Archived: The Oaks

Updated 25 June 2019

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection was conducted by one adult social care inspector on day one and day three of the inspection. One medicines inspector and a medicines team support officer conducted the second day of inspection.

Service and service type

The Oaks is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

This service is also a domiciliary care agency. It provides personal care to people living in their own homes on the same site as the care home.

The service does not have a manager registered with the Care Quality Commission. A registered manager is someone who, along with the provider, is legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We looked at the information we held about the service, such as notifications we had received from the provider. A notification is information about important events which the service is required to send us by law. We reviewed concerns raised with us and sought feedback from the local authority safeguarding team. We used all of this information to plan the inspection.

During the inspection

We spoke with five people who used the service about their experience of the care provided. We spoke with nine members of staff including the interim clinical lead, interim compliance officer, deputy manager, general manager, care quality and compliance manager, two care workers and two nurses.

We looked at a range of documents and records related to people’s care and the management of the service. We viewed four people's care records, two staff recruitment and induction files, training and supervision information, staff rotas and a selection of records used to monitor the quality and safety of the service. We also conducted a comprehensive medication audit.

After the inspection

We continued to seek clarification from the provider to corroborate evidence found. We looked at training data and reviewed additional feedback received from a relative.

Updated 25 June 2019

About the service

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.