Archived: The Oaks Care Home

About the service

The Oaks Care Home is service that provides accommodation, nursing and personal care for up to 16 people. At the time of our inspection, 13 older people were living in the home, some of whom may have a physical disability and/or dementia.

The Oaks Care Home 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. The home is in one adapted building over two floors.

Why we inspected

This was a scheduled inspection. We had also received concerns from members of the public regarding staffing levels and the environment which we took into account.

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

People did not feel safe from abuse. Staff did not recognise different types of abuse or how to report it. The registered manager and provider did not recognise abuse and how to report this. We raised safeguarding concerns to the local authority from what people had told us and records of incidents we had read. Risks to people’s safety were not always monitored or reviewed. People told us that their care needs were not met in a timely way. People’s medicines were not always managed and stored in a safe way. People were not protected from the risk of cross infection.

People’s care was not always robustly assessed and reviewed to ensure it was up to date and in line with best practice. People were not supported by staff who had the skills and knowledge to do so. People who needed support to eat were malnutrition as records did not clearly demonstrate that people had sufficient to eat and drink. People were not 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 support this practice.

Staff did not treat people in a kind and caring way and their dignity was not maintained. The staff group did not always treat people as individuals and respected the choices they made. People did not always receive care and support in a person- centred way.

People’s care was not always delivered in a timely way, people experienced consistent delays in receiving personal care. The provider could not be assured the staff group had sufficient knowledge and skills to support people with their care needs including end of life care. People were not supported to maintain their hobbies and interests. Complaints were not fully addressed to ensure satisfactory outcomes were made.

There were significant and widespread shortfalls in the way the service was led. The provider and registered manager did not lead by example. People, relatives and staff were not involved in the running of the service, the provider did not have a good line of communication and was not transparent to those involved in the service. The audits the provider had in place were futile and did not escalate shortfalls to improve practice.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to safe care and treatment and governance of the service at this inspection. Please see the action we have told the provider to take at the end of this report.

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 request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will 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.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

During this inspection, we found sufficient action had been taken to address the previous breaches of the Regulations around staffing levels, recruitment and assessment and mitigation of risk to improve so that the service was no longer rated inadequate. However, we identified further areas of concern at this inspection, which the provider had not identified. There continued to be areas needing improvement and the provider needed to ensure improvements were sustained and fully embedded within the culture of the service. Therefore the provider remains in breach of Regulation 17, Good Governance.

The Oaks Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The Oaks Care Home provides personal care and accommodation for up to 16 older people, some of whom may be living with dementia. There were 15 people who were living at the home on the day of our visit.

There was a registered manager in place at the time of our inspection visit. A registered manager from the providers other service came to support the inspection visit. 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.

Some risks to people were not consistently assessed when people first moved into the home, which meant that some people were placed at potential risk of harm. However, we found that improvements were being made and staff and management were learning and therefore improving the safety of people’s care. Staffing levels reflected the needs of the people who lived there. Staff were able to meet people’s needs and keep them safe from harm. The management of people’s medicines had improved, however further work was required to ensure this was following best practice. The environment of the home did not always promote people’s safety and we raised concerns with the provider regarding the security of the building.

The registered manager had put in place checks to ensure staff were competent in their roles and supporting people in line with best practice. New staff were beginning to receive training prior to starting work for the provider in line with the Care Certificate. The Care Certificate is an agreed set of standards that sets out the knowledge, skills and behaviours expected of those who work in Health and Social Care. Staff sought people’s consent before supporting them, staff understood and recognised the importance of this. We found people were supported to eat a healthy balanced diet and drink enough. We found that people had access to healthcare professionals, such as their doctor when they required them.

The home environment still did not fully promote people’s independence and dignity. The provider acknowledged during our previous inspections in January 2016, October 2016 and October 2017 that work was required to improve the bathroom facilities for people. At this inspection we found this work had still not been completed. The provider told us their plans to have this completed had now moved to August 2018. People told us that staff treated them kindly and respected their privacy. Relatives raised concerns about their family members’ dignity and respect, as they often found them wearing other people’s clothing.

People received care that was responsive to their individual needs. Staff were beginning to embed a culture where they engaged with people and supported them to maintain their interests. Information on how to raise complaints was not always provided to people and their relatives. Relatives told us they had raised complaints, but when we looked at the provider’s complaints since the last inspection there were no records of these to demonstrate that complaints were listened and responded to.

People felt the service was run well, while we received a mixed response from relatives about this. Staff felt there had been some improvements in the running of the service and felt morale had improved. Some staff reported to us that the provider continued not to listen about how the service should be run, and that the changes in the environment were minimal. Systems to ensure the service was delivering good quality care were beginning to take place, however these were not always comprehensive. The provider was beginning to understand their responsibilities in ensuring they were meeting the legal requirements. However their systems were not consistent to demonstrate how they identify areas for improvement. The systems that were in place were not embedded to demonstrate consistency for the running of the service.

At this inspection we found the service was inadequate overall, and in the key questions safe and well-led. The inspection identified five breaches of regulation.

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

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.

The Oaks Care Home provides personal care and accommodation for up to 16 older people, some of whom may be living with dementia. There were 16 people who were living at the home on the day of our visit.

There was a registered manager in place at the time of our inspection visit. A registered manager from the providers other service came to support the inspection visit. 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.

Risk's to people were not adequately assessed when people’s care needs changed, which meant that staff took actions that put people at potential risk of harm. There were not sufficient staffing levels in place to keep people safe from harm, staff had raised this as an on-going concern, however the registered manager and provider could not demonstrate that staffing levels reflected people's care needs. Staff did not have clear direction for some prescribed medicines, for example, where people who had swallowing difficulties required fluid thickener staff did not know how thick the fluid should be. The storage of controlled drugs and was not locked or secure.

The registered manager did not have checks in place to ensure staff were competent in their roles and in line with best practice. New staff had not received training prior to working and relied on their past experience. Staff supported people with their consent and agreement and staff understood and recognised the importance of this. We found people were supported to eat a healthy balanced diet and with enough fluids to keep them healthy. We found that people had access to healthcare professionals, such as their doctor when they required them.

The home environment did not promote people’s independence and dignity. The provider acknowledged in our previous inspection in January 2016 and October 2016 that work was required to improve the bathroom facilities for people, on this inspection we found this had not been completed, with no clear plan in place for when this would happen. People told us that staff treated them kindly and respected their privacy.

People did not always receive care that was responsive to their individual needs as people had to wait for staff to become available to support them. Information on how to raise complaints was provided to people, and people knew how to make a complaint if they needed to. We looked at the providers complaints over the last 12 months and found that one complaint had been received and responded to with a satisfactory outcome.

People and staff did not feel included or listened to in the way the service was run. Staff told us they did not always feel valued. There were ineffective systems in place to ensure the service was delivering good quality care. The provider did not understand their responsibilities in ensuring they were meeting the legal requirements and did not have a robust systems in place to identify areas for improvement. The providers had not been able to assure themselves they were delivering good quality care to people.

We undertook a further comprehensive inspection on 4 and 5 October 2016 which was unannounced. This was to check the provider had followed their plan and to confirm that they now met legal requirements and to review the ratings of the service. We found that the provider was now meeting the legal requirements in relation to three breaches. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (The Oaks Care Home) on our website at www.cqc.org.uk.

The Oaks Care Home provides accommodation and care for up to 13 older people. There were 13 people who were living at the home on the day of our inspection.

At the time of our inspection there was 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.

People lived in a safe environment as staff knew how to protect people from harm. We found staff recognised signs of abuse and knew how to report this. Staff made sure risk assessments were in place and took actions to minimise risks. There were sufficient staff on duty to keep people safe. People’s medicines were administered and managed in a safe way.

People and relatives felt that staff had the knowledge and skill to care for people in the right way. We found people were supported to eat a healthy balanced diet and with enough fluids to keep them healthy. People had access to healthcare professionals, such as the chiropodist and their doctor when they required them and where supported to attend hospital appointments.

People told us that staff treated them kindly, with dignity and their privacy was respected. People and relatives views and decisions they had made about their care were listened and acted upon.

People did not always receive personal care in a timely way during busier periods. The provider told us they would address this, however staff had not expressed this view to the provider for them to be able to rectify this. Staff continued to be task-led in their approach to care. We found there was very little stimulation for people who expressed their frustration of boredom with staff.

People and relatives knew how to complain and felt comfortable to do this should they feel they needed to. We looked at the providers complaints over the last nine months, since our last inspection. We found two complaints had been received, both of which had been responded to with satisfactory outcomes for the complainants.

While people and relatives felt the registered manager was approachable and listened to their concerns and made changes were they were able. We found that, while people received good healthcare, people’s social well-being was not addressed. We continued to see that the registered manager had not made changes to improve this aspect of people’s care.

At the time of our inspection there was 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.

People were not always kept safe as the provider did not have adequate checks in place to ensure the equipment used within the home was safe and fit for purpose. Lack of regular safety checks and servicing of equipment placed people at unnecessary risk of potential harm.

People did not always live in a clean and hygienic home because there was were no systems in place to ensure the cleaning that took place was effective and happened in a timely way.

People told us they felt safe. Staff recognised signs of abuse and knew how to report this. Relatives and staff told us there were enough staff to provide care and support to people. People and relatives did not raise any concerns around the management of their medicines. People’s medicines were stored and managed in a way that kept people safe.

People and relatives felt that staff had the knowledge and skill to care for people in the right way. Care and support was provided to people with their consent and agreement. Where it had been deemed that the person did not have the capacity to make decisions on their own behalf the registered manager had taken steps to ensure the Mental Capacity Act (MCA) had been followed. People were supported to eat a healthy balanced diet and were supported with enough fluids to keep them healthy. We found that people had access to healthcare professionals, such as their doctor when they required them.

People and their relatives were involved in planning their care. However, people’s views and decisions they had made about their care not always acted upon. We found that staff treated people kindly; however their dignity was not always considered. We saw that people were not always supported to continue their hobbies and interests that was individual to them.

Relatives told us that they would know how to make a complaint and felt comfortable to do this. The provider had not received any written complaints. The registered manager confirmed that verbal complaints had been received but had not been recorded. The provider was unable to demonstrate that verbal complaints had been responded to and that the complainant was satisfied with the provider’s response.

The provider was not meeting the requirements of the law. We found three breaches of regulations, in premises and equipment, dignity and respect and good governance. You can see what action we told the provider to take at the back of the full version of the report.

At the previous inspection on 10 June 2013 we identified areas of concern with infection control, medicine management and quality assurance in the home. This resulted in the provider receiving a warning notice for medicines and compliance actions. This inspection was made in order to follow up on the warning notice and compliance actions.

We found that the provider had made improvements in order to manage the risks associated with the unsafe use and management of medicines.

The provider had made improvements. The provider had used information from audits or complaints to improve the service.

We found that people lived in a clean environment and the provider had reduced the risk of the spread of infection.

The provider treated people with respect and dignity. One person told us: "They (staff) are very polite and helpful".

Appropriate standards of cleanliness and hygiene were not being maintained. This placed people at risk of getting an infection.

We found that the provider was not using information from audits or complaints to improve the service.

When we visited we found people were not receiving their medicines as prescribed. We found that appropriate arrangements were not in place to manage the risks associated with medicine management.

When we visited The Oaks we spoke with eight people who used the service. Not all of the people living there were able to speak with us due to their level of health needs. People told us that the, "Care is good", and the staff do, "The best they can".

The provider was not always respecting what was important to people regarding their care and treatment.

Appropriate standards of cleanliness and hygiene were not being maintained. This placed people at risk of acquiring an infection.

Staff told us that they had support and training to help them with their work.

Staff told us that they had knowledge of safeguarding and prevention of abuse.

We found that the provider was not using information from audits or complaints to improve the service.

We found that people did not always have the correct amounts of medicines left. We also found medicines not being stored appropriately.