Church View Residential Home

Oakwood Nursing Home is a residential care home providing personal and nursing care to 19 people aged 65 and over at the time of the inspection. The service can support up to 29 people.

The home can accommodate 29 people in shared and single rooms across two floors in one building. The home has shared communal bathrooms. There is a communal lounge, dining area and courtyard garden.

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

The judgement of this service takes into account the previous breaches and rating in each domain.

Risks to people had not been monitored or reduced. At this inspection people were at risk of pressure sores, dehydration, infection, exposure to chemicals and unsafe food safety measures.

Medicine management required improvement. We found a prescribed flammable cream stored incorrectly.

The provider had failed to analyse accidents, incidents or information of concern. When things had gone wrong, preventative measures had not been put in place which led to repeated issues.

The location had inadequate amenities available for people, we found areas of the location to be in a state of disrepair.

People continued to be at risk of falls from height, windows were not consistently restricted. This had also been identified in our previous inspection 28 April 2021.

Care records did not always contain the correct information and people’s choices and beliefs had not been followed.

Staff treated people with dignity and respect. However, the provider’s systems and processes did not always support person centred care and not all risks had been mitigated to ensure people were safe.

The provider had failed to ensure there was adequate oversight of the service. Quality assurance systems and processes did not identify or address issues in the service during this inspection and the previous two inspections.

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; however, the policies and systems in the service did not support 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 7 July 2021) and there were two breaches of regulation. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part due to multiple concerns received about risks to people not being managed safely. A decision was made for us to inspect and examine those risks.

We found the provider had not taken effective actions to mitigate the risks.

The inspection was also prompted in part by notification of a specific incident. Following which a person using the service died. This incident is subject to an 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 clinical care.

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 have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive 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 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 safe care, the premises and oversight of the service at this inspection.

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 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.

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 Nursing Home is a residential care home providing personal and nursing care to 12 people aged 65 and over at the time of the inspection. The service can support up to 29 people.

Accommodation is set out across two floors with private rooms sharing communal bathrooms. There is a communal lounge and dining area and access to a courtyard garden.

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

Risks to people from the environment and health conditions were not consistently well managed. People were not consistently protected from the risk of infection.

The providers systems and processes were not consistently effective in identifying areas of concern.

The provider did not have a registered manager in place at the time of the inspection.

There was a system for reporting accidents and incidents and the provider and manager understood the need to be open and transparent if things went wrong.

People were protected from the risk of abuse.

Staff were recruited safely and there were enough staff to meet peoples’ needs.

Medicines were managed safely.

People and their relatives were involved in the care, they were well informed of changes and received regular contact.

Staff received regular support and supervision and felt listened to by the provider and management team.

The staff and management team worked in partnership with other professionals to ensure peoples’ needs were met.

The provider and management team were in the process of reviewing the service at the time of the inspection with the aim of improving the safety and quality 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

The last rating for this service was requires improvement (published 23 January 2020). 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.

Why we inspected

The inspection was prompted in part due to concerns received about the managerial oversight of the service. 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.

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 Nursing 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 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 the safety, quality and governance of the service 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 for 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.

Oakwood Nursing Home provides personal and nursing care for up to 29 older people, some of whom live with a dementia.

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

The management of medicines required improving to ensure people received their medicine’s safely and had been stored appropriately, administered according to GP instructions and followed best practice guidance.

The environment was not always clean and repairs and maintenance were required in various areas of the home. This had not always been identified or addressed in a timely manner. The prevention and control of infection required improving to ensure clinical waste was disposed of safely and appropriately.

Staffing levels required reviewing to ensure there was enough staff adequately deployed to consistently meet people’s needs in a timely manner according to their wishes. Staff received irregular supervision and did not always receive feedback on their practice.

The systems and processes in place to monitor the safety and quality of the service required strengthening. Concerns identified at this inspection had not been identified by the provider, however, the provider took immediate action to respond to the concerns raised.

People received care from staff they knew which included the use of regular agency staff. Staff had a good understanding of people's needs, choices and preferences. People were encouraged to make decisions about how their care was provided and their privacy and dignity were protected and promoted. Staff gained people's consent before providing personal care.

People and their relatives were involved in the planning of their care which was person centred and updated regularly. People were supported to express themselves, their views were acknowledged and acted upon. There was a complaints system in place and people were confident any complaints would be responded to appropriately.

Staff understood their roles and responsibilities to safeguard people from the risk of harm. People’s risks were assessed at regular intervals or as their needs changed. Care plans informed staff how to provide care that mitigated these known risks. People were supported to access relevant health and social care professionals.

Staff were recruited using safe recruitment practices. Staff received training to enable them to meet people’s needs.

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 28 April 2017).

Enforcement

We have identified breaches in relation to insufficient management of medicines, prevention and control of infection and lack of governance and oversight of the service.

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

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 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.

The service had a registered manager. 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.

People continued to receive safe care. Staff were appropriately recruited and there were enough members of staff to provide care and support so that people felt safe in the home. Staffing levels were kept under review to ensure that people’s needs were met in timely way.

People were consistently protected from the risks of harm. Staff understood their responsibilities to safeguard people and knew how to respond if they had any concerns.

People continued to receive effective care and treatment. People had detailed personalised plans of care in place to inform and enable staff to provide consistent care and support. They received their medicines in a timely way. People had enough to eat and drink and enjoyed a varied and nutritious diet. The staff support, training and professional development systems ensured staff had the right skills, knowledge and experience to effectively meet people’s needs on a daily and long term basis.

People were enabled to make choices about the way in which their care and support was provided. There were positive relationships between people using the service and the staff. The staff were caring and treated people with respect, kindness and compassion. They had a good understanding of each person’s care and treatment needs.

People’s representatives knew how to raise a concern or make a complaint and the provider responded appropriately to any concerns or complaints. There were systems in place to monitor the quality and standard of the service. Timely action was taken to address any shortfalls and make improvements. The registered manager was readily approachable by staff and service users alike for guidance and support.

Below is a summary of what we found. The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

We found that people's needs had been appropriately assessed before they were admitted to Oakwood Nursing Home. After admission to the home we saw that their needs were regularly reassessed to ensure they continued to receive safe care when their needs changed. This meant that staff had the up-to-date information they needed to minimise identified risks to people's safety and welfare.

We saw there were sufficient numbers of experienced and competent staff on duty to safely meet people's personal and healthcare needs. We found that staff had been appropriately trained to provide safe care. One person said, 'The staff are helpful and kind so that makes me feel safe.'

There were suitable arrangements in place for staff to respond to emergencies, deal with incidents, or seek guidance from their manager or the nurse-in-charge. This meant that staff received the advice and support they needed to manage problematic situations safely, effectively, and in a timely way.

The three staff we spoke with said they had received training in the safeguarding of vulnerable adults (SoVA) and they knew how to report concerns. This meant that people were protected from the risk of neglect or unsafe care.

We found that the home had been appropriately maintained. We saw that people were cared for in an environment that was clean and hygienic. We found that the equipment in place for staff to use was appropriately serviced. This meant that people were cared for in a safe environment.

Is the service effective?

Staff had received the up-to-date information, training and managerial support they needed to do their job effectively. We spoke with staff and observed them going about their duties in an unhurried, purposeful way. They were able to tell us about people's individual needs and how they delivered their care. This meant that because staff had a good knowledge of each person's care needs and preferences they were able to provide effective care.

Is the service caring?

When we saw staff interact with people their manner of approach was patient, kind, and good humoured. They encouraged people who struggled to do things for themselves but made sure people were safe. We saw they provided people with timely assistance whenever that was appropriate but never 'rushed' anyone.

Is the service responsive to people's needs?

People said they received the support they needed to enable them to do what they could for themselves. One person said, 'I try to do what I can but I know the staff will help me if I get in a muddle.'

We saw that there was enough staff on duty to meet people's needs. The three staff we spoke with said they were able to meet people's needs without feeling under pressure. One person said, "I only have to ask if I need anything. They always come when I need their help."

Is the service well led?

The staff we spoke with all confirmed that they had received the support and guidance they needed from the manager and other senior staff, such as the nurse-in-charge. They said they were encouraged to raise issues for discussion or make suggestions for improvements. They all said the manager and other senior staff were approachable and always supportive. This meant that people were assured of receiving care from staff that were appropriately managed.

One person spoke with commented that the staff and owners were "always attentive" and "very kind". A visitor said that they were "pleased and happy" with the care their relative had received.

We saw that the home was being redecorated and that people had been asked to help choose new pictures to go on the walls.

We found the home to be clean, comfortable, free from odour, and well maintained. We found that 'Oakwood Nursing Home' was appropriately staffed to safely and effectively meet the needs of the sixteen people in residence when we visited.

We spoke with four visiting relatives who said they were welcome to visit at any reasonable hour. They all said they found the staff friendly and helpful. One visitor said, "I am more than happy with the care and attention mother receives."

We heard staff talk with people and their tone of voice was friendly, they explained what they were doing and they used words of encouragement when, for example, they physically assisted people to move around. We saw that people seated in the communal lounge were dressed in clean clothing .