Oakham Grange

Oakham Grange is a care home with nursing. Accommodation is over three floors. All rooms are en-suite and there are a range of accessible communal areas internally and externally. The service can accommodate up to 68 people, some of whom are living with dementia. At the time of our inspection 50 people were using the service.

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

The provider had made improvements in all areas of the service, and this was ongoing. To ensure new and improved systems and processes were fully effective and safe, further time was required for these to become fully embedded and sustained.

This inspection identified further improvements were required in governance procedures such as monitoring processes. Record keeping in particular was identified to be inconsistent and needing strengthening.

People were protected as far as possible from abuse and avoidable harm. Whilst improvements had been made to the reporting of safeguarding incidents to the local authority safeguarding team, an incident was found not to have been reported. The provider was completing an investigation to understand what went wrong.

People’s risks associated with their care and treatment needs had been reviewed and guidance for staff improved upon. This was an area of continued improvement.

Staff deployment had increased. Additional nursing staff were on duty day and night and new unit clinical service mangers had been appointed and due to commence shortly.

Clinical competency assessments had been completed by nursing staff and additional training provided for all care and nursing staff and this was ongoing. People felt permanent staff were competent and understood their health conditions and care needs.

People described staff as caring and kind. Staff had been recruited safely and received ongoing opportunities to review their work, training, and development needs. Staff were positive about the improvements being made at the service and felt better supported and valued.

Medicines management had improved and was ongoing. The systems and processes that monitored medicines however, needed further improvement.

Lessons learnt processes had been further developed and action had been taken and was ongoing to ensure learning opportunities were robust and effective.

Infection prevention and control best practice guidance was followed. The service was clean and hygienic.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way. Improvements were ongoing in relation to the assessment process of people's mental capacity. Mental capacity assessments and best interest decisions for people who lacked capacity to consent had been completed.

Recognised assessment tools were used to assess and monitor health care needs. Further improvements were identified in relation to weight monitoring and action was being taken.

People’s dietary needs and preferences were known and understood, food and fluid were monitored to ensure people received sufficient to eat and drink. Improvements had been made and were ongoing in response to concerns raised by people about meal choices.

Staff worked with external health and social care professionals, to support people to achieve positive outcomes in their ongoing care and treatment needs.

The environment was adapted to meet people’s needs and was comfortable, spacious, and pleasant.

People and staff were positive about the new manager, they were described as being supportive, approachable, and knowledgeable. Senior management, leadership and oversight had increased and senior staff were present daily at the service. The management team were open and honest, they recognised further improvements were required at the service. An ongoing improvement and action plan were in place.

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

Rating at last inspection and update

The last rated inspection for this service was inadequate (published 5 July 2023). Breaches in regulations relating to safe care and treatment, staffing, safeguarding, consent, and governance were identified. The provider completed an action plan after the inspection to show what they would do and by when to improve and meet the breaches in regulation related to safeguarding and consent. Warning Notices were served for the breaches relating to safe care and treatment, staffing and governance.

At this inspection we found enough improvements had been made in relation to some breaches in regulation. However, the provider remained in breach of 1 regulation relating to governance.

This service has been in Special Measures since the last inspection. During this inspection, the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

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.

Please see the safe, effective, and well-led sections of this full report. You can read the report from our last inspection, by selecting the 'all reports' link for Oakham Grange on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Oakham Grange is a care home with nursing. Accommodation is over three floors. All rooms are en-suite and there are a range of accessible communal areas and outside areas. The service can accommodate up to 68 people, some of whom are living with dementia. At the time of our inspection 49 people were using the service.

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

People’s health needs were not safely supported. Staff did not have clear guidance on how to support people’s needs. Staff did not record when clinical care was provided to people, so we were not assured that people received clinical care as planned. There were no nurses in the service at night-time – which left people at risk. There were safe recruitment checks to ensure staff were of good character. People reported that there were enough staff to respond to their needs, but staff did not always have time to spend with them. Medicines were not always managed safely and lessons were not always learnt to ensure improvements were made to care.

Staff were not always suitably trained to complete safe care. Nurses did not receive recent clinical supervision or competency assessments to ensure they were suitably skilled. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests. People were given enough to eat and drink. Some people required altered textured food and drink to ensure they could swallow safely. This had not been altered safely for 1 person - which put them at risk of choking. People received support to access support from external health and social care professionals but people’s healthcare needs were otherwise not well supported by staff.

People told us that staff were kind and treated them with respect. However, people felt that staff sometimes did not have time to spend with them. We saw people were given privacy as needed.

Care was not always personalised to people’s preferences as staff did not have specific guidance on people’s unique needs. We were not assured that people would receive good quality end of life care. This is because most staff had not received end of life training. People’s communication needs were met. People were able to engage in activities at the home. The management team responded to individual complaints about care to ensure improvements were made.

The management team were aware that action was needed to improve Oakham Grange. There was a quality improvement plan in place and some actions had started to take place. However, we were not assured that this was resolving concerns at the service in a quick enough way to keep people safe. When we raised concerns during the inspection, further action was taken by the management team – for example arranging for staff training.

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 2022).

Why we inspected

The inspection was prompted in part due to concerns received about medicines and allegations of neglect. Specific allegations were still being investigated by the local authority safeguarding team. We made a decision to inspect and consider risks at the service.

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 Oakham Grange on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, staffing, consent and governance. Please see the action we have told the provider to take at the end of this report. We have sent the provider warning notices. These give the provider a specified amount of time to make improvements. We will then inspect to review if the required improvements have been made.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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.

Oakham Grange is a care home with nursing. Accommodation is over three floors. All rooms are en-suite and there are a range of accessible communal areas and outside areas. The service can accommodate up to 60 people, some of whom are living with dementia. At the time of our inspection 38 people were using the service.

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

At the time of our visit some people were isolating due to a COVID-19 outbreak so our ability to speak with people was limited. We did observe some people interacting with staff. Interactions were positive and respectful. People were comfortable and chatted to staff in a relaxed manner and were confident asking staff when they needed anything.

Staff knew people well and understood their responsibilities to protect people from harm and abuse. Risks were assessed and managed so that people’s freedom and human rights were upheld. Accidents and incidents and any environmental risks were analysed and discussed at safety meeting so that risk was reduced as much as possible.

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; the policies and systems in the service supported this practice.

People’s medicines were managed in a safe way by staff who had training and were assessed as competent. The service was very clean and hygienic, and staff followed Infection control policies and procedures to reduce the risk of infections.

There were enough staff with the right skills and experience to meet people’s needs. Staff were kind and caring and motivated to achieve good outcomes for people. People were supported to follow their hobbies and interests and to maintain relationships with the people important to them. Staff were flexible in their approach so care and support was person centred.

There was a clear management and support structure in place, people and staff were consulted and listened to. Quality monitoring and governance was effective in driving improvements and identifying risks. Staff worked with partner agencies so people received all the care and support they required.

This service was registered with us on 27 August 2020 and this is the first inspection.

Why we inspected

This was a planned inspection following registration.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.