Oakdene Care Home

Oakdene care home is a residential care home providing personal and nursing care to up to 35 people. The service provides support to older people with physical and/or mental health needs. At the time of our inspection there were 29 people using the service.

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

We found significant improvements at the service since our last visit. The registered manager had been in post approximately 10 months, during this time they had worked with the provider to improve the care, environment and quality monitoring processes to enhance the standard of care for people.

People told us they felt safe at the service. The registered manager and their deputy worked with the provider to ensure all safeguarding concerns were dealt with appropriately. There were processes in place to enable learning from events.

The environmental and personal risks to people’s safety were well managed. Assessments of people’s needs had been undertaken using nationally recognised assessment tools, and measures to reduce risks had been put in place using these risk assessments.

People were supported by adequate numbers of staff who had been recruited safely and received appropriate training for their roles

People received their medicines safely, and there were good quality monitoring systems in place to manage medicines and to highlight and reduce possible errors.

The service was clean and there were good infection prevention and control processes in place to reduce the risk of infections to people.

People’s nutritional needs were well managed. People enjoyed the food served to them. They were given choice and supported with their meals by a staff group who showed good knowledge of their nutritional needs.

Peoples’ health needs were well managed and there were good working relationships with external health professionals to provide good outcomes for people.

The environment people lived in was well maintained and the provider had an ongoing improvement and refurbishment plan in place.

People were supported by a staff group who treated them with respect and maintained their dignity. They were supported to maintain relationships with their families and there was a clear activities program in place to reduce people’s feelings of boredom or isolation.

The service had systems in place to manage complaints and concerns from people or their relatives and people told us they felt listened to.

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.

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 inadequate (published 20 February 2023). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 20 February 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. The overall rating for the service has changed from Inadequate to Good based on the findings of this inspection.

Follow up

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

Oakdene Care Home is a care home providing personal and nursing care for up to 35 people. The service provided support to older people with a mixture of physical and mental health needs. At the time of our inspection there were 29 people using the service. One of these people did not receive support with the regulated activity ‘personal care.’ We therefore did not consider their records when making our judgements.

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

People did not receive safe care. This is because care staff did not have enough written guidance or training to complete their role safely. Concerns with the environment were not managed safely. The emergency buzzer system could not always be heard, so did not allow a timely response from staff. People were at risk from getting trapped in bed rails.

Hoist slings (used to lift people to aid moving to a new position) were damaged. This risked causing injury, by failing when in use. Topical creams were not stored or recorded appropriately, and staff did not always record why, ‘as needed’ medicines were given. The home was not always clean, leaving people at risk from the spread of infection.

Staff did not use nationally recognised risk assessments effectively. People received enough to eat and drink, but kitchen staff did not have enough training to understand how to prepare altered texture diets effectively. Visiting professionals’ advice was recorded, however this hadn’t always been followed.

People were not supported to have maximum choice and control of their lives. This meant staff may not support them in the least restrictive way possible and in their best interests. The policies and systems in the service did not support more effective practice.

There was poor oversight of the service. When risks were raised, there had been a failure to take timely and effective action. This poor management had left people at risk of harm. A new manager had been employed but had only been in position for a week, so their work was not yet embedded 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

The last rating for this service was good (published 21 March 2018).

Why we inspected

The inspection was prompted in part due to concerns received about staff training, unsafe moving and handling, bed rails, and cleanliness. The local authority had also completed an audit in November 2022 and identified some concerns about safety at the care home. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. 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.

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 has changed from good to inadequate based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Oakdene Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to consent, safe care and treatment and good governance.

Details of what action we have taken can found at the end of the inspection report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.

Oakdene Care Home is registered to provide accommodation, nursing and personal care for 35 older people. There were 31people living in the service at the time of our inspection visit.

The service was operated by a company who was the registered provider. The company was run by a sole director. 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. In this report when we speak about both the company and the registered manager we refer to them as being, ‘the registered persons’.

At the last inspection on 14 April 2016 the service was rated, ‘Requires Improvement’. Although there were no breaches of the regulations we found that improvements were needed to ensure that people reliably benefited from receiving safe and responsive care. This was because there were not always enough care staff on duty, people did not always receive meals that met their expectations and care was not consistently provided in a person-centred way. In addition, there were shortfalls in the arrangements that had been made to ensure that the service was well led. In particular, quality checks had not always been completed in the right way and this had resulted in the persistence of the concerns we had noted.

At the present inspection the service was, ‘Good’. We found the individual concerns we had previously raised had been addressed. Suitable quality checks were being completed and had ensured that there were enough care staff on duty. In addition, people told us that they enjoyed their meals and we saw that they received person-centred care.

Our other findings were as follows. There were systems, processes and practices to safeguard people from situations in which they may experience abuse including financial mistreatment. Risks to people’s safety had been assessed, monitored and managed so they were supported to stay safe while their freedom was respected. This included occasions when people became distressed and needed support in order to keep themselves and others around them safe. In addition, medicines were managed safely. Background checks had been completed before new nurses and care staff had been appointed. Furthermore, there were robust arrangements to prevent and control of infection and lessons had been learned when things had gone wrong.

Nurses and care staff had been supported to deliver care in line with current best practice guidance. People were helped to eat and drink enough to maintain a balanced diet. In addition, suitable steps had been taken to ensure that people received coordinated and person-centred care when they used or moved between different services. Also, people had been supported to live healthier lives by having suitable access to healthcare services so that they received on-going healthcare support. Furthermore, people had benefited from most of the accommodation being adapted, designed and decorated in a way that met their needs and expectations.

People were supported to have maximum choice and control of their lives and care staff supported them in the least restrictive ways possible. The policies and systems in the service supported this practice.

People were treated with kindness, respect and compassion and they were given emotional support when needed. They had also been supported to express their views and be actively involved in making decisions about their care as far as possible. This included them having access to lay advocates if necessary. In addition, confidential information was kept private.

Although in practice people received personalised care that was responsive to their needs information was not always presented to them in an accessible manner. In addition, people had been offered opportunities to pursue their hobbies and interests. The registered manager recognised the importance of promoting equality and diversity. This included but was not limited to supporting people if they chose gay, lesbian, bisexual and transgender lifestyles. People’s concerns and complaints were listened and responded to in order to improve the quality of care. Furthermore, suitable provision had been made to support people at the end of their life to have a comfortable, dignified and pain-free death.

There was a registered manager who promoted a positive culture in the service that was focused upon achieving good outcomes for people. They had also taken steps to enable the service to meet regulatory requirements. Nurses and care staff had been helped to understand their responsibilities to develop good team work and to speak out if they had any concerns. In addition, people, their relatives and members of staff had been consulted about making improvements in the service. Furthermore, the registered persons had made a number of arrangements that were designed to enable the service to learn, innovate and ensure its sustainability. Also, the registered persons were actively working in partnership with other agencies to support the development of joined-up care.

Oakdene Care home is registered to provider personal and nursing care for 35 people who are over the age of 65. It is situated in a grade 2 listed building in the centre of Sleaford. There were 34 people living at the home on the day we visited.

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.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS were in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect themselves. The registered manager had made appropriate requests for people to assessed under the DoLS and all the care provided minimised the restriction on people. Where people were unable to make decisions for themselves processes were in place to ensure decisions were made in the person’s best interest.

Systems were in place to identify the number of staff needed to support people and to ensure that staff employed has the appropriate qualifications and skills to meet people’s needs. However, staffing levels at night did not support people to receive care in a timely manner. Staff were supported to maintain and improve their skills through ongoing training and support from the nurses and the registered manager. Checks were completed before staff started to work in the home to ensure that they were of good character and safe to work with the people living at the home.

Risks to people while receiving care had been identified and care was planned to keep people safe and healthy and where need equipment was in place and used safely. Risks around people being able to eat safely and maintain a healthy weigh were assessed and advice from healthcare professionals sought when appropriate. However, there was a lack in the variety of food offered to people. In addition information related to fluid intake was not immediately acted upon following a person’s discharge from hospital. Medicines were safely managed by staff and available to people when needed.

Staff were kind and courteous when speaking to people. However, we saw at times that staff were focused on the task instead of delivering person centred care and did not always take account of people’s feelings or need. In addition the care provided was not always delivered in a timely fashion.

Care plans had been developed with people’s involvement and accurately reflected their individual needs. They recorded the care needed to help people to retain and improve their skills in caring for themselves. However, call bells were cancelled by staff and people experienced delays in staff returning to provide the care they rang to receive. People were engaged by a well developed activities programme which supported them to be entertained with crafts, events and visits out. People who were cared for in their room were also supported to access a variety of entertainments.

The provider has systems in place to monitor the quality of care they provided to people living in the home and took appropriate action when they identified areas of concern. People were able to offer their views on the care they received through meetings and surveys and the provider listened to their concerns and worked to resolve them.

On the day of our visit we toured the building and observed the interactions between staff and people who lived at Oakdene.

People were provided with information about what they could expect while living at Oakdene and were encouraged to contribute their views about how the service ran and could be improved.

We found that the environment was very clean and bright, yet homely and well adapted to meet the needs of the people who lived there.

Staff were friendly and professional and supported people sympathetically whilst they helped them to maintain their dignity and respect. We found the staff very caring.

People told us they were well cared for and felt safe. They said they had sufficient food and drink to meet their needs and food was of good quality.

We saw that the provider was responsive and met people's changing support needs.

The provider had in place a suitable process for ensuring there were sufficient numbers of suitably trained and experienced staff to meet people's needs.

We have judged that the home was well led and managed by senior staff and the owners who were well regarded by other members of the staff team and the people who lived at Oakdene.

Prior to our visit we reviewed all the information we had received about the service. During the visit we spoke with eight people who used the service, two relatives and one visitor. We also spoke with four members of the staff team, the registered manager and one of the owners of Oakdene Care Home.

We looked at some of the records held in the service including the care files for four people. We conducted a walk around of the home.

People who used the service were supported to make their own decisions where they were able to do so. We saw staff asking people for their views and preferences. One person said, " The staff don't do anything until they've asked. They show the utmost respect."

The provider had taken action to enure that vulnerable people were protected from abuse and were safe. One person living at Oakdene said, " Of course I'm safe. If I felt any differently I wouldn't be here would I ?"

The building was clean and odour free. A visiting relative told us, " I used to be in the cleaning business. This place is clean."

Members of the staff team that we spoke with told us that they felt well supported and had the right training to deliver good quality care.