Oak Cottage

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement.

This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of legal regulation in relation to consent arrangements.

This service scored 50 (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 did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health and care needs with them.

Assessments were completed by managers who spoke with people and their relatives to assess the support required. However, the initial assessment did not always trigger further assessment for identified needs. For example, when the initial assessment identified people diagnosed with dementia, kidney function issues, mental health needs or end of life wishes

the care plan did not address these areas which were left unassessed within the care plan.

The provider did not always make sure people’s care and treatment were effective, because they did not always check and discuss people’s health, care and wellbeing. Care plans lacked guidance on individual needs which placed people at risk of receiving unsafe or inappropriate care.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Care delivery did not consistently follow evidence-based standards. For example, people’s care plans and training for those staff to support them did not enable them to understand and plan how to meet those behavioural and psychological symptoms of dementia in a positive and pro-active manner. Good practice recommendations, such as the NICE dementia guidelines were not in use within the service for dementia or other areas where people required enhanced support.

The provider’s systems did not ensure that staff were up to date with national legislation, evidence-based good practice and required standards. Staff champions were in place but not able to share their knowledge meaning people were not told about current good practice that is relevant to their care and were not subsequently involved in how this is reflected in their care plan.

Staff and leaders had not had the opportunity to learn about new and innovative approaches that evidence shows can improve the way their service delivers care. This meant, people experienced inconsistencies in the quality of care they received due to these areas requiring improvement.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff worked well across teams and services to support people, although we have reported that plans did not always reflect people’s needs accurately, this had little impact on how staff engaged with external health professionals. We observed staff worked together cohesively to help deliver people’s day to day support. Daily handover meetings enabled staff to allocate their workload and prioritise any tasks of care related appointments.

We received positive feedback from an external professional who worked closely with the home on a regular basis. They told us, “As a staff team they work hard to make sure the clients get the care they need; they will always pick up the phone or email and when needed get the GP in or a dietician when needed. They are very responsive to our assessments and will provide us with feedback on how things have gone. As a team we work well.” A second professional though commented, "The staff are caring, they will get people referred when they need it, but the care records still do not show what support people need. It would be difficult to look at the care plan and understand how to support them."

The provider did support people to manage their health and wellbeing, but people could not always maximise their independence, choice and control.

People’s health needs were routinely monitored by staff and people had regular visits from GP’s, nursing teams, dentists, opticians and podiatrists. Healthcare professionals were fully involved in supporting people and told us that staff had a good understanding of the health conditions of people living at the service.

However, improvements needed have been noted in this report to demonstrate that information about people’s health conditions were not updated when needs changed or had not been included in care plans. Care plans contained very little information about people’s future goals and maximising their independence. Some people we were told were not long-term placements and would be transitioned back to the community. The care plans did not set out how these goals would be achieved, and those people spoken with were unaware of the timescale or next steps to this transition. Staff continued to require further specific training for these health conditions. Although staff knew people well, the lack of oversight meant some staff may not have the knowledge or guidance needed to provide safe and effective care tailored to people’s individual needs. As a result, there was a risk people could experience avoidable harm, or their health needs might not be met in a timely or appropriate way.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and

consistent, or that they met both clinical expectations and the expectations of people themselves.

Since our previous inspection in November 2024 the provider had made improvements to the nutritional support within the service. The service had recently been recognised at a silver level by the dietician service for meeting peoples nutritional and dietetic needs safely. This was further demonstrated by people’s nutritional needs being managed well.

Systems to monitor the effectiveness of people’s care, treatment and support were not robust, and actions to improve outcomes were not consistently taken. For example, actions to update care records had been ongoing for months. Managers did not consistently monitor outcomes to assess effectiveness or use the findings to improve and further develop the care provided to people. This meant opportunities to implement new innovations for positive changes for people were missed.

The provider did not always tell people about their rights around consent and did not always seek consent for people who lack capacity in accordance with their legal responsibility to do so.

People told us that staff were patient and kind, asked permission to support them and respected their decisions. One person said, “All the staff are very polite and will always ask if I want to get up, have a shower, go downstairs and so on. If I want a lay in or don’t want to do something, then they come back later.” Consent was sought for areas such as sharing information with health care providers and use of photographs. These consent forms were signed by the care manager without reference to the persons wishes or discussion with the appointed person. Those consents were signed when people moved into the service and were not reviewed since.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS)

Staff spoken with were able to tell us how they supported people to make decision who may lack capacity. One staff member said, “When someone cannot decide for themselves [they may lack capacity]. They cannot make those choices like we can. We must only decide, with them and their family what the best thing is to keep them safe.” Staff said if they thought a person may lack capacity, they would raise with the managers but did not know how the process progressed through assessment.

Mental capacity assessments [MCA] had been completed for some, but not all decisions. However, the quality of these were poor and did not provide a clear rationale as to why the person lacked capacity at that time. The MCAs were not revisited to reassess capacity whereby a person at the time of assessment may have been experiencing fluctuating capacity or confusion caused by infection for example.

The best interest decision that follows the MCA is a balanced, objective assessment of what is best for that individual person in their specific circumstances. The best interest decisions we reviewed were not balanced and did not provide an objective assessment. For example, one best interest decision concluded, “Staff to make sure personal care is maintained in the least restrictive way.” This Person was referred to the GP and mental health team for medication assessment, however there were no accompanying strategies staff could use or assessment to understand why the person refused care. The decision was therefore the opinion of the decision maker and did not take a balanced and objective view.

CCTV had been installed in the home in communal areas and no person whether lacking capacity or not had been consulted for their consent to be recorded.

Where staff assessed that people were not safe to leave the building alone, Deprivation of Liberty Safeguard applications were submitted as required to the local authority. Whilst awaiting authorisation, staff had not developed an interim plan to manage that deprivation in the least restrictive manner. For example, by ensuring the deprivation does not remove people’s enjoyment of places and spaces as part of their care away from the home.