Oulton Park Care Centre

Oulton Park Care Centre is a care home registered to provide personal and nursing care to 60 older people across two units.

People’s experience of using this service and what we found

People told us that they were safe and well cared for in the service. Significant improvements had been made to how risks were identified, planned for, managed and mitigated. This meant people were protected from the risk of potential harm. Medicines were managed, monitored and administered safely.

The environment was safe and appropriate checks were carried out to identify risks in the environment. Infection, prevention and control procedures were implemented effectively across the service.

Improvements had been made to the staffing level and there were now enough staff to provide support to people at the time they needed it.

Since the appointment of a new management team, significant improvements had been made to the management and oversight of the service. Shortfalls were identified and acted upon robustly, and the management team had driven positive improvement across all areas of service provision.

Improvements had been made to the environment and people now had access to sources of meaningful engagement and activity.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was ‘Inadequate’ (Report published 17 August 2021). At this inspection improvements had been made and the service is no longer in breach of regulations.

This service has been in Special Measures since 17 August 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

The service was rated ‘Inadequate’ at the last inspection and we needed to check whether the improvements had been made.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Oulton Park Care Centre is a care home registered to provide personal and nursing care to 60 older people across two units.

People’s experience of using this service and what we found

Whilst people using the service told us they felt safe, we found that the service did not always have clear and robust measures in place to reduce the risks to people. Where risks had been identified, there was not always appropriate care planning in place to guide staff on how those risks should be reduced. Where care plans were in place, these had not always been followed and this had not been identified by senior staff.

The numbers and deployment of staff meant that people did not always receive support from staff when they required it, either to keep them safe or to ease emotional distress.

Not all of the shortfalls we found had been identified in audits by the service. Despite concerns being raised by staff about the staffing level, improvements had not been made by the time of our visit.

The management and oversight of the service had not been effective, as the quality of the service had deteriorated since our previous inspection on 11 December 2019. The service had struggled to recruit and retain a consistent manager during this time.

People did not have access to sufficient sources of meaningful engagement and were at risk of social isolation.

People received sufficient support to eat their meals. However, observations identified that people did not always have drinks available to them.

The environment was safe and appropriate checks were carried out to identify risks in the environment. Infection, prevention and control procedures were implemented effectively across the service.

Improvements had been made in the management and administration of medicines. These were now managed and administered safely.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the environment policies and systems in the service did support this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was ‘Requires Improvement’ (Report published 1 April 2020). At this inspection enough improvement had not been made and the provider was in breach of further regulations.

Why we inspected

The service was rated ‘Requires Improvement’ at the last inspection and we needed to check whether the improvements had been made.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to managing risks to people, ensuring appropriate staffing levels, ensuring person centred care is delivered and ensuring good governance and oversight of the service at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

The service provides purpose-built accommodation on one level. The service has a dedicated unit that specialises in providing care to people living with dementia.

People’s experience of using this service and what we found

We were prompted to bring this inspection forward because of concerns shared with us regarding the management of the service and poor care. The service has had three registered mangers since August 2018 and the last registered manager had left shortly before our inspection, a new manager had been quickly recruited and had assured us they would apply for registration in the near future. However, this quick succession of managers had been disruptive to the management of the service and its efforts to improve the quality of service people received.

Medicines had not always been managed in a way that ensured that people received them safely and at the right time. During our observations we found there was poor practice in its management and administration. Most of our concerns in regard of the medicines had already been noted and action was being taken to better manage the medicines and retrain staff.

People's nutritional and hydration needs were assessed to ensure they received appropriate support that met their needs. Although, we saw examples where specialist diets needed to be recorded with more clarity. The service worked to ensure that people received person centred care when they used and were supported by different services.

People received care that was personalised and responsive to their needs, the care plans held enough information to guide staff on meeting people’s needs but would benefit if more detail was included. However, staff knew people well, understood them and their personal preferences. People’s experiences, concerns and complaints were listened to; steps had been taken to investigate complaints and to make any changes needed.

The service has gone through many changes with three different registered managers since August 2018. This had had a negative effect on people’s wellbeing and the management of the service. However, the newly appointed manager was liked by people living in the service, their relatives and staff. They told us they were open and made themselves available. It had been recognised that the staff had also had a difficult time and were receiving support, many of them had worked under all of the previous managers and had to get used to the many different management styles. There was still work that needed to be done, but work was underway to make improvements to the quality of the service people received.

There were various quality assurance systems in place, but we noted that a number of issues identified in the latest audit had also been identified in previous audits without action being taken. This was possibly due to the lack of management leadership; the last two registered managers had left after only three months and seven months respectively. The provider acknowledged our concerns and ensured us that they would be monitoring the service and would support the new manager as they settled into their post.

People where well protected from bullying, harassment and abuse by staff that were trained to recognise abusive situations and knew how to report any incidents they witnessed or suspected. Staff we spoke with during the inspection understood their responsibilities to raise concerns and there were arrangements in place in place for reviewing and investigating incidents when things went wrong.

Personal risks to people were fully assessed and steps had been put in place to keep people safe. Staffing levels were sufficient to keep people safe. People were protected by staff that had been safely recruited. The home was clean, and staff had access to equipment that protected them and the people they supported from cross infection.

People’s needs were assessed, and they received care in line with current legislation from staff that had the knowledge and skills they needed to carry out their roles.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Meaning people were asked for their consent by staff before supporting them in line with legislation and guidance.

Staff we spoke with talked about the people who used the service in a caring and positive way. People told us that staff were kind, caring and protected their privacy and dignity. We saw evidence in records that people were able to express their views and staff listened to what they said and took action to ensure their decisions were acted on.

The building was purpose built to accommodate older people with wide corridors, safe access and easily read signage to help people find their way about. The gardens were well maintained, and people told us they enjoyed walking in the gardens and helping to look after them.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last comprehensive inspection for this service was on 6 November 2018 and the resulting rating was Requires Improvement. (Published December 2018) At this inspection there was a breach of regulation with regard to the management of medicines.

The provider completed an action plan after that inspection to show what they would do and by when to improve.

On 2 May 2019, after concerns were raised with us in regard to continued medicines errors, we undertook a focused inspection to review the Key Questions of safe and Well-led only. We also checked what action had been taken with regard to the breach of regulation in the management of medicines from the previous inspection.

No areas of concern were identified in the other Key Questions, we therefore did not inspect them. Ratings from the previous comprehensive inspection for those Key Questions were used in calculating the overall rating at that inspection.

During that inspection we found there was no longer a breach of regulation but that further improvements were still required. The rating remained as Requires Improvement. (Published May 2019)

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Oulton Park Care Centre on our website at www.cqc.org.uk.

Oulton Park Care Centre is a purpose built care home that provides personal and nursing care for up to 60 people. At the time of our inspection visit on 3 April 2019, there were 58 people living in the service.

People's experience of using this service:

¿ People did not always get their medicines as prescribed and medicines systems were not always safe.

¿ Risk assessments were in place. However, actions in place to mitigate risk were not always recorded in sufficient detail.

¿ There were sufficient staff to meet people's assessed needs.

¿ There were systems in place to safeguard people from abuse.

¿ Action plans were in place to improve the quality of the service.

Rating at last inspection: At the last inspection the service was rated Requires Improvement (21 December 2018). At that inspection there was a breach of regulation with regard to the management of medicines. At this inspection we found there was no longer a breach of regulation but that further improvements were still required. At the previous inspection we also rated Well-led as requires improvement. At this inspection we found that improvements had been made with a registered manager now in place. However, further improvements in the quality of audits were required.

Why we inspected: This inspection was brought forward due to information of risk or concern.

Follow up: We will follow up this inspection in line with CQC policies.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Oulton Park 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. Oulton Park is registered to provide care for up to 60 people. It provides purpose built accommodation on one level. The service has a dedicated dementia unit. 55 people were living in the service during our inspection.

The service’s registered manager had left the week before 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. The provider had responded to the departure of the registered manager and made appropriate arrangements for the management of the service. This included the transfer of a registered manager from one of the provider’s other services to Oulton Park to manage the service. The new manager had carried out a variety of audits in the service and during our inspection they provided us with an action plan setting out how they planned to improve the service.

People did not always receive their medicines as prescribed. People who had medicines prescribed to be administered at specific times were not always given them at that time. Stock control measures had not always ensured there were sufficient medicines in stock to meet people’s prescription.

Care plans were not always fully completed to reflect people’s changing needs. Where there was a risk to people from receiving care and support, for example the use of bed rails, risk assessments were not always in place. Care plans did not detail people’s life history to enable staff to provide people with the care and support as they required.

The provider had audits in place to assess and monitor the quality of the service. These had identified where the service was not providing good quality care and support. However, we found that in some instances issues identified in an audit had not been dealt with promptly.

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

We received mixed feedback from people as to whether there were sufficient staff to provide the care and support they required. Staff told us that this had been an issue but that this had recently improved. The new manager told us that they had addressed how the rota was managed and this had resulted in improvements. During our inspection visits we observed staff had time to sit and speak with people.

Staff were supported to develop their skills, knowledge and competencies by completing a range of developmental training. During our inspection visits we observed positive, caring interactions between people and staff.

People’s nutritional needs were met. Mealtime experience were pleasant and unhurried with people provided with the support they required. Where people had specific individual nutritional needs, these were met.

Staff contacted health care professionals promptly when people were unwell and people were supported to access a wide range of services to maintain their health and well-being. There was good liaison with the local GP and clinical commissioning group.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff sought consent before carrying out care support and people told us they were happy with the care they received.

The provider used a system of audits used to assess and monitor the quality of the service. These had identified where the service was not compliant with the provider's policies and procedures which resulted in action plans being implemented to improve the service. However, we did note that in some instances issues identified in an audit were not always dealt with promptly.

Oulton Park provides support for up to 60 people. It has a separate specialist dementia unit which has its own garden. On the day of our inspection there were 53 people living in the service.

The service 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.’

Risks to people had been identified, assessed and were managed safely. Staff understood the signs of potential abuse and what action they needed to take if it was suspected. There were sufficient numbers of staff employed to meet people’s needs and the service followed safe recruitment practices. People’s medicines were managed safely and administered by trained staff.

Staff were trained in all essential areas and participated in an induction programme. They were supported by the management team, receiving regular supervision.

The service was meeting the requirements of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards. However care plans did not always fully evidence how people lacking capacity were supported to make decisions.

We received positive feedback from health care professionals regarding the service provided. Referrals to health care professionals were made promptly and their advice was acted upon.

People and staff had developed positive, caring relationships. People felt they were well looked after by kind friendly staff who understood and knew them well. People's preferences and choices were known and respected by staff and were encouraged to express their views and be involved in all aspects of their care. A range of activities were provided and where people moved into the service with particular hobbies and interests they were supported to maintain these.

People, their relatives and staff spoken with had confidence in the management team and felt the service had clear leadership. There were effective systems to assess and monitor the quality of the service and address any concerns.

People’s health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others.

We saw that appropriate action had been taken in emergencies, or where a person’s health had significantly declined. People were protected from the risk of abuse because steps had been taken to identify the possibility of abuse and prevent it from happening, and the provider responded appropriately to any allegations of abuse.

The purpose-built premises were clean, well decorated and maintained.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Staff had a positive and person-centred attitude and worked well together.

Records were accurate, generally up to date and regularly reviewed. However, there were some inconsistencies and the frequency and thoroughness of reviews of risk assessments and of care plans varied.

Everyone's care and treatment was planned in an individual and person-centred way. This was done either with their involvement, or if they did not have the capacity, with the involvement of their representative. This showed that people who used the service were involved in making decisions about their care and support so far as they were able to do so.

The service was following national guidelines on the prevention and control of infection. They were linked to NHS specialists for further advice. This showed that people were protected against risks of infection.

There was a plan for the training and development of staff. This was managed through regular supervision and appraisals.

The provider had a comprehensive quality assurance process including surveys, audits and monthly reports.