Residents at a care home in Yate were "at potential risk of harm" due to low staffing levels, according to an official report.
The Care Quality Commission has now published a report into Oaktree Care Home and gave it a rating of requiring improvement.
The CQC gave the care home a rating of requiring improvement in all areas - safety, effective, responsive and well-led - except for caring, where it was classed to be good.
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Oaktree Care Home has said that the care and safety of residents are their highest priority and that they listen carefully and act on all feedback from the Care Quality Commission.
The report states: "There remained a high use of agency staff, which was having an impact on the delivery of care and staff morale.
"There were occasions when the home was not staffed according to provider's staffing tool due to short notice sickness and the agency staff cancelling their shifts.
"We found a breach in regulation and served a requirement notice in respect of staffing to ensure there were sufficient numbers of suitable and competent and experienced staff.
"We could not be assured people at risk were eating and drinking enough. This was because staff were not completing food and fluid charts for those people that had been assessed as being at risk of malnutrition or dehydration."
However, the CQC also found that overall feedback was positive about their experience of care and support, adding that people's needs were assessed and planned for.
The report states that residents were not always protected from risk because the provider failed to deploy enough suitably qualified, competent and experienced staff.
"We could not be satisfied people were always cared for by enough staff and there was a potential risk for people to come to harm," the report continues. "The current staffing levels, competency, skill mix and how each shift was led required review.
"All nine staff that contacted us after the inspection said the home was short staffed and how this was impacting on staff morale."
The report states one nurse told them about a person who had lost 10 kg over the last three months and they had requested staff commence a food and fluid intake monitoring chart.
"Staff were unable to locate these for this person," the report states. "Staff had been given the instruction to action this, however six days had passed, and this had not been commenced.
"We looked at daily food and fluid intake charts for eight people from the period of 3 November to 8 December. None of the charts had been completed in full.
"The fluid charts had not been totalled over each 24-hour period. This meant staff would not be alerted if people had not had enough to drink and whether any enhanced care and monitoring was required.
"There were gaps on every chart indicating that some people had only been offered fluids three times over a 24-hour period. Records consistently indicated a poor fluid intake.
"Charts consistently recorded a poor food intake where people had only eaten 3-4 mouthfuls of food over a 24-hour period."
Oaktree Care Home is registered to provide personal and nursing care for up to 78 people and has a unit dedicated to people living with dementia. The last rating for this service was requires improvement.
The CQC said: "We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner."
What the care home says
A spokesperson for Healthcare Homes said: “The care and safety of our residents are our highest priority and we listen carefully and act on all feedback from the Care Quality Commission. As an operator with an excellent track record in care quality we were very disappointed not to have secured a higher rating for the home.
"This is the first inspection by CQC since taking over the home and we have made many improvements to the home and the services it provides.
"We were aware that the challenge to recruit permanent staff and find agency staffing combined with the continuing impacts of Covid was starting to affect record keeping.
"An improvement plan was already in place at the time of the inspection and monitoring systems were being improved.
"We acknowledge and very much regret an isolated incident of a resident losing weight. However, the level of weight loss was not as severe as reported.
"We have taken a number of substantive measures with the appointment of a new clinical lead and the creation of an additional role to address the concerns raised by the CQC and to oversee all clinical matters.
"The staffing challenges that the home has been facing are well known across the sector. The CQC have themselves reported today that the average shortfall of permanent staff in care in the South West has doubled in the past 6 months to 12.1% making it the second worst affected region of the UK.
"Finding agency staff to fill the shortfall is extremely challenging, especially given that the care sector has to compete directly with the NHS for scarce agency resource but it cannot match the NHS’s ability to fund the spiralling costs of agency.
"As a company we are not waiting for the economy to find the solution to our staffing challenge. We are leaving no stone unturned to attract and retain permanent staff.
"We are running intensive advertising campaigns, investing in career development training, offering a generous joining bonus for new recruits and offering incentives to current staff to encourage friends and acquaintances who are looking for a new career to come forward.
"The CQC highlighted a number of positives when inspecting the home. They rated Oaktree as ‘Good’ for ‘Caring’ and reported that residents spoken to showed their appreciation describing our team as “amazing”.
"The CQC describes the care provided as compassionate and that residents are well supported with dignity and respect.
"We are enormously proud of the hard work and commitment of the teams across all of our homes who have delivered amazing care to residents through an extended period of very challenging conditions caused by successive waves of the Covid epidemic and significant structural challenge in the care sector in the form of major staff shortages and recruitment challenges.”
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