Oak Manor Nursing Home

Oak Manor Nursing Home is a residential care home which provides nursing and personal care for people. The service can support up to 61 people and specialises in providing care for people living with dementia.

There were 22 people using the service at the time of our inspection. The premises are in a rural setting with all facilities on the ground floor.

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

Refurbishment at the service had been undertaken since our last inspection, addressing concerns we had previously identified in relation to suitability of the garden area and improper use of fire exits. At this inspection, we identified further repair work that was required, which the service had not independently identified. However, these repairs were undertaken immediately during the inspection.

This location has not been fully compliant with regulations since it was inspected on 11 February 2019. Their has been ongoing concerns with maintaining compliance and the acceptable level of safe care.

Care plans detailed how to support people in their daily life's. Ensuring risks were assessed to keep the person safe.

Medicines were stored securely for the safety of the people supported. Medicines were well audited to ensure people received their medicines as directed/ prescribed.

People were comfortable in the setting and were observed having positive interactions with staff.

Families spoke positively about the staff and felt that their loved ones were safe and well supported.

People were involved in planning and reviewing their support. Care plans were shaped around the person’s preferences.

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.

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 21 December 2020) and there were breaches of regulation 15 due to the premises not being maintained, regulation 12 due to provider not assessing and monitoring risk, regulation 19 due to a failure to report significant incidents and regulation 17 due to the quality and safety of the service not being assessed and monitored .

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Exiting special measures

This service has been in Special Measures since 21 December 2020. 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.

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.

Oak Manor Nursing Home is a residential care home which provides nursing and personal care for people. The service can support up to 61 people and specialises in providing care for people living with dementia. There were 46 people using the service at the time of our inspection. The premises are in a rural setting with all facilities on the ground floor.

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

Improvements had been made to reduce the risks to people from the spread of infection. Additional cleaning processes and resources had been put in place since our last inspection. Staff adherence to government guidance in the wearing of personal protective equipment had improved. Improvements were being implemented to oversight of this by the manager and the provider however these were not yet embedded.

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 Inadequate (Published November 2020)

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about infection prevention and control identified at a previous inspection. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

CQC have introduced targeted inspections to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Oak Manor Nursing Home is a residential care home which provides nursing and personal care for people. The service can support up to 61 people and specialises in providing care for people living with dementia. The premises are in a rural setting with all facilities on the ground floor.

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

Improvements had been made to reduce the risks to people from the spread of infection. Additional cleaning processes and resources had been put in place since our last inspection. Staff adherence to government guidance in the wearing of personal protective equipment had improved. Improvements were being implemented to oversight of this by the manager and the provider however these were not yet embedded.

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 Inadequate (Published November 2020)

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about infection prevention and control identified at a previous inspection. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

CQC have introduced targeted inspections to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Oak Manor Nursing Home is a residential care home which provides nursing and personal care for people, some of whom are living with dementia. The service can support up to 61 people and specialises in providing care for people living with dementia. The premises are in a rural setting with all facilities on the ground floor.

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

People did not always receive care and support which was safe and met their needs. Safe systems were not in place to reduce the risk and spread of infection, including COVID-19. Staff were not wearing PPE in accordance with government guidance and cleaning procedures were not robust. Oversight of cleaning was poor, and some areas were visibly dirty. This placed people at increased risk.

Some areas of the service were not in a good state of repair. The provider had not made enough adaptation to the service, such as additional handrails, to ensure it was safe for people to move around. The garden remained overgrown and unsafe for people to use. These issues had been identified at previous inspections in May and September 2019.

Although management of incidents between people who used the service had improved, one incident which met the safeguarding threshold and two falls causing injury and hospital admission had not been notified to the Care Quality Commission.

Relatives gave us mostly positive feedback but several commented on poor communication and remained unaware of recent management changes at the service. This poor communication raised relatives’ anxieties at a time they were unable to see their relatives due to COVID-19 restrictions on visiting.

The newly appointed manager had made a lot of changes and begun the process of driving improvement. They were held in high regard by the staff. However, many of the significant failures we found had not been identified by them or the provider’s audit processes. Audit systems did not always identify concerns or act quickly when things needed to be addressed. This placed people at continued risk of unsafe care and treatment.

The new manager had begun improving the service and the provider’s regional manager was supportive of them. However, the failings we indentified led us to have significant concerns about the service. We were pleased to note people’s feedback was mostly positive and some aspects of the service were working well. This was particularly clear in relation to increased and more consistent staffing as well as a commitment to more person centred care plans. We were assured by the prompt actions taken to address our urgent concerns about infection prevention and control. However, the fact that some longstanding concerns remained and the poor infection prevention and control we identified during our inspection visit meant we were not assured of the safety and quality of the service.

Rating at last inspection (and update)

The last rating for this service was Requires Improvement (published 11 November 2019) and there were breaches of regulation relating to person centred care and to the premises and equipment. The provider completed an action plan after the last inspection to demonstrate what they planned to do to address the issues we found. At this inspection we found the provider had made improvements relating to person centred care but had not done enough to address the environmental concerns. This meant they remained in breach of the regulation relating to premises. We also identified new breaches of other regulations.

Why we inspected

We received information in relation to poor staffing levels, poor cleanliness, concerns about people's dignity being upheld and poor record keeping. Some of these concerns had been raised by staff. We also had concerns about the ongoing management and oversight of the service. As a result, 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. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at 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 coronavirus and other infection outbreaks effectively.

The overall rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the Safe 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 Oak 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 failing to notify CQC as required, poor infection control practice, poor maintenance of the premises and poor leadership and oversight at this inspection.

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 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 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.

The premises are in a rural setting with an older building being extended. All facilities are on the ground floor. People’s bedrooms are accommoded off a circular corridor that returns to the lounge and dining room at the front of the care home. The service specialises in providing care for people living with dementia.

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

Since the last inspection the provider and management have been working hard to improve this service. People have benefitted from the changes that have been made and the ongoing plans will further improve people’s experiences. Therefore, this service has moved out of special measures and is now rated as requires improvement.

The number and dependency levels of people using this service had reduced since our last visit. This was because of action taken by the service to temporarily suspend admissions until the service had improved the provision of service.

There continued to be a high use of agency staff at the service. The registered manager and provider had a constant recruitment campaign running to recruit permanent staff. There had been a strong focus on change of culture within the service. Communication systems had improved and were still being refined.

Staff had received training and support to better perform their roles and this was ongoing. For example, training relating to dementia, wound care and end of life was on-going. Staff morale had positively improved.

People were safeguarded from abuse and people were provided with sufficient to eat and drink that met the needs of people living with dementia and associated health conditions. Infection control matters had improved.

The provider had mobilised resources within the organisation and had addressed the quality assurance issues raised at the last inspection. The providers own monitoring of the service was more effective, and they had oversight of events at the service and were responding effectively to those findings.

Environmental issues still remained. The development of outside safe space had yet to be addressed. There was a lack of working shower/bathing facilities for the numbers of people resident during our inspection visit, but we have been informed this has been resolved.

Care planning documentation is still extensive and overly burdensome for staff to complete and navigate. People were still not meaningfully engaged in day time occupation. One activities person had recently been appointed and more were planned.

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.

Rating at last inspection (and update)

The last rating for this service was Inadequate (report published 1 May 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

This service has been in Special Measures since 1 May 2019. 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 was a planned inspection based on the previous rating. However, the timing of the inspection was prompted in part due to concerns received about staffing levels and care practices. A decision was made for us to inspect and examine those risks earlier than scheduled.

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

Follow up

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.

People’s experience of using this service:

¿ There were widespread concerns found at the service. The overall rating for this service is 'Inadequate' and the service is therefore in ‘special measures’.

¿The service was in breach of nine regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

¿People were not supported safely. Actions to assess and address risks to people’s health, safety, and wellbeing were not always taken.

¿People were not protected from abuse and improper treatment.

¿Infection control was not well managed.

¿The service was not always fully staffed. This impacted on the safety of people in the service and in ensuring people’s needs were met.

¿There was a negative task focused culture in the home. There were tensions amongst the staff team which impacted on the delivery of the care provided.

¿Staff were not always clear regarding their role and responsibilities.

¿Quality assurance processes had been ineffective in identifying issues in the home in a timely manner so action could be taken to prevent the service from deteriorating.

¿The provider’s own audits had identified issues within the home and they had started to take some action to make improvements. At the time of our inspection it was too early to assess how effective these actions would be and if improvements could be made and sustained.

¿Training and support for staff was not effective in ensuring good quality care was provided.

¿People were not always supported to eat enough and preferences relating to food were not always provided for.

¿Staff did not always seek people’s consent when supporting them.

¿Staff did not always support people in line with best practice guidance and legislation.

¿Staff did not work effectively with each other and other professionals to provide effective and high-quality care.

¿The environment, including the design of the service, did not meet people’s individual needs.

¿People were not always treated respectfully and their dignity was not always promoted. People’s human rights were not consistently upheld.

¿People and relatives were not fully involved in assessing and planning their care. Care was not provided in a way that met people’s individual needs and preferences, this included in relation to social activities and interests.

Rating at last inspection: Good (report published 4 November 2017)

Why we inspected: The inspection was brought forward because we received information of risk and concern.

Enforcement: See end of full report for action we told the provider to take.

Follow up: The overall rating for this service is 'Inadequate'. This means that it has been placed into 'Special Measures' by CQC.

¿Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

¿If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

¿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.”

There was a manager in the home who applied to become a registered manager 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 home is run.

At the last inspection, the home was rated Good overall. At this inspection we found the home remained Good.

Why the home is rated Good…

People received support to take their medicines safely. Staff knew how to keep people safe from the risk of harm. Actions had been taken to reduce risks to people’s safety. There were enough staff to keep people safe and meet their needs.

Staff were competent to carry out their roles effectively and had received training that supported them to do so. People were supported to eat freshly prepared meals, and their individual dietary needs were met. People were able to access and receive healthcare, with support, if needed.

At our last inspection, we rated the key question of “Is the home effective?” as requires improvement. This was because although staff knew how to support people to make day to day decisions about their care, the principles of the Mental Capacity Act had not always been followed when some decisions had been made on behalf of people. Although improvements had been made to the environment to help the people who lived there to orientate themselves around Oak Manor, some areas were in need of redecoration and refurbishment. Improvements had been made by the homes management team to address this and an action plan put into place. Sufficient progress had been made, with a timescale for completion of the outstanding work to be done.

People were able to make choices and decisions that affected their daily lives. Staff supported them in the least restrictive way possible; the policies and systems in the home complimented this practice.

Staff were kind and compassionate in the way they delivered support to people. People were treated with dignity and respect. Staff ensured that people were able to have visitors, and enabled people to maintain relationships with relatives and friends who did not live nearby.

People and their relatives were confident that they could raise concerns if they needed to and that these would be addressed.

The manager ensured that the home was well run. Staff were committed to the welfare of people living in the home. The manager ensured they kept links within the local community and people were part of regular events.

Further information is in the detailed findings below.

At the last inspection in November 2014, we found the provider in breach of two Regulations of the Health and Social Care Act 2008 (Regulated Activities) 2010 in relation to infection control and the environment for people living with dementia. The provider sent us an action plan to say they would be meeting the relevant legal requirements by February 2015. We found that the necessary improvements had been made and that the provider was no longer in breach of these Regulations.

Oak Manor Nursing Home is a care home that provides accommodation and nursing care for up to 61 older people who are living with dementia. On the day of our inspection, there were 58 people living within the home.

There was a manager working at the home who is registered with us. 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 and associated Regulations about how the service is run.

People who lived in the home were safe. Risks to their safety had been assessed and actions taken to reduce any risks that had been identified. People received their medicines when they needed them and they received enough food and drink to meet their needs. The staff supported them to maintain their health.

There were enough staff available to meet people’s needs, preferences and to keep them safe. These staff had received appropriate training and supervision to enable them to provide people with effective care.

The staff knew how to support people to make day to day decisions about their care. However, the principles of the Mental Capacity Act had not always been followed when some decisions had been made on behalf of people.

Improvements had been made to the environment to help the people who lived there to orientate themselves around Oak Manor. However, some areas were in need of redecoration and refurbishment.

People were cared for by kind, compassionate and caring staff who knew them well. The staff were polite and treated people with dignity and respect.

People had a choice about how they wanted to live their lives and the staff promoted this. People were encouraged to maintain their independence and to participate in activities that complemented their hobbies, interests and that promoted their wellbeing.

Any concerns raised were dealt with quickly and the staff were happy working in the home. They were supported by a management team who were good leaders and who promoted care that was based on people’s individual needs and choices. Communication within the home was good and therefore, the staff understood their individual roles and responsibilities which contributed to the provision of good quality care.

There were effective systems in place to assess and monitor the quality and safety of the care that was provided to people living at Oak Manor.

We have made a recommendation regarding following the principles of the Mental Capacity Act 2005 when making best interest decisions on behalf of people.

We found that the service had put in place decision specific mental capacity assessments for those who required one. These assessments set out the best interest process staff should follow if they found someone was not able to consent to care which would be in their best interest. We found that care planning no longer made reference to people's ability to make decisions and instead referred staff to the assessment of capacity. Staff had undertaken face to face training in the Mental Capacity Act and now demonstrated a much improved knowledge of this.

We observed the lunch time meal service and found that there was a much improved procedure in place to ensure that staff protected people from the risks of inadequate nutrition.

We found that staff were aware they should not be restraining people and that staff had undertaken face to face training in challenging behaviour.

We found that people using the service or their relatives, were involved in their care planning and decisions about their care. People were involved in making decisions on a daily basis.

We found that the service was not undertaking assessments of people's capacity to make informed decisions. The provider was not acting in accordance with the Mental Capacity Act.

We found that there was appropriate assessment of people's physical care needs, leading to plans of care and assessments of risk for people using the service. One relative told us, "...I'm very satisfied". Another told us, "...They do exceptionally well".

We found that that the service was not safeguarding people against the risk of unlawful or excessive restraint. Staff were restraining people using the service without being trained to do this, so placing people at risk. On one occasion, staff did not act appropriately to make a safeguarding referral where this would have been appropriate.

We found that staff had training in key subjects relating to providing care to people using the service. However, staff said they would benefit from more training in managing challenging behaviour. Staff had access to regular supervision and annual appraisals were booked for all staff.

We found that the service had a programme of audits to monitor and assess the quality of the service.