Oak Springs Care Home

Oak Springs is a residential ‘care home’ which provides accommodation and personal care for up to 74 older people, including people living with dementia. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Care is provided over three floors. The service can provide en-suite accommodation. At the time of the inspection 69 people were living at Oak Springs Care Home.

At the time of the inspection there was a registered manager in post. 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. During the inspection we found the registered manager to be open, transparent and receptive to the feedback provided.

At the last inspection which took place in August 2017 we identified breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Oak Springs was awarded an overall rating of ‘Requires Improvement’. Following the inspection, we asked the registered provider to complete an action plan to tell us what changes they would make and by when. During this inspection, we looked to see if the registered provider had made the necessary improvements.

At the last inspection, we found the registered provider was in breach of regulation in relation to ‘safe care and treatment’ people received. Medication management systems were not followed and the health and safety of people living in the home was being compromised. During this inspection we found that the registered provider was no longer in breach of this regulation in relation to ‘Safe care and treatment’.

At the last inspection, we found the registered provider was in breach of regulation in relation to ‘Good Governance’. The systems which were in place did not effectively monitor and assess the quality and safety of care people received. During this inspection we looked at the governance systems, audits and checks which were in place and found that improvements had been made. Although the registered provider was no longer in breach of regulation in relation to ‘Good governance’ further developments could be made in relation to this area of care.

We have recommended that the registered provider reviews some of the quality assurance systems to further improve the quality and safety of care being provided.

At the last inspection we identified concerns in relation to staffing levels and the deployment of staff. During this inspection the registered manager told us that a monthly dependency assessment tool was completed and analysed. The dependency tool helped to review the dependency support needs of the people who lived at Oak Springs in relation to the levels of staff. Staffing levels were safely managed and people received the level of care and support that was required.

Recruitment was safely managed. People who were employed had undergone the necessary recruitment checks. Pre-employment and Disclosure Barring System checks (DBS) were carried out and appropriate references were sought prior to employment commencing.

Risk assessments were in place for people who lived at Oak Springs. Risk assessments were tailored around the needs of the person, support measures were in place to mitigate risks and assessments were regularly reviewed and updated. Staff were familiar with people’s risks; they received daily updates on people’s health and well-being and if their circumstances had changed.

People were protected from harm and abuse. Staff were familiar with safeguarding and whistleblowing procedures and told us what concerns they would report, who they would report their concerns to and the importance of complying with safeguarding and whistleblowing policies the registered provider had in place. Safeguarding referrals were appropriately submitted to the local authorities and CQC as required.

Accidents and incidents were routinely recorded and analysed. There was an accident and incident reporting policy in place and staff routinely completed accident and incident documentation. The registered manager analysed monthly accident and incidents reports and established trends that were emerging as a measure of mitigating risk.

We found the home to be clean, hygienic and odour free. Communal areas, toilets, bathrooms and bedrooms were well maintained. Infection prevention control measures were in place and staff had access to personnel protective equipment (PPE) such as gloves, aprons and sanitizing gels.

We reviewed health and safety audit tools. Weekly, monthly and annual audits and checks were completed to help monitor and assess the quality and safety of the home. Such audits/checks ensured that health and safety standards were maintained and the safety of people living at Oak Springs was not compromised. Regulatory compliance checks were also completed; compliance certificates were checked and in place during the inspection.

The registered provider was complying with the principles of the Mental Capacity Act, (MCA) 2005. Consent to care and treatment was gained in line with the MCA. People’s capacity was assessed from the outset and records contained the relevant information in relation to the persons capacity. Appropriate Deprivation of Liberty Safeguards (DoLS) were submitted to the local authority and records contained relevant ‘best interest’ information and restrictions which were in place.

Staff received regular supervision and told us they received support on a day to day basis. Staff were supported with training, learning and development opportunities. Training statistics were reviewed by the registered manager and there was a commitment to provide training to staff that helped to enhance their skills, competencies and abilities.

People’s nutrition and hydration support needs were effectively managed. People were regularly assessed and measures were in place to monitor and mitigate risk. We found that appropriate referrals were made to external healthcare professionals and any guidance which was provided was incorporated within care plans.

Reasonable adaptations and adjustments had been made to the environment to support people who had limited mobility and were living with dementia. There had been noticeable improvements to the environment and the registered manager was committed to enriching the lives of people who lived at Oak Springs.

People were supported with ‘choice’ in relation to the food that was offered. We received positive feedback about the quality and standard of food and the registered manager ensured that people were given the opportunity to share their views and thoughts about the food they received. ‘Meal time experience’ surveys helped the registered manager to create menu’s around the suggestions, preferences, likes and dislikes of people living in the home.

We observed people being treated with dignity and respect. Staff provided kind, caring and compassionate support in a genuine and sincere manner. People’s independence was promoted and staff were committed to providing care and support that was tailored around their needs.

Confidential information was securely stored and protected in line with General Data Protection Regulation (GDPR). This meant that people’s sensitive and personal information was not unnecessarily shared with others.

A person-centred approach to care was evident. Records were tailored around the needs of the person and staff were familiar with the likes, dislikes, preferences and wishes of people they supported.

The registered provider had a complaints policy in place. People and relatives were familiar with the complaints process and told us they would feel comfortable making a complaint if required. A complaints folder had been created; the registered manager regularly reviewed the variety of complaints submitted to establish trends and ensure lessons could be learnt.

People had the opportunity to engage and participate in a range of different activities arranged by the dedicated activities co-ordinators. We received positive feedback about the different activities that were taking place. Activities were stimulating and were tailored around the suggestions and interests of the people who lived at Oak Springs.

People were sensitively supported with end of life wishes and preferences. Records we checked contained end of life documentation (where required) and staff were familiar with any specialist support that was needed

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Systems were in place to gather feedback regarding the provision of care that was delivered. People, staff, relatives and external professionals were encouraged to share their views, opinions and thoughts around the quality and safety of care people received. This enabled the registered manager to identify areas of strength but also areas that needed further attention.

The registered manager was aware of their regulatory responsibilities. The registered manager notified CQC of all events and incidents that occurred in the home in accordance with statutory requirements. Ratings from the last inspection were displayed within the home as required.

Royal Oak Care Home is a purpose-built home offering personal and nursing care. Including residential, specialist residential dementia care, general nursing care and respite care. Care is provided over three floors. The service can provide en-suite accommodation and care for a maximum of 74 people. At the time of the inspection 41 people were living at Royal Oak Care Home.

There was no registered manager in post. The previous manager had left the service in April 2017. A new manager took up their duties in June 2017 and was in the process of applying to register with the Care Quality Commission.

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.

During the previous inspection we identified a breach of regulation because medicines were not stored or administered safely. On this inspection we saw that the system for recording the administration of records was neither consistent nor robust. People were at risk of running out of medicines. Some medicine storage systems were unsafe. The provider remained in breach of regulation.

At the previous inspection the service was in breach of regulation because some fire doors did not operate correctly which placed people at risk in the event of a fire. As part of this inspection we checked to see if the necessary improvements had been made in accordance with the provider’s action plan. We saw that not all fire doors closed fully on each occasion they were tested. We were particularly concerned about the fire doors leading to the kitchen which were not operating safely at the time of the last inspection. During this inspection we saw that they closed fully on some occasions, but not on others. The provider remained in breach of regulation.

Prior to the inspection we received information of concern that some pre-admission information was not secured before people were admitted. We found that some pre-admission information was missing from care records. This meant that the provider could not make an accurate determination whether Royal Oak Care Home could meet the person’s needs before they arrived.

Regular audits of safety and quality were completed by the manager and clinical staff. Audits had proven effective in identifying some areas of concern and producing action plans to improve performance. However, audit processes had not consistently identified significant issues and had not always resulted in timely action by the provider.

You can see what action we asked the provider to take at the end of the report

Prior to the inspection we received information of concern which alleged that people regularly waited an excessive amount of time to receive care. On the inspection we saw that there were sufficient numbers of staff deployed to meet people’s basic needs for the majority of the time. This was done in accordance with the relevant dependency assessments. However, a number of people required 2:1 support with personal care which left only one member of staff to provide care for the remainder of the people on that unit. We made a recommendation regarding this.

At the inspection in February 2017 we identified a breach of regulation because assessments and care plans were not consistently completed to an acceptable standard. As part of this inspection we checked to see that the necessary improvements had been made and sustained. The service had made and sustained sufficient improvement and was no longer in breach of regulation.

Staff understood their responsibility to keep people safe and were vigilant in monitoring risk. They had completed a training course in adult safeguarding and were able to explain what they would do if they suspected that someone had been abused or neglected.

Accidents and incidents were recorded in sufficient detail. We saw evidence that they had been analysed to identify patterns or trends.

Staff had supervision scheduled every two months. The records that we saw indicated that the majority of supervisions had been delivered as scheduled. Staff told us that they had access to formal and informal supervision and felt well supported.

Staff were trained in a range of subjects which were relevant to people’s needs. For example, moving and handling, adult safeguarding, health and safety and food hygiene. However, the records that were provided during the inspection did not clearly evidence that staff had been trained in other important subjects such as dementia and the Mental Capacity Act 2005 (MCA).

New staff were given a basic induction when they took up employment at Royal Oak Care Home. However there was no record of them being observed and assessed as competent. This meant that the provider could not be certain that staff had the right skills, knowledge and values to provide safe, effective care.

The service was operating in accordance with the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People were supported with their healthcare needs by the nurses and through contact with community based healthcare services.

The building required additional work to ensure that it was better suited to the needs of people living with dementia. We made a recommendation regarding this.

People and their relatives spoke positively about the attitude and approach of the staff and the quality of care. The staff that we spoke with knew the people that they cared for well and were able to explain their care needs.

Throughout the inspection we saw staff engaging with people in a positive and caring manner. Staff spoke to people in a respectful way and used positive, encouraging language.

The service had a policy and procedure for receiving and dealing with complaints. 30 complaints were recorded in 2017. Each had been dealt with in accordance with the relevant policy and included the production of a written response.

The manager understood their responsibilities and had submitted notifications appropriately. They responded openly and honestly to the issues raised and requested support from the provider to rectify some of the concerns before the end of the inspection. The manager was aware of the day to day culture within the service and was visible throughout the inspection. People told us that the manager was supportive and approachable.

The service had introduced extensive changes since it opened in October 2016. Some of these changes had been made in response to the last inspection and others in response to issues identified internally.

Royal Oak Care Home is a purpose-built home offering personal and nursing care. Including residential, specialist residential dementia care, general nursing care and respite care. Care is provided over three floors. The service can provide en-suite accommodation and care for a maximum of 74 people. At the time of the inspection 17 people were living at Royal Oak Care Home.

A registered manager was in post.

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.

Prior to the inspection we received information of concern which alleged that medicines were not being managed safely. We wrote to the provider requesting information about these concerns. We looked at the processes for the safe management of medicines within the service and spot-checked medicine administration record (MAR) sheets. We saw evidence that medicines were not always safely administered and recorded. We found a breach of regulation regarding this.

On an escorted tour of the service we were alerted to uneven floors on the first and second stories. There was significant bowing of the floors in a number of areas which created a risk for people, especially those with mobility difficulties.

Prior to the inspection we received information of concern alleging that a fire door did not function properly. We wrote to the provider requesting information about these concerns. As part of this inspection we assessed the functionality of fire doors throughout the service. We saw that two fire doors did not function correctly meaning that they would not be effective in reducing the spread of fire. We found a breach of regulation regarding this.

Prior to the inspection we had received information of concern which alleged that people were not adequately protected from the risk of harassment and poor care. We wrote to the provider requesting information about these concerns. Risk was not consistently and safely managed within the service. Risk assessments lacked detail and the files themselves were not presented in a consistent order which made it more difficult to locate important information.

Some people were not getting care as defined in their care plan. For example, for one person, we saw that they were at risk of weight loss. The care plan stated that the person needed to be weighed weekly. When we checked we saw weight recordings were eleven days apart in one instance and despite this and the family expressing concern, they were not weighed again until two weeks later. We found a breach of regulation regarding this.

Staff told us that they were given informal supervision on a regular basis. However, records relating to formal supervisions indicated that meetings had been held with two members of staff since October 2016. Training was a mixture of e-learning and classroom based activity. Staff were trained in subjects relevant to their roles including; moving and handling, adult safeguarding and first aid. However, the records relating to training were unclear. We made a recommendation regarding this.

Capacity was only assessed on a generic basis with no consideration of people’s capacity to consent to specific aspects of their care. Not all staff had been trained in the Mental Capacity Act 2005 (MCA) as required by the provider. The records that we saw did not clearly demonstrate that the service was operating in accordance with the MCA. We made a recommendation regarding this.

Although the service had been designed to meet the needs of people living with dementia there were no obvious signs of appropriate adaptations. For example, accessible signage to help people to use the building more independently, or objects of reference to assist them in identifying their own rooms. We made a recommendation regarding this.

People were supported with their healthcare needs by the nurses and through contact with community based healthcare services. District nurses were in regular attendance and referrals were made to other community based services as required. However, some healthcare referrals were not clearly evidenced within care records.

People’s privacy and dignity were promoted by staff and people told us that they felt respected. However, we reported on two occasions that confidential information had been left on the same nurses’ station where it could be easily accessed by other people living at Royal Court or visitors.

Records relating to assessment and care planning were not consistently completed or reviewed to an acceptable standard. This meant that people were placed at risk of receiving inappropriate or inadequate care. Other records associated with the care plans were confusing, lacking in detail and were not consistently completed. We found a breach of regulation regarding this.

Person-centred information was not consistently recorded in care files. The files that we looked at contained limited or no information relating to what people liked to do, eat, drink or wear. People’s personal histories and preferred activities were not recorded in sufficient detail to inform staff. We made a recommendation regarding this.

The management team was supported by a contracted management consultant. Each party held responsibilities in relation to the assessment of quality and safety and completed audits as required. However, none of the audit processes had identified the significant issues, omissions and errors found during the inspection. Where issues had been identified, for example with the non-operational fire doors, effective action had not been taken to ensure people’s safety.

There was no evidence of the provider being directly involved in monitoring the service. This meant that the provider did not have effective oversight of the Royal Oak Care Home and was primarily reliant on information generated from within the service. We found a breach of regulation regarding this.

The staff that we spoke with understood their individual responsibilities and knew what was expected of them. They told us that they enjoyed their jobs and were motivated to provide good quality care.

People and their relatives spoke positively about the attitude and approach of the staff and the quality of care. We observed the provision of care throughout the inspection and saw that staff treated people with dignity and respect.

People were given a good choice of nutritious food and drinks in accordance with their healthcare needs and personal preferences.

You can see what action we told the provider to take at the back of the full version of this report.