This inspection took place on 8 and 9 December 2016. Our visit on 8 December was unannounced.We last inspected the home in June 2015. At that time we rated the service ‘Requires Improvement’ with a rating of ‘Inadequate’ in the ‘well-led’ domain. We identified breaches in five of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to make improvements in relation to infection control, storage facilities, maintenance of equipment, working within the principles of the Mental Capacity Act, monitoring the quality of the service, provision of activities, supervision of staff and gathering feedback from people who used the service. At this inspection although we found there had been improvements in some areas, some issues we identified at the last inspection had not been addressed.
At this inspection we identified breaches of five of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to infection prevention and control, maintenance of premises and equipment, disposal of offensive waste and unsafe storage of equipment; the provision of activities; failure to display the Care Quality Commission (CQC) inspection ratings and lack of governance.
We identified one breach of the Care Quality Commission (Registration) Regulations 2009. This was because the registered provider had failed to notify the CQC that they had entered into a Corporate Voluntary Arrangement. This is an arrangement that allows an insolvent company to pay creditors over a fixed period of time and continue trading during this period.
We made one recommendation. This was in relation to the communal living space. You can see what action we told the provider to take at the back of this report. We are currently considering our response in relation to enforcement for some the breaches of regulations and we will update the section at the end of this report once any such action has concluded.
Oaklands Rest Home is registered to provide accommodation for up to 32 older people who require residential care. At the time of our inspection there were 24 people living at the home. When we visited the home there was a registered manager in place. 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.
Staff had a good understanding of how to keep people safe and what action they should take in order to protect vulnerable people in their care. Recruitment checks had been carried out on all staff to ensure they were suitable to work with vulnerable people. During our time in the home we observed there to be sufficient numbers of staff to care for people and to respond to their needs promptly.
The home was clean and free from unpleasant odours. However, we found that there were problems with the general maintenance in some parts of the home and steps had not been taken promptly by the registered provider to rectify them. Two storage rooms which contained equipment that could cause injury to people if they entered unsupervised were not locked. This had been identified during our previous inspection, but no action had been taken to rectify this.
Staff wore personal protective equipment (PPE) such as disposable gloves and aprons when carrying out care tasks and we found toilets and bathrooms were well stocked with soap and paper towels. This measure helped protect people from the spread of infection. However, waste bins were not foot-operated, which meant that staff risked contaminating their hands when disposing of soiled items.
The provider did not have a contract with an approved company for the safe disposal of offensive/hygiene waste, such as incontinence products and wound dressings and, at the time of this inspection, staff disposed of this material in the domestic waste collection. Information contained in the ‘Health and Social Care Act 2008 Code of Practice on the prevention and control of infections and related guidance’ states: ‘If the home employs carers to assist in the activities of daily living then waste should not enter the domestic waste stream’.
The kitchen was clean and food was stored safely. Safety checks for the building, such as for the hoists, passenger lift, electrical appliances and gas were up-to-date.
There were appropriate systems in place for the effective ordering, control, management and administration of medicines at Oaklands.
Staff had undertaken a variety of training, including dementia awareness, safeguarding vulnerable adults and end of life care which ensured they had the skills and knowledge required for their roles. Staff supervision was undertaken regularly by the registered manager.
The home was working within the principles of the Mental Capacity Act (MCA) and where people were deprived of their liberty to receive care and treatment the appropriate deprivation of liberty safeguards (DoLS) authorisations were in place.
People spoke highly of the staff and told us they were kind and caring. Our observations during the inspection confirmed this. Care plans were ‘person-centred’ and were reviewed regularly.
People were supported to maintain good health and where needed specialist healthcare professionals, such as district nurses were involved with their care. People had their weight monitored regularly and the food was of a good standard.
The home had a large lounge which provided a communal living area for people who used the service. However, the layout of the room did not make social interaction between people easy, as all the chairs were placed in a long line around the walls of the room. This limited the possibility for conversation. There was a lack of meaningful activities for people to take part in.
The home had a complaints procedure and people we spoke with knew how to make a complaint if they needed to. Only one complaint had been received during 2016 and this had been dealt with appropriately.
There were some quality assurance processes in place; however they had not identified the issues we found during our inspection nor had they addressed some of the issues we identified at our last inspection in June 2015.
During our inspection we identified that the registered provider had entered into a Company Voluntary Arrangement to pay their creditors over a fixed period. Despite this, the registered manager and staff provided a supportive and caring environment for the people who lived at Oaklands.
The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.”