The Care Quality Commission (CQC) has rated The Oaks in south east London inadequate and placed it in special measures to protect people following an inspection in September and October.
The Oaks, run by The Oaks (Spring) Limited, is a residential care home providing personal and nursing care for up to 113 people, some living with dementia and some with additional mental health needs. This was the first time the service had been rated since this new provider took over the service.
This unannounced inspection was prompted due to concerns CQC received about safe care and treatment as well as the management of medicines and person-centred care.
Following this inspection, the service has been rated inadequate overall. It has also been rated inadequate for being safe and well-led. It has been rated as requires improvement for being caring, effective and responsive.
The service is now in special measures, which means it will be kept under close review by CQC to keep people safe and it will be monitored to check sufficient improvements have been made. CQC has also taken additional enforcement action, which will be reported on when legally able to do so.
Antoinette Smith, CQC deputy director of operations in London, said:
“When we visited The Oaks, it was worrying to find that the provider didn’t always make sure people could get help when they needed it. For example, we saw that many people's call bells were too far away to use and care plans contained confusing information about whether people were even able to use them to get help. During our inspection we noticed that some staff ignored the call bells which is unacceptable.
“Care plans also didn’t have enough detail for staff to keep people safe in other areas. For example, they didn’t contain information about whether people needed support to eat and drink, and we saw this put people at risk of dehydration on this inspection. Also, people weren’t receiving their medications as proscribed.
“It was concerning that although The Oaks is supposed to be providing specialist dementia care and mental health care to people, the building wasn’t fit for this purpose, and staff didn’t have the appropriate training. They also didn’t always meaningfully engage with people who needed special one-on-one support respectfully or treat them with dignity.
“The building didn't meet the needs of people with dementia as it hadn’t been adapted to their specific needs, making it difficult for people to get around and affecting their independence. There were also maintenance issues; a door with exposed broken glass was first reported by staff in March this year and again in May, but leaders had done nothing to fix it and it remained broken when we inspected in the autumn.
“We have taken enforcement action against the provider to focus their attention on the areas where we want to see significant improvements. In the meantime, we’ll continue to monitor the service closely to ensure people are safe whilst improvements are made and won’t hesitate to take further action if we’re not assured people are receiving safe and dignified care.”
Inspectors also found:
- Mealtimes weren't relaxing and enjoyable. Food choices were shown in a way which didn't always make it easy for people with memory issues to have control and make choices
- Care plans didn't have enough details about people's personal history, their interests, or what they enjoy doing
- People weren't always given enough activities to keep them interested
- There were cupboards containing dangerous cleaning products that were left unlocked and unattended. This could put people at risk of getting hurt
- There was a lack of effective leadership and there was not a registered manager in place at the time of this inspection.
However:
- The provider ensured there were enough staff to support people in the service, especially for people that required one-on-one support due to distressed behaviours
- Staff were positive about the culture of the organisation in general and they were happy with the support received from senior managers.
The report will be published on CQC’s website in the next few days.