CQC report explained · a nursing home
What the CQC found at Oakham Grange
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, August 2023
Rated Requires Improvement; inspectors found major progress after an Inadequate rating, but record keeping and oversight still created risks.
This was an unannounced follow-up inspection on 17 and 18 July 2023. Inspectors spoke with people, relatives and staff, observed care, and reviewed care records, medicines records, staff files, training records, audits and incident information.
The home had improved staffing, training, medicines arrangements, infection control and care planning. People and relatives described staff as kind, competent and responsive. The home was clean, and people were supported with food, drink, healthcare and choices.
However, records were not always accurate or complete. Checks did not identify some medicines shortfalls, one safeguarding incident had not been reported, and some care plans and incident records lacked important detail. The home remained in breach of Regulation 17 on good governance.
The overall rating changed from Inadequate to Requires Improvement. The home was no longer in Special Measures, but the improvements still needed to become reliable and lasting.
More nursing cover
The home increased nursing cover to two nurses during the day and one at night. Staff were also assigned to the same unit to improve continuity.
“Since the last inspection, staff deployment had increased, this included having a nurse on duty at night and 2 nurses during the day.” from the report
Kind and knowledgeable staff
People and relatives spoke positively about staff being caring, kind and knowledgeable about individual health and care needs.
“People described staff as caring and kind.” from the report
Improved training and clinical support
Training and competency checks had improved, including clinical assessments for nurses. A clinical lead provided additional support and oversight.
“Nurse competency assessments had been completed, and ongoing training and support was provided by the clinical lead.” from the report
Infection control
Inspectors were assured that the home used suitable infection prevention measures and kept the environment clean and hygienic.
“The service was clean and hygienic.” from the report
Open communication
Managers told people and relatives about the previous inspection and incidents affecting residents. Relatives spoke positively about the manager's openness.
“Relatives confirmed they had been made aware and spoke positively about the managers open and honest approach.” from the report
Incomplete governance checks
seriousAudits did not identify medicines problems found by inspectors. Care records and incident records also lacked important or consistent detail.
“The provider's systems and processes that monitored quality and safety were not sufficiently robust.” from the report
Medicines recording and monitoring
seriousInspectors found problems with recording medicine storage temperatures, topical creams, medicine patch rotation and checks for people who self-medicated. Minor stock discrepancies were also under investigation.
“Staff had not followed the provider's policy about recording room temperature storage of medicines.” from the report
Safeguarding reporting
seriousOne safeguarding incident had not been reported to the local authority. The provider was investigating what had gone wrong and planned further learning.
“However, it was identified 1 safeguarding incident had not been reported.” from the report
Care records lacked detail
needs fixingSome care plans were contradictory, limited or out of date. This included records about catheter care, Parkinson's disease and a device that had already been removed.
“People's care records had been improved upon, but guidance for staff was sometimes contradictory or limited in parts.” from the report
Some training still incomplete
needs fixingThe provider had improved its training programme, but records showed that not all staff had completed the new or refresher training at the time of inspection.
“However, training records showed not all staff had completed new and refresher training, but a training plan confirmed ongoing training was booked.” from the report
Outstanding best interest decision
needs fixingOne person's best interest decisions had not been completed. This had been outstanding since April 2023 while the home waited for a relative to respond.
“However, we identified 1 person who had outstanding best interest decisions.” from the report
- 01What has been done to fix the continuing breach of Regulation 17, and how will you prove that audits now identify problems?
- 02How are you checking medicines storage temperatures, topical creams, medicine patches and self-medication?
- 03How will you make sure every safeguarding incident is reported to the local authority when required?
- 04Which staff still need training, and when will all outstanding training and competency checks be completed?
- 05Are admissions still suspended, and how will the home make sure care plans and best interest decisions are complete before someone moves in?
This was an unannounced follow-up inspection focused on the areas linked to the previous action, with ratings given for Safe, Effective and Well-led; Caring and Responsive were not rated in this report. This explanation was written from the published report of 9 August 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, July 2023
Rated Inadequate and in special measures; inspectors found serious risks in clinical care, medicines, staffing and management.
This was an unannounced inspection on 4, 5 and 17 April 2023. Two inspectors spoke with people living at the home, relatives and staff. They reviewed care records, medicines records, staff files, training records and management documents.
Inspectors found serious problems with safety. Care plans did not give staff enough guidance, records did not show that some clinical care had been completed, medicines were not always managed safely, and there were no nurses working overnight when the inspection began. One person was given food with the wrong texture, creating a choking risk.
Staff were described as kind and respectful, and people had access to activities, visitors and outside health professionals. However, staff did not always have enough time to spend with people, care was not always personalised, and staff training and supervision were not sufficient.
The overall rating fell from Good at the previous inspection to Inadequate. Safe, Effective and Well-led were rated Inadequate. Caring and Responsive were rated Requires Improvement. The home was placed in special measures, with warning notices issued and further checks planned.
Kind and respectful staff
People told inspectors that staff were kind and treated them with respect. Staff asked permission before care and protected people's privacy.
“People told us that staff were kind and treated them with respect.” from the report
Privacy respected
Staff knocked before entering bedrooms and checked whether people wanted doors open or closed. Private personal care was carried out with the door shut.
“This meant people were given privacy.” from the report
Activities and visitors
People could take part in activities, including trips and animal therapy. Relatives said they were free to visit as they wished.
“We saw animal therapy was at the home on the day that we inspected.” from the report
Safe recruitment checks
The staff files reviewed showed that recruitment checks were completed to assess whether staff were of good character.
“Staff were safely recruited to ensure they were of good character.” from the report
Quick call-bell response
Inspectors saw staff respond quickly when people used call bells. Management audits also showed that a quick response was usual.
“We saw staff respond to these bells quickly when pressed.” from the report
Unsafe clinical care and medical devices
seriousStaff did not always have clear instructions for medical devices, and records did not show that required checks and dressing changes had been completed. This created a high risk of infection and other harm.
“We were therefore not assured that the required dressing had occurred as planned. This put the person at high risk of infection.” from the report
Medicines not managed safely
seriousMedicine stock errors were not investigated promptly. The inspection found that one person had missed medicines four times, and other medicine records and instructions were unsafe.
“These February and March errors not being identified and acted upon sooner placed the person at increased risk of harm.” from the report
No nurses overnight at the start
seriousThere were no nurses at the home overnight when inspectors began. The on-call arrangements did not give enough assurance that people needing urgent nursing support would receive it quickly.
“While this recruitment occurred, we were concerned that people were at risk during the night-time.” from the report
Insufficient staff training
seriousSome staff lacked training in supporting distressed behaviour, catheter care and altered diets. Nurses had not received recent clinical supervision or competency checks.
“There was not always suitably skilled staff to support people's needs effectively.” from the report
Unsafe food texture
seriousOne person who needed altered food received the wrong texture, which could cause choking. Not all kitchen staff had been trained in altered diets.
“We saw that 1 of these people received food that was the incorrect texture, this could risk them choking.” from the report
Poor records and slow improvement
seriousCare plans and records did not consistently guide staff or show what care had been provided. Management audits had not identified or resolved these problems quickly enough.
“Systems had not been established to assess, monitor and mitigate risks to the health, safety and welfare of people using the service.” from the report
- 01How are you now providing nursing cover overnight, and what happens if a resident needs urgent nursing support?
- 02How do you check that medicines are given correctly and investigate missed doses or stock errors immediately?
- 03How do staff access full, up-to-date care plans, especially agency staff caring for people with medical devices?
- 04What training and competency checks have nurses and care staff completed for clinical care, catheter care, distressed behaviour and altered diets?
- 05How do you check that food and drinks have the correct texture for people at risk of choking?
This was an unannounced inspection of the care home with nursing, covering all five CQC key questions and reviewing both the premises and the care provided. This explanation was written from the published report of 5 July 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Oakham Grange
3 rated inspections over a year: the service has slipped, from Good to Requires improvement.
- August 2023Requires improvementcurrent ratingup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- July 2023Inadequatedown from GoodSafe: InadequateEffective: InadequateWell-led: Inadequate
- April 2022GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- August 2020
Registered with the Care Quality Commission on 27 August 2020.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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