Oakham Grange’s Response to CQC’s inspection report
On 4, 5 and 17 April 2023 our service, Oakham Grange was inspected by the CQC. This was a comprehensive inspection.
We received a draft inspection report relating to the visit which we responded to in detail. We found the draft report contained a number of inaccuracies and made conclusions on the basis of unsubstantiated comments. We responded to the draft report and addressed areas where the CQC failed to consider our evidence thoroughly or fairly. We had hoped the CQC would amend the report in light of our response to provide readers with a balanced understanding of the quality of care we provide at Oakham Grange. Unfortunately, the CQC failed to do this.
Whilst we have a legal obligation to display our inspection report and rating, we felt it very important to provide readers with the full context on this matter. We believe the contents of the inspection report and its findings does not reflect the care provided at Oakham Grange and we refute the CQC’s overall rating of Inadequate.
Please find below a copy of the key assertions made within the draft report followed by our responses to the same. We trust that any reader of the CQC’s report will agree with us that the conclusions reached do not accurately reflect the services provided at Oakham Grange.
| CQC Assertion in Report | Our Position |
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Agency staff had only access to summary guidance rather than service users’ full care plans and this presented a risk to service users when administering medicines. |
Agency staff are not qualified to administer medicines, unless they are a registered Nurse. This criticism is therefore irrelevant to the service. Agency staff members are provided with a one-page document detailing a service user’s relevant information and are routinely supervised by a permanent member of staff. Therefore, we reject the assertion that service users are placed at risk of harm at Oakham Grange.
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Staff did not have sufficient guidance to assist them with in-dwelling medical devices which placed service users at risk of harm.
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There have been no safety incidents arising from in-dwelling medical devices at Oakham Grange and the CQC’s comment is therefore unsubstantiated. We have updated our guidance on in-dwelling medical devices and a copy was sent to the CQC, post-inspection along with in-dwelling audits undertaken.
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| A medicine stock check completed two days before the inspection had not yet been investigated. The CQC raised these concerns and the management team then investigated. | A medicine stock check was undertaken two days before the inspection and the management team was scheduled to investigate the day the CQC inspected. We therefore refute the CQC’s assertion that these concerns were brought to the attention by the CQC and were not expeditiously actioned. |
| A syringe driver was broken but no detail was recorded regarding steps undertaken to ensure the relevant service user was safe from an overdose/under dose | The tube of the syringe driver had come apart from the pipe and an overdose would not have been possible. Further, the time between the resident being checked and the syringe driver being replaced meant the likelihood of an under dose was minimal. This was documented in the service user’s records, and an explanation provided to the CQC but this was rejected. |
| Staff did not complete regular reviews of topical patches and one service user’s topical patch had come off without staff realising | Staff members check service user’s topical patches 2-3 times a day when providing personal care. Regarding the service user identified, the topical patch was reapplied and the service user did not suffer harm. This explanation was provided to the CQC but they failed to take this into account. |
| Oakham Grange took one week to refer a safeguarding incident to the Local Authority |
This delay was an isolated incident in an otherwise unblemished history of expeditious reporting at Oakham Grange. Regarding the incident referenced, no harm was caused to the service users concerned.
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| People were at risk of neglect and records suggested service users did not receive the clinical care required. | We refute the suggestion that service users did not receive the clinical care required. No service users have been harmed nor have they been admitted to hospital due to not receiving the required clinical care. |
| At the time of the inspection, there were no overnight nurses present and one service user was likely to require urgent support for a health condition |
At the time of the inspection, the level of medical dependency was minimal and overnight nurses were not needed. However, an on-call night nurse resided a four-minute walk from Oakham Grange. Regarding the service user referenced, they were unlikely to require urgent support and we informed the CQC as such. The CQC failed, however, to take this into account along with the principle of proportionality. Currently, we have 1 FTE nurse on-shift at night.
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| There was an insufficient number of staff members working and a staff member reported having insufficient time to perform personal care |
We currently have a ratio of one staff member to every four service users at Oakham Grange which is proportionate in all the circumstances. The CQC confirm within the report that there were sufficient staff to respond to emergency buzzers and we raised this apparent disparity with the CQC accordingly but they failed to amend the report.
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A relative and a service user stated that agency staff did not know the procedures
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Oakham Grange has 49 residents and more than 100+ relatives who visit. For two people to state, in their opinion, that agency staff did not know the procedures is minimal and subjective. This statement is not reflective of agency staff at Oakham Grange.
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Staff did not feel confident in supporting one service user and did not feel appropriately trained in challenging behaviour
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All staff are appropriately supervised and provided with on the job training regarding working with service users who display challenging behaviours and a specialist mental health nurse is always on-site for consultation. At the time of the inspection, and owing to staff rotas, 3 out of 12 staff members had completed the ‘Behaviours that Challenge’ training. Currently, this number has increased to 6 and training of the remaining staff members is imminent.
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Care staff did not receive training in catheter and UTI’s and there was insufficient guidance in catheter care
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Only nurses provide catheter and UTI care to residents, not care staff. We raised this with the CQC however they failed to take this into consideration. Since the inspection, all care staff have now received basic information on catheter and UTI care to enhance their knowledge.
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Only 2 out of 4 kitchen staff had received training on altered diets
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The service’s chefs are trained in IDDSI and one chef is always on duty with a kitchen assistant. Therefore, the CQC’s assertion that service users were at risk of being provided with incorrectly altered food is negligible. This was explained to the CQC but rejected.
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People’s ability to make decisions were not clearly assessed and recorded
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The CQC used the word ‘people’ but only referenced one service user. We raised this with the CQC, to prevent readers from being misled but the CQC failed to change the report.
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People were unhappy with the food
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Food surveys have routinely been provided to service users, even before the inspection, and Oakham Grange has actively made changes following the feedback received. In May 2022, our overall score for food was ‘Excellent’ and 100% of our service users reported that they were offered a wide variety of meal options.
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Family members reported that staff had insufficient time to spend with the service users and focused on tasks
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Our staff are committed to the well-being of our service users and we refute the CQC’s assertions that staff were solely task-focussed.
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Some people felt staff did not know how to meet their needs as they asked them how they liked to be cared for
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Staff ask service users how they wish to be cared for as they are committed to person-centred care. This is not a criticism, and we challenged the CQC on this point.
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Changes via the suggestion box did not result in quick change
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The specific criticism mentioned by the CQC did not arise via the suggestion box as the suggestion box is routinely monitored. Where we can implement change, we do.
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| 20 out of 35 staff have received end of life care training |
We believe this number to be sufficient in all the circumstances given the mix of staff on shift. However, this number will increase to 27 as of 22 June and the remaining staff members will complete end of life training on 1 August.
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We reviewed a person’s end of life care plan and this was not good quality
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The service user referenced was not receiving end of life care and we challenged the CQC on this point. The CQC failed to take this into consideration.
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| Mental capacity records contained errors and the management team were arranging staff training | At the time of the inspection, all staff received basic Capacity Act (“MCA”) training. On 24 May 2023, advanced MCA training took place and further bite-size, targeted training is also being provided to staff members. |
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Unapproachable management team
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We refute the assertion that our management team is inapproachable. Members of the Senior Management Team routinely walk around the service and talk to staff and service users. Our General Manager holds a two-hour protected time slot each week for the staff to come and speak with her should they wish to raise any concerns. This is in addition to any other time(s) the staff wish to speak with her. We raised this with the CQC, but they failed to take our response into consideration and amend the report accordingly.
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