Oakdene Nursing Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement.

Requires improvement:This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of legal regulation in relation to governance and oversight.

This service scored 57 (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 had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities. However, we were not assured, shared vision and strategy were fully enshrined within the service and further improvements were needed.

We found improvements were made since the last inspection as to how well the service was managed and led. Leaders and managers had shaped its culture by engaging with staff, people who use services, carers and other stakeholders. However, although improved, was still not always effective. For example, staff did not always demonstrate a good understanding of the service’s vision, values and strategic goals. We were not fully assured staff at all levels had a well-developed understanding of human rights, and they always prioritised safe, high-quality care. Managers and staff did not always share an understanding of the risks and issues facing the service.

Staff told us they felt leaders were inconsistent in promoting a culture of collaboration, where people and staff are listened to and communicated with, to help promote learning and improvement. Comments from staff included: “A lack of clear communication and support from certain managers sometimes makes staff feel undervalued. At times, there aren’t enough staff to provide the level of care we want to give, which can be frustrating” and “Many staff members feel unsupported and disrespected, leading to a high turnover rate. This has severely impacted morale and the overall work environment. I believe it is essential for the owners of the company to listen to the staff and take our concerns seriously. The reliance on agency staff has also become problematic for our residents with dementia, who require continuity in their care.”

Not all leaders understood the context in which the provider delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty.

Although significant improvements were made to the way the service was managed, there was still instability within the leadership of the service and therefore there was no established management structure in place at the time of our inspection.

Support for staff from managers was still inconsistent due to a lack of a registered manager at the time of our inspection. Staff told us there was high turnover of managers. Leadership at the service was unstable - there had been 3 interim managers since our last inspection. We received mixed feedback about the management team. Staff told us they did not always felt supported: “While some managers provide support, others can be less approachable”, “No one ever even did an end of probation meeting with me, I didn't get a one-to-one supervision with home manager until December/January this year when [manager’s name] started” and “One-to-one supervisions with a senior member of staff are available, but they do not happen as often as I would like. I believe regular supervision is important for professional development and ensuring high-quality care, so I would appreciate more opportunities for feedback and support.”

Although the managers had a good understanding of CQC requirements, in particular, to notify us, and where appropriate the local safeguarding team, of incidents including potential safeguarding issues, disruption to the service and serious injury, this knowledge had not always been applied into practice. Managers and staff had not always shared an understanding of the risks and issues facing the service. For example, oversight of safe recruitment processes, assessment and management of environmental risks or appropriate thorough review and investigation of incidents and concerns by the managers were unreliable or inconsistent. Although significant improvements were made to the way the service was managed, there was still instability within the leadership of the service and therefore there was no established management structure in place at the time of our inspection.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

The provider had whistleblowing policy in place and procedures for staff to actively raise concerns, which were effectively embedded. Staff survey and team meeting minutes evidenced staff have been given the opportunity to speak up and drive improvement. There was also evidence of action taken in response to feedback from staff. There was a positive culture of speaking up where staff felt confident to actively raise concerns and those who did (including external whistleblowers) were supported, without fear of detriment. Leaders were open to feedback and staff felt supported and encouraged to speak up and raise concerns about quality of care.

Staff were aware of the term ‘freedom to speak up’ and how to execute this freedom. We saw posters around the premises actively encouraging staff to voice concerns. Staff told us: “The management provides open door policy to staff. There is also protocol for whistleblowers in the home policy.” Results of staff survey completed by the provider in September 2024 confirmed 97% staff knew how to report concerns about quality of care, with 85% staff were aware of provider’s external whistleblowing system.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Provider had policies and procedures supporting diversity and inclusion within the service and promoted diversity and inclusion in the workforce. Staff were from diverse backgrounds, and everyone was welcomed into the service. Staff told us they would care for anyone if they needed it, regardless of their background. Staff received training in equality, diversity and inclusion; completion rate was 100% when we visited. Staff and leaders demonstrated good understanding of the Equality Act. Staff were able to recognise discrimination and bullying and knew how to report this. Leaders took action to prevent and address bullying and harassment at all levels and for all staff, including those with protected characteristics under the Equality Act and those from excluded and marginalised groups.

Leaders supported work towards an inclusive and fair culture by improving equality and equity in the team and ensuring equality of opportunity and experience for the workforce within their place of work, and throughout their employment.

The provider did not always have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

Governance, accountability arrangements and quality assurance systems improved significantly since our last inspection. However, management systems were still not yet always robust and effective in identifying and managing risks to the quality of the service. Processes were in place to ensure the service operated safely but they were not always effective. Audits at provider level had not identified the shortfalls found within the inspection. For example, regular health and safety audits were completed however they didn’t identify concerns relating to the environmental risks. Risk associated with legionella disease was not always identified and effectively mitigated.

Also, we found no evidence of audits of behavioural monitoring reports being completed for people using the service. We discussed this with the management and they and took immediate action and completed behavioural monitoring reports during the inspection and intended to continue monitoring them through auditing.

In addition, we found that medicine used to control behaviours prescribed as when required in times of distress was administered regularly when person was calm and settled. That had not been identified by the quality assurance processes. We discussed this with the management, and they took immediate action to rectify this. We will assess sustainability of these changes at the next inspection.

Quality assurance systems did not always operate effectively in helping to ensure people consistently received safe and good quality care and support. For example, quality assurance systems had failed to identify safeguarding incidents and had not ensured safeguarding incidents records were accurate to monitor and mitigate risks. Due to safeguarding incidents records being inaccurate, it was not possible to identify trends and themes in safeguarding, therefore measures could not be actioned to mitigate future risks. Audits had not always resulted in a continuous and sustainable improvement in the service or action to manage risks and ensure service users were safe.

This meant that provider’s quality assurance processes needed further work to operate effectively, as opportunities for further improvement and development had been missed, and people remained at risk of harm.

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not always share information and learning with partners or collaborate for improvement.

We were not assured the service was fully embedded in the community it served and was not always considered a valued partner by others in the community. Lack of stability in leadership team over last 2 years led to inconsistencies in fostering positive relationship with local community and collaborative partnership working. We were not assured staff and leaders always engaged with people, communities and partners to share learning with each other that results in continuous improvements to the service. These networks were not always used to identify new or innovative ideas that can lead to better outcomes for people and the manager recognised the need for more collaborative partnership working to drive improvements. The manager told us: “I know Oakdene used to have great reputation within the local community. I will be focusing on restoring that reputation and reestablishing the relationship with the local community. I am planning on organising open days and summer fares, celebrating successes and good news stories. I will be actively using all my links. I have been working in Dorset for years, fostering and developing links with local organisations. I signed up to networks like Partners in Care, Women Leaders or Medication optimisation in Care Homes programme. Also working closely with local authority and community mental health team.”

We received negative feedback from partners about collaboration and joined up working with the service. Partners commented on high turnover of staff and instability of the leadership structure which resulted in poor communication and collaboration. Comments included: “We don’t feel service is well led. Managers keep changing. Regular manager is needed not a changing one and more regular staff employed” and “No, we do not feel the service is well led. There seems to be a high turnover of managers. When a new manager arrives, they bring in new ideas and changes, so on occasion, there appears to be improvement for a short time. Then the manager leaves. There is no consistency.”

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

Staff told us they felt more involved in developing and evaluating improvement and innovation initiatives. Staff felt this had improved recently with the new management team in place. Comments included: “I did feel supported and appreciated by [managers’ names] a lot and they made me want to come to work every day. I was told if I want any advance course or training, I should reach out to them as they saw lots of potential in me. If I shared any idea with [managers’ names] and the idea got implemented, they would gladly tell the whole team where the idea came from and shower praise on you. They would never take your idea and take the glory. Oakdene also has a platform called star of the month to appreciate staff monthly.”

Managers actively encouraged staff to speak up with ideas for improvement and innovation and actively invested time to listen and engage. This resulted in more trust developing between leadership and staff. However, we were not assured culture of reflective practice and collective problem-solving was fully embedded.

We were not assured the service was effectively monitored to ensure continued learning and improvements. Quality assurance arrangements were not always effective and applied consistently. Concerns were investigated and lessons were shared and acted on. However, some investigations lacked the full rigour needed and the learning was not always applied inconsistently.

Improvements were not always identified, and where they were, action was not always taken or identified shortfalls were not always rectified in a timely way and lessons learnt had not always been effectively shared with all staff to prevent re-occurrence. Improvements were not fully embedded and sustained in practice. For example, we found staff lacked full understanding and awareness of how to support people with choking emergency. This had placed people at risk of not having their care needs identified or risks of harm identified to prevent a re-occurrence.Staff and leaders had not consistently demonstrated a good understanding of how to make improvement happen. The approach was inconsistent and had not always included measuring outcomes and impact. There were processes to ensure that learning happened when things went wrong, and from examples of good practice however they were not always effective.