19 & 25 February 2015
During a routine inspection
This inspection took place on 19 February 2015 and was unannounced. We visited again on 25 February 2015 and on this occasion the provider knew we would re-visit on that date. We last inspected Oakdale Lodge in February 2014. At that inspection we found the home was meeting all the regulations that we inspected. Oakdale Lodge provides care for up to 30 older people some of whom have nursing care needs.
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.
Relatives we spoke with expressed their concern following recent reports in the local newspaper regarding the potential sale of the land the home is located on. The speculation had led to a great deal of anxiety for people, relatives, and staff. In response to these concerns senior managers held a meeting a few days prior to our visit to update people on the current situation.
People told us “They felt safe at Oakdale Lodge.” Others said, “It’s the people, the way we all get on together.” Relatives also considered the home to be a very safe place for their family members. One commented, “It’s lovely, and I’ve got no worries”. “The girls are lovely”. “I visit most days.” “They’re marvellous, all of the staff”. “I couldn’t have picked a better home.” Another said, “They have worked wonders and worked very hard, and I am over the moon how settled [my relative] is.”
Staff had a good understanding of how to manage people’s behaviours that challenged the service and had developed interventions and strategies to help them manage such behaviours.
Staff carried out risk assessments where required and people were routinely assessed against a range of potential risks, such as when using risk of falling, choking, and mobility.
Staff we spoke with had a good understanding of safeguarding and the provider’s whistle blowing procedure. They also knew how to report any concerns they had. The provider had a system in place to log and investigate any safeguarding concerns made known to them.
People received personalised care that was responsive to their needs. People had their needs assessed and the assessments had been used to develop person centred care plans. Care plans had been evaluated regularly each month. Where people’s needs had changed action was taken to keep them safe. Relatives and health care professionals we spoke with praised the positive impact this had made to people. A relative told us, “They are doing art and crafts and the staff are amazing.”
There were sufficient numbers of suitable staff to keep people safe and meet their needs. Staff carried out their duties in a thorough and calm way. The registered manager monitored staffing levels to ensure there were sufficient care and support staff available to meet people’s needs. Relatives told us, “I’m sometimes surprised at the number of staff”. “There always seems to be plenty of staff, and “Yes, there is usually enough staff”. Others said “We’ve never felt the staff are not coping.”
We found there were robust recruitment procedures in place. This helped to protect people as checks had been carried out on potential staff before a decision was made to employ them.
Staff told us they felt supported by the provider, by way of training, supervision and appraisal. However records showed some staff had not received an annual appraisal within the last twelve months and at least six supervision sessions in the previous 12 months. This is a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we have told the provider to take at the back of the full version of this report.
Staff were supported to carry out their caring role and received the training they needed. Records confirmed staff training was up to date at the time of our inspection.
Staff followed the requirements of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS). MCA assessments and ‘best interests’ decisions had been made where there were doubts about a person’s capacity to make a specific decision. The registered manager had also made DoLS applications to the local authority where required.
We observed people and staff over the lunch-time period and staff made sure people were safe and had support if they needed it. Staff interaction with people was warm, kind and caring preparing lunch and supporting people in the communal kitchen /dining area. People were provided with meals which they preferred and had requested.
We saw people were supported with their health care needs and prompt referrals were made for medical assistance when needed. Family members told us that staff provided support to their relative to attend health appointments. Another said, “They look after my relative’s needs and keep me informed if there are any concerns.” Another family member said, “I visited the home the other evening and I was told how [my relative] had enjoyed their recent holiday with members of the staff team.” A member of the community nursing team who regularly visited the service told us, “We have no concerns they follow the care plans.”
The home’s complaints procedure was available in different formats. People had no complaints about their care and were confident any issues would be dealt with appropriately. People were encouraged to share their views about the service and these were acted on. For instance, people were able to influence the decoration of the communal areas of the home and had been involved in the decoration of their own bedroom.
There was regular consultation with people and family members via the carer’s forums and their views were used to improve the service. The provider undertook a range of audits to check on the quality of care provided. Information was analysed to look for trends and patterns and to identify learning to improve the quality of the care provided.
The provider undertook regular health and safety checks and these were up to date. This included checks on passenger lifts, electrical appliances, safety checks of people’s bedrooms and fire safety. The home had emergency evacuation plans in place which were reviewed monthly. The staff identified potential areas of risk in respect of people’s care, such as the risk of falls and skin damage, and took steps to reduce the likelihood of people being harmed by such risks occurring.
The service was managed well and the registered manager ensured good quality and consistent care. This was reflected in the comments we received from a number of healthcare professionals who had contact with the service. Relatives of people who used the service were also pleased by the way the service was managed. One relative commented, “Keeps on top of her job.”