Oakdene Nursing 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

Effective – 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 assessment we rated this key question good. At this assessment the rating has remained good.

Good:This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 62 (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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

People’s needs were comprehensively assessed and included consideration of their physical, mental health, sensory, social and communication needs. Appropriate assessment tools were used to effectively support the assessment of people’s health and care needs and these are used by staff with the right understanding and skills.

People and their relatives told us they were involved in care planning and reviews. Relatives told us: “I have been involved in my [loved one] care plan review in recent months” and “I have been involved in a care plan review recently.”

Expected outcomes were identified and care and support were regularly reviewed updated. Staff recognised and responded promptly and adequately to people’s changing needs. Appropriate referrals to external services like dietitian or physiotherapist were made in a timely manner to make sure that people’s needs were met.

Staff received training in complex health conditions like diabetes, pressure ulcers, swallowing difficulties and palliative care. Staff applied their learning effectively and in line with best practice, which led to good outcomes for people’s care and support and promoted a good quality of life.

We received positive feedback from staff from staff about their involvement how care and support was planned and delivered. Comments included: “We review care plans and risk assessments every day. We have resident of the day and that day we call resident’s family to discuss with them if any changes. If there are no changes we still call them to give an update find out if they are happy with the care provided and if there's anything they would like us to do.”

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Care and support were planned and delivered in line with current evidence-based guidance, standards, best practice, legislation and best use of technology. However, we this was not always effectively monitored to ensure consistency of practice and to ensure it was fully embedded in the service. Assessments of people’s needs were comprehensive and expected outcomes were identified. Care and support were regularly reviewed and updated. Appropriate referrals to external services were made to make sure that all people’s needs were met.

People's care plans outlined their food and drink preferences. There was guidance in place to support people to eat safely when they were at risk of choking or needed their food to be a certain consistency. Staff demonstrated good understanding how to support people with this. Systems were in place to monitor people's nutritional intake and weights, and risk associated with dehydration and malnutrition. Care plans identified the level of support people needed from staff to prevent malnutrition and dehydration and this information was available to the staff working in the kitchen. The dining room information was laminated on the kitchen wall and the super menu list was taken to each person daily to log their preference for the meal and then taken to the kitchen to prepare their choices of meal. However, we found discrepancies on super menu list and dining room information regarding people’s needs and preferences. For example, guidance for 1 person on super menu stated they needed their food cut to bite size pieces which was not recorded on dining room information. The super menu for another person stated they had allergy to onions, but dining room information stated they had no allergies. Staff did not always apply their learning effectively and in line with best practice. This meant people’s care and support not always led to good outcomes.

We were not assured all people’s day-to-day health and wellbeing needs were met, and people always experienced positive outcomes related to these needs. We received mixed feedback from people and their relatives in regard to meeting people’s hydration and nutritional needs. Comments included: “I usually visit my [loved one] at one of the meal times as I am concerned staff do not have the time to assist [them] with patience whilst [they] eats. I have sometimes had to look for more food because [they were] still hungry. I was assured that [they] were getting fortified food and had been referred to a nutritionist (I have had no update on this event with prompting) I have seen one fortified yoghurt per day as an extra (and even then, sometimes it is still on her bedside table unopened). Residents loved ones have raised concerns at the meetings on the size and lack of hot food at supper. Initially macaroni cheese and cauliflower cheese etc were offered but now it’s back to half a sandwich and a bowl of soup. Not high calorific content. I do not feel the food reflects my [loved one’s] needs. For example, today it was hard and scratchy fish and chips. Until I questioned if this was suitable for my [loved one], whose chewing ability is failing, the answer I received was: 'No; I'll mention it to the team leader'”, “When I was visiting [my loved one] at mealtimes I noticed [they] struggled to eat. I ensured they changed and updated [their] care plan that [they] need to be supported with food all the time. Staff were feeding [my loved one] when they could so sometimes when they were busy [my loved one] wouldn’t have any food. I was coming over every day to support [them] with lunch. I requested support with food to be put in [their] care plan as permanent rather than occasionally and they did.”

We received mixed feedback from staff on evidence-based care delivery. Staff told us: “I think that residents who have their relatives visit regularly have a better life than those who don't. Outings are very few and far between and activities are not good at all, residents complain a lot that they are bored. Managers come and visit and totally take over their lounges. I think residents who have local relatives receive better care than those who don't and I think this is due to the fact that relatives could walk in at any time and so therefore carers don't want to get in trouble for having not cleaned or dressed the resident properly” and “I always try to support residents in doing as much as they can for themselves. For example, if someone can eat independently but needs help cutting their food, I assist only with what is necessary rather than taking over. Similarly, for residents with mobility challenges, I encourage them to participate in transfers as much as they are able, rather than relying entirely on staff. However, there are times when time constraints or staffing levels can make it difficult to fully support independence, as staff may need to complete tasks quickly to meet everyone’s needs.”

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.

Staff did not always work collaboratively across services to understand and meet people’s needs. Information was always effectively shared between teams and services where they worked together to deliver a person’s care. Not all relevant staff understood people’s needs, how they should be met and by who, for example when people were referred between services. This meant people’s care was not always effectively coordinated, to ensure they received support and treatment they needed timely and consistently.

We received negative feedback from visiting health and care professionals about collaborative working. They told us that some staff don’t know people they support well and don’t fully understand their health and care needs. Comments included: “When our paramedic or our health care assistant visit a care home, they are struggling to find someone with them to show where is the patient and also what are the issues”, “Staff do not appear to know the residents very well. If a nurse is visiting a patient whom we do not know, carers have a responsibility to know some information about residents in their care. Carers should be receiving hand-over from colleagues at shift change” and “A nursing colleague was kept waiting for 45 minutes, because none of the carers on duty were able to locate the new insulin pens, they did not appear to know where to look.”

Professionals told us they experienced difficulties in effectively communicating with the home. They told us: “The nurses are regularly asked by carers to document care in paper notes in the care home. Our team managers have previously met with Oakdene managers to clarify that the nursing team are not required to document in care home notes, we document in our own electronic patient system and it is the responsibility of the care team to document in care home notes. This is the value of nurses always being accompanied on visits by an experience member of the care team, who can then update care home notes appropriately” and “The phone system is frustrating. When GP keep trying to call, there’s no reply. We also had issues with communication between staff at Oakdene. Examples when GP sent medication to the pharmacy, then staff needs to know which pharmacy to go and when, for urgent prescription need to collect same day.”

Staff were participating in weekly multidisciplinary meetings with local GP surgery. However, we were not assured all staff were proactive in working with other services when multidisciplinary involvement was required, and any actions were always followed up on as needed.

The provider supported people to manage their health and wellbeing to maximise theirindependence, choice and control. Staff supported people to live healthier lives and wherepossible, reduce their future needs for care and support.

We received mostly positive feedback from people and relatives about support people received to manage their health and wellbeing and enhance independence. One relative told us: “[My loved one] is no longer mobile and due to the persistence of one of the carers, [they] have been supplied with a comfortable chair which [they] can be hoisted into when [they] get up and stay in it until [they] need to return to bed. It is on wheels so [my loved one] can be moved to the lounge, dining room etc without the risk of falls whilst transferring.”

Most staff told us they felt proud working at Oakdene Nursing Home, and they felt that resident living there had good life. Comments included: “I believe in the difference we make every day. I’m proud to be part of a team dedicated to providing compassionate, person‐centred care that truly enhances our residents’ quality of life. Even when challenges arise, knowing that my work helps residents feel safe, respected, and engaged is incredibly fulfilling. The positive feedback from residents and their families and the focus on creating a warm, supportive environment reaffirms my commitment and pride in the work we do.”

Staff told us they felt improvements could be made to encourage independence and enhance people’s wellbeing. Comments included: “Some of our residents are capable to walk to the shop located literally next door on their own to be able to buy small things like soap for themselves but unfortunately are not 'allowed' to. Bulk toiletries for these residents are being ordered instead of them being supported to go out and buy their own. I have walked with one lady to the shop so she can buy herself a bar of soap, she told me she had been asking for the last fortnight for someone to go with her” and “Regarding our residents living with dementia, we empower them to maintain their independence by encouraging participation in daily activities and decision-making regarding their care.”

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The provider established robust processes of monitoring the effectiveness of people’s care, treatment and support and ensuring action were taken to continuously improve it.

The provider actively sought and considered feedback from people, their families, carers, professionals and stakeholders as appropriate when monitoring individual outcomes. Results were used to drive improvement.

We found feedback forms and feedback and suggestions box located in the entry hall in by the signing in book available for all visitors. There were regular residents’ and relatives’ meetings where people expressed their opinions, wishes and preferences. We received mainly positive feedback form people and relatives about their involvement in driving improvements. Comments included: “I have not been contacted by the home regarding the care service they provide. There were a number of residents meetings initiated by management which I attended”, “From regular relatives’ meetings I could tell by the comments that other relatives had concerns. However, at the most recent relatives meeting the comments were far more positive with relatives thinking that there had been an improvement in care. Communication has improved a lot over the last few months, I feel more aware of what is going on and relatives meetings are more regular” and “I am asked for feedback when a care review takes place.”

Staff felt there could be improvements made to people’s experiences and their quality of life. Comments included: “Sometimes there are not enough things for residents to do and I feel that the activities side of it could be improved on. The food choices could be better as well. Some of the food is not what the older generation really wants or is used to eating” and “Efforts are made to enhance residents’ quality of life. The ‘wish tree’ initiative encourages residents to express their preferences for activities and community engagement.”

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

We received some negative feedback from relatives about staff respecting people’s human rights at Oakdene Nursing Home. Relatives told us they were not always involved in best interest decision meetings for their loved ones. Comments included: “I hold Power of Attorney to make decision about health and wellbeing of [my loved one]. When [they] became incontinent, I was not informed I only noticed that [they] were wearing continence pads. I was not involved in making that decision and [my loved one] cannot hold the conversation”, “I have raised concerns to the most recent manager in the respect of how [my loved one] is supported when being repositioned in the bed or have continence care. There are staff who have moved [my loved one] about the bed without asking or speaking about what they are about to do. It’s a small polite gesture which should be a normal procedure.”

Staff told us they understood the importance of ensuring that people fully understand what they are consenting to and the importance of obtaining consent before they deliver care or treatment. Comments included: “For residents who lack capacity, we adhere to the Mental Capacity Act (MCA), involving their families and making decisions in their best interest, prioritising their safety and well-being” and “We respect our residents and their wishes, therefore before any care intervention, we communicate with the residents and gain consent. Residents do have choice and staff respect residents’ choices relating to care and community access.” Staff demonstrated some working knowledge of the relevant legislation but lacked guidance on how to put these into practice effectively to ensure that people’s human and legal rights were consistently upheld and respected. Evidence demonstrated staff were not always clear and did not follow national guidance in relation to consenting processes - please see safeguarding section of the report for more detail.