The inspection took place on 20 December 2017 and was unannounced.Oakfield House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a 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.
Oakfield House is registered to accommodate care and support for up to 30 older people. At the time of the inspection there were 24 people living at the service.
There was a registered manager in post. 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 last inspected the service on16 November 2016, the service was rated requires improvement, there were no breaches of regulations at this inspection. Therefore, the provider was not required to provide an action plan to show what they would do and by when to improve the key questions, safe, effective, responsive and well led to at least good. There were no risk assessments in place for potential risks to people’s health and welfare, the principles of the Mental Capacity Act 2005 (MCA) were not always followed. There were no effective audit and quality assurance processes in place. We carried out this inspection to check that improvements had been made. At this inspection we found improvements had not been made and there were two breaches of regulation.
At the last inspection, not all potential risks to people’s health and welfare had been assessed. At this inspection, there were some risk assessments in place; these did not contain detailed guidance for staff to follow to mitigate risks. Environmental risk assessments had been completed, however, the fire risk assessment was not up to date and measures to mitigate risk had not been actioned. We contacted Kent Fire and Rescue following the inspection. Not all checks on the environment had been completed in accordance to best practice, for example, water temperatures in people’s rooms, to reduce the risk of scalding.
People were not consistently protected against the risk of infection. Accidents and incidents had been recorded and action had been taken on an individual level. However, there was no overall analysis to identify patterns and trends and the action needed to reduce the risk of them happening again.
At our last inspection, there was not a comprehensive and effective audit system in place to identify shortfalls in the service and to drive improvement. At this inspection, the registered manager had not taken action and there had been no improvement. The registered manager had not recorded any audits to monitor the quality of the service and identify areas of improvement within the service.
Quality assurance surveys had been sent to people, relatives, staff and stakeholders such as district nurses, responses had been mainly positive. There had been no analysis of the results and no action had been taken to address any concerns. Staff confirmed that they attended staff meetings and were able to make suggestions. The minutes for these meetings had not been recorded and there was no record that the suggestions had been actioned.
It is a legal requirement that a provider’s latest CQC inspection report rating is displayed at the service where a rating has been given. This is so that people, visitors and those seeking information about the service can be informed of our judgments. We found the provider had not conspicuously displayed their rating in the service. The registered manager had not attended forums or engaged with outside agencies to keep their knowledge up to date and had been unaware that they needed to display the rating for the service.
Previously, the principles of the MCA had not always been followed. At this inspection, elements of the MCA were still not being followed. People’s capacity had been assessed in relation to the decision of where they wanted to live but not in relation to their ability to make day to day decisions. Staff confirmed that best interest decision discussions had taken place when making decisions about people’s health and welfare, however, these had not been recorded. Staff sought consent to support people and asked them how they wanted to spend their time or what they wanted to eat and drink.
The registered manager met with people before they moved into the service to check that the staff were able to meet the person’s needs. However, the assessments of people’s health care needs had not been completed in line with guidance. We recommend that the registered manager finds out about how to assess people’s needs in line with current guidance.
Each person had a care plan, but, these did not always contain detailed information about how people liked to be supported. Some information within the care plans was not consistent and there was a risk that staff who did not know the person would not be able to give support in the way the person preferred. People were not consistently asked about their end of life wishes, some people’s wishes had been recorded, but there was a risk that people would not receive care as they prefer.
Staff knew how to recognise signs of discrimination and abuse. They were confident that any concerns would be dealt with appropriately. The registered manager had reported incidents to the local safeguarding team when appropriate.
There were sufficient staff on duty, who had been recruited safely. Staff received one to one supervision. The registered manager had not prioritised training and not all staff had received essential training. However, staff had an understanding of their responsibilities and we observed staff support people safely. People received their medicines safely and when they needed them.
People were supported to eat and drink enough to maintain a balanced diet. Staff referred people to specialist health care professionals such as dieticians when required and followed the advice given. People had access to opticians and chiropodists as needed.
People had the opportunity to take part in activities of their choice. People told us they knew how to complain and that the registered manager dealt with any concerns they had. The registered manager had not recorded when they had dealt with concerns. This was an area for improvement.
People told us that staff treated them with kindness and respect. Staff supported people to be as independent as possible. People’s religious beliefs were recorded and supported by staff. Visitors were able to visit whenever they wanted and were always made to feel welcome.
There was an open and transparent culture within the service. The registered manager was known to people living at the service, people and relatives told us that they were approachable. Staff told us they felt supported by the management team and they could speak to them about any concerns they may have.
Oakfield House is a large converted house that has been adapted to meet the needs of people living at the service.
Services that provide health and social care to people are required to inform CQC of important events that happen in the service. CQC check that appropriate action had been taken. The registered manager had submitted notifications in an appropriate and timely manner and in line with guidance.
At this inspection two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. You can see what action we have asked the provider to take at the end of the report.