Archived: Red Oaks Care Community

Red Oaks Care Community is a care home providing personal and nursing care to 21 people aged 65 and over at the time of the inspection, including those living with dementia. The service can support up to 40 people. Red Oaks Care Community is purpose built. It is split over two floors with communal areas on each floor.

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

During this inspection we did not speak directly with people at the service due to the increased risks associated with the COVID-19 pandemic. People appeared relaxed and had a good rapport with staff.

We identified gaps in the Medicines Administration Record (MAR) which were not reported and investigated promptly. We recommend the provider makes further improvements about management of medicines. Peoples care records were generally up to date and relevant.

The provider had reviewed and updated their Infection Prevention and Control (IPC) procedure to reflect national COVID-19 guidance. The home was clean and appropriate checks were in place for people visiting the service.

Quality assurance processes were in place to ensure improvements were made. Issues identified during our last inspection had been actioned and rectified to ensure people were no longer at risk of fire or risk of scalding from a hot water outlet.

The provider had reviewed and updated their dependency tool to ensure people’s need were correctly assessed and to deploy sufficient numbers of staff to meet people’s needs. Staff told us they felt supported by the new manager and we could see evidence of staff morale improving. Staff were keen to drive the improvement and make positive changes to the service.

The provider and the manager demonstrated a willingness to make further improvements and had implemented service improvement plans to evidence how they were committed to improve the running of the service.

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 16 October 2020), there were four breaches of regulation. We issued the provider with a Warning Notice and asked the provider to complete an action plan to show what they would do to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations however we have made some recommendations.

Why we inspected

We undertook this focused inspection to check whether the Warning Notice we previously served in relation to Regulation 12 (Safe Care and Treatment) and 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. We also checked whether the provider had followed their action plan and to confirm they now met legal requirements regarding Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 Registration Regulations 2009 Notifications.

This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has not changed. This is based on the findings at this inspection.

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 coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Red Oaks Care Community on our website at www.cqc.org

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.

Red Oaks Care Community is a care home providing personal and nursing care to 23 people aged 65 and over at the time of the inspection, including those living with dementia. The service can support up to 40 people. Red Oaks Care Community is purpose built. It is split over two floors with communal areas on each floor.

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

People were at risk of avoidable harm because their individual risks were not always recorded accurately, regularly monitored, or well managed.

Risks associated with the environment had not always been safely managed.

People were not always protected from the risk of avoidable harm or abuse because the systems and processes in place to safeguard people were not always effective. Lessons had not been learnt when things went wrong.

There was no registered manager in post and there was ineffective oversight of the service by the provider. Management of the service had been inconsistent and the provider’s governance processes were not effective. Quality assurance systems and processes failed to identify concerns relating to safe care. Where issues had been identified the service did not act in a timely manner to address them.

Medicines were not always managed safely. We could not be sure people always received their medicines as prescribed. The provider’s medicines audit system was not effective.

There were not always enough staff to give people the care and support they needed. The provider had not always staffed the service in-line with people's assessed dependency levels.

Infection prevention and control procedures did not always follow Government guidance and requirements. People were not always supported to maintain social distancing and the provider did not always follow guidance regarding safe admissions from hospital.

The provider’s quality audits were ineffective. They had not identified the issues we found during the inspection; including health and safety issues and staffing levels.

Staff said they felt able to approach the manager with any comments or concerns. They felt morale at the home was improving. Relatives felt their loved ones receive good care.

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 19 July 2019) and there were multiple breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been made and the provider was still in breach of regulations. This service has been rated requires improvement for the last three consecutive inspections. We will arrange to meet with the provider to discuss how they will make the improvements to the service.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 22 and 23 May 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve good governance and staffing.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions; Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions, not looked at on this occasion, were used in calculating the overall rating at this inspection. The overall rating for the service remains 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 Red Oaks Care Community on our website at www.cqc.org.uk.

We found evidence that the provider needs to make improvements. Please see the safe 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 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 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 the safety of the care people receive, staffing and the governance arrangements the provider has in place to monitor the safety and effectiveness of this service.

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 with the 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.

People’s experience of using this service: People did not always receive effective care that was personalised to their needs. There was not always guidance to make sure they received the right support with medicines.

Although some clinical training for nurses has improved, staff had not been provided with training in some specific needs of people, including support with distressed behaviours.

The service was not always following the principles of the Mental Capacity Act 2005. There was contradictory information about who could support people to make decisions where they lacked capacity.

The provider’s quality assurance checks had not been effective in highlighting the gaps in medicines, personalised support and record keeping.

Most people and relatives felt staff were kind and friendly. People were treated with respect. People being nursed in bed were provided with some one-to-one support to prevent social isolation. There was a range of activities for people to join in if they chose.

People were supported to use local health services and a visiting healthcare professional said there was good communication with the home.

The provider had encouraged people and relatives to give their views. Monthly meetings were being arranged for people and their relatives. A complaints policy was in place although recent complaints and actions taken had not been recorded.

Staff said they felt able to approach the manager with any comments or concerns. They felt morale at the home was improving. The manager held daily morning meetings with senior staff from all departments.

Relatives felt that there had been some improvements since the new manager took up post. They felt there was a more consistent staff team and communication had improved.

Rating at last inspection: Requires Improvement (report published in November 2016).

Why we inspected: This was a planned inspection to assess what improvements had been made by the registered provider.

Enforcement: We have identified continued breaches in relation to staffing and good governance. Please see the action we have told the provider to take at the end of this report.

Follow up: We asked the provider to submit to the Commission an action plan to show how they will make changes to ensure the rating of the service improves to at least Good. We will monitor the progress of the improvements, working alongside the provider and local authority. We will return to visit as per our re-inspection programme.

Red Oaks Care Community provides accommodation, nursing and personal care for up to 40 older people and younger adults. The service provided care to people living with a range of physical and mental health conditions, including some people living with dementia and acquired brain injury from accidents or stroke. At our last inspection in December 2016 the service was rated as Good.

We carried out this inspection on the 22 and 26 February 2018. At the time of our inspection there were 33 people living at the service. This included 29 people who received nursing care.

There was a registered manager at the time of 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run. Since our inspection the provider has informed us the registered manager has now left the service and a new manager has been appointed.

People’s safety from risks associated with their health conditions or some equipment used for their care was not always consistently ensured. Related care and safety improvements were either, made or in progress following recent local authority safeguarding investigations concerned with people’s care at the service.

Overall people and relatives felt people were now safe at the service. People and their relatives knew how to raise any concerns they may have about people’s safety but sometimes experienced delays before these were dealt with by the provider.

Staff knew how to recognise and report suspected harm or abuse of any person receiving care. Revised care incident reporting measures were recently introduced, which staff now understood. This helped to protect people from the risk of harm of abuse.

The provider had not always ensured sufficient or timely staff planning and deployment arrangements to meet people’s changing needs. Recently revised staffing arrangements and additional staff recruitment helped to reduce any risk to people from insufficient staffing.

The provider followed required staff employment and nurse professional registration checks. This helped to ensure staff were safe to provider people’s care

Improvements were made to ensure people’s medicines were safely managed. However, the provider was not proactive to ensure this until relevant external authorities concerned with people’s care had asked them to.

The service was clean and well maintained. The provider’s arrangements for cleanliness, infection prevention and control helped to protect people from the risk of acquired health infection. Staff were not always provided with relevant safety equipment relating to people’s care in a timely manner.

People were able to move around the home safely and independently with sufficient space and relevant equipment to enable them to do so.

Staff were not always trained, informed or supported to ensure people always received effective and consistent care.

People were not always supported to maintain their health in a timely or consistent manner. Related records were not always accurately maintained to help ensure this. Management improvements to rectify this were was not yet fully completed or shown to be maintained.

People were supported to have the required type and consistency of food and drinks they enjoyed.

People’s care plans showed how their consent or appropriate authorisation was obtained for their care. Best interests’ decisions were made for people’s care when required, but not always accurately recorded. We recommended the provider seeks further support and training to ensure this.

Staff did not always ensure people’s dignity, comfort, choice and independence in their care. Staff usually ensured people’s privacy when required.

People and relatives were involved in agreeing some aspects of people’s individual care but not actively consulted in relation to service planning for home life or informed to access independent advocacy services if they needed to. Friends and family were made welcome and free to visit people at the times people chose.

Environmental adaptations often promoted people’s independence and orientation but service information was not always accessible to people in a format they could easily understand. We recommend the provider reviews their service information against nationally recognised information standards for people who may benefit from this

People did not always receive individualised, timely care from staff in a way that was meaningful to them. People’s views about their care, daily living and lifestyle arrangements were not regularly sought or acted to ensure this met with their needs and choices.

People and relatives were informed and knew how to make a complaint if they needed to. Some experienced delays before their concerns were acted on and resolved. Complaints records were not effectively monitored or accurately maintained to consistently show how their resolution was achieved.

The provider’s systems and arrangements to check the quality and safety of people’s care and to consistently drive and ensure service improvements when required were not effective. This meant people were not always protected from risks associated with the ineffective monitoring and evaluation of the service.

The provider had displayed their most recent inspection rating and related report summary as required. The provider had sent us written notifications informing us of important events when they occurred at the service. We are liaising with the provider following information received after our inspection that the registered manager no longer works at the service.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report.

This is the first time where we have rated the service as ‘Requires Improvement.’

Accommodation for up to 40 people is provided in the service over two floors. The service is designed to meet the needs of older people living with or without dementia. There were 33 people using the service at the time of our inspection. This location was registered for this provider by the CQC in April 2016.

A registered manager was in post but she was on extended leave. An acting manager was in place and was available throughout the 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.

Staff knew how to keep people safe and understood their responsibilities to protect people from the risk of abuse. Risks were generally well managed so that people were protected from avoidable harm and not unnecessarily restricted.

Sufficient staff were on duty to meet people’s needs and staff were recruited through safe recruitment practices. Medicines were safely managed.

Staff received appropriate induction, training and supervision. People’s rights were protected under the Mental Capacity Act 2005. People received sufficient to eat and drink.

External professionals were involved in people’s care as appropriate. The environment had been adapted to support people living with dementia.

Staff were kind and knew people well. People and their relatives were involved in decisions about their care. Advocacy information was made available to people.

People received care that respected their privacy and dignity and promoted their independence.

People received personalised care that was responsive to their needs. Care records contained information to support staff to meet people’s individual needs, though care plans could be further improved.

A complaints process was in place and staff knew how to respond to complaints.

People and their relatives were involved or had opportunities to be involved in the development of the service. Staff told us they would be confident in raising any concerns with the management team and that appropriate action would be taken.

The provider was meeting their regulatory responsibilities. There were effective systems in place to monitor and improve the quality of the service provided.