Oaklodge Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last inspection we rated this key question good. At this inspection the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent. This service was in breach of legal Regulation 17, good governance. This was in relation to oversight of the service.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they

did not always check and discuss people’s health, care, wellbeing and communication needs

with them.

The registered manager had a process in place for reviews that involved the person, however

this was not equitable across all the people. Those who had different communication needs

were not supported to be involved in their reviews in a way that worked for them. We brought

this to the attention of the registered manager who reviewed their practice to support the

involvement of the person in reviewing their care.

People’s relatives were involved in reviewing people’s needs. One relative told us, “It seems

pretty regular. I read through a new one recently. I was able to give comments and feedback,

and they adjusted it.” Another relative said, “Decisions are made with our involvement”.

The provider did not always plan and deliver people’s care and treatment with them, including

what was important and mattered to them. They did not always follow legislation and current

evidence-based good practice

standards

.

The provider did not ensure legislation and guidance was being followed to an acceptable

standard, such as the Mental Capacity Act

2005

. For example, people were not involved or

present during the assessment of their mental capacity, and there was little evidence that their

relatives, or other relevant professionals were involved in the best interest decision making

process.

Staff used reminiscence theory in some areas of the service, such as in the decoration and

pictures on display in the communal areas. However, there was room for improvement to

implement this and other guidance for dementia into activities and other aspects of the service.

The provider used evidence-based tools to assess the risk of pressure ulcers (Waterlow) and

malnutrition (Malnutrition Universal Screening Tool - MUST). Staff completed these to a good

standard and applied it to all people

necessary. For example, people were weighed regularly,

and where there was a concerning weight loss or gain, this would be identified using MUST and

a referral would be completed to a relevant professional, such as a Dietician.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services. The staff reported that they felt they were a good team, who worked together well to provide good care to people. We found during our assessment that there was a friendly atmosphere and how staff worked well together using effective communication. One person told us that “our team meetings are productive. They give us a chance to share updates, talk about any concerns or changes.” We found that documentation, such as care plans, were not always clear or coherent, which would not support a smooth transition from one service to another.

The provider did not always support people to manage their health and wellbeing, so people

could not always maximise their independence, choice and control. Staff did not always support

people to live healthier lives, or where possible, reduce their future needs for care and support.

The provider had not ensured there was a process to acquire or record people’s goals or

aspirations, particularly in relation to their health. Where staff had recorded outcomes in

people’s care plans, they did not focus on individualised goals but used standard statements

that were repeated across multiple people’s care plans. For example, care plans in relation to

personal care, often had the outcome as “to maintain personal hygiene” rather than focusing on

goals or developing that person’s independence.

One person told us that they are not always involved in appointments, such as phone

consultations with the GP. They told us “The staff speak with the GP and then tell me what is

going to happen.” This was confirmed by staff who told us they tend to speak to the GP and then

relay the information to the person.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves. The provider’s systems to monitor people’s care and outcomes were not robust across the service. Although staff completed records when people were distressed or displayed behaviours that challenge, there was no system to review or collate this information to establish ways to reduce distress for people. We brought this to the attention of the provider who arranged for this practice changed during our inspection. Staff did not always complete people’s daily logs with the detail required to monitor people’s care. The registered manager did not have an effective system of the oversight of people’s daily records as they had not identified these were not completed to a sufficient standard to monitor whether people were receiving their planned care and experienced good outcomes. Where people were able to communicate verbally, they were encouraged to feedback about their care, and staff looked for ways to improve people’s outcomes following this feedback.

The provider did not tell people about their rights around consent or respect these when

delivering care and treatment.

People were at risk of receiving care they had not consented to. During our inspection, we

reviewed mental capacity assessments, and best interest decision records. These were vague

and there was a lack of evidence of relatives or professionals had been involved in best interest

decisions. We observed a senior staff member completing mental capacity assessments without

the person being present, which is not in line with the legislation or best practice guidance. The

provider was receptive to feedback on this and began to change the way they assessed

people’s mental capacity during our inspection.

People’s access to their finances were restricted without the safeguards in place. The provider

kept people’s “petty cash” money in a lockable safe. There were no consent forms or mental

capacity assessments, and best interest decisions recorded to demonstrate people had

consented to their money being locked in the safe. Following feedback from the inspectors, the

provider changed their practice and implemented the relevant processes, including consent

forms. However, we found that people were not offered an alternative option so were not supported to make an informed decision. The provider failed to have systems in place to assess, monitor and manage people’s mental capacity assessments and best interest meetings.