Oakdene Rest Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question Good. At this assessment the rating has changed to Requires Improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to people’s safe care and treatment including the way medicines were managed and fit and proper persons.

This service scored 56 (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 proactive and positive culture of safety based on openness and honesty. Staff listened to concerns about safety, these were investigated and reported in a timely manner. Lessons were learnt to continually identify and embed good practice.

Staff knew the process to report incidents and accidents. When people had experienced falls, staff assessed them to check for any injury. Staff told us, “If there is an accident, we remove the danger, see to the person, record the incident and write anything to prevent it happening again.” A person told us, “I have had a few falls the staff are always there to help.”

Where there were possible concerns a person might have a serious injury following an accident appropriate healthcare advice and services were sought. A relative told us, “[Person] had a fall when [they] first came, [staff] had paramedics out, they took [person] to hospital…there were no problems and were brought straight back [to the] home. [Person] has not had any more falls.”

The management team ensured actions were taken to prevent future risk of harm following accidents and incidents such as changing the layout of people’s rooms and reviewing their medicines. There was a process in place to analyse incidents and accidents at the service. This helps identify whether there were any patterns or trends so changes could be made to drive continuous learning and improvement. Lessons learned were shared in meetings and memos with staff.

The provider worked with healthcare partners to establish safe systems of care to monitor and manage safety. They made sure there was continuity of care when people moved between different services.

The registered manager ensured that people’s needs were assessed before they moved into the service. A relative told us, “I looked around. [Registered Manager] and [Deputy Manager] came to our house and told [person they were] going on holiday. When [person] moved in, they did not look back.”

Staff also ensured that when people moved between services that information was shared with other professionals and services when required. For example, people were supported during hospital admissions and returns. We observed staff re-assessed a person’s mobility needs after a period of being away from the service and returning.

Staff worked with health and social care professionals to ensure people received care that met their needs. People confirmed they received support from other professionals when required. A relative told us, “Whenever a district nurse or doctor comes, staff are with [person] all the time so [person] has their support."

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Staff had received safeguarding training and were aware of possible signs or symptoms of abuse. Staff knew how to raise any potential safeguarding concerns and felt confident these would be acted on. A staff member said, “Safeguarding starts as soon as we have [people]. Value them, keep them safe from harm, abuse and neglect and provide care how they wish to continue to live their lives. If I had a safeguarding issue I go to my senior or head of care.” Staff knew the process to escalate concerns internally and externally if required. There were posters in the service with safeguarding and CQC contact details and staff knew how to whistle blow.

The registered manager knew their responsibility to safeguard people and worked with the local authority to raise and address any potential safeguarding concerns. A professional told us, “I feel the care home staff in Oakdene are empathic and understanding and help the clients feel safe in their environment.”

People and relatives told us they felt the service supported people safely. A person said, “The staff make me feel safe.” A relative said, “I don’t have any concerns it’s nice to walk out the building and not be worried.”

Staff had made Deprivation of Liberty (DoLs) applications to the local authority to deprive some people of their liberty. People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLs), which is part of the Mental Capacity Act 2005 (MCA). There was a tracker in place to monitor when these had been approved or were due for renewal.

The provider had not worked well with people to understand and manage risks. Some people’s risks and care needs had not been fully assessed, monitored or mitigated.

For example, risks in relation to diabetes had not always been fully assessed. Although there was some information to support staff to identify high blood sugar levels and the action to take; guidance around what blood sugar level was too low and the measures to take to monitor and manage this risk was not clear. Staff knew the signs and gave different examples of the action they would take, however, when the person had experienced blood sugar levels that were too high or low, it was not always evident whether immediate action was taken to increase or decrease these accordingly. This meant the person was placed at potential risk of harm of their health deteriorating. Staff practice was inconsistent around re-checking the person’s blood sugar levels to ensure they were returning to an acceptable level in a timely manner. This is important to ensure that any risk to the person was monitored and managed safely and effectively to reduce risk of health deteriorating and serious harm.

Another person experienced seizures. Their risk assessment and care plan did not provide full guidance for staff to support them to identify the signs the person was experiencing a seizure. The care records also lacked sufficient guidance on how to monitor and support the person following a seizure. We asked staff about signs of a seizure and what action they took. Most staff knew how to support the person. However, there was no record of the care given to the person during or after a seizure except if these lasted too long and then an ambulance was called.

People who had been identified as requiring their fluid intake to be monitored due to risk of dehydration had not always had this risk effectively monitored or managed. Records showed that people were not always offered enough fluids to meet their fluid target and people were frequently not meeting them. This placed people at potential risk of harm, although we did not find any evidence of dehydration or harm during this assessment.

The registered manager amended care records to provide clearer guidance and made changes to processes for diabetes, epilepsy and dehydration risk management. We will review these at our next inspection.

People and relatives felt staff supported their needs well. A relative said, “They are there for any of [Person’s] needs."

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The home environment was maintained by a member of maintenance staff. They completed regular checks to ensure the home environment remained safe such as checking water temperatures to ensure people were not at risk of scalding or Legionnaire’s disease and fire alarm testing. A person told us, “We have a good maintenance man.” Staff told us maintenance carried out works where required in a timely manner when issues were reported. External contractors and professionals had completed other checks to ensure the home and equipment remained safe for people. This included gas, electrical and fire safety assessments as well as checks of equipment such as hoists and slings which staff used to support people to mobilise. The registered manager kept oversight of the homes health and safety and worked with the provider to ensure environmental concerns or improvements were implemented. A relative told us, “There is an onsite person. They upgrade things as money permits. There have been new floors.”

A professional commented on the home environment and said, “[The home] use wall transfers to make areas more interesting…and have a “post office”, “bakery” and “quiet lounge”. This is working well, and [people] have been engaging in the new areas, and their loved ones have been sitting alongside them.

Staff had not always been recruited safely. The provider had not assured themselves that staff were suitable and safe to work with people. Some staff had gaps in their employment history without explanation. We raised this with the registered manager who immediately contacted staff to document an explanation for the gaps. The registered manager had completed other necessary steps for safe recruitment, they obtained references for new staff and completed Disclosure and Barring Service checks as required.

The management had not completed additional risk assessments for staff to support safe working. The registered manager also put these in place during the inspection and added auditing staff files to their action plan following the inspection.

The provider had not always ensured staff were qualified, skilled and experienced to deliver care. For example, care staff were administering insulin without a recent competency assessment from a relevant healthcare professional. This meant that people were at risk of receiving support from staff who had not been trained to do so. The registered manager addressed these identified issues following our feedback and submitted evidence to show that staff were re-trained following the inspection. Some people living at the service required support to manage diabetes or catheter care. Not all staff had received training around diabetes awareness or catheter care. Although most staff were knowledgeable about the risks and how to manage them for these needs, documentation around diabetes management had not demonstrated this. The management team assigned staff both courses following the inspection.

The provider had made sure there were enough staff, whom they supported with regular supervision and appraisals. There were enough staff deployed in the home to meet peoples’ needs. The registered manager completed dependency assessments to understand the staffing baseline required and staffed above this. We observed staff supported people in a timely manner during the inspection. People and relatives were happy with the staffing levels. A person said, “I think there is enough staff.” A relative told us, “There are always carers around. I know the management team do not employ agency staff and I don’t notice a huge turnover.” Another relative said, “Oh yes, absolutely enough staff, there are occasional days when there are less. [Staff] are always walking up and down the corridors. There is plenty.”

Staff told us that generally they felt there were enough staff. However, some staff told us that in the afternoon when there was 1 less staff member, if there were incidents or people became unwell, this felt more pressured. We fed this back to the registered manager who told us they or the deputy manager supported staff during these times.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and knew to share concerns with appropriate agencies promptly.

We observed the home was clean during both of the days we visited and the domestic staff were attentive. There was a cleaning schedule in place and staff were allocated cleaning tasks and areas 7 days a week during the day and night.

Feedback from people and relatives was positive in relation to the cleanliness of the home. Comments included, “The home is always clean.” And “I have never ever found cleanliness lacking at all.”

Staff had received appropriate infection prevention and control training, staff and people maintained good hand hygiene and staff utilised personal protective equipment appropriately while carrying out their duties.

Staff were aware of signs of infection and monitored people for these. If there were any concerns people were experiencing an infection these were escalated to relevant healthcare professionals to ensure appropriate care and treatment.

The registered manager and provider kept oversight of infection prevention and control through regular audits.

The provider did not always make sure that medicines and treatments were safe and met people’s needs.

People’s medicines had not always been managed safely. For example, staff had not recorded the time they administered a person’s Parkinson’s medicines. They told us they were confident the person received their medicines at the same time each day, however, the provider could not be assured that this time was within the 30-minute window as recommended in national guidance. This meant the person was at potential risk of experiencing symptoms of their conditions or their condition deteriorating.

A person had ‘as required’ (PRN) medicine prescribed to manage their risk of low blood sugars. Although the person had experienced low blood sugars they had not been administered their PRN medicine. Some PRN medicines did not have protocols in place to support staff to know when and how to administer these medicines.

Staff were not always following manufacturers guidelines, to ensure medicated patches were not put on the same area too frequently to avoid skin irritation when administrating a person’s pain relief patch.

Medicine administration records did not always contain full information to support safe and effective administration. For example, certain medicines come with warnings such as Paracetamol has a warning to ensure the maximum dose is not exceed, but this information was not always recorded on the MAR chart as required. Other medicines come with specific instructions about how to administer the medicine such as before, after or with food. This information was also not always recorded on the MAR chart.

Medicines had not always been stored at the correct temperatures. This can impact the effectiveness of the medicines.

Although regular audits had been completed, they had not identified the issues we found at this inspection. Following the inspection the provider began to take action to address the medicine’s concerns raised. We will review this at our next inspection.

People and relatives felt medicines were well managed. A person said, “They sort all that out for me.” A relative said, “Medicines there has been no issues.” Another relative felt their loved one’s pain was well managed.