Archived: Oakwood Residential Home

Oakwood Residential Home is a residential care home providing personal care and accommodation for up to 28 people. The service provides support to older people and those who may be living with dementia. At the time of our inspection there were 21 people using the service. Accommodation was spread over two floors accessible via a lift.

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

At this inspection the provider had failed to address the breaches of regulation identified at our previous inspection in August 2022. The provider had submitted an action plan following the last inspection but had failed to make or sustain improvements in these areas.

Systems to oversee the quality and safety of the service were not robust or effective throughout all levels of management. The provider did not maintain effective oversight of the service to support the manager to meet their responsibilities around providing good quality care.

Governance processes and systems had not identified all the concerns we found. Medicines were not being properly and safely managed including controlled drugs. There were omissions and errors, a lack of stock control and monitoring, lack of training and effective auditing. Systems to identify and mitigate risk were not effective. People were at increased risk of harm due to poor infection control procedures. Risks related to the premises were not safely managed, this included risks related to fire safety and Legionella.

The provider did not ensure recruitment checks were carried out in line with the regulations. People were at increased risk of being cared for by staff without the knowledge and skills to fulfil the requirements of their role. Staff did not always receive training or training updates in line with their role. There were significant numbers of staff who required or were overdue updates in key areas relevant to their role, such as medicines; mental capacity; moving and handling; fire; safeguarding adults; first aid, infection control, food hygiene; dementia; end of life care and health and safety.

People's assessments and care plans were not always accurate or complete. People's care was not always personalised. Further work was required to reduce the risk of people experiencing social isolation through personalised activities. The home environment did not reflect dementia friendly best practice to best meet people's needs.

Systems and processes to safeguard people from the risk of abuse were not effective. The provider did not always report allegations of abuse in line with safeguarding requirements. This resulted in an increased risk of harm to people. Lessons were not always learnt when incidents occurred to reduce the risk of re-occurrence.

We found the principles of the Mental Capacity Act 2005 (MCA) were not always followed, for example in relation to the use of bed rails, care and treatment and medicines. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible, and in their best interests; the policies and systems in the service did not support this practice.

People told us they felt safe. We received mixed feedback from relatives including, "Yes, just about safe. Staff go into [relative’s] room to check them minimally and don’t check regular" and "Yes [relative] is safe from what I’ve seen."

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 rating for this service was requires improvement (published 1 November 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service and in part due to concerns received about risk management and staffing. A decision was made for us to inspect and examine those risks.

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.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Oakwood Residential Home on our website at www.cqc.org.uk.

Enforcement

We have identified the provider failed to fully address the action we told them to following our last

Inspection. There were continued breaches in safe care and treatment, staffing and fit and proper persons. We have identified further breaches in relation to person centred care, dignity and respect, need for consent, safeguarding, premises and equipment, good governance and failure to notify 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

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.

Oakwood Residential Home is a residential care home providing personal care and accommodation for up to 28 people. The service provides support to older people and those who may be living with dementia. At the time of our inspection there were 23 people using the service. Accommodation was spread over two floors accessible via a lift.

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

People told us they were happy and safe living at Oakwood Residential Home. We were told by people living in the service and their relatives that they felt included, safe and well cared for. The service was clean and well maintained. However, risks related to legionella had not been fully mitigated.

Risks to individuals were assessed when they started but we found they were not always up to date and reflective of their current needs. The registered manager worked well with other health-care professionals to ensure that learning took place and necessary changes were made to continually improve. However, this was not always reflected in people’s care plans. We found that the provider had not been following their own falls procedure and there was no evidence of observations being made after a fall to monitor the person’s condition for signs of deterioration.

People were supported safely and appropriately by sufficient staff who knew people well. However, not all staff had satisfactory evidence of conduct in previous employment in health or social care, with children or vulnerable adults. Staff training was not always complete or up to date although we did not observe any evidence of poor care during the inspection.

Processes and procedures were in place to store and administer medicines safely. We were somewhat assured appropriate infection prevention and control measures were in place to protect people against the risk of COVID-19 and other infections. However, wearing of masks in line with government guidance could have been better.

The registered manager felt they were not well supported by the provider and needed more support to ensure training was up to date. The staff team told us they felt supported by the registered manager. People who used the service and staff were involved in how the service was managed. The registered manager had processes in place to monitor and improve the quality of the service people received.

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 good (published 19 May 2018).

Why we inspected

This inspection was prompted by a review of the information we held about the service.

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.

This report only covers our findings in relation to the key questions safe and well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Oakwood Residential Home on our website at www.cqc.org.uk.

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 monitor the service and will take further action if needed.

We have identified breaches in relation to managing risks to people, the risk of legionella, staff recruitment practice and training at this inspection. We found that the two areas reviewed were now rated as requires improvement.

Follow up

We have requested an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

There was a registered manager at the home. 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.

Oakwood Residential 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.

At our last inspection, we rated the service good. At this inspection, we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The provider worked in partnership with other stakeholders and was pro-active in promoting health monitoring and preventative care for people at risk of hospital admission. Staff worked with medical professionals to use tools and assessments this meant that current information about people’s needs could easily be transferred between services.

The registered manager was dedicated to their role and was a prominent presence within the home. Staff were caring and compassionate and understood the importance of treating people with dignity and respect. There were enough suitably skilled and qualified staff to meet people’s needs. The registered manager carried out robust recruitment checks and monitored staff’s performance and behaviour through observation and supervision.

Staff received training which was relevant to their role. Staff had received additional training in end of life care. This helped to ensure that people were treated empathically when receiving care at the end of their life. Staff had also received training in providing effective support around meeting the communication needs of individuals with sensory loss.

Staff understood their responsibilities in keeping people safe from abuse and harm. The registered manager had made appropriate referrals to local safeguarding authorities and had worked in partnership with them to help keep people safe.

People told us they felt safe and comfortable living at Oakwood Residential Home. They told us that there were plenty of activities to keep them occupied and staff were attentive and responsive to their needs. People told us they were involved in making decisions about their care and their independence, preferences and routines had been considered by staff when developing their care plans.

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.

The registered manager was focussed on making improvements to the home. They had worked to make the environment more homely through a series of renovations. The registered manager also used feedback from people, relatives, and other stakeholders in order to make changes to drive improvements. They were constantly assessing the quality and safety of the service through a series of audits and checks and had formulated an ongoing action plan, which identified how and when key improvements would be made.

Risks to people’s health and wellbeing were assessed, monitored and mitigated. Where people’s health and wellbeing changed, care plans and risk assessments were quickly adjusted to help ensure people were receiving the correct care interventions.

There were safe systems for ordering, storing, administering, recording and disposal of people’s medicines. Staff were aware of the support people needed around their medicines for pain or anxiety.

The home was a clean environment. There were systems and processes in place to help prevent the risk of infections spreading.

People told us they enjoyed the quality and choice given around their food and drink. People were given the appropriate level of support to meet their nutritional and hydration needs.

The home is based on two floors with an interconnecting stair lift. Some bedrooms have en-suite facilities and there is a separate bathroom and shower room. There is a large lounge, where activities are held and a dining room where most people eat their meals.

There was a registered manager in place. 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 of the Health and Social Care Act 2008 and associated regulations about how the service is run.

At our previous inspection, on 24 and 27 March 2015, we identified that infection control risks were not being managed safely. We issued a requirement notice and the provider sent us an action plan detailing how they would meet the regulation. At this inspection we found action had been taken and improvements had been made.

The laundry room had been extended and a clear process was in place to reduce the risk of cross contamination. The home was clean and staff followed appropriate infection control practices.

People told us they felt safe at the home. Staff knew how to identify, prevent and report abuse, and the provider responded appropriately to allegations of abuse. Clear systems were in place for managing medicines and people received their medicines when they needed them.

Most risks to people were managed safely, although the risks of one person smoking had not been documented. People were supported to take risks that helped them retain their independence and avoid unnecessary restrictions.

The process used to recruit staff helped make sure that only suitable staff were employed. There were enough staff to meet people’s needs at all times. Staff were suitably trained, were supported appropriately in their work and felt valued.

Staff followed legislation designed to protect people’s rights and liberties. They sought verbal consent from people before providing care and acted in their best interests.

People liked the food and were able to make choices about what they ate. They received appropriate support to eat and drink enough. Appropriate action was taken if people started to lose weight and they were able to access healthcare services when needed.

People were cared for with kindness and consideration. Staff knew people well and build positive relationships with them. People’s privacy and dignity were protected at all times and they were involved in planning their care.

Staff encouraged people to remain as independent as possible and empowered them to make choices about all aspects of their lives. Care plans provided detailed information about how people wished to receive care and support. Staff were responsive to changes in people’s needs and this was reflected in people’s care plans. A range of activities was provided based on people’s individual interests.

The registered manager sought and acted on feedback from people and their families. A suitable complaint procedure was in place and complaints were dealt with promptly.

There was a clear management structure in place and management were supportive of staff. Staff enjoyed working at the home and worked well as a team. There was an open and transparent culture. Staff welcomed visitors and had formed good working relationships with external professionals.

Key aspects of the service were audited regularly to help ensure the service ran well. Where improvements were identified, these were implemented promptly. An effective system was in place to analyse incidents and accidents and learn lessons from them.

At the following inspection on 23 and January 2014, we identified the provider was not meeting the requirements of four regulations. We issued warning notices and told the provider to make improvements.

At this inspection, on 24, 25 and 26 June 2014, we found the provider had made improvements but was not meeting the requirements of the regulations.

We considered the evidence we had gathered under the outcomes we inspected. We spoke with nine people who used the service, five family members of people who we were unable to communicate with us due to their mental frailty, seven members of staff, the registered manager and a community healthcare professional. We also looked at 10 care plans and records relating to the management of the service.

We looked at outcomes relating to 11 regulations. We were accompanied by a specialist advisor, a pharmacy inspector and an expert by experience who had experience of people with dementia.

We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

This is a summary of what we found:

Is the service safe?

We found the service was not safe because people were not protected against the risks associated with medicines. Staff had received training in infection control and appropriate guidance was followed. However, not all people were cared for in a clean environment.

Some areas of the home were in need of decoration and laminate flooring in some communal areas was badly worn. There was a lack of handrails in some communal areas and access to the garden was not safe.

There were not enough qualified, skilled and experienced staff to meet people’s needs. People told us this meant they were sometimes not able to go out on trips or did not always receive certain treatments as frequently as they required.

Arrangements to safeguard people’s property were not effective and there were no arrangements in place to account for the use or disposal of alcohol brought in for people, to ensure it did not go missing. People were, therefore not protected from the risk of abuse.

The provider had a system in place to identify, assess and manage risks to people using the service. However, we found the risks associated with a person who smoked had not been assessed. This put them and others at risk.

Recruitment practices were safe, and pre-employment checks were conducted as required in most cases. There were arrangements in place to deal with foreseeable emergencies. Fire evacuation plans were in place and understood by staff.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The service had policies and procedures in place in relation to DoLS. One person was subject of a DoLS authorisation and we saw they were receiving appropriate monitoring and support.

Is the service effective?

The service was not effective as care plans had not been developed in relation to people’s continence. People’s hydration needs were not monitored effectively. It was, therefore, not possible for staff to easily identify whether people had received sufficient fluids each day.

Staff demonstrated a good understanding of people, including their likes and dislikes. However, we found staff were not aware of key information about the health of three people. Their lack of awareness meant they may not be able to provide safe and appropriate care to these people.

We saw nutrition plans had been completed for each person. These provided catering staff with information about people’s dietary needs and preferences.

Is the service caring?

We found care staff were caring and showed compassion. 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 with us. We observed positive interactions between people and staff.

People told us they were able to make choices. For example, when they got up, how they spent their day and what activities they took part in. A choice of meals was available each day and people said they could request alternatives if they didn’t like the menu of the day.

We noted the care plan for one person specified their preference for a male care worker. We found only female care staff were employed during the day which meant this preference could not be met.

People’s privacy and dignity was promoted, but was not always respected. We observed staff sometimes knocked before entering people’s bedrooms. However, on two occasions we found staff entered people’s bedrooms without knocking.

Is the service responsive?

We found the service was not always responsive to people’s needs. For example, the care plans for five people stated they lacked mental capacity to make decisions. However, there were no records to show how this related to specific decisions. In two cases we saw consent forms had been signed by relatives to give themselves, or other relatives, permission to access people’s records. This did not comply with relevant legislation.

We found staff lacked knowledge of the Mental Capacity Act, 2005 (MCA) and how to make decisions in people’s best interests. Most staff had not received training in MCA, although we saw this was planned.

People were given appropriate information and support regarding their care or treatment. We saw ‘service user guides’ had been prepared and were available in people’s rooms.

The provider used survey questionnaires to seek people’s views about the service. We looked at the results from the most recent survey, conducted in March 2014. We found they had been analysed and action taken to address concerns. Minutes of residents’ meetings showed they provided additional opportunities for people to express their views.

Is the service well-led?

We found not all aspects of the service were well-led. The provider had recently introduced a system of audits to monitor the quality of service provided. However, the system had not had time to become embedded in practice and was not yet working effectively. For example, records confirmed that care plans had been audited monthly, but it was not clear what issues these had identified or what changes had been made.

The provider had not completed an audit of infection control and had not identified the infection control concerns we found during the inspection. Medication audits had also not identified concerns we found during the inspection. Therefore, the audits were not robust.

The provider did not always take account of complaints and comments to improve the service. Family members told us verbal concerns were not always resolved effectively. We found there was no system in place to analyse complaints and identify learning from them.

Records showed most staff had not completed training in dementia or MCA. This meant they may not have the knowledge required to care for people with dementia appropriately.

During this inspection we used a variety of methods to help us understand the experience of people using the service. We spoke with eight people, three family members, three external healthcare professionals and observed care and support being delivered. We also 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 with us.

During our SOFI we saw staff interacting positively with people in the lounge. We heard staff using people’s preferred names and speaking with them in a calm and respectful way. Some people told us their needs were met and they were satisfied with the care and support they received. One person said, “They look after me pretty good”. One family member said the care had improved recently and that their relative was “so much better now”. However, two other family members told us they had concerns about the standard of cleanliness at the home and said their relative’s health care needs were not always met.

We looked at 15 care plans and associated records and saw a new format had been developed. However, we found the risks of people falling were not managed effectively and care plans did not contain adequate information about how people’s complex needs would be met. There were inadequate arrangements in place for the provision of meaningful activities or mental stimulation.

We looked at records of safeguarding training which showed all staff had received refresher training. Staff we spoke with knew how to identify and report abuse. However, the service had not complied with a condition attached to an authorisation for deprivation of liberty safeguards (DoLS) in respect of one person. People were not protected from the risk of abuse by other people using the service who posed a risk to them.

The provider had not taken the steps necessary to meet the requirements of the code of practice on the prevention and control of infections. Personal protective equipment, soap and disposable towels were not available in key places, so staff could not follow the home’s procedures.

We looked at 10 bedrooms and found six were not clean. Three bedrooms smelt of urine; three beds were stained with dried urine; and six bedroom carpets were badly stained with dark patches of an unidentified substance. Laundry policies and procedures had not been developed to minimise the risk of cross contamination within the laundry room and staff could not access the hand washing sink.

We looked at a sample of 12 medication administration record (MAR) charts. The arrangements for obtaining medicines were not robust. Appropriate arrangements were not in place to ensure people were able to self-administer inhalers safety. There were inadequate arrangements in place to ensure people received their “as required” medicines safely and consistently.

We served three Warning Notices on the provider and registered manager in relation to continued non-compliance with regulations regarding the care and welfare of people who use services, cleanliness and infection control and the management of medicines.

We also set compliance actions regarding the safety and suitability of premises, safeguarding people who use services from abuse, requirements relating to workers and assessing and monitoring the quality of service provision.

We conducted a further inspection on the 11, 16 and 19 September 2013 to check the registered persons had taken the appropriate action to meet the requirements. During the inspection we also looked at essential standards relating to staffing and the maintenance of records.

We found improvements had been made to the laundry and a new sluice facility had been created. However, we found none of the essential standards we inspected were being met.

There were inadequate arrangements in place for the safe handling of people’s medicines. Care plans and risk assessments did not reflect the current needs of people, which put them at risk of receiving inadequate care. The care plans had not been reviewed although the needs of people had changed and this may impact on the care they received.

People were not provided with a safe environment to live in. The checks on essential safety equipment had not been carried out. There were inadequate bathing facilities to meet people’s needs. We found the hot water delivery in people’s bedrooms were unsafe and put them at risk of harm.

The recruitment process and staff training were not robust to ensure staff were fit for the job. The staffing levels were decreased at the weekends that may put people at risk of not receiving the care and support they need.

There were some audits being carried out. However these were not robust and did not look at adverse incidents and develop strategies in order to minimise or eliminate risks. There was no action plan developed to show how shortfalls identified through surveys and audits would be addressed.

The management of records was poor and the records for the safe management of the service were not adequately maintained. This puts people at risk to their welfare and safety.

The care plans and records of care were variable and did not always reflect the current needs of people. We found medicines management was not robust and put people at risk of not receiving their medications safely.

The infection control process did not ensure the risk and spread of infection was adequately managed. People were not provided with adequate facilities to meet all their needs. The recruitment process was not followed to ensure all necessary staff checks were completed. The supervision and support for the staff was not embedded in practice ensuring their practices were monitored.

There was a process to assess the quality of the service provision, however this was not robust and not carried out effectively. The health and safety practices and checks were not adequate. The system to assess the health and safety risk and the environment was lacking and may impact on people.

The service took steps to ensure people were involved in decisions about their care and support. People’s diversity, values and rights were respected. A member of staff told us that their approach was to “care for people with compassion and respect, and they feel cherished”.

We reviewed care plans, and found issues with completeness and lack of personal information. Plans did not ensure or evidence that everybody’s care and welfare needs were fully met. However, the provider was taking steps to address this and support was observed to be respectful and responsive to people's basic needs.

There were effective procedures and systems in place for the management of medication.

The service had problems maintaining its staffing level. The provider was taking action to address the situation, but at the time of inspection it had yet to be resolved. When the service was understaffed people had to wait longer for support to get up in the morning, and it took longer for staff to respond to call bells.

People were listened to and their comments and complaints were responded to appropriately.