Oaktree Lodge Residential Home

Oaktree Lodge Residential Home is a residential care home providing accommodation and personal care to up to 34 people. At the time of our inspection there were 26 people living at the service. Oaktree Lodge Residential Home provides support to older people with a range of health and social care needs, including some people who were living with dementia.

People’s experience of using this service and what we found

Medicines were not always managed safely, or records did not always evidence this. Action was taken during and immediately after the inspection to make improvements.

We found no evidence that people had been harmed, however improvements were required to protect people from the risk of infection and cross contamination. We made a recommendation for the provider to comprehensively review and prioritise the repairs and improvements required at the service to mitigate the risks to the health, safety and welfare of people using the service.

Although systems were in place to monitor and improve the quality of the service, these needed to be embedded and monitored for effectiveness. Action plans ensured tasks were completed and improvements were shared with the staff team. Staff worked in partnership with other professionals to ensure people’s needs were effectively met.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People’s capacity to consent to their care and specific treatments had been assessed and decision making processes were documented.

People were kept safe from avoidable harm because staff knew them well and understood how to protect them from abuse. The service worked with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

There were enough staff to support people, and staff were safely recruited. People were supported by staff who had the training, knowledge, skills and support to carry out their roles.

There had been recent changes throughout the staff team, but the management team were clear about the quality of care and service they aimed to provide. Staff were positive about the changes at the service.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 21 March 2022) and there were breaches of regulation.

At this inspection we found improvements had been made, although there were further areas of improvement required. The service remains rated requires improvement. This is the second consecutive time the service has been rated requires improvement.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains requires improvement based on the findings of this inspection.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified a breach of regulations in relation to the safe management of medicines and identifying and mitigating environmental risks at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Oaktree Lodge is a residential care home providing personal care to 34 people. At the time of the inspection there were 30 people living at the home.

People’s experience of using this service and what we found

We found people could be at risk of experiencing environmental injuries should they fall against uncovered radiators, unsecured furniture or get tangled in electrical wires. No risk assessments identified these risks and no actions were being taken to mitigate those risks. Where people had been found unsupervised outside of the care home, we found no incident record had been logged and their risk assessment confirmed the incident but had failed to record actions taken to mitigate future incidents. People who were new to the service did not have a personal emergency evacuation plans (PEEPs) in place prior to our inspection. Action was taken during the inspection to address this shortfall. PEEPs are important as they give details to what assistance and or equipment someone might need in the event of an emergency.

During our inspection we identified improvements required to infection control procedures within the home. This included clinical waste bins not being the recommended pedal bin type, improvements to the cleaning of high touch points and ensuring accurate records were in place. Visitors on our arrival required access to surgical face masks action was taken to address this during our inspection. Improvements were also required to ensure the environmental risks were identified and mitigated where possible to people within the lounge and dining areas in relation to COVID-19. Guidance was not being followed on people’s admissions within the home and risk assessments had not been undertaken for all new admissions.

Improvements were required to the recording of people’s Medicines Administration Charts as not all people had records in place relating to the administration of pain patches. We found people were at risk of cross infection as medicines were being administered from dirty contaminated plastic disposable cups. People had access to medicines which were not securely locked away. We found during our inspection medicines being disposed of and left in a black plastic disposable sack, whilst the member of staff left the trolley to administer medicines to people. This left medicines accessible to people and staff as they were not securely locked away.

The providers quality assurance system had failed to identify the shortfalls found during this inspection. For example, we found shortfalls relating to the recording and reporting of incidents and accidents, along with infection control procedures and the use of equipment and cleaning within the service. We found systems had also failed to identify environmental risks, how these were being managed and the recording of the risks and what actions were being taken to mitigate the risks.

People told us they felt safe. Although we received mixed feedback about the quality of the care and support people received. This related to the use of agency staff and at times staff’s attitude. The service was using agency staff which was having a negative impact on the care and support people received. People told us the support they received from agency staff was not of the same quality and there had been a recent occasion where the agency staff had arrived late which had affected people’s morning routines.

Staff had received safeguarding training and knew how to identify abuse and who to go to. People, staff and visitors were part of regular testing and people received visits in line with government guidance. Support was provided to people by staff who had pre employment checks completed prior to commencing their employment.

The provider undertook relatives’ meetings and they sent regular updates in between. When people were unable to receive visitors, the service provided regular updates via newsletters, emails and phone calls. Quality assurance questionnaires were sent to people, relatives and staff so their feedback could be sought. Staff felt improvements had been made since the change in ownership at the home and staff felt supported and happy working at Oaktree Lodge. Some felt improvements could be made to ensure vacancies were filled rather than using agency staff. The registered manager attended meetings with other registered managers, and they felt they had a positive working relationship with local health and social care professionals.

Rating at last inspection

The last rating for this service was Good. (February 2018)

Why we inspected

This inspection started as an infection prevention assurance inspection. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

During this inspection we identified concerns and therefore we opened this inspection up to a focused inspection looking at Safe and Well-led.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have identified breaches in relation to the environment, the safe management of medicines and managing risk. We also identified improvements were required to the providers quality assurance process to improve provider oversight.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The service had visiting procedures in place to check visitor’s temperatures. Visitors were not let into the home if they were running a high temperature. They received a lateral flow (LFT) test before entering the home. There was plenty of personal protective equipment (PPE) available for visitors on arrival along with hand sanitiser. People were being supported with face to face visits, visits in the garden pod and end of life visits. Staff were also supporting with telephone calls and video calls.

Staff had access to plenty of personal protective equipment (PPE) and they had a good understanding of what PPE to wear and when. Staff had received training in infection prevention control and people’s health was monitored by staff who had been trained to recognise minor changes to people’s health which could make a difference to the care and treatment they receive. Staff felt supported by the registered manager and the provider and they were able to raise any concerns directly with them.

The home was open to admissions. When people were admitted from home or hospital, they had to have a negative polymerase chain reaction (PCR) result. There was a weekly testing programme for staff. This consisted of a PCR test and a twice weekly LFT. Most people and staff had received their two doses of the vaccine.

The service was clean and there was regular cleaning of high touch areas such as handrails, banisters, light switches, TV remotes, door handles and call bells.

Oaktree Lodge Residential Home also provides a domiciliary care service to people in their own homes, we therefore gave 48 hours notice to the provider. This was because we wanted to speak with people in their own homes and wanted their permission to do this. However the provider had given notice that they would cease delivering this service on 7 March 2018. During our inspection, we therefore only focused on the leadership, management and forward planning towards closing this part of the service.

During this inspection we checked that the provider was meeting the legal requirements of the regulations they had breached. You can read the report from our last comprehensive inspection, by selecting the 'All reports' link for Oaktree Lodge, on our website at www.cqc.org.uk.

Oaktree Lodge Residential Home 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.

Oaktree Lodge residential home provides care and accommodation for up to 34 people older people and people living with dementia. On the days of the inspection 30 people were living at the home. The home was over four floors, with access to all floors either via stairs or the lift.

There was a registered manager in post. 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.

People and their relatives were complimentary about the registered manager, the staff and the care they received. Staff knew people well and delivered care in the way they preferred. The service had a relaxed homely atmosphere and was clean throughout.

People’s care needs any risks to their health and wellbeing were comprehensively assessed and clear plans were in place to guide staff on how best to support people. There were good systems in place to identify any changes in people’s health and well-being and staff took swift action when they identified any health needs.

Staff were competent, knowledgeable and caring and recruited safely. They received appropriate training and supervision. The registered manager monitored staff performance and addressed any issues promptly.

People had plenty to eat and drink and had a choice of food and drink. Staff ensured people received support if needed but promoted independence as much as possible.

Staff respected people’s decisions and understood how to support people to make their own choices. Regular activities were available for people should they wish to take part, however, if people wished to spend the majority of time in their room this was respected.

The provider had an effective governance system in place to manage the quality of the service. There was a system of daily checks by senior staff and deputy managers overseen by the registered manager. These checks ensured staff carried out their tasks to the standard expected by the manager.

Medicines were mostly managed safely. We identified a training need in the administration of aerosol inhalers and a missed dose of one medicine which we brought to the attention of the registered manager. We have made a recommendation about this.

Oaktree Lodge residential home provides care and accommodation for up to 34 people. On the days of the inspection 30 people were living at the home. The home was over four floors, with access to all floors either via stairs or the lift. One set of stairs had a stair lift in situ. Some bedrooms have en-suite facilities. There are shared bathrooms, shower facilities and toilets. Communal areas included two lounges, one conservatory, one dining area and back garden with decking and patio area.

The service also provides domiciliary care services to adults within the Portishead, Clevedon and Nailsea area. On the day of our inspection 37 people were using the service. The domiciliary care service provides support to older people living at home.

The service did not have a registered manager at the time of the 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. There was a manager in post however they had not applied to be registered with us. We raised this with the provider who told us they would ensure an application would be completed.

People did not always have adequate risk assessments and guidelines in place relating to their care needs. The provider had no care plan and support plans in place for people who were at risk of developing pressure sores. Those people at risk did not have records completed that confirmed support provided by staff.

People felt safe although not all notifications were being made when required to the Care Quality Commission. A notification is information about important events which the service is required to send us by law. People could be at risk due to the department of health’s code of practice not being followed. This was due to poor use of personal protective equipment such as gloves and aprons. Clinical waste and dirty laundry was being left in communal hallways which placed people at risk of cross infection.

People had personal evacuation plans in place although these did not always include a photograph of the person so they could be identified by someone who did not know them. People were at risk of receiving unsafe medicines and some records were poor and not all staff being trained. People were not always being supported by staff who received regular supervision and training. Staff did not always have adequate checks completed prior to working with vulnerable people.

Staff felt well supported and demonstrated a kind and caring approach to people they cared for.

Staff who worked for the residential home had staff meetings and these were used for learning opportunities to prevent issues from reoccurring. However staff who worked in the domiciliary care service did not. People were supported to maintain relationships with people who were important to them.

People’s consent to care and treatment was obtained, and staff asked people for their consent prior to supporting them. Care plans reflected if people had capacity to make their own decisions. People were involved in their care planning and referrals were made to health care professionals when required.

The environment had risk assessments in place and people and staff felt the home was welcoming and friendly. People had access to activities and people enjoyed participating in these. People told us they enjoyed the meals and care plans reflected people’s individual dietary needs. Although this information was not always available to kitchen staff.

People and relative’s views were sought. People and relatives felt able to raise any concerns and there was a complaints policy in place. The provider had no quality assurance systems in place that monitored the quality and safety of the service and identified areas for improvement.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People were treated with respect and dignity by the staff and they told us that they felt safe. One person told us "They really look after you here". The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one. This meant that reasonable steps had been taken to protect people from abuse.

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns and investigations. This reduced risk to people who used the service and helped the service to continually improve.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly.

The needs of residents were taken into account when making decisions about the qualifications, skills and experience required when appointing new staff. Recruitment practice was safe and thorough. Policies and procedures were in place to make sure that unsafe practice was identified and people were protected. Disciplinary procedures were applied fairly and resulted in positive outcomes. This helped to ensure that people's needs were always met.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. Staff had received training to meet the needs of the people living at the home.

People's health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People said that they had been involved in writing them and they reflected their current needs.

Although Oakwood Lodge had not been originally built as a care home, people's needs had been taken into account when it had been converted. The layout of the accommodation enabled people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people with physical impairments.

Relatives and friends confirmed that they were a made welcome when they visited, could share meals with residents and could stay overnight if necessary.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were patient and gave encouragement when supporting people. People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this. A visitor said "Everyone is very friendly and caring here".

As well as addressing physical needs, care plans also described specific ways of comforting individuals if they became distressed. Individual preferences were always respected and people who lived at the home were encouraged to arrange their rooms to reflect their own taste and wishes.

The manager had developed a good relationship with a local GP surgery. Regular weekly visits ensured that any long-term medical issues were addressed in a timely manner. We were told that GPs responded quickly if there were more urgent medical problems that needed to be resolved.

Is the service responsive?

People's needs had been assessed before they moved into the home. Records confirmed that people's preferences, interests, aspirations and diverse needs had been recorded. Care and support had been provided that met their wishes. Special attention was paid to nutritional needs and people told us that they enjoyed the home-made food.

People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives. People took part in a range of activities both in and outside the home on a regular basis.

People knew how to make a complaint if they were unhappy. No-one that we spoke with had had cause to complain but they were confident that any problems would be dealt with effectively.

Is the service well-led?

The service worked well with other agencies and services to make sure people received continuity of care. People who lived at the home confirmed that staff listened to their views, both individually and during the monthly residents meeting. Changes that they had suggested had been acted on whenever possible.

The service has a quality assurance system. Records seen by us showed that identified shortfalls were addressed promptly. The registered manager of the home was actively involved in the day-to-day care of residents and was able to train and supervise less experienced staff. This meant that any weaknesses in the care provided were rapidly addressed. As a result of these measures the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. They had a good understanding of the ethos of the home and told us that they enjoyed helping the people who lived at Oaktree Lodge. This helped to ensure that people received a good quality service at all times.

We saw that the provider had a policy on safeguarding people from abuse. Staff had attended training to ensure that people who lived in home were protected from the risk of abuse. People said they felt safe with staff who supported them.

We saw the provider had an effective system in place to regularly monitor the quality of service that people received. People told us they were able to discuss issues openly at the residents' monthly meetings. People said they were aware of the complaint procedure. One person said 'I am quite content, I have no complaints'.

People told us that the home was clean and the food was good. One person said: "this is an excellent home. I love it here, the food is good, it's very clean. The staff are very polite and always cheerful. I have been here a long time".

We found that there were sufficient numbers of suitably qualified, skilled and experienced staff at all times.

Three relatives we spoke with told us that their family members were in a good place. They said their relatives were happy and settled as staff were kind.