Archived: Oakdene Residential Home

Oakdene Residential Home 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.

The home is registered to provide accommodation and personal care for up to 16 people. At the time of our inspection 8 people were living at the home.

The home required and had 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. The registered manager is also the nominated individual and the provider (a director of the company that owns the home). They had delegated the day to day running of the home to a home manager (in this report referred to as the manager). The manager had been working at the home since March 2018, however the registered manager remains legally responsible for the safe running of the home.

At our inspection in January 2018 the overall rating for the home was, 'Inadequate'. Since then the service has been in 'special measures'. This inspection was to see if significant improvements had been made.

At our last comprehensive inspection in August 2018 there was breaches of Regulation 9, 10, 11, 12, 13, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There was also a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

In November 2018 we completed a focused inspection due to specific information of concern in relation to a lack of heating and hot water at the home. During that inspection the provider took steps to restore these essential services at the home.

At this inspection we saw that the provider had addressed many of the significant shortfalls previously identified. However, there are still some areas of concern and the provider was still in breach of Regulations 11, 12, 17 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Therefore, the service continues to be rated ‘Inadequate’ and remains in ‘special measures’.

The provider had not taken steps to assure themselves that the service was consistently safe. For example, the manager had not assured themselves over a period of five or six days, that an adequate fire detection system was in place on the first floor of the home. Also, the manager had appointed a new member of care staff with very little information with regard to the staff member’s suitability for the role and therefore placed people’s safety at risk.

Fire safety and safe recruitment of staff are both areas of the management of the home that have been in breach of the regulations due to significant concerns at recent inspections. The systems in place at the home to ensure the service was safe, were not being used effectively to mitigate risks.

We looked at people’s care files and saw that any risk present in their care and support had not always been appropriately assessed and appropriate guidance had not consistently been provided for staff members to reduce the risk.

This meant that the manager and therefore the registered manager could not be assured that the service was consistently safe.

The service was not always working within the principles of the Mental Capacity Act (2005). Assessments of people’s capacity did not outline the decision they were assessing the person’s capacity to be able to make. Assessing people’s capacity is done when there is a reason to believe the person may not have capacity and a significant specific decision needs to be made. After reading people’s capacity assessments it was unclear if it had been deemed that the person had capacity or not.

Since our last inspection there had been an improvement in the systems that support people to manage their healthcare appointments. If needed people were supported to manage their mail and correspondence and appointments were recorded in the diary. Staff helped to ensure people were able to get to their appointments.

Each person now had a recent care plan that was stored on an electronic system. There had been improvements in the quality of people’s care plans at the home. However, some information in people’s care plans was missing or did not always match the care they received. We recommended that the provider arranged for people’s care plans to be reviewed.

People told us that they were happy living at Oakdene; and they felt well cared for. One person said, “The staff are very caring, they look after me.” We saw that the day to day interactions between staff and people living at the home were caring. People were provided with compassionate emotional support and staff spent time interacting with people in the lounge during the afternoon. One staff member told us that they now did this more often. They said, “We have more time to spend with people. We used to be up the wall.”

There had been a significant improvement in the activities available that people can choose to be involved in. One person told us, “There is more stuff going on now. We have had singing and dancing today, we do jigsaws, have the piano man come and the ukulele lady; they are very good.” During our inspection we observed a sing along at the home which people enjoyed. One person who was singing said, “When you are singing you just forget about everything, don’t you?”

People were positive about the food provided at the home. Comments about the food from people included; “Really nice”, “Very tasty”, “Marvellous” and “Compliments to the chef”. We observed one lunchtime and saw that there has been a significant improvement in people’s dining experience.

Staff told us that they felt that recently there was more support available for them. Since our last comprehensive inspection, a new training provider had been sourced and staff were working through a programme of computer based training courses. There had also been recent one to one refreshment of training and assessment of staff knowledge in safeguarding vulnerable adults and the safe administration of medication, with the manager. Recent safeguarding alerts had been appropriately dealt with at the home.

The manager was very enthusiastic about the home and the people living there. It was clear that the people living in the home had a warm and positive relationship with the manager. One person told us, “The manager is brilliant. You can see them just for a chat.” Staff members spoke about the manager having a positive influence on the home. One staff member told us they had, “Seen a lot of changes recently, positive changes.”

At this inspection the safety of the environment of the home had significantly improved. The risks previously identified in August 2018 had been resolved. The manager arranged for a series of checks, audits and services to take place at the home to ensure it was safe. The home appeared clean to an acceptable standard and the communal areas of the home had been refurbished.

Most audits and checks that took place at the home had been effective in raising standards. For example, the medication administration audits had been effective in reducing medication recording errors. This was because it had led to an improvement in staff’s practise and the administration of medication was now safe. The home’s cleaning and kitchen cleaning audit had contributed to a nicer environment. The manager had been responsive in using information from the audits to improve the quality of the support provided for people.

The overall rating for this service is still 'Inadequate'. This service has been in 'special measures' since it was first rated 'Inadequate' following our inspection in January 2018.

Following our inspection in January 2018 we issued a notice of decision to cancel the provider's registration. The provider started an appeal process against this decision. This appeal has now been withdrawn by the provider; therefore the decision to cancel the provider's registration took effect.

We had carried out an unannounced comprehensive inspection of this service between 9 and 16 August 2018. After that inspection we received information of concern in relation to a lack of heating and hot water at the home. As a result, we undertook this focused inspection to look into those concerns. This report only covers our findings in relation to the questions; ‘Is the service safe?’ and ‘Is the service well-led?’ You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Oakdene Residential Home on our website at www.cqc.org.uk

The home is registered to provide accommodation and personal care for up to 16 people. At the time of our inspection nine people were living at the home.

The home required and had 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. The registered manager delegated the day to day running of the home to a relief manager. The relief manager had been working at the home since March 2018, however the registered manager is still legally responsible for the safe running of the home.

During our previous inspection in August 2018 we again rated the service overall ‘Inadequate’. Since January 2018 the service has been in ‘special measures’. This inspection did not change the rating of this service.

At this inspection in asking the questions; ‘Is the service safe?’ and ‘Is the service well-led?’ we found continued breaches of Regulation 12, 17, and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There was also a continued breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. There was no longer a breach of Regulation 13, as systems had been improved at the service that helped protect vulnerable adults from abuse.

When we arrived at the home the central heating and hot water were not working. The service was using multiple portable electric heaters. The communal areas of the dining room and lounge felt warm and people told us they were warm.

The provider had taken some steps to ensure that people were warm in the home. However, they had not done this safely and ensured that additional risks had been mitigated. We asked the provider to complete a risk assessment for each individual to identify and minimise the risks of using portable electric element heaters; to keep regular temperature checks of the home to stop it becoming too hot or too cold; to place an extra member of staff on duty over the weekend to provide additional checks and to stop using items to wedge open fire doors.

We returned on Monday 26 November 2018 and found that a new heating and hot water system had been fitted and that the service had put the safety measures requested in place. The home was warm.

The old boiler had been identified as being, ‘immediately dangerous’ on the 14 November; ten days earlier and the gas supply had been capped. The gas safety certificate for this appliance and the gas supply had been allowed to run out of date twelve weeks earlier. The provider had not informed the CQC of this. It is It is clear in the Care Quality Commission (Registration) Regulations 2009 that this is a reportable event; this shows a pattern of the provider not providing the CQC with information that they have a legal obligation to do so.

There were also other safety risks with the environment identified during this inspection.

The leadership at the home was still reactive. The registered manager and the systems in place were not yet identifying areas requiring immediate improvement and ensuring that appropriate actions were being taken and necessary improvements were being made to ensure that the care and accommodation provided was safe and of high quality.

There had been improvements in the management of people’s medication, still further improvements were required. There was still insufficient information held on each staff member used at the service, as highlighted previously.

There were improvements in how accidents and incidents were recorded and managed at the home; in how people’s mail and healthcare appointments were managed; food safety and people’s financial records.

People told us they liked living at the home, that they felt safe and had been warm in the week before our inspection.

The overall rating for this service is still ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the registered provider's registration of the service, will be inspected again within six months of the last comprehensive inspection report.

The expectation is that registered 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 registered 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 registered provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

Oakdene Residential Home 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.

The home is registered to provide accommodation and personal care for up to 16 people. At the time of our inspection 10 people were living at the home.

The home required and had 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. The registered manager delegated the day to day running of the home to a relief manager. The relief manager had been working at the home since March 2018, however the registered manager is still legally responsible for the safe running of the home.

During our previous inspection in January 2018 we rated the service overall ‘Inadequate’. Since then the service has been in ‘special measures’. This inspection was to see if significant improvements had been made within this timeframe.

At this inspection there was breaches of Regulation 9, 10, 11, 12, 13, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There was also a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

The provider had not addressed many of the significant shortfalls identified at the last inspection and in some areas people’s care had deteriorated. The systems the registered manager had in place had not ensured that the service was safe and was providing effective care for people.

Some improvements had been made to the environment of the home and the safety of the administration of medication. However, parts of the environment were still not safe for people. We asked to see a copy of the risk assessment for the home’s refurbishment works and we were not shown one. Systems at the home did not always reduce the risks to people’s health and wellbeing.

The procedures at the home to protect people from abuse or avoidable harm were not robust. For example; the registered manager could not be assured that new staff had been safely recruited. People had not received effective support to manage their healthcare needs and; appropriate steps had not been taken to ensure that people’s legal rights were protected.

There had not been significant improvements in the training and support of staff members. Staff had not received appropriate support, training, supervision and appraisal to enable them to carry out their duties effectively.

The provider had still not ensured that people had always been treated with dignity and respect. People’s food and the support they received to help them eat, did not always meet their needs and reflect their preferences.

Areas of people’s care files that had been updated were person centred. However sufficient improvements had not been made to ensure that people's care plans accurately reflected their needs.

Systems at the home that should assure the registered manager that care provided is safe and of good quality, were either missing or not working effectively. This meant that people had continued to receive care that was not safe, effective or responsive to their needs and placed them at risk of avoidable harm and of receiving inappropriate care.

There had been some refurbishment to the environment of the home and standards of cleanliness had improved. It was evident that staff knew people well and that positive relationships had been formed.

The overall rating for this service is still ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the registered provider's registration of the service, will be inspected again within six months.

The expectation is that registered 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 registered 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 registered provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

At the last comprehensive inspection on 20 September 2016 we found a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had not ensured that audits and risk assessments at the service were effective.

We also identified a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had not ensured that the premises and equipment were safe to use and were used in a safe way.

After the inspection we asked the registered provider to complete a report of actions to inform us of the action they would take to meet legal requirements. However this was not received. This was because the provider had made an error and sent the report to the wrong e-mail address.

At this inspection we found improvements had not been made and further concerns were identified. We are now considering the appropriate regulatory response to the concerns we found. We will publish the actions we have taken at a later date.

Oakdene Residential Home is registered to provide accommodation and personal care for up to 16 people who require support with their personal care. They specialise in supporting older people. At the time of our inspection there were 14 people at the service who were living with a range of age related conditions including dementia. One of these people had been staying at the service on a respite basis and left the service on the first day of our inspection. Accommodation is provided over two floors with the first floor accessible via a flight of stairs or stair lift. Three of the bedrooms were for occupancy by two people. There were toilets and bathrooms on each floor.

There was a registered manager in place. 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. The registered manager told us they worked at home and visited the service once a week and the day to day management of the service had been delegated to a manager.

The provider had not addressed the shortfalls identified at the last inspection. They had no effective internal quality assurance systems in place to assess and monitor the service provided to identify shortfalls and drive improvement. Records were not properly maintained to make sure they were accurate and fully complete. Care plans did not always contain accurate information regarding people’s care needs and daily records did not detail information on people's wellbeing or how they had spent their time.

The administration and management of medicines was not safe. Medicines were being administered by staff who had not been assessed as safe to do so. Staff did not have access to specific guidance for when PRN (as required) medication, including pain relieving medicines, could be administered to individuals or for how long before medical advice should be sought. Medicine records were not fully complete or accurate and medication audits were not robust.

Risks to people’s health and safety had not always been identified, assessed and reduced. Routine health and safety checks had not always been completed and risks identified.

The provider had not ensured that staff understood the principles of the Mental Capacity Act so that they knew how to gain lawful consent for people’s care and treatment. Whilst applications of the Deprivation of Liberty Safeguards (DoLS) had been submitted to the local authority for some people, decision specific capacity assessments had not been completed as required.

Staffing levels were not always sufficient to protect people from the risk of harm. There were not always sufficient numbers of staff on duty to supervise the communal areas of the service and be on hand if people needed assistance. For four hours one day each week and two hours on another day only one member of staff was on duty.

The procedures in place to protect people from abuse were not robust. Information and guidance about safeguarding people and how to make a safeguarding referral, was not readily available to staff. The providers own policy on safeguarding people was out of date and did not reflect all categories of abuse. The CQC had not been notified about significant incidents that had occurred at the service including allegations of potential abuse as required.

People were not always provided with the opportunity to participate in activities they found enjoyable and stimulating to help them maintain their physical and psychological health.

People enjoyed the food on offer but referrals had not been made to relevant healthcare professionals so that people’s swallowing difficulties could be investigated.

People saw their GP when needed and health care professionals visited the service on a regular basis to review, monitor and treat people’s health needs.

People’s privacy and confidentiality was not always ensured or their dignity respected. Records containing private information about people were not always stored securely. At times staff were indiscreet and discussed people’s care in front of others.

Required identity and security checks had been completed before staff started work but staff records did not contain all the required information.

The provider had not ensured that staff had always received the training they needed to meet people’s assessed needs effectively and keep up to date with current good practice.

People were complimentary about the staff who they described as “Kind” and “Caring” and the manager who they said ‘listened’.

Complaints had been recorded and responded to appropriately.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the registered provider’s registration of the service, will be inspected again within six months.

The expectation is that registered 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 registered 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 registered provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

Oakdene Residential Home is in a detached building in a residential area of Birkenhead. The building was of a Victorian style with well-kept gardens. The home is registered to provide support for up to 16 people. At the time of our visit 13 people were living at the home.

Accommodation is over two floors, the top floor is accessible by a staircase with a stair lift. There were 13 bedrooms, six on the ground floor and seven on the top floor. Three of the bedrooms were for occupancy by two people. There were toilets and bathrooms on each floor.

The home required and had 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.

We found breaches relating to the premises and equipment being safe to use and being used in a safe way. Also the provider had not ensured that audits and risk assessments at the home were effective. You can see what action we told the provider to take at the back of the full version of the report.

As part of fire safety checks fire escapes were not being checked. Some fire doors were blocked or were not working properly. Appropriate warning signs and staff training in the use of oxygen were not in place. There was no recent evidence of the safe serving and storage temperature of food. Food was not always stored safely.

Care plans did not clearly reflect the needs of people or the care provided for them. The design of people’s care plans made it difficult for carers to obtain up to date information. The health and safety audits of the home and reviews of people’s care plans had not picked up on concerns or ensured that people’s care plans were up to date. There is no evidence that the registered manager had oversight of these processes.

Activities for people at the home did not meet the variety of needs of people living at the home.

People overwhelmingly told us they were happy living at Oakdene Residential Home. One person told us, “I’m very happy here, very happy”. The staff had a caring approach towards the people living at the home. We observed staff treating people with patience and respect. Staff took the time to listen to people. People’s friends and relatives told us they were made to feel welcome when they visited. Some people’s relatives told us their family members had been doing better since moving to the home.

People living at the home and their relatives told us they felt safe at the home. One person told us about the staff, “I trust them all”. The home was clean. Health and safety checks of the electrical, gas, fire safety, water and lifting equipment were completed. People using their rooms had call bells to hand to alert staff if they needed help. People’s medication was safely stored and administered. The deputy manager kept a record of accidents and incidents that happened at the home. These were audited and learnt from.

There were adequate numbers of staff to care for the people supported and to maintain the home. We didn’t see anybody waiting for assistance. There was an established staff team of experienced carers working at the home.

New staff were inducted into the service and had shadow time with the deputy manager. Staff received appropriate training and told us they felt well supported with supervisions, training, annual appraisals and staff team meetings. Staff received training in and were knowledgeable about safeguarding vulnerable adults.

People told us they enjoyed the food provided. There was plenty of food and drink available and people’s preferences and dietary requirements were catered for.

The deputy manager told us that they gain feedback from people living at the home and their family members from periodic questionnaires. Families were always kept up to date with regular communication.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is what we found:

Is the service caring?

We spoke with four people who lived at the home. Three people were happy with the care provided. Comments included 'Staff are nice and friendly, they do their best for you'; Staff are 'very good'; 'Very accommodating, I've no complaints'. One person said they did not think they were well looked after, but said 'Some staff are nice'. We observed staff supporting people throughout the day and saw staff were kind and attentive and supported people at their own pace.

Is the service responsive?

People's needs and risks had been assessed on admission to the home. Care plans were person centred and showed people's individual needs and preferences had been discussed with the person and/or their families. Care plans gave simple but clear guidance to staff on how to care for people in accordance with their wishes. Records showed that access to prompt medical support from GPs and other healthcare professionals was provided as and when required.

Is the service safe?

We observed a medication administration round and saw that medication was administered to people at the home safely. People's medication records showed medications were appropriately signed for and given at the right time. Stock levels in relation to people's medication were correct and corresponded to people's medication records. This indicated that the suitable systems were in place to safely manage medication at the home.

Some of the policies and procedures at the home however were either out of date or were not in place. Care plans had at times been inconsistently updated in relation to people's physical health needs and not all confidential personal records were stored securely. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service effective?

We saw that people's care was reviewed each month to ensure support continued to meet their needs. Staff were knowledgeable about people's needs and spoke warmly about the people they cared for. People's consent was sought prior to the delivery of personal care and care plans reflected people's decisions about their care. There were systems in place to assess people's risk of malnutrition and special dietary requirements. Food stores showed adequate food and drink supplies and the home's menu book showed a suitable diet was provided. We observed the lunchtime period and saw that people were given enough to eat and drink. People confirmed this.

Is the service well led?

There were systems in place to ensure people's health and safety were met. Environmental, accident/incidents and medication audits were undertaken and people's feedback on the quality of the service provided was sought through the use of an annual satisfaction questionnaire. This enabled the provider to come to an informed view of the standard of care and the effectiveness of leadership at the home.

During this visit, we reviewed the care records of two people. We saw support plans now contained sufficient detail about a person's needs and the care they required.

The provider had put in place effective maintenance arrangements for the home. A number of improvements to the home had been organised for example, the installation of a new kitchen, re-decoration of the ground floor, new dining rooms and roof repairs. We also saw that the majority of repair and maintenance issues noted at our last inspection had been fixed.

The provider was now monitoring the quality of the service provided. Satisfaction questionnaires had been given to people who lived at the home and their relatives and positive feedback had been received. A monthly audit of the home for cleanliness and general state of repair was also in place.

We reviewed two care records and found care plans and risk assessments were in place and personalised to the individual. We saw that staff spoke to people kindly and with familiarity and supported people at their own pace.

We looked at the home's maintenance arrangements. We found a lack of effective maintenance arrangements in place and a number of repair and maintenance issues were identified.

We reviewed the arrangements for the recruitment and support of staff. We found relevant checks had been undertaken to ensure staff were suitable to work with vulnerable people and the provider had put systems in place to ensure staff were appraised, supervised and trained in the workplace. The provider may find it useful to note that at the time of the inspection some staff appraisals and training were outstanding.

We looked at how the provider assessed and monitored the quality of the service provided and sought people's views. We found inadequate checks were being made on the quality of the service and the health and safety risks posed to people living at the home. We also found a lack of feedback arrangements for people living at the home and their relatives.