Oak Lodge Residential Home

People’s experience of using this service and what we found.

The providers systems and processes required further improvements to ensure records contained all the required information to meet people’s needs. Some people’s care records had missing signatures, as a result there was a lack of recorded evidence to confirm people had viewed their care records.

The provider had safeguarding systems and processes in place to keep people safe. Staff knew about the risks to people and followed the assessments to ensure they met people's needs.

People felt safe and were supported by staff who knew how to protect them from avoidable harm.

People received their medicines safely and as prescribed and were supported by sufficient numbers of staff to ensure that risk of harm was minimised.

Staff had been recruited appropriately and had received relevant training, so they were able to support people with their individual care and support needs.

Staff sought people's consent before providing care and support. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way and in their best interests: the policies and systems in the service supported this practice.

People's individual communication needs were considered to support them to be involved in their care.

Staff spoke positively about working for the provider. They felt well supported and that they could talk to the management team at any time, feeling confident any concerns would be acted on promptly. They felt valued and happy in their role.

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

Rating at last inspection and update

The last rating for the service was inadequate (published on 01 February 2023) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. As a result, we undertook a focused inspection to review the key questions of safe, effective, and well led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Oak Lodge Residential Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Oak Lodge is a residential care home providing personal care to 15 people aged 65 and over at the time of the inspection. Some people were living with dementia. The service can support up to 17 people in one adapted building which is laid out over two floors.

People's experience of using this service and what we found

Risks in relation to the premises were not always identified, assessed or managed. There was a lack of appropriate risk assessments and control measures in place to manage the risk to people posed by hazardous substances stored on the premises.

People did not always receive their prescribed medications and in accordance with their specific guidance. Medicines were always not stored safely. There were a number of issues identified with the management of sharps, a sharp is a device that has sharp points or edges such as needles and syringes.

Some people were receiving regular pain-relieving medication via (skin) transdermal patches. There were no charts in place to record the site of application of these transdermal patches or to confirm the removal of their previous patches.

Care records were not always completed accurately or clearly to demonstrate safe practice and enable effective monitoring to take place. We found numerous unexplained gaps in some peoples’ repositioning charts.

Care records showed some people who had been identified as lacking capacity did not have decision specific capacity assessments and best interest decisions recorded for having bedrails fitted.

Governance systems and processes were not effective to monitor risks to people's care and to ensure care records contained relevant information.

Audits and maintenance checks completed by the provider had not identified the issues identified during the inspection such as unsafe equipment, inconsistent care recordings and care records lacking relevant information about people’s health needs.

Systems were in place to protect people from the risk of abuse and harm. People were comfortable, relaxed and happy around care staff and staff understood how to keep people safe. Staff understood who to report concerns to as well as the risks to people's health.

Staff had regular training opportunities and training specific to people's individual needs was provided however improvements were required in relation to neglect and health and safety.

Staff had good knowledge and understood people's health conditions and the support they required.

Staff followed the infection control procedures the provider had in place.

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

Rating at last inspection

The last rating for this service was requires improvement published 21 August 2019

Why we inspected

The inspection was prompted in part due to concerns received about care delivery. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well Led.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe and care treatment, premises and equipment, the need for consent and governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Oak Lodge is a residential care home providing personal care to 15 people aged 65 and over at the time of the inspection. Some people were living with dementia. The service can support up to 17 people in one adapted building which is laid out over two floors.

People’s experience of using this service and what we found

Some progress had been made to address some of the concerns found at the last inspection. For example, staff recruitment procedures had become safer, a range of audits and checks had been introduced to monitor the service and a new deputy manager had been recruited to strengthen the management team. However, improvements were still required in a number of areas to improve the quality of the service.

Work had taken place to complete and review risk assessments and improve the handling of people’s money. More work was needed to make sure risk assessments were up to date and reflected people’s current needs.

The local authority was supporting the home to improve the infection control processes and told us although progress had been made, further work was needed to complete all of the required actions.

Staff knew how to keep people safe and understood how to report concerns. There were enough staff on duty to meet people’s needs and people received their medication at the right time.

Further improvements were needed to make the environment more suitable, especially for those people living with dementia. Staff received training that was relevant for their role but had not yet completed all training required.

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

People had access to healthcare services when required and told us they enjoyed the food.

People and their relatives were happy with the way care and support was provided. Staff did not always take the opportunity to engage people in conversations or activities during the day.

Staff respected people’s dignity and privacy and encouraged people to be as independent as possible.

Improvements were needed to make sure all information such as notices and policies were given to people in a format they could understand. Staff knew how people preferred to communicate.

People and their relatives were happy with the range of activities on offer and we saw end of life care being delivered with respect and dignity.

Improvements had been made to quality assurance processes, but more time was needed before these were fully implemented. The management team had made some improvements but needed to work more closely in partnership with other agencies to ensure areas for improvement were fully addressed.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 17 May 2019) and there were multiple breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since May 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Follow up

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

Oak Lodge is a ‘care home’. People in care homes receive accommodation and 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. The home is in one adapted building over two floors.

There was a registered manager at the time of the inspection, however we only spoke with them briefly before they had to leave the home.

Rating at last inspection: At the last inspection the service was rated Requires Improvement. The report was published 31 January 2017.

Why we inspected: This was a scheduled inspection based on the previous rating.

People’s experience of using this service:

¿ People were not always protected from abuse because the providers systems and processes to protect them were not in place to identify and respond to abuse.

¿ Potential risks to people had not always been identified in how to reduce the risk of harm.

¿ There were enough staff on duty to keep people safe and meet their needs.

¿ People’s medicines were managed in a safe way.

¿ Infection prevention and control practices were not monitored or reviewed.

¿ People were not supported to have maximum choice and control of their lives and staff did not work within the principles of the Mental Capacity Act (2005)

¿ Staff sought external healthcare professional’s advice and followed their guidance in how to support people.

¿ Staff spoke to people in a kind and caring way

¿ People’s care was delivered in a timely way, with any changes in care being communicated clearly to the staff team.

¿ People were not supported to go on outings. People with dementia were not provided with activities that stimulated them.

¿ People had access to information about how to raise a complaint. Record keeping of complaints was poor to enable the provider to demonstrate whether any had been received and acted upon in-line with their policy.

¿ The provider did not have quality assurance systems in place, to assess, monitor, mitigate and improve the service.

We found seven breaches of regulation at this inspection, Regulation 9, 11, 12, 13, 17 and 19 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 of the Registration Regulations 2009.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

Enforcement: Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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

This inspection took place on the 25 and 28 November 2016. At our last inspection in July 2015 we rated the provider as ‘requires improvement’. At this inspection we found although some improvements had been made there were still areas in the service where improvements were needed.

Oak Lodge is a residential home which provides accommodation for up to 17 people who require personal care. At the time of our inspection there were 16 people living at the home.

At the time of our inspection there was no registered manager in place. The service had been without a registered manager since October 2015. The provider had recruited a new manager who was present at this inspection. The manager told us they would be applying to the Commission to become the registered manager following our inspection.

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.

People told us they got their medicine’s on time, however medicines were not always stored safely and people’s medicine records did not always contain up to date information about their medicine routine. Systems were in place to ensure risks to people’s health and safety were managed by staff. People told us there was sufficient staff to meet their needs. Safe recruitment practices were operated by the provider.

Staff had received training which meant they were able to meet the needs of the people who lived at Oak Lodge. People’s rights were protected as the principles of the Mental Capacity Act (MCA) had been followed. People ‘s nutritional needs were met. When people’s health needs changed they received support from outside healthcare professionals.

People told us they were supported by kind and considerate staff. We saw staff supported people using friendly language. People were comfortable with staff. Staff gave people choices and respected decisions people made about their care. Staff told us and we saw they supported people to remain independent when they were able. People were supported by staff who respected their privacy and dignity. People were supported to maintain relationships that were important to them.

People told us and we saw they were happy with the care they received whilst living at Oak Lodge. People and their relatives told us they were involved with the planning of their care. People had access to activities. People and their relatives felt comfortable in raising concerns about their care and there was a system in place to record any complaints received. The systems in place to monitor the care people received were not always effective because they did not identify the areas we highlighted during our inspection. People enjoyed living at Oak Lodge and had the opportunity to be involved with the running of the service. Staff told us they were supported by the manager.

People we spoke with told us that they were happy with the support they received and were involved in giving feedback about the service.

One person living at the home told us: "They are all good carers in their own ways. I get on with them all".

Everybody we spoke with said that they were happy to be living there and spoke highly of staff.

We completed a tour of the home. We found that the provider had taken steps to provide care in an environment that was suitably designed and adequately maintained. People we spoke with commented that the home could benefit from being redecorated. The provider told us they would send us a refurbishment plan by 23 August 2013.

Staff told us they were supported to deliver care safely and to an appropriate standard.

We found that the records we looked at were accurate and fit for purpose.