Archived: Oakford Manor Nursing Home

Oakford Manor Nursing Home is a care home providing personal and nursing care to 23 people aged 65 and over at the time of the inspection. The service is registered to support up to 50 people, however this includes eight ‘companion rooms’ which were not used. Each person living at the service has their own bedroom. The building is set over two floors, during inspection the ground floor was used for people receiving nursing and personal care and the first floor was used for people who received personal care.

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

There were widespread and significant shortfalls in the way the service was led by the provider. The delivery of high-quality care was not assured by the leadership or governance in the home. Audit systems failed to highlight the concerns we found during the inspection. There continued to be a lack of stable management in the home. Staff told us they felt managers were unsupported in their role by the provider.

National guidance in relation to new admissions during COVID-19 was not followed. This placed people and staff at increased risk. Risk assessments were in place but did not always cover all relevant risks to people’s health and safety. Accidents and incidents were reported to the relevant agencies; however, little action was taken by the provider to learn from these. The provider did not ensure there were always enough suitably qualified staff to give people the support they needed.

Records did not always show that care was delivered in a way that responded to people’s needs. There was a complaints policy and procedure in place which people and their relatives had access to. Some language used in care plans was not respectful. The provider responded immediately and assured us action would be taken to address this.

Staff were observed to be kind and caring with close bonds with people. People were involved in care planning.

Most 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 generally supported this practice. The provider did not always recognise their responsibility in ensuring people were protected under the Mental Capacity Act (MCA), this was addressed after our inspection.

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 rating for this service was inadequate (published 23 September 2020) and there were multiple breaches of regulation. This resulted in a warning notice for the service. We returned to the service to follow up the breaches of regulation and see if sufficient improvement had been made. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 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.

We have found evidence that the provider needs to make improvement. Please see the safe, effective, caring, responsive and well led sections of this full report.

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 Oakford Manor Nursing Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safety, governance, staffing levels, staff training, safeguarding people from abuse and meeting legal requirements.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains 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 of 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.

Oakford Manor Nursing Home is a residential care home providing accommodation for people requiring personal and nursing care to 28 people aged 65 and over at the time of the inspection. The service is registered to support up to 50 people. There were eight 'companion rooms' but these were not being used at the time of the inspection, everyone living there had their own bedroom. The building is set over two floors, during the inspection the ground floor bedrooms were used by people receiving nursing and personal care, people receiving assistance with only personal care lived in the upstairs bedrooms.

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

People were at risk of harm because the provider had not always assessed risks to people’s health and safety or done all that was reasonably practicable to mitigate risk, including those which were healthcare related. The provider did not ensure there were always enough suitably qualified staff to give people the support they needed.

The provider did not follow or meet national guidance in relation to infection prevention and control for the Covid-19 pandemic. This put people and staff at risk. The provider had not introduced procedures to detect and control the spread of infection during the Covid-19 pandemic. Staff did not always wear or have access to appropriate Personal Protective Equipment (PPE).

People were at immediate risk of avoidable harm because of the way they were supported to move. Some unsafe practices were used. When things had gone wrong, the provider did not always learn from events or take action to improve safety.

There were widespread and significant shortfalls in the way the service was led. Staff told us the service was not well-led. Staff said they feared repercussions from speaking with us and told us there was a blame culture. Quality assurance arrangements were not applied consistently. There was little evidence of learning, reflective practice or service improvement.

The home was clean and free from malodours and medicines were safely managed.

Rating at last inspection – The last rating for this service was Good (Published May 2018).

Why we inspected

We received concerns in relation to infection prevention and control and the way staff assisted people to move. As a result of this and other information we had received, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. We completed a risk assessment relating to the Covid19 pandemic that was ongoing at the time this inspection was completed. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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 no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Oakford Manor Nursing Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, governance and staffing at this inspection. We have served a Warning Notice against these Regulations. We have told the provider we require them to be compliant in these Regulations within 12 weeks of receiving our Notice.

At our last comprehensive inspection in July 2016 we rated the service as 'Good.'

Risks associated with medicines were mostly well managed; however some medicines were not stored securely in people’s rooms. Staffing was mostly sufficient; however there was an occasion when staff were not free to respond and check a person was safe. Systems and processes were in place to safeguard people from abuse; these covered staff recruitment practices and staff training and knowledge on safeguarding procedures. Systems also ensured accidents and incidents were recorded and analysed and steps to improve and learn were identified. Actions were taken to reduce known risks including those from infection. Actions were taken to reduce falls however, the service had not always identified when control measures to reduce the risks associated with falls were not effective.

We have made recommendations regarding the deployment of staff and the management of risk.

People’s needs for a balanced diet, including any specific dietary needs, were identified and met. Where people required healthcare from other professionals this was arranged and helped to ensure good on-going healthcare support for people. The premises had been changed to ensure they were fully accessible to people. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Staff were supported and trained to have the skills and knowledge in areas relevant to people’s needs. Assessments of people’s needs were in place. They included assessments of any health related needs as well as any diverse needs including those in relation to a person’s religion or disability.

The staff team were caring, kind and friendly. Staff had developed positive relationships with people and knew them well. Staff were mindful of promoting people’s independence and respecting their privacy and dignity. People were supported to be actively involved in decisions about their care.

Systems were in place to ensure complaints could be made and were investigated. People had opportunities to give feedback and raise any issues and have them responded to. People’s care and support reflected their preferences and choices and identified what was important to them. People and when appropriate, their relatives, were involved in making decisions about their care. Staff understood how people communicated and involved people in their care and gave them choices.

A registered manager was in place and they understood their responsibilities for the quality and safety of the service. Systems and processes were in place to assess, monitor and improve the quality and safety of services. The service was focussed on achieving good quality outcomes for people and worked in partnership with other health and social care professionals to ensure people received appropriate care. People, relatives and staff had opportunities to engage and be involved in the development of the service.

Further information is in the detailed findings below

Oakford Manor is registered to provide accommodation for up to 50 people. At the time of our inspection, 40 people were living there. The service is registered to care for people who need nursing or personal care. The service provides personal and nursing care for adults and older people with a range of medical conditions, including dementia, multiple sclerosis, motor neurone disease and people who have experienced strokes.

The service has 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 were not consistently protected from the risk of infection. Although staff had recently received training in infection prevention and control and were knowledgeable about their responsibilities, they did not consistently demonstrate this in their practice.

There were sufficient staff to ensure that people’s needs were met in a timely manner. People’s care and nursing needs were assessed and recorded, risks identified, and steps taken to reduce the risk of avoidable harm. People had their care reviewed on a regular basis, and they and their relatives were involved in this.

Staff understood how to keep people safe from the risk of potential abuse. Where incidents occurred, the provider notified the local authority. However, the provider did not consistently notify CQC about these incidents. People, staff and relatives felt confident to raise concerns about care.

People felt the care provided kept them safe, and relatives also felt this was the case. People and relatives spoke positively about staff, saying they were cared for by staff who treated them with kindness, dignity and respect. They were encouraged to continue with hobbies and interests, and to maintain relationships that were important to them. People were also cared for by staff who were knowledgeable and skilled to provide personal and nursing care to the training standards set by the provider.

Medicines were stored, documented, administered and disposed of in a safe way and in accordance with current guidance and legislation.

Staff had a good understanding of the principles of the Mental Capacity Act 2005 (MCA), including how to support people to make their own decisions. The provider was working in accordance with the MCA, and people had their rights upheld in this respect.

People and their relatives were positive about the quality and choice of food and drinks. We also found that people were supported to maintain their health and to access healthcare services when required.

The provider had a clear complaints policy, and people and relatives felt able to make a complaint or raise concerns. The provider investigated complaints according to their policy, and created opportunities for people to provide regular feedback about the service, which was acted on.

There were systems to monitor and review all aspects of the service, and these were undertaken regularly. This meant the provider was able to identify areas of good practice and areas for improvement, and to make changes to improve the quality of the service. People, relatives, and staff felt supported to make suggestions or raise concerns about any aspect of the service. There was an open and inclusive culture within the service.

Our observations of care being delivered by the staff were good. We saw that staff were caring and spoke with people in a respectful manner, showing consideration and empathy.

We found the premises to be comfortable, well equipped, clean and safe. There were good systems in place for ensuring that the premises and the equipment were well maintained.

We saw that there were robust recruitment procedures in place and the provider had taken steps to ensure that people who lived at Oakford Manor were protected from the risks associated with unsafe recruitment.

We spoke with three people who lived at the care home. They all gave positive comments about the care they received: 'The staff are very good, very kind. They always knock on my door before they come in, and ask me if I would like a bath or shower. There is lots of choice and no restrictions.'

'I'm very happy here, the staff look after me very well, they always ask me before we do anything, and I feel I've still got control over my life.'

'I feel very settled here, everyone is very nice to me, and if I need anything the staff are only too happy to oblige.'

We found two areas of non-compliance relating to consent to care and treatment and care and welfare. We discussed these areas of non-compliance with the area manager during feedback who acknowledged agreed with the concerns raised.

At the time of our inspection the provider did not have a registered manager in post.

We met with two senior managers. The newly recruited manager was on holiday. The operations director received our inspection feedback. During the inspection we spoke with the agency nurse, six care staff, the activity organiser, two visitors and nine people who used the service.

We reviewed how staff gained consent to care for people and how people were safeguarded from abuse. We saw care records that were well written, informative and generally updated regularly. Staff told us and we saw records that the staff were trained to safeguard people from abuse.

The pharmacist reviewed the home's medication administration and procedures. Staff we spoke with told us they were currently well supported by the senior staff and the management team. They told us they received supervision and an annual appraisal. We looked at how the managers monitored the quality of the service and the staff's record keeping.

People we spoke with told us they were settled living in the home and they were satisfied with the care they received.

Three areas of non-compliance relating to consent, care and medication administration were discussed at feedback and this was acknowledged and agreed by those receiving it.

Generally we found improvements in most areas since our previous inspection in February 2013. We saw a number of improvements in how people's care and welfare needs were met, particularly in respect of the care planning system.

We found that some improvements had been achieved in the management of medicines in the home. However, we still had concerns regarding the arrangements in place for stock control and record keeping. People told us that there were usually staff available when needed and our observations supported this. However, we found that there were some gaps in staff training. This meant that staff might not have the training they need to carry out their role and keep their skills up to date.

We saw that there had been improvements in quality monitoring at the care home, particularly in relation to improvements in the care planning system. However, our concerns relating to medication and record keeping showed that the quality monitoring systems in these specific areas were not always effective.

We looked at medication and records about medication for fifteen people. Although we saw some improvements, we found concerns about the safe handling of medicines for thirteen people.

We found that there were systems in place to assess and monitor the quality of the service provided. However, we found that these systems were not effective in ensuring that necessary improvements were made and sustained.

We saw that improvements had been made to people's care records since our last inspection visit. However, we found there were still significant deficits in care and medication records.

People told us they liked living in the home. One person said, 'Generally I can please myself, when I go to bed and when I wake up'. People said they felt safe and the staff were good with them. Relatives told us they were generally happy with the care provided. One said, 'The care staff are very good and some are brilliant!", and, "I have no issues with the staff in the home, only the higher management". Relatives we spoke with also expressed their concerns about too many changes in management at the home.

We found that care plans had not all been updated and instructions in care plans were not always carried out by staff. This meant that people were not protected against the risks of receiving inappropriate or unsafe care.

We found that there were not always enough staff available to meet people's needs. This meant that people did not have the help they needed, for instance, with eating meals.

We found that the systems in place were not effective in identifying, assessing and managing the risks to the health, safety and welfare of people using the service.

We found that care records were not always accurate or up to date.

In this report the name of a registered manager appears who is no longer in post at Oakford Manor. Their name appears because they are still registered with us as the registered manager at Oakford Manor.

At our inspection in October 2012 we found that people living at Oakford Manor were still not protected against the risks associated with the unsafe use and management of medicines.