, with regard to significant events. This was in breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

Training records showed and staff confirmed that they had undertaken training in relation to safeguarding people who may be vulnerable by virtue of their circumstances.

We saw some improvements had been made with regard to the premises. The provider had begun a programme of redecoration and refurbishment at the home. A number of rooms were in the process of being redecorated during our inspection. The provider was also in the process of obtaining quotes to modify the ramp access at the rear of the property to make it more accessible for people who used the service.

The home did not have any links with advocacy services, nor was there any information available at the home for people who used the service on how to access such services.

People and their relatives told us there were no restrictions on visiting times.

The provider was looking into different ways of gaining people's feedback in addition to conversing with them during time they spent at the home.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At our last inspection we found breaches of legal requirements in respect of: staffing levels, staff training and support, recruitment practices, the safe management of medicines, how risks to people were assessed and managed, accuracy and completeness of records, consent to care and treatment, nutrition and hydration, taking people's views and opinions into account when care was assessed, planned and delivered, dignity and respect, management and leadership, quality assurance systems and statutory notifications not having been submitted as required.

During this inspection, we found some improvements had been made, but the Provider was still in breach of legal requirements, as set out in the rest of this report.

Oakendale Residential Care Home is a small care home which is registered to provide 24 hour care for up to fifteen older people. The home is a converted large domestic property, split over three floors. The home has been fitted with a lift and stair lift to reach the upper levels. At the time of our inspection, there were eight people who lived at the home.

The service did not have a registered manager in post. 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.

The provider had not ensured that sufficient numbers of suitably qualified, competent, skilled and experienced persons were deployed at all times. This was in breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Recruitment procedures had not been operated effectively to ensure persons employed at the service were of good character and had the qualifications, competences, skills and experience necessary to carry out their role. This was in breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The service had not established, and operated effectively, systems for the proper and safe management of medicines. This was in breach of Regulation 12 (2) (g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The Provider had not established, and operated effectively, systems and processes to prevent abuse of service users. Staff were not able to describe what forms abuse may take and were not aware of local reporting procedures. Information for staff about how to report concerns and who to report to had not been made available to them. This was in breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider had not ensured staff had received such appropriate support, training, professional development, supervision and appraisal as was necessary to enable them to carry out the duties they were employed to perform. This was in breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The service was not working within the principals of the Mental Capacity Act 2005. Additionally, the service had not sought and recorded people's consent to care and treatment in each case. The service had allowed a family member to make decisions on a person's behalf without having sight of the proper authorisation. This was in Breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The service had not ensured they worked collaboratively with the person to deliver responsive care which met people's needs and reflected their preferences. This was in breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The service did not demonstrate good management and leadership at all levels. The systems designed to assess, monitor and improve the quality of the service provided were not being operated effectively. This was in breach of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

Following our last inspection, the registered manager had implemented new documentation with regard to risk assessments and care planning. We found improvements had been made in this area. However, since the registered manager had left the home, risk assessments had not been reviewed and updated accordingly. This meant people's written plans of care may not have met their needs fully.

Staff followed infection prevention and control guidelines and used personal protective equipment appropriately.

The service had made improvements with regard to the accuracy and completeness of records, which now included a good level of detail.

People's nutrition and hydration needs were being met. The service had implemented a new menu, with input from people who lived at the home. Monitoring of people's weight and nutritional intake was being undertaken appropriately.

The Provider had continued with their program of refurbishment and redecoration at the home. The majority of bedrooms and the lounge had been redecorated and provided light and pleasant surroundings for people who lived there.

We observed staff to take a very caring approach to people who used the service. Staffing levels had remained constant whilst the number of people who used the service had decreased, which meant staff were able to spend more time with people. Staff treated people with dignity and respect. Staff knew people well and showed genuine care for them in their interactions.

The service had undertaken a lot of work to gather more information about people, their life histories, likes, dislikes and preferences. The information had then been used, along with reviews of care where the person was involved; to shape the care delivered to people.

The Provider had recently implemented satisfaction surveys in order to gain feedback from people about their experience of care at the service.

We found several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, as shown above.

You can see what action we have told the Provider to take at the back of the full version of the report.

Services awarded an inadequate rating for any key question will be re-inspected within six months. If there remains an inadequate rating after six months, in any key question the service will go into special measures.

If sufficient progress has not been made when we re-inspect and there are inadequate ratings for any key questions, further action will be taken to prevent the service from operating, either by proposing to cancel their registration or to vary the terms of their registration. We will then closely monitor the service until it either closes or substantial and rapid improvements are made.

Therefore this service will remain in special measures.

Where we have identified breaches of regulation during inspection which are more serious, we will make sure action is taken. We will report on any action when it is complete.

We spoke to three people living at the home, the manager and two care staff. The three people we spoke to all said they made their own decisions about their care and treatment. One person told us, 'I do my own thing, the staff don't tell me what to do and they say they are there to help me'.

People told us they chose social and recreational activities they wanted to do. We saw people reading and watching television. One person said they had their own shed in the grounds of the home were they painted and kept personal items. They said, 'I have a lot of canvas and do lots of painting. I enjoy painting and it keeps me busy'.

Another person talked about the meals on offer and said, "I like the menu there's lots of choice. I like most of the meals but my favourite is corn beef hash or eggs or cheese on toast. Staff know what I like and they come and ask you what you want form the menu'".

People told us the staff talked to them about their care and support needs. This usually involved discussions about how they wanted their personal care to be provided or how they wished to spend their day.