This unannounced inspection took place on 18, 19, 27 and 30 March 2015.
The Oaks is a nursing home which can accommodate up to 113 older people with dementia or mental health issues across six units. The home is located in New Eltham, south east London. There were 85 people using the service at the time of our first inspection visit.
We last inspected the Oaks in March 2014. At that inspection we found the service was meeting all the regulations that we assessed.
A registered manager was not in post at the time of our inspection. 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 had recently started work at the Oaks and they had commenced their application for registration with CQC.
Prescribed medicines were available and administration records were up to date on five units. These showed that the people on these units were receiving their medicines regularly and as prescribed. The arrangements for the management of people’s medicines on one unit were found to require improvement. You can see what action we told the provider to take at the back of the full version of this report.
Most of the people told us they were happy and well looked after. We observed positive relationships between staff and people at the service and their visitors. Staff knew people’s needs and preferences well and treated people in a kind and dignified manner.
There were clear procedures in place to recognise and respond to abuse and staff had been trained in how to follow these. Staffing numbers were sufficient to help make sure people were kept safe.
Risk assessments were in place and reflected current risks for people at the service and ways to try and reduce these. Care plans were in place and being reviewed to ensure the care provided was appropriate for people. Equipment at the service was well maintained and monitored and regular checks were undertaken to ensure the safety and suitability of the premises.
Staff received training to help them undertake their role and were supported through regular supervision and appraisal. We saw staff had received training in the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). They were aware of people who did not have the capacity to consent to some aspects of their care and the importance of working in their best interests.
The mealtime experience for the people living at the Oaks could be improved. Accurate and accessible information about the meals provided was not consistently being given to people using the service. People did not always have choices about the amount and variety of food they were served. The mealtimes we observed were task focused with little emphasis on them being a social occasion and an opportunity for interaction.
People had access to a range of health and social care professionals when required. They and their relatives or friends were supported sensitively in end of life care.
Effective systems were not fully in place to regularly assess and monitor the quality of services people received or make the improvements required. The medicine audits had not picked up and rectified the shortfalls we found during our inspection.
There was a positive culture at the home where people felt included and consulted. People and their visitors commented positively about the acting manager. They felt confident they could share any concerns and these would be acted upon.
Work was taking place to update the premises and replace items of furniture. We have made a recommendation for the provider to look at ways of making the environment more dementia friendly.