We carried out a review of the data available to us about Oak Lodge Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Oak Lodge Care Home, you can give feedback on this service.
Oak Lodge Care Home is a care home providing personal and nursing care for up to 71 older people, some of whom were living with dementia. There were 62 people living at Oak Lodge Care Home at the time of the inspection. It accommodates people in one adapted building with an enclosed garden.
People’s experience of using this service and what we found
The provider had experienced significant staffing challenges related to the COVID-19 pandemic. The registered manager had put measures in place to promote staff recruitment, retention and wellbeing in response. The registered manager told us these challenges were ongoing.
There were enough staff in place to meet people’s needs. People’s needs were assessed and monitored to help ensure appropriate staffing numbers were deployed.
The registered manager was working in response to feedback from staff in relation to staffing levels and the use and quality of agency staff. They had put measures in place to increase staffing contingencies and improve communication when new or agency staff were working.
Staff were very attentive and knew people well. Staff told us that they were very busy in their role but worked to ensure this did not negatively impact on the care people received.
Support plans viewed contained appropriate information about people's nutrition and hydration needs. Staff spoken to also had a good understanding of people and the specific support they needed around eating and drinking.
The registered manager had improved resilience and contingency to staffing arrangements to ensure people's dietary needs were met. This included training staff to cover kitchen duties in an emergency and developing easy to follow recipes which auxiliary kitchen staff could follow.
There were appropriate policies and procedures in place to mitigate risks related to the COVID-19 pandemic. The service had gone to great lengths to facilitate visits and promote people’s wellbeing throughout the COVID-19 pandemic.
There were effective systems in place to oversee the maintenance and safety of 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
The last rating for this service was good (published 27 September 2018).
Why we inspected
We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in response to concerns received about staffing levels, support people received with eating and drinking and maintenance of the home. We decided to inspect to examine those concerns and check there were no wider associated risks.
The Care Quality Commission (CQC) have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.
We found no evidence during this inspection that people were at serious risk of harm from the concerns raised. Please see the safe and effective sections of this full report.
You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Oak Lodge Care Home on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.
Oak Lodge Care Home is a care home for up to 71 people who require nursing and personal care. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. At the time of inspection there were 70 people living at the home.
The service had a registered manager. 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 living at Oak Lodge Care Home received a service which was responsive. The provider found imaginative and creative ways to make sure people's care and support met their needs and reflected their preferences and background. People near the end of their life received care and treatment of a high standard which was recognised by external professionals. Where people had concerns, the provider listened to identify ways to improve the service.
People living at the home were put at the centre of processes to monitor and improve the quality of the service. People received a service which was well led. There was a very open, inclusive atmosphere in the home, with a strong sense of team working and ethos of continuous improvement. There was a very effective system of governance, and thorough and sustained systems of quality assurance. The provider paid particular attention to developing the skills of staff which led to an improved level of care.
The provider had systems in place to protect people from risks to their safety and welfare, including the risks of avoidable harm and abuse. Staffing levels were sufficient to support people safely. Recruitment processes were in place to make sure people were supported by staff who were suitable to work in a care setting. There were arrangements in place to store medicines safely and administer them safely and in line with people's preferences. Arrangements to control and manage the risk of infection were established in line with national guidance.
People's care and support needs were assessed and care plans developed based on national guidance. Staff received appropriate training and supervision to maintain and develop their skills and knowledge to support people according to their needs. Staff put into practice the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. People were supported to access healthcare services, such as GPs and specialist nurses and therapists.
People experienced good continuity and consistency of care, from staff who were kind and compassionate. The registered manager had created an inclusive, family atmosphere at the home. People were relaxed and comfortable in the presence of staff who invested time to develop meaningful relationships with them. People's independence was promoted by staff who encouraged them to do as much for themselves as possible. Staff treated people with dignity and respect and were sensitive to their needs regarding equality, diversity and their human rights.
We undertook an unannounced comprehensive inspection at Oak Lodge Care Home on 22 and 25 November 2016 at which two breaches of regulations were found. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for ‘Oak Lodge Care Home’ on our website at www.cqc.org.uk.'
Oak Lodge Care Home is a purpose built home set over four floors providing nursing care for up to 71 people including people who live with dementia, mental health conditions and have general nursing needs. At the time of our inspection there were 68 people living at the service.
The home had a registered manager. 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 sufficient staff to meet people’s needs. The registered manager had increased the staffing provision at the service since our last inspection. This included additional staffing allocated to each of the four floors of the service and additional staff during the evenings and overnight. People and their relatives told us they felt that staffing levels had improved at the service since our last inspection.
Risks to individuals were safely assessed and monitored. There were systems in place to ensure that changes in people’s health and wellbeing were quickly identified to reduce the risk of harm to people. The registered manager and clinical services manager took an active role in supporting staff to monitor risks by working with people and holding regular meetings with staff to assess and monitor risks to people.
A registered manager was not in place at the time of the inspection, although the manager had applied to be registered with the CQC and their application was being processed. 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.
Staffing levels were not sufficient to keep people safe and not enough staff were deployed to ensure people’s needs were met in an effective and person-centred way. Due to the staffing levels people were not always protected from individual risks to keep them safe.
Most medicines were managed appropriately, although there was a lack of information about when to administer ‘as required’ medicines and topical creams were not always documented as given as needed. The issues found in relation to PRN medication and administration of topical creams was discussed with the manager who agreed to investigate these issues and take appropriate action.
Staff sought verbal consent before providing care and treatment, however the service did not always follow the principles of the Mental Capacity Act, 2005 (MCA). Not all decisions made in peoples best interests had been preceded by an assessment of their ability to make the decision themselves. Our findings in relation to the MCA were immediately addressed by the manager.
Not all staff were up to date with the provider’s mandatory training, however staff demonstrated a good awareness and understanding of most the training they received with the exception of the MCA training.
The management team had not built a supportive relationship with all staff and relatives. Work was needed by the management team to address low staff morale and the high turnover of staff. Care staff told us they felt unsupported and not listened to by the management team. Although staff received support through supervisions, these were sporadic.
Staff had a good understanding of how to identify if people were at risk of abuse and knew what to do in these circumstances. The provider had a safe and effective recruitment process in place to help ensure that staff they recruited were suitable to work with the people they supported.
People were supported to maintain good health and had access to appropriate healthcare services. Family members confirmed that their relatives were seen regularly by doctors and other healthcare professionals such as GPs, dentists and chiropodists. People’s records showed that they had regular contact with these services and the outcomes were recorded in detail.
People and their relatives described staff as “kind” and “caring”. We observed positive interactions between people and staff. Staff knew people well and spoke about them fondly. They engaged in meaningful conversations and encouraged people to remain as independent as possible.
People’s privacy and dignity were protected at all times. They, and their relatives when appropriate, were involved in planning the care and support their received. Care was delivered in a personalised way and people were supported to make choices.
Care plans included clear guidance about how people wished to receive care and support. They were updated regularly and staff were responsive to changes in people’s needs. A range of activities was provided.
Quality assurance systems were in place to monitor both the safety of the environment and the quality of the clinical care provided and these were followed. Issues or concerns raised were acted upon in a timely manner.
We identified breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.
We inspected Oak Lodge Nursing Home on 20 and 22 October 2015 and this inspection was unannounced. Oak Lodge Nursing Home is registered to provide accommodation and personal care for up to 71 people. At the time of the inspection there were 57 people using the service. The service was over four floors, and each floor was defined by the level of care required by each person.
There was a new manager in post who was waiting for was in the process of becoming registered with CQC. 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 also a deputy manager in post, as well as 13 registered nurses and 59 care staff. There were two maintenance workers, two administration staff, a head housekeeper and housekeeping staff, a head chef as well as other kitchen staff.
The people were well cared for and there were enough staff to support them effectively. The staff were knowledgeable about the individual needs of the people and knew how to spot signs of abuse. People’s relatives said they felt their loved ones were safe and supported by the care staff and the manager. The manager followed safe processes to check the staff they employed were suitable to work with vulnerable people. Medicines were managed safely and people received their medicines as prescribed.
Care records and risk assessments were person-centred, up to date and were an accurate reflection of the person’s care and support needs. The care plans were written with the person, so they were fully involved in the planning and identifying of their support needs. The care plans included the person’s likes and preferences and were reviewed regularly to reflect changes to the person’s needs.
Staff received regular supervision and had completed training appropriate to their role. The service had ensured that all required checks had been completed prior to the staff being employed.
People’s relatives said the manager and staff were caring. They spoke to people in a kind, respectful and caring manner. There was an open, trusting relationship between them, which showed that the staff and provider knew the people well. We observed staff supporting people with respect whilst assisting them to maintain their independence.
Staff said they worked well as a team, and the manager provided support and guidance as they needed it. There was an open and transparent culture which was promoted amongst the staff. This allowed them to learn from incidents and changes were made to the service following feedback from people, their relatives and staff.
The manager demonstrated a good understanding of the importance of effective quality assurance systems. There was a process in place to monitor quality and to understand the experiences of the people who used the service. The manager had a desire to learn and implement best practice throughout the service.
Is the service safe?
Is the service well-led?
This is a summary of what we found;
Is the service safe?
There was a process which the staff followed to ensure people received their medicines as prescribed. Medicines was managed appropriately and maintained securely and this included controlled drugs. A random sample of the medicines in stock indicated prescribed medicines were available to people. The system for managing 'bulk medicines' such as cream and ointments was being reviewed as this did not follow the provider's policy for prescribed medicines.
There was a planned staffing roster and staffing had been reviewed following recent concerns. There was adequate number of staff on the day of our inspection and staff received regular training and updates to maintain their skills.
Is the service well-led?
The records of care were maintained securely and available when we requested them. Personalised records of care and treatment were reviewed regularly and changes recorded. The records, such as food and fluids were accurately completed during the day but at night they were not accurate. The provider had a system for the senior staff on shift to monitor this daily in order to address the inaccuracy of records for food and fluids.
Is the service safe?
Is the service effective?
Is the service caring?
Is the service responsive?
Is the service well-led?
This is a summary of what we found-
Is the service safe?
People were cared for by staff who were fully aware of their needs and who had the skills to provide the support people required. There were adequate staff on duty to meet people's needs and we observed staff were available and attended to people ensuring they were safe. Systems were in place to ensure people's changing needs were met and they were referred to external professionals as required. Staff followed their procedures for infection control. Risks assessments had been completed and equipment was in place for the safe moving and handling of people. A senior member of staff told us they had looked at the 'fluctuating' staffing and had recruited over their numbers in order to ensure they have adequate staff.
The management of creams and ointments which were prescribed was not robust and may impact on people's welfare and wellbeing. We asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the management of people's prescribed medicines.
Is the service effective?
People's care and support were based on thorough assessments and care plans developed to support people's needs. Relatives told us they were consulted as appropriate to provide information about their relative's needs. Systems were in place to ensure care was delivered according to people's needs. Staff sought the support of external professionals to ensure care was tailored to people's needs and up to date guidance such as tissue viability nurses' support.
Is the service caring?
We observed the staff showed attentive and caring attitude towards people when providing care and support. They provided reassurance and support to people in a calm and supportive manner. A person told us 'the staff have time to talk with people and provided reassurance when it was needed'. People told us the staff were 'very caring and really good'. A relative said 'you can go home and not worry'. We saw staff supporting people with their meals at a leisurely pace and interacted positively with them. Relatives told us staff 'always' respected people's dignity. A person told us 'this is never a problem.'
Is the service responsive?
An assessment was completed prior to people moving into the home to ensure their needs could be met. People told us they had been involved in their relative's assessments and care planning, and that their views and preferences were taken into account. Staff carried out regular reviews of people's needs and action taken to address any changes.
Is the service well-led?
Systems were in place to regularly assess and monitor the quality of service provided. Risks were assessed and appropriate action plans were in place. There were processes in place to review and learn from incidents, accidents and complaints. People's views were sought through satisfaction surveys and action plan developed to address any issues as needed.
At the last inspection in August 2013, the management of people's records were not managed effectively. At this inspection we found records were stored safely and securely. These were available when we requested to see them. There were minor shortfalls in some records for continence management and fluids charts recording at night. We asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the management of these records.
People were assessed prior to receiving care. The care plans did not always contain adequate information to support people's needs. They did not show how people's specific identified needs would be met and were not reviewed regularly. Pressure relieving equipment was provided, however this was not managed safely and may put people at risk of skin breakdown, as staff did not follow the care plans.
The provider carried out some audits to assess the quality of the service provision. Action plan to deal with the outcome of their surveys was not robust as this did not take into account all the issues raised. There was a process in place to deal with any concerns/complaints and staff responded to people as required. The records were not accurate and did not reflect what care and support people had received. The infection control processes were not adequate and may pose infection control risk to people.
Relatives were complimentary about the care and the arrangements that the staff had made to celebrate a person's birthday. People told us that the food was very good and three relatives said that choices were available. People told us that the staff came and checked on them to ensure that they were all right. Relatives commented that the care at the home was 'very good' and 'very helpful staff'.
Two relatives told us that they had not been fully consulted by care managers prior to their relatives moving into the home. However once they were admitted, the manager and staff provided them with appropriate information. They said they felt that their relatives had settled in well and could approach the staff if they needed anything.
Two relatives raised some concerns with us about payments for equipment and they discussed this with the manager on the day. Another relative had raised some concerns about their relative's care and staff's practices. The manager took appropriate actions. We were told that people knew how to raise any concerns and they were happy to discuss them with the manager. People also told us that at times they waited for a long time for help when they pressed their call bells.
They said that they could approach the staff and the manager with any concerns and were confident these would be addressed. One person said that the staff always wave to them when passing their rooms and she liked that.
People told us that the food was 'very good.' They said the home was 'always very nice and clean' and well maintained. Relatives told us that they visited several times a week and found that people 'always looked well dressed and clean.'
Relatives told us that there were a lot of staff changes and this was not good for people with dementia. They felt that people needed familiar faces in order 'to build trust.' We were told that there was an issue with personal belongings such as spectacles going missing and not available for 'four to five days' at times.
Visiting professionals said they attended the home regularly and the staff sought help and advice for the residents as appropriate. They said that staff did not always follow through when they identified any problems that may affect the care of people.
Another person said that the staff did help them and they preferred to remain in their rooms and that this was all right.
Relatives told us that the home had a large number of agency staff and that at weekends this 'was worse'. They said that they felt their relatives' needs were not always met as the staff did not know the residents.
One person told us that some of the care staff 'can be rough'. Another person said that they were on tablets for their chest and the staff administered these to them.
The relatives told us that care was variable depending on which staff were on duty. Some people said that the home was 'chaotic' at times and this was due to the high level of agency staff.
Two people said there were problems with staff not knowing the residents.
People told us that the care had deteriorated in the last few months as there had been no manager.
We heard that the meals were good and the residents were offered choices. People were concerned that food and fluid charts were poorly maintained and did not demonstrate what diets and fluids people had received.
People said that the privacy and dignity of the residents were not always maintained and staff did not attend to people's needs at times. People have told us that the residents were not always moved appropriately and that put them at risk of harm.