Archived: Oak Lodge Care Home

Oak Lodge Care Home is a nursing home which is able to provide care and accommodation to up to 47 people. The home specialises in providing care to older people. At the time of the inspection there were 26 people living at the home.

People’s experience of using this service:

The provider had made improvements to ensure people lived in a home which met legal requirements. They had an action plan in place to further develop and improve the service. People, staff and visitors were positive about improvements made.

People benefited from a new management team who were committed to providing person centred care and continually seeking people’s views on the care they received. One visitor said, “Since [manager’s name] has been here there has been change. They are trying to make the home meet the residents needs rather than residents meet the home’s needs. It is a complete new state of affairs, putting residents first.”

People’s needs were assessed and care plans were in place. However, the care plans did not always give clear information about people’s wishes and preferred routines. This meant there was not always clear guidance for staff to make sure people received care and support in accordance with their wishes and preferences. The provider was working to address this.

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

People were cared for by adequate numbers of appropriately trained staff to ensure their safety. People felt safe at the home and with the staff who supported them. One person said, “I haven’t had any reason not to feel safe.” A visiting relative said, “Quite happy, I’ve never worried about safety, those girls [staff] are marvellous.”

People were cared for by staff who were kind and patient. Staff helped people to maintain and develop relationships and friendships and visitors were always made welcome.

People’s well-being was monitored by staff and trained nurses ensured people’s healthcare needs were met. Where people required specialist care, referrals were made to appropriate professionals outside the home.

There were some organised activities but a number of people felt this was an area which could be improved. The provider informed us they were in the process of re-structuring the activities team and they hoped this would lead to improvements for people.

Ratings at last inspections:

At the inspection published 17 November 2017 the home had an overall rating of inadequate and was placed into special measures.

The service was rated Requires Improvement with one inadequate domain at our last inspection. (Published 16 October 2018.)

Following the last inspection, we met with the provider to ask what they would do and by when to improve the key questions; safe, effective, responsive and well led to at least good. We also imposed three conditions on the locations’ registration to require them to provide regular updates on the progress being made to comply with the regulations and improve standards of care for people.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any key question. Therefore, this service is now out of Special Measures.

Why we inspected:

This was a scheduled/planned inspection based on previous rating;

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Oak Lodge Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Oak Lodge Care Home is registered to accommodate up to 47 people who require personal and nursing care. At the time of the inspection there were 27 people living at the home.

When the service was last inspected in October 2017 we found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had failed to ensure sufficient improvements had been made in relation to the safe management of medicines, where there were identified risks to people, measures that could be taken to reduce these risks were not always in place or clear, exposing people to risk. No incident analysis was completed to identify patterns or trends to reduce any risks that may be present.

There were not enough staff consistently deployed to meet people's needs, poor staffing levels had resulted in people's care needs not being consistently met and their dignity being compromised.

The service had not met their responsibilities with regard to the Deprivation of Liberty Safeguards (DoLS), the service had not complied with the principles and legislation set out within the Mental Capacity Act 2005.

The quality and detail of people's care plans was inconsistent and the provider had failed to ensure that sufficient governance systems had been implemented to monitor the health, safety and welfare of people.

As a result of the findings of the inspection in October 2017, we served a notice of decision to vary the conditions of the provider’s registration. We required the provider to report to the Care Quality Commission detailing their assessment of the dependency of the people living at Oak Lodge Care Home, and an associated staffing level assessment, and provide us with an audit confirming that appropriate and accurate assessments had been undertaken for people living at Oak Lodge Care Home. We also placed the service in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms 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.

Whilst we found some improvements had been made since our last inspection, we identified the provider had not ensured there were sufficient improvements in relation to the safe management of medicines. Current practice did not ensure people were fully protected against all risks associated with medicines.

Although people told us they felt safe, two members of staff told us at times staff were using unplanned restraint for one person during personal care. Whilst staff knew how to recognise and report abuse, not all of the staff we spoke with felt confident to raise concerns relating to poor care.

Whilst we found systems had been implemented to improve the quality and safety of the service, we found these still weren’t fully effective at identifying shortfalls and ensuring timely action was taken to address shortfalls.

Some improvements were still required to the processes in place where people lacked the capacity to make decisions for themselves.

There was a registered manager in post. The registered manager was not available during the inspection and they were currently absent from the home. There was a deputy manager in post who was also not available during the inspection, the provider had arranged for a covering manager from another service to cover in their absence. 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 Head of Operations was also present during the inspection.

Improvements had been made to risk assessments and incidents and accidents were analysed for themes and trends.

Overall feedback from people, relatives and staff was that staffing levels had improved. The provider had procedures in place to ensure that suitable staff were recruited. Staff told us they received adequate training, supervision and support.

There were systems in place to ensure people were protected from the risk of the spread of infection. There were a range of checks in place to ensure the environment and equipment in the home was safe.

The provider had met their responsibilities with regard to the Deprivation of Liberty Safeguards (DoLS). DoLS is a framework to approve the deprivation of liberty for a person when they lack the mental capacity to consent to treatment or care and need protecting from harm.

People commented positively about the food and they received and said they had enough to eat and drink. People’s nutritional needs were assessed and their weights were monitored where required. People were supported to access healthcare professionals.

The premises were generally well maintained and safe. There were plans to improve the exterior of the home to make it fully safe for people to access.

People and their relatives spoke positively about the staff supporting them. Staff described how they supported people in a way that promoted their privacy and dignity. Staff spoke positively about the people they supported and knew them well.

There were a range of activities on offer for people to take part in. People, their relatives and staff had the opportunity to provide feedback on the service.

People and their relatives knew who the deputy manager was, and they felt able to approach them with any concerns. People, their relatives and staff commented they thought improvements had been made since our last inspection.

We found three continuing breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The well led key question remains ‘Inadequate’ and the service therefore will remain in ‘special measures’.

During the September 2016 inspection, we identified the provider was not doing all that was reasonably practicable to reduce identified risks to people and the provider had not ensured that people’s medicines were always administered in line with their needs. In addition to this, we found there was not always sufficient staff to meet people’s needs and governance systems to monitor the health, safety and welfare of people were not used effectively.

We set requirement actions in relation to the breaches of regulations we identified in September 2016. The provider wrote to us in December 2016 to tell us how they would achieve compliance with these requirements. During this inspection, we found that insufficient action had been taken to meet the requirements of the three regulations the service had breached at the inspection in September 2016. In addition to this, we found breaches in other regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Oak Lodge Care Home provides a service for people who require personal and nursing care. The service is able to accommodate up to 47 people. The building is divided into two parts. The main part provides nursing care to older people and The Acorns provides care for up to eight people who are living with dementia. At the time of the inspection there were 37 people living at the service.

There was no registered manager was in post at the time of inspection. The registered manager in post at the time of our previous inspection was no longer employed at the service. A new manager had commenced employment prior to this inspection in August 2017, but was not available on the day of the inspection due to annual leave. 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 addition to this, the deputy manager in post at the previous inspection was no longer employed at the service. A new deputy had commenced employment approximately one week prior to our inspection.

The provider had failed to ensure sufficient improvements had been made in relation to the safe management of medicines. Current practice did not ensure people were fully protected against all risks associated with medicines. We found that where the service had identified risks to people, measures that could be taken to reduce these risks were not always in place or clear, exposing people to risk. We found that fire evacuation plans were unsafe, with the current record of people living at the service being inaccurate and no guidance for staff on how to escort people during an evacuation.

Accident and incidents were recorded, however no analysis was completed to identify patterns or trends to reduce any risks that may be present. We requested an analysis of historical incidents which were sent to us following the inspection, however these records were dated after the inspection so had been produced retrospectively at our request. People gave mixed feedback on staffing, however from examples we were given it was evident the provider had not taken sufficient action since our last inspection to ensure that sufficient staff were consistently deployed to meet people’s needs.

The service had not met their responsibilities with regard to the Deprivation of Liberty Safeguards (DoLS). DoLS is a framework to approve the deprivation of liberty for a person when they lack the mental capacity to consent to treatment or care and need protecting from harm. People can only be deprived of their liberty so that they can receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005. At the time of the inspection there was no system to monitor current applications and DoLS status so it was unclear who had a DoLS application in process.

The service had not complied with the principles and legislation set out within the Mental Capacity Act 2005. Consent to care was not consistently sought in line with current legislation and guidance and best interest decision records or meetings had not been completed when required. There was currently no effective system in operation that monitored training provision and staff feedback was mixed about the style and platform training was currently being delivered. Some staff had not received an induction in line with the provider’s policy and their competency had not been assessed in certain aspects as a result of this. Staff supervision and appraisal evidencing staff were well supported in their role had not been completed as required. Improvements were needed in relation to the monitoring of people’s food and drink intake and a more person centred approach to some people’s dining experience was needed.

Although people’s feedback was positive, we found the service was not fully caring as poor staffing levels had resulted in people’s care needs not being consistently met and their dignity being compromised. Some people reported how they had waited a significant amount of time to use the toilet and another person explained they had purchased incontinence pads due to the significant time it could take staff to support them to use the toilet. We made observations of people waiting for the toilet and this matter was also raised as a concern during a recent relatives meeting.

The quality and detail of people’s care plans was inconsistent. People and their relatives had commented that they did not feel involved in reviews and some reviews were overdue. Within some people’s care plans we found key information about people, their preferences and things that were important to them had not been completed. This would help to ensure care was delivered in a person centred way. We found that people’s end of life care plans were incomplete and required improvement.

People gave examples of when care was not delivered in line with the needs and preferences. For example, some people told us they were left in bed for too long during the day and others told of how they continued to be supported by care staff of the opposite sex despite raising this with the service. The complaints system in operation required improvements to ensure people’s complaints and concerns were addressed consistently.

The provider had failed to ensure that sufficient governance systems had been implemented to monitor the health, safety and welfare of people. Ineffective governance had not identified the concerns we found during our inspection and placed people at risk. The service had received provider level governance checks and auditing that had identified concerns, however a second or follow up audit had not been undertaken to monitor if the shortfalls previously identified had been addressed. The provider had failed to ensure their rating was displayed as required by law and people were unsure of the current management arrangements.

The environment was maintained and equipment used within it was subject to regular testing and servicing. There were safe recruitment procedures in operation and staff understood how to identify and report suspected abuse. People felt safe and told us they received effective care and we found people had access to healthcare professionals when needed. We observed positive interactions between people and staff and people said staff were caring. Staff understood the needs of the people they cared for and visitors were welcomed. People had access to activities within the service. Staff we spoke with were positive about the new management and future direction of the service.

We found three continuing breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and identified a further four breaches. We are considering the action we are taking and will produce a further report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms 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.

This inspection was unannounced and took place on 13 September 2016.

Oak Lodge Care Home provides a service for people who require personal and nursing care. The home is able to accommodate up to 47 people. The building is divided into two parts. The main part provides nursing care to older people and The Acorns provides care to up to eight people who are living with dementia. At the time of the inspection there were 40 people living at the home.

There was a manager at the home who was awaiting registration with the care quality commission to become the 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.

Although people said they felt safe, we found some examples which placed people at risk of unsafe and inconsistent care. For example, the service did not always have enough suitable staff to consistently meet people’s needs in a timely manner. A relative, who visited the home most days, said although they felt their relative was safe and well cared for, there were times when the home was short staffed and people had to wait some time to be assisted. The clinical director and manager accepted staffing arrangements needed to be explored due to the high dependency of some people living at the home.

Staff told us they did not get enough quality time to spend time with people. They said whilst they did talk with people during tasks they were unable to give them any extra time. Staff spoken with raised concerns that they did not have time to, “Just sit and have a chat”, they felt the main social interaction was left to the activity coordinators. During the inspection call bells were often ringing for more than seven minutes and staff were seen to be busy delivering care and carrying out tasks only.

We looked at the way people’s medicines were managed and stored. Medicines were administered by registered nurses and care coordinators. Medicines were kept securely in locked medicine trolleys which were stored in locked treatment rooms when not in use. However we checked people’s records and stock levels during our inspection and found some of these to be incorrect. The manager carried out an immediate investigation.

Some people who required assistance to take their medication told us sometimes they did not receive their medicines when they were due. One person said “I waited until 10pm and they still didn’t come”. Staff told us not all staff were trained to administer medication, which meant people had to wait until the registered nurse or care coordinator were available to administer the medicines. This meant people were at risk as medicines were not administered in accordance with the prescriber’s instructions and at the suitable times.

There were inconsistencies and inaccuracies in people’s care records, including how people’s risks were monitored. This meant people may not have received the care they required. The provider’s quality assurance system had not operated effectively in identifying and making changes without delay when improvements were needed.

Throughout our inspection staff showed kindness and consideration to people. When staff went into any room where people were they acknowledged people. Staff had a good rapport with people and were seen to be friendly. When staff supported people they spoke to them in a kind and calm manner. One member of staff took time to play a few tunes on a piano in a lounge area; this gave enjoyment to a person sat in the room, who had received little interaction throughout the day.

“One person said, “Staff are very good on the whole, I love it that they all know my name and say hello [name] how are you today”.

Staff had the skills and knowledge they needed to meet people’s needs. They had received training at the start of their employment on how to recognise and report any suspicions of abuse. They said they were confident they could speak with the manager or provider about any concerns and they would listen and take action. One member of staff said “I would know how to report any abuse and would do so without hesitation.”

People were able to take part in activities with minimum risks to themselves and others. A member of staff told us, “We are supported by the new manager and often see senior managers around the home; they always enquire how the activity programme is going. We have a budget and we also fund raise. We share a mini bus with another of the homes; it is great for community links.

The provider had a system in place for responding to people's concerns and complaints. People and relatives told us they knew how to complain and felt assured that staff would respond and take action to support them.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.