Oaklands Care 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.
 

This service scored 59 (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 and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff recorded safety events on the provider’s electronic care planning system. Management reviewed these, and the registered manager completed monthly analysis to identify patterns and trends. We found safety events had been appropriately actioned.

People and relatives told us they felt able to raise concerns about safety and were confident these would be addressed appropriately and promptly. Partner agencies also described the management team as open and transparent.

Where areas for improvement had been identified, information was shared with staff to support learning and drive improvements. The management team were responsive throughout our assessment and demonstrated a willingness to address the improvements identified.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Relatives described the referral and admission process positively. They told us the management team visited people in hospital or where they were living to assess their needs and ensure the service could provide appropriate care and support. One relative told us, “My [family member] liked it immediately, they settled straight away.”

The registered manager told us families and relevant professionals, including the rapid response team, were involved in assessments where appropriate. This helped staff understand people’s needs before they moved into the service. Additional support was provided to people without family involvement. For example, staff collected personal belongings from people’s homes to help make their move as comfortable and reassuring as possible.

Pre-assessment documentation we reviewed was detailed and captured important information, including people’s care and support needs, communication preferences, likes and dislikes. This supported staff to understand people as individuals and plan for a safe and person-centred transition into the service.

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.

Safeguarding concerns were reported, investigated and monitored appropriately. Where required, referrals were made to the local authority and notifications were submitted to the Care Quality Commission (CQC).

People and their relatives consistently told us they felt safe and well cared for. One relative described how, for the first time in years, they felt reassured leaving their family member because they knew they would be well looked after, whether they visited or not.

The registered manager described how they supported staff to remain alert to potential safeguarding concerns and recognise signs of abuse or harm. They told us all safeguarding concerns were investigated, and families were involved where appropriate, supporting an open and transparent approach.

Staff received safeguarding training and had access to the provider’s safeguarding policy. This supported staff to understand their responsibilities and take appropriate action if concerns arose.

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). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found that where people were subject to a deprivation of liberty, the provider had implemented appropriate safeguards and processes.

The provider did not work well with people to understand and manage risks. Staff did not provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risks to people were not always effectively assessed or managed. Where people were known to enter other people’s bedrooms, appropriate measures were not always in place. This increased the risk of people’s privacy and dignity being compromised and their personal belongings being disturbed or misplaced.

Behaviour support plans for people who experienced agitation were not always person-centred or clear about effective de-escalation approaches. This meant staff did not always have sufficient guidance to recognise and respond consistently to people’s distress, which could result in people becoming more anxious or unsettled.

Some care plans lacked important guidance about identified health risks. One person’s catheter care plan did not provide sufficient information about regular changes and cleaning, increasing the risk of inconsistent care and avoidable health complications. Another person required repositioning to protect their skin, but the required frequency was not recorded, increasing the risk of skin deterioration and pressure damage.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

Some environmental risks had not been fully identified or addressed. These included unsecured shelving in a communal area, items stored on top of wardrobes, a tub of fluid thickener on a drinks trolley left unattended in a communal area, and a visible control of substances hazardous to health (COSHH) cupboard access code. When the registered manager was made aware of some of these issues, prompt action was taken to address them and reduce the risk to people. We observed people walking independently in socks, including on a wet floor. Some people were wearing gripped socks, which reduced the risk of falls; however, this did not apply to everyone observed during the assessment. This increased the risk of falls for those who were not wearing appropriate footwear.

However, people told us they thought the home was clean and tidy. We saw that bedrooms and shared areas were cleaned daily. Call bells and sensor mats worked when tested and windows were appropriately restricted. Maintenance checks were regularly completed and any identified issues were reported, prioritised and addressed.

Many bedrooms were personalised and relatives told us they were assisted with personalising them. Efforts had also been made to make the home have a more homely appearance, particularly in corridors. However, some decorative features may have caused confusion for people living with dementia. These included decorative letterboxes which didn’t open, a door at the end of a corridor made to look like a garden path and mirrored writing outside one bedroom. This meant the environment did not always support people living with dementia to orientate themselves and move around the home safely and independently.

Although the provider had systems in place to maintain the environment and respond to maintenance concerns, risks were not always identified promptly, and action was not always taken to ensure people were consistently protected from avoidable harm. Following our assessment, the provider had taken steps to address some of the concerns we raised.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

Staff responded promptly when call bells and sensor mats activated. However, staffing arrangements were not always effective in ensuring people were consistently supervised and supported. There were periods when no staff were present in communal lounges despite several people being seated there, and some people were unable to request support independently. This meant people may not always have received timely support and their safety and wellbeing may have been compromised during those periods.

Staff were safely recruited. We found some gaps in employment history within some staff files but the management team told us these issues had already been identified, and a wider review of recruitment records was underway.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

Out-of-date masks remained in storage available for use, increasing the risk of infection exposure if they were to be used. Shared slings were not stored in a way that clearly identified whether they were clean or awaiting laundering. As these were shared, this created a risk of cross contamination. We found unfinished radiator covers and handrails which may make effective cleaning more difficult, leaving behind dirt and bacteria and making dirt less visible. Several food items, ingredients and condiments did not have opening or stock dates recorded, and staff were unclear about cleaning schedules for some food storage containers. This increasing the risk of cross contamination.

An exposed section of a bathroom call cord and damaged bathroom furniture also presented potential infection control concerns. This meant infection risks were not always effectively identified and managed. The damaged bathroom furniture was removed during our assessment. As this is a nursing home for people living with complex dementia care needs, they relied on staff and the environment to reduce these risks, and some of the concerns identified increased the potential for infection to spread.

However, the home overall was clean and staff described structured laundry processes which supported infection prevention and control.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

People’s medicines were managed safely and in line with their individual needs and preferences. Staff recorded the use of topical creams and ointments on electronic medicines administration records (eMAR), with body maps showing where these should be applied. Guidance was available to help staff administer medicines in the way people preferred.

Clear person-specific guidance was available for medicines prescribed ‘as required’ (PRN), including variable doses, with the actual dose administered recorded. Thickeners used for people with swallowing difficulties were also recorded when used.

Where people received medicines covertly, disguised in food or drink, appropriate assessments and documentation were in place to support safe administration. Controlled drugs were managed appropriately, with regular balance checks completed by staff.

The provider had systems for recording medicines-related incidents and errors. Managers and staff responsible for medicines also completed regular audits to check procedures were being followed.