Archived: Oakleigh Care Home

Updated 13 February 2018

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, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on 6 & 21 November 2017 and was unannounced on both days.

On the first day the inspection was carried out by two 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. In this case our expert was experienced in the care of older people. On the second day two adult social care inspectors visited the home.

We carried out the inspection to check the provider had taken action to address the breaches of regulations identified in the last inspection report which was published in July 2017.

We spoke with six people who used the service, two care workers and the registered manager. We looked at three people's care records which included medication records. We looked at two staff files and other records relating to the day to day running of the home such as training records, maintenance records, meeting notes, survey results and audits. We observed people being cared for and supported in the communal rooms, observed the meal service at lunch time and looked around the home.

Before the inspection we looked at the information we have about the service including notifications sent to us by the registered manager. We contacted the local commissioning and safeguarding teams to ask for their views on the service.

On this occasion we did not ask the provider to complete a Provider Information Return (PIR). This is a form which gives the provider the opportunity to tell us about their service and any improvements they plan to make.

Updated 13 February 2018

The inspection took place on 6 and 21 November 2017 and was unannounced on both days. There were six people living in the home on 6 November and five on 21 November 2017. Four people were permanent residents at the home.

Oakleigh is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Oakleigh accommodates a maximum of 29 people in one adapted building.

The last inspection was in May 2017. At that time we found the provider was in breach of four regulations. Two of these Regulation 9 (Person centred care) and Regulation 17 (Good governance) were continued breaches since the previous inspection in November 2016. The other breaches were in relation to Regulation 12 (Safe care and treatment) and Regulation 11 (Need for consent). The overall rating was requires improvement, however, the service was placed in ‘special measures.’ We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. In this case we rated the service inadequate in the ‘well led’ domain on two consecutive inspections.

On the first day of our inspection there was a registered manager in place. However, they told us they were leaving on 17 November 2017. They have made an application to cancel their registration with 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.

On the second day of our inspection there was no registered manager and the provider told us the ex-manager would be returning to work in the home as a senior care worker.

People told us there were enough staff to meet their needs. There was some disruption to the staffing as in the course of our inspection the registered manager and two senior care workers left. This would have left the service without enough staff to cover the rota. However, all three staff retuned to work at the home within a week. We were concerned the registered manager, provider and care staff had not identified the staffing situation as a potential safeguarding issue.

People who lived at the home told us they felt safe. Staff knew how to recognise and report abuse. The provider did not always work co-operatively with external agencies to ensure safeguarding concerns were fully investigated.

We found the provider had not taken suitable action to be sure agency care workers had been properly checked before they started working in the home.

For the most part people’s medicines were managed safely. However, there was a risk of overuse of medication by staff who were not familiar with people’s needs.

Risks to people’s safety and welfare were not always well managed. The provider had addressed most of the issues with the environment which we brought to their attention at the last inspection. However, there were still concerns and some of these were repeated from the last inspection. For example, we found weekly checks on the fire systems had not been done. The design and décor of the building did not take into consideration the needs of people who lived at the home. This was the third consecutive inspection where we raised issues about the low levels of lighting.

Staff had received training on safe working practices and said they felt supported by the registered manager.

Overall, people were satisfied with the food and told us they were offered a choice of meals. We found the meals offered were not always nutritionally balanced.

The home was working in accordance with the requirements of the Mental Capacity Act.

People were supported to meet their health care needs and had access to the full range of NHS services.

People told us staff treated them with dignity and respect and we observed this during our visit. We saw staff supported people in a kind and compassion way.

People were at risk of not always receiving care which was appropriate to their needs. People were not supported to plan for their end of life care.

People were supported to take part in a variety of in house activities which took account of their individual interests.

There was a complaints procedure in place; none of the people we spoke with had any complaints about the service.

People who used the service had the opportunity to share their views by means of meetings and surveys.

The provider had systems in place to monitor, assess and improve the quality of the services. However, we found these systems were not operated effectively.

We found the provider was in breach of five regulations. Two of these Regulation 9 (Person centred care) and Regulation 17 (Good governance) were continued breaches since the last inspection. The other breaches were in relation to Regulation 13 (Safeguarding people), Regulation 19 (Fit and proper persons) and Regulation 18 of the Registration Regulations (Notifications of other incidents).

The overall rating for this service is ‘Inadequate’ Therefore the service will remain 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.