Oakdene Rest Home

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• 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 changed to Requires Improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 54 (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 did not always make sure people’s care and treatment was effective because they did not always assess and review people’s health and care needs in-depth.

People’s needs were assessed before they moved into the service and were regularly reviewed. Although people did not recall being involved in their assessments or care planning, relatives confirmed they had been involved. A relative said, “I am involved, I am always contacted.”

However, assessments had not always led to comprehensive care planning. For example, risk assessments and care records for diabetes and epilepsy lacked clear escalation guidance and monitoring details.The registered manager amended care records to provide clearer guidance in these areas.

Despite this, most people and all relatives we spoke to were confident the staff understood people’s needs and were able to meet them. A person said, “The staff take care of everything, they have a list of what I need.” A relative told us, “When problems present themselves, staff change things, like how [person is] fed."

The provider did not always plan and deliver people’s care and treatment effectively to ensure people were receiving evidence-based care and treatment.

Care plans and protocols were not always detailed enough. For example, a diabetes care plan did not clearly state what actions to take when blood sugar levels were too low, and the person had been experiencing fluctuations in their blood sugar levels including very low levels. This had not been well-manage with nutrition, hydration or medicines in line with best practice guidance.The registered manager took action following inspection feedback to ensure care records were updated and protocols were discussed with staff.

Records in relation to hydration did not demonstrate people were consistently offered enough fluids in line with good practice guidelines for healthy hydration. Despite this, we observed drinks were available for people throughout the day during our inspection. Following the inspection a system was introduced to ensure this was monitored daily.

Despite this people and relatives were happy with the care they received. A person told us, “They look after me well”, and another said, “Oh yes, they couldn’t be better.” Staff were aware of people’s nutritional needs and supported them to meet these needs. For example, staff offered fortified diets and snacks for those at risk of weight loss. A relative told us, “[Person’s] not really eating. Staff give [them] milkshakes and [person] enjoys that. [They] always like a cup of tea. [Staff] suggest things they think will be easier for [person] to eat.”

Kitchen staff were knowledgeable about people’s nutritional needs. They were aware of people who required fortified foods to support weight gain, those who required low sugar diets due to diabetes and those who required their meals prepared to different textures due to risk of choking, swallowing or chewing difficulties or preferences.

The provider did not always work well across their teams to support people. There were systems in place to support staff to communicate and work as part of a team however these had not always been used effectively. For example, the handover system did not always highlight important risks for people which needed to be monitored or when people had experienced symptoms of their conditions which required increased staff monitoring.The registered manager made changes to the handover process and documentation following the inspector’s feedback. We will check the effectiveness of these systems at our next inspection.

Staff worked in partnership with other professionals to meet people’s needs such as district nurses. People and relatives confirmed staff worked with other professionals when required. A person said, “If I need them.” A relative told us, “[Registered Manager] contacts the GP, [they] had to do that recently.” A professional told us, “The care home staff listen to advice and follow the care plans that we compile with the staff and the clients.” Another professional said, “All of the staff that we have had dealings with at the care home are always polite, approachable and friendly.”

Staff told us the management team were supportive and told us they worked together well as a team.

The provider had not always supported people to manage their health. Records in the service were not always complete to demonstrate that staff were effectively supporting people to manage their health. For example, around diabetes and hydration.

However, staff escalated concerns about people’s health to relevant professionals when required. A relative told us, “[Person] has been unwell. They always let me know obviously. It can be district nurse or paramedic or called 111. They decide [person] needs help and they do what they need to.”

People were encouraged to maintain their well-being and independence. For example, staff encouraged people to participate in activities. We observed a range of quizzes and physical games taking place during our inspection. A person said, “They help me to keep my mind active."

Systems for monitoring outcomes had not been consistently completed or reviewed to ensure people were on target to meet goals or achieve desired outcomes in certain areas of their care.

Although people had received regular reviews of their care needs, the registered manager and provider had not always carried out robust auditing to monitor people’s experience of care.

For example, fluid monitoring records had not been reviewed as part of the quality assurance processes to identify when people were not meeting their fluid targets. This meant action had not been taken to improve outcomes. The senior staff and management had not been aware of features on their new electronic care planning system which enabled them to monitor additional risks for people such as constipation. The registered manager introduced checks to the daily work planning and handover process to improve monitoring going forward.

Despite this, people and relatives felt staff supported them well. A relative told us, “Overall I am happy [with the care]. [Person] has come on bounds, they had an old wound which [staff] have healed up, the girls there are great.” Staff also gave examples of how they had supported people to achieve good outcomes for example engaging an individual, who had previously been isolated, in activities.

Although the provider told people about their rights around consent and respected these when delivering person-centred care and treatment, records were not always completed to demonstrate the provider had followed all of the principles of the Mental Capacity Act 2005 (MCA). Where people lacked capacity to make decisions about their care, this was recorded in their care records. Best interest decisions were recorded for people where required, however, records in relation to these did not always demonstrate that relevant others had been involved in the decision-making process as required. Following the inspection, the provider told us they contacted all families and discussions around mental capacity assessments and risk assessments were now in place.

However, relatives feedback was that they were consulted about people’s care where appropriate. Staff told us they supported people to make decisions about their care. A staff member said, “We gain consent.” A professional told us, “[When we work with the staff], the best interest of the patient is always prioritised.”

People and relatives told us staff asked for consent before they provided care. A person told us, “Yes, they always knock and ask if they can come in.” A relative said, “They knock, and say I’m coming in is it okay if I [provide care]. Now, [person] says, ‘okay get on with it’.” Another relative said, “Here they say, ‘shall we’ and ‘can we’, there is never any forcefulness."