CQC report explained · a nursing home
What the CQC found at Oaklands Nursing Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- People were not always protected from risks such as very hot radiators, fire safety problems, infection risks and incomplete medicines records. There were enough staff and recruitment checks were in place.
- Effective?
- Good
- People's needs were assessed before moving in, staff had relevant training, healthcare needs were met and people received support with food and drink. This rating improved from Requires Improvement at the previous inspection.
- Caring?
- Good
- Staff were kind and caring, and people were generally treated with dignity and respect. People and relatives were involved in discussions about care and the running of the home.
- Responsive?
- Requires improvement
- Activities, communication support and end of life care were available, but care plans did not always explain people's individual needs or the support required. This rating fell from Good at the previous inspection.
- Well-led?
- Requires improvement
- People and relatives spoke positively about the management, but audits and other checks had not found or resolved several safety and care-record problems. This rating remained Requires Improvement.
What inspectors found, March 2020
Rated Requires Improvement; inspectors found kind care and good outcomes in some areas, but safety checks, care records and management oversight were not reliable enough.
Inspectors made unannounced visits on 17 and 19 December 2019. They spoke with people living at the home, relatives, staff and healthcare professionals. They also checked care records, medicines records, staff recruitment files and management records.
The home had enough staff and staff were trained and supported. People were treated kindly, their dignity was usually respected, and their healthcare and food needs were met. Inspectors rated Effective and Caring as Good.
There were important safety concerns. Very hot radiators were not risk assessed, fire doors and fire alarm checks were not always properly managed, infection risks were found, and medicines records did not always show that creams or variable-dose medicines had been given correctly. Care plans did not always give staff enough information about individual needs.
The overall rating remained Requires Improvement, as it had at the previous inspection. Effective improved from Requires Improvement to Good. Responsive fell from Good to Requires Improvement, while Safe, Caring and Well-led stayed at their previous ratings. The provider was asked for an action plan and CQC said it would monitor progress.
Kind and respectful staff
People were seen to be reassured and supported by attentive staff. Relatives and a healthcare professional were positive about the care.
“People were supported by kind and caring staff who respected them and up held their privacy and dignity.” from the report
Enough staff
Inspectors found enough staff on duty to meet people's needs. Nursing staff were employed by the provider and agency nurses were not needed.
“There were sufficient staff on duty to meet the needs of people.” from the report
Good healthcare support
People were assessed before moving in and healthcare professionals were involved when needed. Inspectors found that staff listened to and acted on healthcare advice.
“A healthcare professional told us they did not have any concerns as staff listened and acted upon their advice to ensure people's wellbeing was maintained.” from the report
Food and drink support
Staff encouraged people during meals and provided suitable equipment to support independence. People had drinks available close by.
“People enjoyed the food provided.” from the report
Activities and end of life care
People could take part in activities, religious support and social events. End of life care plans included people's wishes, including where they wanted to remain at the end of life.
“People's care plans for end of life care were person centred and contained details of their end of life wishes such as wanting to remain at the home.” from the report
Hot radiators and fire safety
seriousSome radiators were hot enough to potentially scald people and had not been risk assessed. Fire doors did not always close properly, and fire alarm testing and records of break-glass points were not reliable.
“We found radiators along corridors, in a bathroom and a bedroom which were very hot to the touch and could have potentially scalded people.” from the report
Medicines records
seriousRecords did not always show that prescribed creams had been applied. For variable-dose medicines, the amount given was not always recorded, so inspectors could not confirm that people received the prescribed dose.
“Therefore, we were unable to establish whether people received their medicines as prescribed.” from the report
Care plans did not contain enough detail
needs fixingSome care plans did not explain the equipment, pain relief or blood sugar information staff needed to provide safe, individual care.
“People's care plans did not always detail the support people needed to meet and respond to their individual needs.” from the report
Infection control
needs fixingInspectors found equipment and waste bins that needed repair or replacement. These problems increased the risk of infection spreading.
“These examples increased the risk of infections spreading within the environment and amongst people.” from the report
Management checks were not effective
seriousAudits and other monitoring systems had not identified several safety, privacy and medicines-record problems. This led to a breach of the good governance regulation.
“This placed people at risk of harm. This was a breach of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.” from the report
- 01What has been done to prevent people being scalded by the hot radiators, and how is this now checked?
- 02How are fire doors, fire alarms and break-glass points tested and recorded?
- 03How do you make sure prescribed creams and variable-dose medicines are given and recorded correctly?
- 04How are care plans checked to ensure they include each person's equipment, pain relief and blood sugar needs?
- 05What action has been taken in response to the Regulation 17 breach, and what evidence can you show of improvement?
This was an unannounced planned inspection that assessed all five CQC questions, including the premises and the care provided; it followed a previous Requires Improvement rating. This explanation was written from the published report of 12 March 2020 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, December 2018
Rated Requires Improvement; inspectors found kind, personalised care, but gaps remained in training, mental capacity records and quality checks.
Inspectors visited on three days, with the first visit unannounced. They spoke with people living in the home, relatives, staff and health and social care professionals. They reviewed care records, medicines records, training and recruitment files, complaints, incidents and quality checks.
The home had improved since the previous inspection, when it was rated Inadequate and placed in special measures. Inspectors found people were safe, medicines were managed properly, staffing levels were sufficient, and the building work and infection control problems had been addressed.
Care was kind and respectful, and people received personalised support, activities and help with communication. However, some staff training was not up to date, the induction did not fully meet Care Certificate requirements, some mental capacity assessments were unclear, and quality checks had not found inaccurate care records.
The overall rating was Requires Improvement. Safe, Effective and Well-led were rated Requires Improvement. Caring and Responsive were rated Good. The home was no longer in special measures.
Kind and respectful care
Staff knew people well and treated them with dignity. They offered reassurance and responded calmly when people were distressed or confused.
“We saw people were supported by staff who were polite, kind and attentive to their needs and requests.” from the report
Personalised support
Care plans reflected people's histories, personalities, needs and preferences. Staff adjusted support when people's needs changed.
“People's care plans were comprehensive and individual to them, portraying a good understanding of the whole person, their personality and personal history.” from the report
Safer medicines and environment
Medicines were managed by nurses whose competence was checked each year. Building work had finished and inspectors found the home clean, well-lit and free from hazards.
“We did not identify any hazards associated with the condition of home's physical environment, which was well-maintained, appropriately-lit and clutter-free throughout.” from the report
Good activities and communication
People were supported to take part in activities that matched their interests. The home used communication aids and accessible materials for people who needed them.
“The activities coordinator organised a weekly programme of activities, which included visits from local entertainers and interest groups, including a local gardening club, musicians and pet therapy sessions.” from the report
Open management
People, relatives and professionals found the management team approachable and willing to listen. Staff said they felt valued and supported.
“People and their relatives knew who the registered manager was and expressed confidence in the management team and their willingness to take on board feedback.” from the report
Training gaps
needs fixingSome nurses and a small number of care staff were not up to date with training. The induction programme had not been reviewed to ensure it covered the Care Certificate.
“Whilst this had led to significant improvements in the overall standard of staff training, we identified some nurses and a small number of care staff were not up to date with their training.” from the report
Inaccurate care records
seriousQuality checks did not identify repeated entries saying bedrails were raised, even though the care plan said bedrails should not be used. This could have led staff to follow the wrong instructions.
“On numerous occasions staff had recorded that they had checked the bed rails and that they were in the raised position.” from the report
Quality checks not yet reliable
needs fixingThe provider had introduced more audits, but these had not found all the problems with mental capacity records, staff training and care records.
“However, we found there was scope for further improvement in the provider's quality assurance processes.” from the report
- 01Have all nurses and care staff now completed the training that was out of date at the inspection?
- 02Has the induction programme been updated to cover the Care Certificate requirements?
- 03Have all mental capacity assessments been rewritten so each one clearly identifies the specific decision being considered?
- 04How do you check that care records accurately reflect each person's current care plan, particularly where bedrails or falls prevention are involved?
- 05How do you analyse complaints and everyday concerns to identify repeated problems and lessons for the service?
This was a planned comprehensive inspection covering all five key questions, the premises and the care provided; the report also notes that the first inspection day was unannounced. This explanation was written from the published report of 4 December 2018 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 Oaklands Nursing Home
4 rated inspections over 3 years: the service has slipped, from Good to Requires improvement.
- March 2020Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- December 2018Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- May 2018Inadequatedown from GoodSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- November 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- May 2014
Report published without a new overall rating.
- August 2013
Report published without a new overall rating.
- May 2013
Report published without a new overall rating.
- August 2012
Report published without a new overall rating.
- February 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 26 January 2011.
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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