During a routine inspection

Oakdene is a residential care home for 71older people. The home consists of two separate buildings within the same grounds and offers both residential and nursing care to older people, some of whom are living with a dementia. At the time of our inspection there were 54 people using the service.

At the last inspection, the service was rated ‘Good’. At this inspection we found the service remained ‘Good’ although some improvement was required in management oversight.

People were protected from avoidable harm as staff understood how to recognise signs of abuse and the actions needed if abuse was suspected. There were enough staff to provide safe care and recruitment checks had ensured they were suitable to work with vulnerable adults. People had their risks assessed and actions to minimise risks were understood by staff and respected people’s freedoms and choices. Medicines had been administered safely by trained staff that were aware of the actions needed if a medicine error happened. Staff had completed infection control training and followed procedures that protected people from avoidable infections. The service was responsive when things went wrong and reviewed practices in a timely manner.

People had their needs and choices assessed prior to living at Oakdene and this information had been used to create care plans that recognised people’s diversity and lifestyle choices. Care plans had been developed in line with current legislation, standards and good practice guidance. Staff had completed induction and on-going training that enabled them to carry out their roles effectively. People had access to healthcare when needed and working relationships with health professionals enabled effective care outcomes for people. The principles of the Mental Capacity Act 2005 were followed which ensured people had their rights protected.

The environment and use of technology met people’s needs and helped them maintain their independence. People had personalised their rooms and some had memory boxes which contained photos and memorabilia that represented past interests and hobbies.

Staff were caring and showed patience and kindness when interacting with people, ensuring people had their privacy and dignity respected. They understood people’s individual communication needs enabling people to be involved in decisions about their day to day lives.

Social opportunities included one to one time with staff, group activities in the home and community and fund raising events. Links with the community included providing a place of safety for people with a dementia experiencing a crisis.

Oakdene had not always met their legal responsibilities to share information with CQC in a timely manner. They also were not able to demonstrate processes had been followed to meet regulatory standards when dealing with complaints prior to February 2018. A complaints process was in place that people were aware of and felt able to use. A complaints log had been commenced from February 2018 which demonstrated people’s complaints had been investigated and the appropriate actions taken.

A whistleblowing and grievance procedure was in place but staff had not always felt empowered to use them to report concerns about their wellbeing in the work place. Management changes had taken place which had created a more open and positive culture, improved communication and teamwork.

Further information is in the detailed findings below.

During a routine inspection

This unannounced inspection took place on 02, 04 and 22 December 2015. The home is a nursing and residential care home and provides support and personal care for up to 70 older people, some of whom had dementia. The home has two separate buildings within the grounds. One is called Acorn Lodge. Acorn Lodge provides care and support for up to 26 people who have dementia and less physical needs whereas the nursing home provides support for up to 44 people with similar needs but who also have nursing needs. At the time of our inspection there were 67 people using the service, 24 people at Acorn Lodge and 43 people in the nursing home. Both buildings at Oakdene Nursing Home and Acorn Lodge have a ground floor and a first floor which is served by a lift and stairs. There are large landscaped gardens surrounding Oakdene Nursing Home and Acorn Lodge with secure gardens to the south and east of Acorn Lodge.

The home was last inspected on the 10 December 2013 and found not to be meeting the standards in the care and welfare of people and managing records. We found that there were ineffective systems in place to ensure people were protected from the risks of skin damage and people's care records did not always contain sufficient information to guide staff on how to meet their needs. These records were not always complete.

At this inspection improvements had been made to the care and welfare of people and in how their records were maintained. Staff told us they visited people in their rooms more frequently to reduce the risk of skin damage and we saw this happen during our inspection. Care records were complete and contained relevant information.

The manager who was a registered manager had been at the service since 2009 and registered in 2012. 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 were enough staff to care for people. We saw sufficient staff available to assist people with their care and support needs and staff were present to help people carry out their activities. Four people and one relative told us that staff were present and available but sometimes took time to respond to people’s call bells. One staff member told us that staffing was good across days and nights but that there had been recent staff sickness and leave agreed for staff for other reasons and this meant that existing staff then agency staff were used to fill the gaps. One person said, “The staff get quite busy and I’ve had to wait for some time for them to respond”. Recruitment processes were followed and newly appointed staff were employed only once all the appropriate checks had been made.

People were at reduced risk of abuse and kept safe because staff were aware of how to report abuse and protect people from harm. One staff member told us that physical harm and neglect would be reported to a senior staff member like a nurse or the head of care or social services and would be recorded in the notes. People told us they felt safe living at the home. One person said, “I feel quite safe living here”.

People received care from staff that showed an understanding of the risks to people. One person required re-positioning to safely eat their meals. A staff member said, “We carry out regular assessments especially where people may be at greater risk of accidents”.

Medicines were managed safely. Medicines were ordered, received, checked, administered and discarded safely. People told us that staff visited them in their rooms when administering their medicines and staff remained with them until they had taken their tablets.

Staff received training, support and had annual development plans. This included moving and handing to support people with managing their posture and movement and safeguarding adults. Nurses had to demonstrate that they had met their professional responsibilities; this is known as re-validation with their professional body.

People were offered nutritious meals and could choose between hot and cold foods. People who needed help with their meals were supported by staff and on occasion by their families. People told us that the food was “good”, “tasty” and “you get plenty”.

Some people living at the home did not have the mental capacity to make decisions about their care and where they lived. We looked at records and spoke with the local authority to confirm that people had received mental capacity assessments and where necessary Deprivation of Liberty Safeguard (DoLS) authorisations. Some people were still waiting to be assessed for DoLS authorisations due to a backlog of applications by the local authority. The registered manager explained that staff at the home had contacted the local authority to identify people where the arrangements for their care may deprive them of their liberty.

People were cared for by staff that showed empathy and carried out their role with respect for people. In the communal areas we saw staff engaging with people in a relaxed manner.

People received personalised care and support from staff who communicated important changes through shift handover meetings. One person told us that staff respected their choice to remain in bed and in their room. This person had capacity to make this decision.

Improvements were made following learning from incidents. On one occasion someone was at risk of harm relating to their posture and newly provided equipment. Since the incident new agency staff were expected to sign a record that they had familiarised themselves with the home’s induction process.

The deputy manager explained how complaints were managed through the complaints procedure and these were fully explored and investigated before being addressed.

Quality and safety checks were carried out at the home and actions were taken to improve the standard of care people received. However one system used for monitoring call bell response times were not effective in identifying trends or in producing sufficient detailed information and the management team told us this would be addressed following the inspection.

During a routine inspection

People were treated with consideration and respect and their privacy was maintained. One person told us, “They knock on the door before they come in.” Another person said, “The staff are very respectful.”

People told us that their needs were met. One person told us, “I cannot fault the care at all.” However, we found that the home did not have effective systems to protect people from the risks of skin damage.

Staff received training in appropriate topics and were supported to carry out their roles. One person’s visitor told us, “They seem to know what they are doing.”

People felt comfortable raising concerns and complaints and the provider had a system to manage these complaints. One person’s visitor said, “I’ve had the odd niggle which I have complained about and they have explained the actions they have taken.”

People’s care records did not always contain sufficient information to guide staff how to meet their needs. Records relating to the management of the home were effectively maintained.

During a routine inspection

People told us that they were happy living at the home and the care was good. One person told us “Very good here. The staff are first class, excellent”.

We saw recent compliments that the home had received from relatives of people who had lived there. One relative had written ‘Mum was so well looked after and enjoying life as best she could’.

Another relative wrote ‘Mum herself valued the life you gave her and so did we’.

People were given appropriate information, their needs were assessed and care planned and delivered to meet these.

Staff had appropriate professional development and were well supported through supervision and team meetings. This meant that people were cared for by competent staff.

The provider monitored the quality of the service. People and staff were able to express their views and these were acted upon. Lessons were learnt from incidents to improve care for the individual person involved as well as the wider group of people using the service and staff.