Archived: Oaks Court House

Oaks court house is a care home providing personal care to for up to 41 older people. People have access to their own bedroom along with communal spaces including lounges and gardens. At the time of our inspection there were 35 people at the home, some who are living with dementia.

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

When incident’s and accidents had occurred, action had not been taken to reduce the risk of reoccurrence, placing people at risk of significant harm as these incidents continued to occur. Risks to people were not managed in a safe way and action was not taken to ensure people’s safety. Safeguarding incidents had not been appropriately reported or investigated placing people at risk of harm. People did not receive their medicines as prescribed and there was a lack of guidance in place for ‘as required’ medicines meaning people may not have these when needed. There were no evidence lessons were being learnt when things went wrong.

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.

There were concerns with the environment, the kitchen was unhygienic and other areas of the home were in need of repair. There were concerns with the risk of cross infection as staff were not always wearing masks correctly.

People did not always have access to health professionals and when advice had been sought this had not always been followed. There were not enough suitably trained staff to support people. Staff had not always received up to date training or some had not received training at all.

People were not involved with their care or were not always able to make choices throughout their day. There was no evidence to show how they were involved with this. Care plans and risk assessments were not always in place and staff did not have information to support people in a safe way. People’s preferences were not always considered. People were not treated in a dignified way.

The systems in place had failed to identify concerns or areas of improvement. The lack of oversight in the home placed people at risk of harm.

We saw some nice interactions between people and staff. There was a complaints procedure in place that was followed when needed.

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 (4 September 2021)

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

The inspection was prompted in part due to concerns received about the care people received. 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 Oaks court house on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment of people including medicines management, staffing levels and staff training, the home’s environment, the lack of dignity provided to people, how people are safeguarded, how people are involved with their care and how the home is governed at this inspection.

We issued a Notice of Proposal to vary a condition on the providers registration and remove the location Oaks Court House.

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.

Oaks Court House is a residential care home providing personal care to 28 people aged 65 and over at the time of the inspection. Some of the people at Oaks Court were living with dementia. The service can support up to 41 people.

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

People were not always safe as the infection prevention and control procedures were not effectively implemented. The provider did not have effective systems in place to identify environmental issues which could put people at the risk of harm. The physical environment did not support the needs of people living with dementia or those with sensory needs.

People were not always treated in a respectful or dignified way. People were not always provided with information in a way they could understand. The provider did not have effective systems in place to identify and drive good and safe care provision.

People received their medicines as prescribed. Staff understood how to protect people from the risk of abuse and knew what to do if they suspected something was wrong. 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

People were protected from the risks abuse as the staff team had been trained to recognise potential signs of abuse and understood what to do to if they suspected wrongdoing. The provider had assessed the risks associated with people’s personal care. Staff members were knowledgeable about these risks and knew what to do to minimise the potential for harm to people.

People received safe support with their medicines by staff members who had been trained and assessed as competent. The provider had systems in place to complete an investigation, should a medicine error occur, to ensure the person was safe and lessons were learnt to minimise the risk of reoccurrence.

The provider supported staff through training and one-to-one supervision. People were supported to have enough to eat and drink and maintain wellbeing. People were referred to additional healthcare professionals when required.

The provider had systems in place to encourage and respond to feedback from people or those close to them. The provider and management team had good links with the local communities within which people lived. The provider had made appropriate notifications to the CQC when required.

The provider, and management team, had good links with the local communities within which people lived.

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 30 September 2020). The service remains rated requires improvement. This service has been rated requires improvement or inadequate for the last four consecutive inspections. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

The inspection was prompted in part due to concerns received about keeping people safe. A decision was made for us to inspect and examine those risks

We have found evidence the provider needs to make improvements in all the key questions we inspected.

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

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.

We found evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Oaks Court House 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 discharge our regulatory enforcement functions required 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 keeping people safe, treating people with dignity and how the service was managed.

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.

Oaks Court House is a residential care home providing personal care to 22 people aged 65 and over at the time of the inspection. Some of the people at Oaks Court are living with dementia. The service can support up to 41 people.

The home accommodates people across three floors. A passenger lift provides access to the first and second floor. At the time of the inspection the second floor of the home was unoccupied.

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

People’s experience of care had improved since the last inspection. Information relating to people’s individual care needs was personalised and offered staff guidance on how to meet their needs. Further improvements were required to ensure risks to people’s health and safety were assessed and clearly documented to reduce the risk of avoidable harm. Improvements were required to documentation within staff recruitment files, to ensure staff were safe to work with vulnerable people. Procedures relating to infection control were in place but were not always well established. People received their medicines as prescribed.

Improvements were still required to the oversight and governance of the home. While improvements had been made since the last inspection further work was required to establish effective auditing and governance systems to ensure people received safe effective care. People and staff reported positive changes at the home and feedback about the new management team was also positive. The manager and nominated individual told us they had focused on improving areas where people were most at risk and would now begin to develop robust systems used to monitor quality and drive improvement.

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 inadequate (published 1 May 2020) and there were multiple breaches of regulation.

Following our last inspection we imposed a condition on the provider's registration to restrict new admissions to the home. We were mindful of the impact of 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 closely monitored the service to keep people safe and to hold the provider to account. 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 improvements had been made in some areas, however in other areas further improvements were still required and the provider was still in breach of one regulation.

This service has been in Special Measures since 1 May 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out a comprehensive inspection of this service on 4 March 2020. 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 safe care and treatment, good governance, dignity and respect, consent and person-centred care.

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 requirements relating to safe care and treatment, dignity and respect and good governance.

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 changed from inadequate 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 Oaks Court House on our website at www.cqc.org.uk.

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.

Enforcement

We have identified a continued breach in relation to good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Oaks Court House is a residential care home and was providing personal care to 27 people aged 65 and over at the time of the inspection. The service can support up to 41 people.

Oaks Court House is located within a residential area. Accommodation is provided over three floors with passenger lift access to the first and second floors.

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

The provider had not made all the improvements we identified at our previous inspection. The provider’s quality assurance systems did not protect the safety of people or improve the quality of the service. Management did not fully understand the impact of risk to people and had not notified us of all incidents which had happened at the home, as required by law.

People had been placed at significant risk of harm. The provider had failed to ensure people were protected against the risk of fire. After our inspection we liaised with the fire service to address this and the provider took immediate action to reduce the risk of harm to people.

The management of risk to people’s health and welfare was poor and the measures in place did not fully reduce these risks. The provider had failed to ensure adequate infection control practices were followed, which placed people at risk of cross infection. Staff struggled to meet people’s needs in a timely way during busier times of the day. Accidents and incidents were not monitored to ensure the risk of reoccurrence could be reduced and lessons learnt where needed. The provider needed to improve their recruitment process in regards to how staff employment information was recorded.

The assessment of people's care needs and the delivery of their care was not fully in line with national standards, guidance and the law to ensure their needs were met effectively. Staff received the training they needed to support people, but this was not always put into practice to ensure people were supported safely.

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.

Staff did not always demonstrate respect towards people. However, people and relatives commented positively about the caring nature of staff towards them.

People's care was not planned around them as an individual and did not reflect how their health and medical needs affected them. Further improvement was needed to ensure people's equality, diversity and human rights were fully represented in care plans. People had not been given the opportunity to discuss and plan for what they wanted to happen at the end of their lives.

People's communication needs were recorded, but improvement was needed to ensure people’s accessible information needs were met. The provider had a complaints process in place and concerns were addressed.

People were supported to have enough to eat and drink, access healthcare where needed and other health and social care services.

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 16 September 2019).

Why we inspected

The inspection was prompted in part due to concerns received about the management of falls and incidents and by a specific incident, following which a person using the service died. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of risk throughout the home.

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, person-centred care, dignity and respect, gaining consent, governance and failing to notify us of incidents at this inspection.

Following our inspection we imposed a condition on the provider's registration to restrict new admissions to the home.

We are mindful of the impact of 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 closely monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.

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.

Oaks Court House is a residential care home providing personal care for up to 41 older people, due to their frailty, health condition, restricted mobility or mental health needs. At the time of the inspection there were 29 people living at the home.

The building was designed as a care home and accommodation was over three floors. The home was not unitised, and most people used communal facilities on the ground floor, although there were smaller communal rooms on all floors.

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

Quality monitoring systems were in place, although these had not been consistently effective. For example some areas of recruitment practice needed improvement, and the environment needed to be improved so there was a better environment for the needs of people living with dementia.

People said they were happy living at Oaks Court and they were positive about the care and support they received from staff. They told us they usually received support from staff in a timely way and were not kept waiting for assistance. We saw staff usually responded to people’s needs and knew their preferences were known and respected by staff, although there were some occasions where people had to wait at times when staff were busy providing care to other people.

People looked comfortable in the presence of staff and people told us they felt safe at the home. Staff were knowledgeable about potential risks to people and were able to tell us how these would be minimised. People said staff were well trained although we did see skills in responding to people who may exhibit behaviour of concern could be improved. The lack of staff training in this area and the need to develop clear positive behaviour plans was agreed by the provider as an area where improvement was needed.

People’s care plans reflected people’s individual needs and preferences. Staff were knowledgeable about people’s needs and preferences and the staff fostered good relationships with the people. People said staff were kind and caring and staff respected people and promoted their privacy, dignity and independence.

People received effective person-centred care and support at the point this was provided and based on their individual needs and preferences. Staff were knowledgeable about people’s needs and preferences and the staff fostered good relationships with the people. There were missed views from people about the activities available to them, although the registered manager had recognised the need to develop these with recruitment of an additional activity co-ordinator, which was in progress at the time of inspection.

Staff understood their role, felt confident and well supported. Staff received supervision and felt well supported by the provider. People's health was supported as staff worked with other health care providers to ensure their health needs were met. 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.

People and their representatives knew how to complain although most people we spoke with said they had no complaints. People were able to communicate how they felt to staff, and said staff were approachable and listened to what they had to say.

People, relatives and staff gave an overall positive picture as to the quality of care people received and said management and staff were approachable.

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 31/12/2016).

Why we inspected

The inspection was a planned scheduled inspection based on the previous rating.

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.

Oaks Court House is registered to provide accommodation and personal care for up to 41 older people, some of whom have dementia. On the day of the inspection there were 23 people living at the home. There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Relatives told us their family members were safe. People appeared comfortable in the presence of staff and staff knew how to protect people from the risk of harm. Staff supported people to manage their risks. There were staff available throughout the home to respond to people when needed. The provider had safe recruitment systems in place which ensured appropriate staff were employed to support people. People received their medicines as prescribed and had access to pain relieving medicines when required.

People were supported by staff who had the skills and knowledge required to meet their needs. Staff received training relevant to their role and were supported by the senior staff and registered manager. People were asked for their consent before care was provided and the registered manager had assessed people’s capacity to make decisions as required by law. People were happy with the food and drink provided and people were supported to access healthcare professionals when required.

People had developed positive relationships with staff and told us staff were friendly and kind. People were involved in making decisions about their care and support. We observed some occasions where staff missed opportunities to engage more with people and encourage or promote their independence. People were supported in a way that upheld their dignity.

People had not always been involved in the planning of their care due to their capacity to make decisions. However, we saw relatives and other professionals had been involved and had been asked to contribute to support and care planning. A programme of activities was available that was relevant to some people’s interests and pastimes, although some people told us they felt the activities offered were not of interest to them.

People and staff told us they felt the home was well managed. The registered manager and staff sought people’s views on the service they received. Staff felt supported by the management of the home and told us they felt their contribution was welcomed, and shared examples of where they ideas had been adopted and improvements made. The registered manager had notified us of events as required by law and felt supported by the provider. There were systems in place to review the quality of care people received and where improvements were identified action was taken to improve the quality of care people received.

In this report the name Margaret Sims appears, who was not in post and not managing the regulatory activities at this location at the time of this inspection. Their name appears because they were still identified as the registered manager on our register at the time.

At our previous inspection on 12 and 15 November 2013, we found that the management of people's prescribed medicines was unsafe. This inspection was carried out to see what action had been taken to ensure that people were appropriately supported to take their prescribed medicines.

During this inspection we looked at records and audits in relation to medicine management. We spoke with one care staff who was responsible for the management of medicines. The people who used the service were unable to tell us about the support provided to them due to their health condition.

We found that systems in place were more effective to protect people against the risks associated with the unsafe use and management of medicines. The care staff in charge said, 'We have worked hard to put systems in place and the manager carries out regular audits."

We found that care plans provided sufficient information to promote staff's understanding of people's assessed care needs. One visiting relative said, 'I am involved in X care planning and I sign it to agree the contents.'

People were provided with well balanced meals to meet their dietary needs. One person said, 'I have a choice of meals and I have a big plate of food.'

Appropriate arrangements were in place to protect people from potential abuse.

The management of people's medicines had improved but there were still areas that needed further attention to ensure systems were more robust.

People had access to appropriate equipment to promote their independence and safety.

Sufficient staffing levels were provided to meet people's assessed needs.

We found that care plans provided staff with relevant information about people's care needs but people could not always be assured that their needs would be met.

There were insufficient food provisions in place to ensure people's nutritional needs were met. One care staff said, 'We occasionally have a gateaux for Sunday tea but that's no good if we haven't got the main food.'

Appropriate arrangements were not place to ensure that people were protected from abuse.

People lived in a clean and tidy environment but the absence of cleaning staff could compromise the daily hygiene standard. One care staff said, "Not having any cleaning staff has had a massive impact on the service."

People had access to appropriate items of equipment to promote their independence but the absence of frequent servicing of that equipment did not ensure that they would be safe to use.

There were insufficient staffing levels provided and this meant that people could not be confident that their needs would be met.

People had access to a complaints procedure that was also available in different formats to promote their understanding.

We found that some improvements had been made to the management of people's prescribed medicines but the provider was not entirely compliant in this area and further work was required to ensure practices were safe.

Some improvements had been made to the management of complaints but the provider was not entirely compliant in this area and further improvements were required. The home had a complaints procedure in place but not everyone who used the service was aware of this. One person who used the service said, 'I'm not aware of the home's complaint procedure but I don't have many problems but if I did the staff would sort things out for me.' The home had received one complaint since the last inspection visit and we found that this had been responded to in a timely manner.

We found that people were provided with information about their care and treatment choices but these were not provided in a format that everyone could understand. We observed that people's right to privacy and dignity was respected.

We found that care plans were in place and provided information about people's care needs but these were not always followed and could compromise the care and support people received.

We found that the management of people's prescribed medicines was inadequate and staff responsible for managing medicines had not received up to date training and this placed people at risk of not receiving the appropriate treatment.

The manager was confident that there were sufficient staffing levels to meet people's needs but confirmed that there had been a shortage. A visiting relative raised concern about the deployment of care staff and felt this compromised the supervision of vulnerable people.

The complaints policy was not in a format that everyone could understand. We found that not all complaints were recorded or responded to. This meant people's comments and complaints may not be listened to or acted on.