A Nottinghamshire care home which did not follow infection control guidance and left residents “not protected” from harm has been ordered to improve by inspectors.
Red Oaks Care Home, on Clipstone Road West in Mansfield, was found to have people “at risk of avoidable harm” when the Care Quality Commission (CQC) visited its site in August 2020.
Inspectors found that people were “not always protected” from avoidable harm or abuse due to issues surrounding safeguarding, while lessons were “not learnt” when things went wrong.
The report, published last month, also found that medicines were not “managed safely”, with audit systems “not effective” and staffing levels not enough to manage demand.
The report said: “People were not always protected from the risk of avoidable harm or abuse because the systems and processes in place to safeguard people were not always effective.
“Lessons had not been learnt when things went wrong.
“The provider’s quality audits were ineffective. They had not identified the issues we found during the inspection; including health and safety issues and staffing levels.”
A spokesperson for the provider confirmed to Nottinghamshire Live that a new manager started at the home on July 27.
Incidents surrounding safety, the spokesperson said, related to incidents in the days that followed where fire alarm doors had not been reset by care staff after being used.
This happened on two separate occasions and the provider admits it is “not normal or acceptable practice”.
The report adds that guidance was not always followed in regards to safe admissions between hospital and the home.
It said: “Infection prevention and control procedures did not always follow Government guidance and requirements.
“People were not always supported to maintain social distancing and the provider did not always follow guidance regarding safe admissions from hospital.”
However, the spokesperson told Nottinghamshire Live social distancing issues came when inspectors found four people sitting around a table inside the home.
This was in breach of Government guidance, but the provider says it had “zero Covid in the home at the time”.
The spokesperson added that its dining experience has been “significantly altered” to ensure social distancing can be met.
The inspection follows a previous visit in July 2019, in which the CQC found “multiple breaches of regulations”.
Upon the return visit, inspectors found that the provider had not made enough improvements and meetings are set to be scheduled between the CQC and staff.
It means the home has been rated as ‘requires improvement’ on three straight visits, with the CQC also viewing that it is ‘inadequate’ in its leadership.
The provider has been told to regularly inform the CQC on issues such as safeguarding and improve the way it assesses and monitors its service.
Speaking following the report, Roger Daniel, chief executive of Red Homes Healthcare, said: “We are devoted to our residents at Red Oaks and their safety and comfort are our top priorities, therefore we are devastated with the outcome of CQC’s inspection report.
“Whilst we accept and respect the majority of its content, we have challenged the areas that we stand by.
“Whilst our staff and families have been incredible throughout the onset of Covid-19 resulting in zero deaths so far … our families put their trust in us and we need to deliver the very best in quality care every single day.
“To this end we have already put rigorous plans in place to comply with CQC’s recommendations and much has already been achieved thanks to the commitment of our staff.
“We’ve recently welcomed a new manager with over 20 years’ experience, the addition of a senior management team and an office manager – who will ensure all paperwork is kept up to date, even when the care team are experiencing unprecedented challenges during this global pandemic.
“We have also increased our regular training sessions and monitoring processes.”