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Archived: The Oaks Nursing Home

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Inspection report

Date of Inspection: 30 April 2012
Date of Publication: 25 July 2012
Inspection Report published 25 July 2012 PDF

People should be treated with respect, involved in discussions about their care and treatment and able to influence how the service is run (outcome 1)

Not met this standard

We checked that people who use this service

  • Understand the care, treatment and support choices available to them.
  • Can express their views, so far as they are able to do so, and are involved in making decisions about their care, treatment and support.
  • Have their privacy, dignity and independence respected.
  • Have their views and experiences taken into account in the way the service is provided and delivered.

How this check was done

Our judgement

The provider was not meeting this Regulation.

People's independence was promoted but their dignity was not respected by all staff members.

User experience

Most of the people who live at The Oaks Nursing Home would find it difficult to help us understand their views about the quality of the care being provided to them. We used a special tool designed to help us understand how people who have Dementia experience the care being provided to support them. We observed five people who live at the service in one of the lounges over two hours starting at 11.55am. We looked at how staff interacted with people and how care was being provided to support people with their needs. We looked for clear and observable signs which would show us how people felt about the care they were receiving.

We found mixed evidence in this outcome area.

We observed that the senior carer was consistently kind, caring and attentive to people living at the service. This staff member showed consideration for people and their feelings and managed difficult situations easily.

We saw that people were provided with specialist equipment to assist them to eat independently which meant they could maintain their skills and abilities.

We also saw that with the exception of one person, all of the staff assisted people to eat at a good pace, making sure they had finished the food in their mouth before offering more to them.

We saw a qualified member of staff was hurrying the person being assisted, putting more food in their mouth whilst they were still finishing off the last mouthful. This was not only undignified but created a risk of the person choking on their food. This person was flinching as this member of staff came near them with the spoon, we did not see the person respond like this to any other staff member who assisted them. We were concerned this may indicate that they were intimidated by the member of staff. We passed on these concerns to the providers for them to take action.

We were concerned about how this member of staff responded to people living at the service more generally. When the staff member was assisting a person to eat they were looking around the dining area, talking to other staff and shouting directions to staff across a communal area. This showed the member of staff was not concentrating on the person they were assisting. We saw this member of staff instruct another who was assisting a person to eat to, "come and take over from me." This meant the staff member had to leave one person part way through their meal to go and assist another. The person then had to wait for a further 10 minutes for someone to carry on assisting them to eat. This was a considerable interruption to the dining experience of that person.

We observed that most of the staff started out communicating well with people they were assisting to eat though they soon lapsed into silence. This meant staff were not communicating effectively with people. We also saw three staff talk about staffing arrangements and lounge cover in the middle of a communal area where people were sitting. This did not help create a homely atmosphere and showed staff were still following an old practice we had been told had stopped.

Other evidence

The local authority and primary care trust visited the service again in April and told us that some staff were still not interacting effectively with people living at the service. They told us they observed that care staff did not communicate well when they were assisting people in the hoist. We did not find that this was the case with the people we observed, but this did suggest staff may be inconsistent in how they delivered this aspect of care.

The local authority told us they were particularly concerned about the interaction with and quality of care for the people with higher dependency needs. We observed that four of the five people we observed slept for the majority of the time, and apart from being assisted to eat, had minimal interactions with the staff. The interactions we did see were kind and genuine, but our evidence did support the observations of the local authority and primary care trust staff.

We had minor concerns in this outcome area following our last inspection of the service on 21 March 2012. The providers told us they would take action to address the areas of concern by providing supervisions and a yearly appraisal for all nursing staff. We saw evidence during our last inspection that staff had received training on dignity issues and they confirmed this to us in interview.

We asked staff about the approach of the nurse we had observed. They felt the staff member could be "loud." A senior staff member told us that care staff went to them for advice, but another said they still looked to the nurse for direction. This was concerning as the attitude and behaviour of the nurse we saw were not appropriate and care staff may believe that this is how they should respond to people in their care.