Tall Oaks Care Home

Updated 1 February 2024

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

The inspection was carried out by 1 inspector.

Service and service type

Tall Oaks Care Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Tall Oaks Care Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 3 people who used the service and 10 relatives. We spoke with 6 staff, including care staff, nurses, a regional support manager and registered manager. We made observations in communal area to find out people’s experience of care. We also contacted an external professional after their details were shared with us by the home.

We reviewed 6 people’s care plans and care records and multiple medicine records. We reviewed 3 staff files to check they were safely recruited and checked agency staff had profiles in place. We looked at management records, such as audits, policies and procedures and building safety records.

Updated 1 February 2024

About the service

Tall Oaks Care Home is a care home providing personal and nursing care to up to 55 people. The home was split between two floors, each with their own communal facilities, although downstairs had a larger space. The service provides support to older people who may be living with dementia or have a physical disability. At the time of our inspection there were 36 people using the service.

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

Risks to people’s health and wellbeing had not always been fully assessed and planned for. As there were a number of agency staff it was important they had access to the correct and current guidance about how to support people. There were also gaps in the recording of support some people were given so we could not be sure they were always receiving this support. Improvements were needed to the management of medicines, but the registered manager was already working on this. Systems in place to monitor the quality and safety of care had not always been effective, although the registered manager had also started putting better systems in place to improve this.

There was mixed feedback about staffing levels, and it was noted relatives and staff felt support was better when more permanent staff were working instead of agency staff. There was missing information in some staff recruitment files, although appropriate checks had been made to see what, if any, criminal convictions staff had. We were somewhat assured that the provider was using PPE effectively and safely. However, the home was clean and tidy and people and relatives told us they always thought it was without malodours. Lessons had not always been learned when things had gone wrong, but the registered manager was already taking steps to address this. There were no restrictions on visiting. People were protected from the risk of abuse by staff who understood their responsibilities and appropriate safeguarding referrals had been made.

The registered manager and management team were working hard to recruit more permanent staff. Relatives and staff felt able to go to the registered manager, if they needed to, despite the registered manager not working there permanently for very long. Staff told us they felt supported. The registered manager was aware of their duty of candour. The service worked in partnership with other organisations and professionals.

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.

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 (published 28 September 2022). The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service. The inspection was also prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of supporting people appropriately with their health conditions. This inspection examined those risks.

As a result, we undertook a focused inspection to review the key questions of safe and well-led only. 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 remained requires improvement 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 inspection reports and timeline’ link for Tall Oaks Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to ensuring people received safe care and treatment, systems in place to monitor the safety and quality of care not always being effective and staff competency at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

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.