Archived: Oakhurst

Below is a summary of what we found. The summary describes what staff told us, what we observed and the records we looked at. We did not speak with anyone living at the home on this occasion.

Following our inspection in April 2014 we contacted the local safeguarding team about our concerns relating to two people who lived at the home. We were also concerned about the environment, staff training and supervision and the quality of assurances systems within the home. The home has since been subject to a safeguarding process, through which the home had been regularly monitored and supported by a group of health and social care professionals.

We had major concerns about the safety of people living at the home following our inspection in April 2014 and took enforcement action against the home. We issued Warning Notices in the areas of: Care and Welfare; Suitability of the Premises; Staff Supervision and Quality Assurance. The Warning Notices were to be complied with by 20 June 2014. At our inspection in July 2014 we found that some areas had been complied with but not all. We have therefore reissued the Warning Notice for Quality Assurance. We have issued compliance actions in the areas of: Consent to Care and Treatment; Care and Welfare; Suitability of the Premises and Staff Supervision.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Where people were not able to consent to care and treatment, we saw no evidence that information had been obtained about the person's capacity to give consent. This meant there was a risk staff could make decisions for people who were capable of making decisions themselves. The provider told us that staff were about to start gathering this information.

We were told by health and social care professionals that an agreement had been reached with the provider that a member of staff would be in the lounge at all times. This was to monitor a number of people who were at high risk of falls. We saw that on several occasions there was not a member of staff in the lounge. This meant that the provider was not acting in accordance with an agreement reached with the safeguarding team and could potentially place people at risk from falling.

A range of risk assessments had been completed including those for pressure areas, nutrition and moving and handling. However, we saw that one person's pressure area assessment made no reference to the fact they were diabetic. This information may have had an impact on the level of risk of the person developing pressure sores. This meant the person was at increased risk of not having their needs met.

At our inspections in April 2014 we found that the carpet in the lounge had holes in it that presented a trip hazard. At this inspection in July 2014 we saw that the lounge and dining room carpets had been replaced. However, the carpet in the hallway had holes that could present a trip hazard.

We were not able to see certificates to confirm staff had received the required training.

We saw records that showed staff supervision was ongoing. The majority of staff had received one formal, recorded supervision.

Is the service effective?

Staff told us that they always asked people for their permission to provide care and always offered choices where possible. We heard staff offering people choices about what they wanted to drink and where they wanted to sit.

We found that the new care plans were more person-centred and reflected the needs of a person as an individual. For example, we saw that the care plans were based on the assessed needs of the individual. We saw that improvements had been made to the recordings on food and fluid charts. We saw that amounts people ate were recorded.

Staff told us they felt they had the skills and training to meet the needs of people now living at the home.

Is the service caring?

At our inspection in April 2014 we had concerns about the home's ability to care for two people living there. At this inspection in July 2014 we found that both these people had moved from the home. Staff that we spoke with were able to tell us about people's needs and how these needs were met.

We saw that improvements had been made to activities available for people. We heard staff asking people if they wanted to play a board game. We saw that more people were sitting in the lounge and veranda areas of the home. This showed that people were able to use more communal areas around the home and the main lounge was not so crowded. Staff said that they now had more time to spend with people. They said this was because there were only 11 people living at the home and that people's personal care needs were lower.

Health and social care professionals that we spoke with praised staff for the way they worked to meet people's needs. They told us they had no concerns about the care people received.

Is the service responsive?

The provider had taken into account the complaints expressed by the representatives of people who used the service. We know this because we saw that one complaint had been received by the home and this had been dealt with appropriately.

Staff told us there had been a recent meeting with the provider. During this meeting they said they had been told about the way the provider planned to move the home forward. They also told us that they felt communication within the home and with the provider had improved.

Is the service well-led?

There had been no Registered Manager in day to day control of the home since December 2013. The Registered Manager has now been deregistered. A manager had been working at the home, but since our inspection in April 2014 the manager had left the home. It is a condition of the home's registration that a manager is registered.

The provider did not have an effective system to regularly assess and monitor the quality of service that people received.

The provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

At our inspection in July 2014 we found that improvements were needed in the areas of consent to care and treatment, care and welfare of people who use service, safety and suitability of premises, supporting workers and assessing and monitoring the quality of service provision. In April 2014 we served a warning notice for assessing and monitoring the quality of service provision. In July 2014 we re-issued the warning notice as the required improvements had not been made. At this inspection in September 2014 we looked to see if the required improvements had been made.

During this inspection we found that a new manager had been in post for less than a week. They were present throughout the inspection and we were joined by the provider's representative for most of the inspection. We spoke with three staff during the inspection and chatted with several people who lived at the home while they were sat in the lounge.

Is the service safe?

People had been cared for in an environment that was safe and clean.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. One application had been authorised by the local authority. Relevant staff had been trained to understand when an application should be made, and how to submit one. This meant that people were not at risk of being unlawfully detained.

There were arrangements in place to deal with foreseeable emergencies. For example, staff were trained in first aid and there were first aid boxes available in the kitchen and the care staff 'station'. We saw that people living at the home had a Personal Emergency Evacuation Plan (PEEP). This meant that staff had the necessary information on how they should safely evacuate people if the need arose.

Is the service effective?

Staff told us that they always asked people for their permission to provide care and always offered choices where possible. We heard staff offering people choices about what they wanted to eat and drink and where they wanted to sit. Staff that we spoke with were able to tell us what they did to support people and knew what to do for them if they needed any additional support. They told us about how they managed one person's aggressive outbursts. Staff told us they found care plans useful in helping them provide consistent care.

Is the service caring?

People told us they thought the staff were all 'lovely' and they enjoyed living at the home. We saw and heard positive interactions between staff and people who lived at the home. Any directions that were given to people were done so in a sensitive and discreet manner. Staff spoke kindly with people, listened carefully to their responses and did not hurry them. This showed that staff had an awareness of the needs of people they cared for.

Is the service responsive?

Daily records showed that people's health care needs were being met as detailed in their care plans. Information about visits from and to health care professionals had been recorded in individual care plans, showing clear evidence that people were supported to maintain access to specialist medical services. For example, we saw that a Speech and Language Therapist (SALT) had visited to advise staff on caring for one person who had swallowing difficulties. We saw that staff were following this advice. We saw that where risks had been identified in relation to pressure areas, appropriate equipment had been provided. This minimised the risks of pressure sores developing.

Is the service well-led?

We saw that the provider had produced a 'Development Action Plan' for August and September 2014. We saw that the actions for August included the upgrading of the fire alarm system that had been completed. Actions for September included roof repairs and room redecorations. The new manager told us that they planned to send out a series of questionnaires to ask, staff, visitors, health and social care professionals and people living at the home for their opinion on the quality of care being provided. They also said they planned on sending out a newsletter to introduce themselves to visitors.

Staff told us they felt things continued to improve at the home. They told us they felt well supported and had much more quality time to spend with the people they cared for. They also said that the atmosphere was much more relaxed and comfortable.

Below is a summary of what we found. The summary describes what people using the service, and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People were not cared for in an environment that was safe and comfortable. The fire officer's report from December 2013 had not been fully acted on. Five bedrooms did not have working radiators and two bedrooms had an intermittent hot water supply. The carpet in the lounge had tape across holes.

Staff did not have the skills to manage people whose behaviour challenged the service. People's care plans did not provide staff with sufficient information to safely manage people's needs.

Staff personnel records contained the information required by the Health and Social Care Act 2008. This meant the provider had taken steps to demonstrate that the staff employed to work at the home were suitable to work with vulnerable people.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The manager told us no applications had been submitted.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. People told us 'They (staff) are my friends ' I love them', 'Staff are lovely, they work really hard' and 'very good staff here'. Staff had received some training to meet the needs of the people living at the home.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were patient and gave encouragement when supporting people. People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this. Staff told us they had asked twice for equipment such as garden furniture that would enable people to use the garden. The provider had not purchased such equipment.

Is the service responsive?

People's needs had been assessed before they moved into the home. Care plans were reviewed each month, but did not reflect people's current needs. Health care professionals had been consulted about managing the behaviour of two people.

Is the service well-led?

Staff felt unsupported by the provider.

There was no effective quality assurance system in place. Staff and people living at the home were not regularly consulted about the quality of care provided.

At the time of our inspection there had been no Registered Manager employed at Oakhurst since December 2013. The provider had not notified us that the previous manager had left. The previous manager had not deregistered with CQC at the time of the inspection, therefore their name still remains on any reports until such time that this information is received. A manager was working at the home, but they had not applied to be registered. It is a condition of the home's registration that a manager is registered.

The people who lived in the home, who we were able to speak with, were impaired by their dementia to a lesser or greater extent. However everyone was able to at least say whether the liked the home, the food and the staff.

All of the people who used the service, who we spoke with, said they were very happy with the home's standards. The comments we received included 'I like this place,' 'I like it here'the staff are very nice'the food is nice,' and 'are well looked after here'.

People who used the service raised no concerns about staff practice and said staff treated them with respect and dignity. People said they were happy with the activities available, and with the support they received with their personal care and health needs.

The accommodation was furnished and decorated to a satisfactory standard. The home was very clean and there were no offensive odours. We were however concerned about the lack of up to date health and safety checks completed and judged this could put people at risk.

The medication system was well organised and operated effectively.

There were satisfactory numbers of staff on duty. However staff recruitment, staff training and formal staff supervision systems were unsatisfactory.

People we spoke with told us they felt involved in their care. The relatives of one person living at the home said 'My [relative] is well looked after here'.

We spent thirty minutes observing the activity and interactions in the lounge and saw staff being polite, respectful and kind. We saw no negative interactions.

People were complimentary about the staff and the care they received. They said they felt safe living at the home and that there were enough staff on duty. They knew how to complain and felt satisfied complaints would be dealt with appropriately.

People were cared for by staff that were supported to deliver care and treatment safely and to an appropriate standard.

The provider had an effective system to regularly assess and monitor the quality of service that people received.

We were shown written responses from people who had used the services at Oakhurst. These included "Thank you for all your support and kindness. You have made us feel very welcome" and "Just to say thank you to you all for all the love and care you have given to our dear [relative]. We could not have wished for a better home. You treated [our relative] like [they] belonged to you as a family".

You can see our judgements on the front page of this report.