About the service:

Oulton Park Care Centre is a purpose built care home that provides personal and nursing care for up to 60 people. At the time of our inspection visit on 3 April 2019, there were 58 people living in the service.

People's experience of using this service:

¿ People did not always get their medicines as prescribed and medicines systems were not always safe.

¿ Risk assessments were in place. However, actions in place to mitigate risk were not always recorded in sufficient detail.

¿ There were sufficient staff to meet people's assessed needs.

¿ There were systems in place to safeguard people from abuse.

¿ Action plans were in place to improve the quality of the service.

Rating at last inspection: At the last inspection the service was rated Requires Improvement (21 December 2018). At that inspection there was a breach of regulation with regard to the management of medicines. At this inspection we found there was no longer a breach of regulation but that further improvements were still required. At the previous inspection we also rated Well-led as requires improvement. At this inspection we found that improvements had been made with a registered manager now in place. However, further improvements in the quality of audits were required.

Why we inspected: This inspection was brought forward due to information of risk or concern.

Follow up: We will follow up this inspection in line with CQC policies.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 6 and 9 November 2018. The first day was unannounced.

Oulton Park 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. Oulton Park is registered to provide care for up to 60 people. It provides purpose built accommodation on one level. The service has a dedicated dementia unit. 55 people were living in the service during our inspection.

The service’s registered manager had left the week before 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. The provider had responded to the departure of the registered manager and made appropriate arrangements for the management of the service. This included the transfer of a registered manager from one of the provider’s other services to Oulton Park to manage the service. The new manager had carried out a variety of audits in the service and during our inspection they provided us with an action plan setting out how they planned to improve the service.

People did not always receive their medicines as prescribed. People who had medicines prescribed to be administered at specific times were not always given them at that time. Stock control measures had not always ensured there were sufficient medicines in stock to meet people’s prescription.

Care plans were not always fully completed to reflect people’s changing needs. Where there was a risk to people from receiving care and support, for example the use of bed rails, risk assessments were not always in place. Care plans did not detail people’s life history to enable staff to provide people with the care and support as they required.

The provider had audits in place to assess and monitor the quality of the service. These had identified where the service was not providing good quality care and support. However, we found that in some instances issues identified in an audit had not been dealt with promptly.

You can see what action we told the provider to take at the back of the full version of the report.

We received mixed feedback from people as to whether there were sufficient staff to provide the care and support they required. Staff told us that this had been an issue but that this had recently improved. The new manager told us that they had addressed how the rota was managed and this had resulted in improvements. During our inspection visits we observed staff had time to sit and speak with people.

Staff were supported to develop their skills, knowledge and competencies by completing a range of developmental training. During our inspection visits we observed positive, caring interactions between people and staff.

People’s nutritional needs were met. Mealtime experience were pleasant and unhurried with people provided with the support they required. Where people had specific individual nutritional needs, these were met.

Staff contacted health care professionals promptly when people were unwell and people were supported to access a wide range of services to maintain their health and well-being. There was good liaison with the local GP and clinical commissioning group.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff sought consent before carrying out care support and people told us they were happy with the care they received.

The provider used a system of audits used to assess and monitor the quality of the service. These had identified where the service was not

This inspection was carried out on 23 February 2016 and was unannounced.

Oulton Park provides support for up to 60 people. It has a separate specialist dementia unit which has its own garden. On the day of our inspection there were 53 people living in the service.

The service 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.’

Risks to people had been identified, assessed and were managed safely. Staff understood the signs of potential abuse and what action they needed to take if it was suspected. There were sufficient numbers of staff employed to meet people’s needs and the service followed safe recruitment practices. People’s medicines were managed safely and administered by trained staff.

Staff were trained in all essential areas and participated in an induction programme. They were supported by the management team, receiving regular supervision.

The service was meeting the requirements of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards. However care plans did not always fully evidence how people lacking capacity were supported to make decisions.

We received positive feedback from health care professionals regarding the service provided. Referrals to health care professionals were made promptly and their advice was acted upon.

People and staff had developed positive, caring relationships. People felt they were well looked after by kind friendly staff who understood and knew them well. People's preferences and choices were known and respected by staff and were encouraged to express their views and be involved in all aspects of their care. A range of activities were provided and where people moved into the service with particular hobbies and interests they were supported to maintain these.

People, their relatives and staff spoken with had confidence in the management team and felt the service had clear leadership. There were effective systems to assess and monitor the quality of the service and address any concerns.

We spoke with visiting relatives and with five people who used the service. They were all happy with the care provided. We saw that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare and in line with their individual care plans. A separate unit was tailored to support people living with dementia and included free access to an enclosed courtyard and a further secure garden area.

People’s health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others.

We saw that appropriate action had been taken in emergencies, or where a person’s health had significantly declined. People were protected from the risk of abuse because steps had been taken to identify the possibility of abuse and prevent it from happening, and the provider responded appropriately to any allegations of abuse.

The purpose-built premises were clean, well decorated and maintained.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Staff had a positive and person-centred attitude and worked well together.

Records were accurate, generally up to date and regularly reviewed. However, there were some inconsistencies and the frequency and thoroughness of reviews of risk assessments and of care plans varied.

Although we were able to talk with some of the people using the service, they were not able to give us their opinions about their care. We spoke to five relatives/visitors who all told us that the service was very good and looked after people well. One relative told us, "(Their relative) is better now than when they came in. They are more responsive and active." Another relative told us that the care and the staff were good. They said that, "We occasionally have small niggles which we mention to staff, who sort them out."

Everyone's care and treatment was planned in an individual and person-centred way. This was done either with their involvement, or if they did not have the capacity, with the involvement of their representative. This showed that people who used the service were involved in making decisions about their care and support so far as they were able to do so.

The service was following national guidelines on the prevention and control of infection. They were linked to NHS specialists for further advice. This showed that people were protected against risks of infection.

There was a plan for the training and development of staff. This was managed through regular supervision and appraisals.

The provider had a comprehensive quality assurance process including surveys, audits and monthly reports.

People and their relatives told us that the care was very good at Oulton Park, and the staff were kind, attentive and helpful.