Archived: Oakwood Grange

We found the following examples of good practice.

Relatives received regular updates about visiting arrangements. Clear guidance for visiting was displayed at the home. A warm and inviting screened visiting room was available for pre-booked visits. Window visits were supported, and a microphone was available to support communication for these. People were supported to use technology, where appropriate, to keep in contact with their friends and relatives. Local school children were writing to pen pals at the home; some school children made gifts and posters to support people’s mental well-being at the home. The home had a clearly defined process for sanitising all gifts brought to the home before being given to people living there.

Staff were supported to social distance, a room had been designated for staff breaks. People had been supported to self-isolate when necessary. Staff were updated through handovers and a discrete PPE station was placed outside the rooms of people who were self-isolating. Clearly defined zones within the home supported this during COVID-19 outbreaks.

One member of staff had been given responsibility for the additional and enhanced cleaning of touch surfaces; this was well-documented. Laundry was pre-sorted into different types and colour-coded and labelled. This meant the laundry person did not have to sort soiled laundry. Separate laundry arrangements were in place and disposable crockery and cutlery had been used for those people who had tested positive for COVID-19. Unused rooms had been repurposed to support infection prevention and control (IPC); such as the visitors' room, additional staff room, and staff changing room.

People were admitted to the home safely. Clear guidance was available and followed. The home had developed good links with health professionals to facilitate safe admissions to the home and ensure appropriate access to health support.

To minimise infection risks staff put on and took off their uniforms at the home; there was a designated changing area for this. Staff were observed wearing appropriate PPE at all times and appeared comfortable wearing this. Good stocks of PPE were available. Regular handwashing was promoted for both people and staff.

Monthly IPC audits checked handwashing and PPE use. An information folder with frequently asked questions had been developed; this contained useful guidance to support people's understanding of PPE wear as well as the Coronavirus in general. There was a clear record of infection risks and actions taken to mitigate those risks. Consideration had been given to vulnerable groups of people and staff. The provider had robust contingency arrangements in place.

Oakwood Grange is a care home that provides accommodation and personal for up to 60 people. At the time of this inspection there were 51 people using the service.

People’s experience of using this service:

• A new manager had recently started working at the service. Staff spoke positively about the new manager and said they were supportive and approachable;

• The service had improved since the last inspection and was no longer in breach of regulation 15. The home was safe, clean and well-maintained.

• People who used the service and their relatives told us they had confidence in the management team and they could raise any concerns, which would be responded to. They also had the opportunity to attend regular meetings about the service to provide feedback and ideas for improvement. Relevant stakeholders were asked for feedback about the service in order to drive improvements.

• People told us staff were kind and caring. They were positive about how they were treated by staff. People told us they were in control of their day to day routines and staff supported them to remain independent.

• People felt safe whilst residing at Oakwood Grange. They had access to other community health professionals as required. Staff supported them safely with their medicines. We made a recommendation about the management of topical creams to ensure these are stored and disposed of appropriately;

• Staff knew about people’s likes and dislikes and knew information about people’s backgrounds. They used this knowledge to care for people in the way they wanted. The service was committed to supporting people at the end stages of their life and worked in partnership with external professionals. We made a recommendation about the content and detail of people’s end of life care plans;

• Staff received a range of training and people thought staff had the right skills and experience to care for them effectively. Staff were empowered to identify and manage their own training commitments through regular supervision and appraisals with the management team.

• People were positive about the quality of the food. People were provided with a range of food options that met their nutritional requirements.

• Risks to people receiving care at Oakwood Grange were assessed and kept under review. People’s needs were assessed and support plans were developed to guide staff in how to care for each person.

• People were offered a range of activities which took place both in the home and in the community. The provider was in the process of implementing a new system to record people’s social activity to help staff plan activities in a person-centred way;

• People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the polices and systems in the service supported this practice.

More information is in the full report.

Rating at last inspection:

At the last inspection the service was rated requires improvement (published 21 March 2018).

Why we inspected:

This was a planned inspection based on the rating awarded at the last inspection.

Follow up:

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

Oakwood Grange is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Oakwood Grange is registered to provide residential accommodation for older people, including those with dementia, for up to 60 people. Oakwood Grange accommodates people over two floors with lift access. On day one of our inspection there were 56 people living at Oakwood Grange. On day two this had increased to 59.

At the time of our inspection the manager was registered with the CQC and they were present on both days of our inspection. 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.

At our last inspection we found breaches of the regulations concerning the premises and consent to care. At this inspection we found some improvements had been made, although we identified concerns regarding cleaning of showerheads and thorough examinations of slings used for moving and handling transfers.

Records of mental capacity assessments, Deprivation of Liberty Safeguards (DoLS) and Power of Attorney had improved since our last inspection, although we recommend the registered provider look at further developing decision specific mental capacity assessments. Staff were aware of the importance of gaining consent to care and knew what to do if people refused care. We saw people being offered choice in their daily routines.

Staff told us the registered manager was approachable and listened to their concerns. Quality management systems were in place and found to be mostly effective, although concerns relating to ongoing maintenance had not been identified.

We looked at the management of medicines which included storage and administration and found this was mostly well managed. However, records relating to the use of topical creams required improvement.

People and relatives provided mixed feedback about staffing levels. The registered provider had calculated the number of staffing hours required to meet people’s needs and this was reviewed on a monthly basis. Rotas showed shifts had the number of staff identified through the registered provider’s dependency tool. However, not all day shifts had two team leaders which the registered manager was addressing through a recruitment process.

Risks to individuals had been identified and assessed and people told us they felt safe living at this service. Staff had received safeguarding training and knew how to identify types of abuse and how to report this. Personal emergency evacuation plans were in place. These were updated in response to our feedback regarding adding the number of staff required to assist people. Recruitment processes were found to be safely managed.

People gave us mixed feedback about the quality of meals provided. One person reported they had not received their breakfast a few days prior to our inspection. On day one of our inspection the breakfast service ran late which meant people may not have had time to regain their appetite in time for lunch.

People were supported to access healthcare in a timely way and visiting health professionals were complimentary about Oakwood Grange and the staff.

Assistive equipment was in place to support people to maintain their independence, although limited evidence of meeting the accessible information standard was available at the time of our inspection.

Care plans were found to be person-centred and contained sufficient guidance for staff to follow. People’s religious and cultural needs were taken into account when care plans were written. Care plans were reviewed on a regular basis. We observed warm interactions between people and staff during our inspection and found people and their relatives were complimentary about staff. Staff were able to describe how they maintained people’s privacy and dignity and people told us this happened in practice.

One family told us they had been restricted in visiting their family member due to an infection control outbreak at this service. The registered manager had taken appropriate action in response to this matter. Responses to complaints were not always submitted within timescales identified by the registered provider, although we found evidence of investigations and responses.

Activities were taking place at the time of our inspection. We saw records of activities which showed people’s involvement and external entertainers visited.

People told us they felt safe living at the home and said they were supported by suitably skilled staff. Staff receiving training and formal support through regular supervision, although we saw the recording of this needed to emphasise training needs and personal development.

We found a single breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take at the end of this report.

Oakwood Grange is a home which offers accommodation to up to 60 older people and people living with dementia. Accommodation is offered over two floors and does not include any nursing care. There was no registered manager in post at the time of our inspection. The manager who had been in post since April was absent from the home at the time of the inspection. The day to day running of the home was being carried out by two peripatetic managers on both of the days we visited the home.

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.

There had been a fire risk assessment carried out which had identified areas of risk which needed to be addressed. We found there were multiple areas which had been identified as high risk which had not been actioned. This meant the building may not be safe in the event of fire.

There were no personal emergency evacuation plans in place which instructed staff how they should assist people to leave the building safely in the event of an emergency.

We found medicines were stored, administered and managed safely and people received their medicines as prescribed.

Staff undertook regular training to ensure they had the relevant skills and knowledge to carry out their roles. Staff were knowledgeable about all aspects of the training they had undertaken when we spoke with them.

Mental capacity assessments, best interest decisions and Deprivation of Liberty Safeguards were not in place for all people who required them. There was little evidence that people had been asked for or given their consent for the care they were receiving.

Despite the home having a ‘dementia unit’ we found the environment was not adapted to meet the needs of people who were living with dementia.

Staff were kind, caring and patient when supporting people. There were positive relationships evident and staff gave thought to maintaining the privacy and dignity of people they were supporting. Staff encouraged people to be as independent as they were able.

Care plans were not always person centred and some did not contain all the information required for staff to meet people’s needs.

There was a programme of activities within the home, which included entertainers and other arranged activities including exercise classes.

The home had several managers over a short timescale, which had left staff feeling unsettled, although staff reported an improvement over recent weeks since the peripatetic managers had been supporting the home.

Monitoring and auditing processes were confused and as a result were not consistent or efficient. This had led to a lack of oversight and concerns about the safely and quality of the care within the home. However these issues had been recognised and action was already being taken by the time of the inspection.

We found the registered provider was in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to the safety of the building and the need for consent .You can see what action we told the provider to take at the back of the full version of the report.