This unannounced inspection took place on the 16 December 2015 in response to information of concern we received from a variety of sources.
We found at this inspection that people’s safety had been compromised in a number of areas. This included the management of people’s medicines, the monitoring of people at risk of and support for people with pressure ulcers, care and support for people with indwelling catheters and monitoring and support for people with their food and fluid intake.
Staffing levels were insufficient to meet the needs of people who used the service. The provider did not have a system in place to ensure continuous assessment of staffing levels to make the changes required when people’s needs changed. There were no nurses directly employed by the provider. All nurses were employed through nursing agencies. There was no clinical lead in post with delegated responsibilities and oversight of nursing tasks and assessment of nursing competencies.
There was a lack of regular safety audits of medicines management within the service. This had resulted in medicine administration errors not being identified and no action taken to mitigate risks and protect people from the risk of harm.
In response to our concerns identified at this inspection we issued an urgent action letter on the 16 December 2015. The provider in response sent us an action plan which told us what action they would take in response to our concerns to mitigate the risks to people’s health, welfare and safety.
The Oaks care home provides nursing and personal care with accommodation for up to 61 people, some of whom required specialist palliative (end of life) care. On the day of our inspection there were 53 people living at the service.
There was 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.
Staffing levels were insufficient to meet the needs of people who used the service. The homes manager worked shifts to cover the rota. There was no member of staff delegated to carry out the role as clinical lead. There were no qualified nurses employed directly by the provider.
We found significant concerns in relation to medicines management. People were not receiving their prescribed pain relief medicines as required. People did not always have access to medicines due to staff not managing stock effectively and stocks of medicines ran out. There were insufficient numbers of trained staff available to administer medicines and excessively long medication rounds. Medication audits were poor and did not identify errors. Poor auditing meant that stock did not always balance and discrepancies were not identified by the provider.
There was also a lack of systems and auditing of the cleanliness of the environment and maintenance of the building. We found poor infection control practices and areas of the service which were not acceptably clean. There were strong odours throughout the service and the carpets and furnishings found to be dirty.
People were not supported to access personal care. Some people were found not have been supported with a bath or shower for up to three months. People were observed to look unkempt and have nails which had not been cared for and supported to clean.
The service was not well-led. There was a lack of clinical governance. The registered manager was not a trained nurse and the post of deputy manager where previously this person would have been the clinical lead had been vacant for several months. There were no clinical audits in place which would have identified the shortfalls we found at this inspection. We were therefore not assured that action was taken to identify and mitigate the risks to people’s health, welfare and safety.
There were no effective systems in place to monitor effectively and proactively the quality and safety of the service provided. The provider failed to operate effective systems and processes to make sure they assessed and monitored the quality and safety of the service on a regular basis. The environment and equipment for people was not suitable to support people safely and ensure people’s individual needs were met.
The provider did not have a robust system in place to evidence their response and outcomes following investigations into people’s concerns and complaints about the quality of the service provided.
During this inspection we identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special Measures’.
The service 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.
This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.