Archived: The Oaks

The Oaks is a residential care home that was providing personal and nursing care to 41 older people at the time of the inspection. The service can support up to 42 people. In addition, the service was providing a domiciliary care service to people living in their own bungalows on the same site. Not everyone using the service receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

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

People told us staffing and management changes over the last year had impacted on their care and been very unsettling. A large amount of agency staff were being used. People's care records had not always been consistently reviewed and quality assurance systems had not been effective in maintaining the quality of care and driving improvements forward in a timely way. People had not always received their medicines in line with their prescription. The provider was taking action to address this.

Health and safety checks were completed and staff understood how to care for people safely. However, opportunities to learn from accident and incidents that occurred were not always maximised, to reduce the risk of recurrence. Staff knew how to identify and report any safeguarding concerns.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. However, staff knowledge in relation to people's Deprivation of Liberty Safeguards in place needed improvement. We have made a recommendation about improving staff knowledge in this area.

People told us they generally enjoyed the food available and had a choice of meals. Records in relation to food and fluid intake and weight monitoring were inconsistent. Action was being taken to ensure staff updated their regular refresher training.

Staff and people using the service reported recent improvements in morale and practice, since the introduction of a new interim management team.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

At the last inspection the service was rated good overall (published 23 August 2018).

Why we inspected

This inspection was prompted by information of concern. It was a focussed inspection, based on the information received. Concerns related to medicines practices, staffing and support with nutrition and hydration needs. We inspected the following three key questions: Is the service safe, effective and well-led?

Enforcement

We have identified breaches in relation to safe care and treatment (medicines) and good governance (quality assurance and record keeping). 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 monitor the progress of the improvements working alongside the provider and local authority. We will return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The service also provides personal care to people who live in their own bungalows on the Hartrigg Oaks site. Not everyone living in the bungalows receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. We do not inspect the premises of people receiving regulated activity in their own home. Facilities at the care home include a gym, coffee shop and swimming pool; these can be accessed by people who live at the home or those who live in their own bungalows on the site.

At our last inspection in February 2016 we rated the service Good. At this inspection we found the evidence continued to support the rating of Good overall, although the key question: ‘Is the service well-led?’ is now rated Requires Improvement. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The Oaks did not have a registered manager, which is a condition of their registration. 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. A new manager was due to start in post the month after our inspection.

We found staff morale and people’s confidence in the leadership of the service had been affected by a staffing consultation which was on-going at the time of our inspection. The provider was working to try and address people’s concerns and provide reassurance in relation to the proposed changes.

People told us they felt safe and staff knew how to protect people from avoidable harm. Risk assessments were in place and updated when required. Staff completed safeguarding training and were aware how to report any concerns. Accident and incidents were monitored, to identify trends, learn from issues that had occurred and prevent recurrence. Appropriate responsive action was usually taken, but we found one example where action identified still need to be completed.

Appropriate checks were completed before staff commenced employment, to ensure they were suitable to work vulnerable people. There were sufficient, suitably trained staff to keep people safe. People told us staff were generally very responsive to their needs, but we received some concerns about recent staffing issues impacting on staff being able to respond to people as quickly as usual.

Medicines were stored, administered and recorded safely. The premises were clean and well maintained to keep people safe. People were supported with their nutritional and healthcare needs and had access to healthcare professionals when they needed them.

Staff received an induction and training to give them the skills and knowledge they needed for their role.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

We received very positive feedback about the staff and it was evident that people and staff knew each other well. People told us that staff were caring and treated them with respect. People’s dignity was maintained and their independence promoted.

The environment was stimulating and people could access an extensive range of activities of their choosing.

The provider had a policy in place for responding to complaints and people told us they would feel comfortable raising any concerns.

Care plans included information about people’s needs and preferences and were usually regularly reviewed. We found some minor issues with care files but, on the whole, they gave staff sufficient appropriate information to meet people’s needs. There were quality assurance systems in place to monitor the quality and safety of the service.

The home was previously inspected in November 2013, and at the time was meeting all regulations assessed during the inspection.

The Oaks Care home forms part of the Hartrigg Oaks retirement village in New Earswick, on the outskirts of the historic city of York. It is managed by the Joseph Rowntree Housing Trust. The home is purpose built and is registered to provide care and accommodation for up to 42 older people, some of whom need nursing care or have a dementia related condition. The Oaks has a number of facilities on site including a gym and pool, which can be used by people from the home. All rooms are en-suite and have either a balcony or patio. There is parking available at the front of the building.

The Oaks 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 who used the service told us they felt safe and we found that staff knew how to protect people from avoidable harm. Risk assessments and risk management plans were in place and they were regularly reviewed and updated in line with the person’s needs.

We saw care files contained personal evacuation plans that detailed any assistance a person required to evacuate the building.

The registered provider had policies and procedures in place to deal with and learn from accidents and incidents involving people at the home. We saw this was not always the case when accidents and incidents did not relate to people receiving a service but the registered provider was implementing plans to address this.

The service had sufficient experienced staffing in place to meet the care and support needs for people using the service. Recruitment processes were robust and ensured that staff were of suitable character to work with vulnerable adults. We saw, and people told us that staff and others at the home treated people in a caring way with respect and dignity.

People were supported to take their medication as prescribed. Medicines were stored securely, and there were systems in place to monitor the quantities of medications kept, and to ensure that it had been administered appropriately.

Deprivation of liberty safeguards (DoLS) were in place for people who needed them. Staff had received training in the Mental Capacity Act 2005, and knew the basic principles of the Act. Staff also identified when a DoLS may be required for a person.

A person’s nutritional and hydration needs were met. People told us that they enjoyed the food and that there were different options available in either the assisted dining room or the café shop. People with special dietary requirements had their nutritional needs assessed and were supported to receive nutrition in line with guidance from professionals.

The home had two activities co-ordinators who worked with a team of volunteers to ensure a programme of activities was available to keep individuals and groups busy throughout the days and evenings. Activities on offer ranged from one to one sensory hand massages to themed evening meals and trips out. The activity planners told us they worked hard to ensure nobody in the home suffered unnecessary social isolation. People told us they could participate as much or as little as they wanted to and everybody told us, there was something available that they were interested in doing.

The registered provider had a complaints process in place and people told us they understood how to complain and we saw that their complaints were acted upon. People knew who the registered manager was and told us that they found they were approachable and responsive to their concerns. We saw a record of compliments and complaints was kept which outlined actions that had been taken in response to concerns that had been raised.

The home was clean and well maintained with no malodours. There were systems in place to monitor the quality of the service by both the registered manager and the registered provider. These looked at areas that included, staffing, training, health and safety, falls, pressure areas, medication indicators and resident engagement. Information gathered from these processes was used to generate improvement by identifying trends and putting in measures to help prevent them from happening in the future.

People told us that they were well cared for but also told us that the staffing arrangements meant that at times they felt very rushed. Comments included "They do talk to me about my care" and "I think the care is good but it is rushed and sometimes staff forget things. Bells are ringing at every moment. What they do they do beautifully, they just need more staff to do it."

People told us that the food was good and they received a choice. We observed people being supported in an appropriate manner during mealtimes. Nutritional assessments were completed so that any risks were identified and appropriate advice was sought where needed.

People told us that there were currently some shortages of staff and that this was impacting on the care they received.

There were quality monitoring systems in place to gain the views and opinions of people regarding the way in which the service ran. One person told us "The staff ask me how I feel. We are asked for our views and opinions."

People told us that they were well cared for and liked living at the home. People told us they could make choices and decisions about how they wanted to spend their time. Comments included "I can make suggestions about my care" and "I've been here a while, I came to look around first. There is plenty going on."

The home was clean and there were systems in place to ensure that infection control was monitored and maintained. People told us that their rooms were kept clean and staff confirmed that they had received training in infection control.

The home had robust recruitment systems in place which helped to protect people and all of the comments we received regarding staff were positive. The staff we spoke with told us that morale was good and that they received regular training to keep their knowledge and skills up to date.

The home had an effective complaints system to ensure that complaints were responded to appropriately. All of the people we spoke with told us that they could tell the staff if they had any concerns or complaints. The home held regular meetings so that people living there could share their views and opinions. One person said "I could tell the manager if I had any complaints. I attend resident meetings so that I can express my views. We do make suggestions and they get acted upon."