Archived: Oakhurst

Updated 12 June 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, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 4 and 13 March and 20 April 2015 and was unannounced. The inspection team consisted of two Adult Social Care (ASC) inspectors.

Before the inspection we gathered and reviewed information we hold about the provider. This included information from previous inspections and notifications (about events and incidents in the home) sent to us by the provider.

During the inspection we spoke with four people using the service, one visitor, five staff, the manager and the registered provider. We also spoke with five health and social care professionals and staff from the local authority who had commissioned some placements for people living at the home.

We observed the interaction between staff and people living at the home and reviewed a number of records. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us. The records we looked at included three people’s care records, the provider’s quality assurance system, accident and incident reports, three staff’s records, records relating to medicine administration, staffing rotas and training records.

Updated 12 June 2015

Oakhurst is registered to provide accommodation and personal care for up to 16 older people. Nursing care is provided by the local community nursing team. Oakhurst primarily provides accommodation and personal care for people with dementia. It is part of the Saffron Care Ltd group which has one other care home and a Domiciliary Care Agency registered with CQC.

This inspection took place on 4 and 13 March and 20 April 2015 and was unannounced. There were ten people living at the home. The service had last been inspected on 3 September 2014 when it met all regulations in the areas looked at.

It is a condition of the home’s registration that a registered manager be employed at the home. There had been no manager registered for the service since 27 June 2014. On the first day of our inspection a manager had been appointed but had not yet registered with the Commission. They were not available on the second day of our inspection and had left their employment with the service by the third day of our inspection. 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.

Prior to this inspection concerns had been raised about the care provided to people. This included care of pressure areas and staff not following the guidelines set by healthcare professionals. This had resulted in individual safeguarding alerts being raised. The investigations into these alerts were still on-going at the time of our inspection. Following these alerts being raised, the local authority had placed a ban on admissions to the home. After our second day of inspection further concerns were received, which had led to the commissioners for the service sending in their CRT (Crisis Response Team) to keep people safe. Following our third visit the commissioners made a decision to terminate their contract with the service. Everyone living at the home had been supported to find alternative accommodation and the home is now empty. The registered provider has since applied to the Care Quality Commission to remove the location Oakhurst from their registration and close the home.

The service was not well led. There had been no person regularly managing the service since the previous registered manager had left the service in December 2013. They had not deregistered until June 2014. Although the registered provider visited the service on a regular basis they had not identified the issues we raised in this report. This was because there was no effective system in place to monitor and improve the quality of care at the service.

People were not safe and were not protected from the risks of harm. One person had developed pressure sores due to them not being turned often enough and by the use of incorrect equipment. Another person’s ability to move had been affected and it was no longer possible to move the person to their chair, because staff had not followed a plan put in place by an occupational therapist. People’s emergency evacuation plans did not identify the nearest evacuation point, which meant staff did not have the necessary information to safely evacuate the building in an emergency such as a fire. People were protected from the risks of cross infection.

People’s medicines were not managed well. The variable dose of one person’s medicine was not recorded in a place that was easy to find and not all handwritten entries on Medication Administration Record (MAR) charts were double signed. This meant people were at risk of receiving incorrect doses of medicines.

People were not protected by the service’s recruitment procedures. There were no dates for staff’s previous employment. This meant it was not possible to discuss any gaps in their employment history. Not all staff had a start date recorded so it was not possible to see if a criminal records check had been obtained before they started work. However, staff had received training in safeguarding people and demonstrated a good knowledge of different types of abuse.

Staffing levels were not adequate for the number of people living at the service. One member of staff had to stay in the lounge at all times (an agreement with the local authority commissioners). This reduced the numbers of staff available to ensure people had the opportunity to participate in regular activities and social interaction. The registered provider had not increased staffing levels in response to this condition being placed on the contract. For example, people who spent all their time in their rooms had limited time spent with them other than when staff were attending to their personal care.

Care plans were large documents and it was difficult to find the most relevant up to date information. There was limited evidence that people or their relatives, were involved in planning their care. There was inconsistency about how people’s needs were assessed, planned for and reviewed. For example, it was not possible to accurately assess people’s nutritional and fluid intake to ensure their health was maintained. It was not possible to determine if people had received adequate amounts of food and fluid.

People did not receive effective care and support from staff who had the skills and knowledge to meet their needs. Staff had received training in many areas but there was no effective system in place to ensure they were putting their learning into action. Some staff had received supervision. However, this was not on-going and did not ensure staff’s competence in their role was maintained.

Staff were not always respectful of people’s dignity. For example, we heard people who needed help to eat being referred to as ‘the feeds’. However, staff were kind and caring and good relationships had been built between staff and the people they cared for. People appeared well cared for and looked clean and tidy.

Staff had an understanding of the Mental Capacity Act 2005 (MCA) and ensured they obtained people’s consent before providing personal care. Where people lacked the capacity to consent to care or treatment steps had been taken to ensure decisions were taken in the person’s best interest. Where appropriate Deprivation of Liberty Safeguards (DoLS) authorisations had been obtained from the local authority to ensure people did not leave the building unescorted in order to keep them safe.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

The overall rating for this provider is ‘Inadequate’. This means that if the home does not close it will be 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.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.