Archived: Oak Lodge Residential Home

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

At the last inspection there was limited information about people's capacity to make specific decisions about different aspects of their care to demonstrate people always received effective care. At this inspection people’s needs were assessed and planned for. People’s capacity to consent had been assessed or was in the process of being assessed. People had some involvement in planning their care and support. Staff worked with healthcare professionals to monitor people’s health and wellbeing.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People had been involved in planning their care when they started to use the service where this was possible. Relatives told us they were involved in the care and support of their family member and were kept informed of any changes or concerns regarding their family member’s wellbeing. One relative told us, “They always tell me if [Family member] is unwell.”

Some people could not recall seeing their care plan or being involved in the reviews of their care. One commented, “I don’t remember a care plan, we’ve never had a chat about my care, probably no need.” Despite this, people told us they were happy with their care and discussed their health with staff. One person said, “There’s nothing that I’m not happy about.”
 

Staff told us they used recognised clinical tools to monitor people’s health and help them assess people’s needs, this included weight and skin check charts. Staff were knowledgeable about using these tools and how to identify potential concerns. One staff member said if they had any concerns, they would raise them with the GP who visited every week.

The registered manager said when people were referred to them, they were provided with information about people’s needs from health and social care professionals. This information included details of any equipment people may need and this was supplied for them. The registered manager told us, “We will say if we can’t meet people’s needs. We have to consider their mobility.” They went on to say those people at risk of falling were located downstairs. There was a hoist available on both floors for use as needed.

The registered manager told us, “We do the care plans and risk assessment on entry (to the home). We will also need to consider their needs if they change. We will do referrals to GPs and falls teams. We are very aware of who we can take.”

The registered manager advised us, “Families will come and see if the home is suitable and give us people’s histories, so we can create a “This is me” document. We will also involve people and get them to sign care plans, if they have capacity.”
 

People’s care plans included information on how the person wished to be supported. People had access to regular checks with health professionals to help maintain their health. Risk assessments were in place where the person had an identified area of risk. These included some control measures to help reduce the risk. For example, a ‘positive behaviour management plan’ was in place for 1 person who could become anxious. This was to help identify the potential reason for behaviours so the person could be supported to reduce them. The registered manager had reviewed the risk assessments regularly.

Staff used an electronic recording system to complete care records which alerted them to potential risks and prompted them to undertake specific checks of people to make sure they were safe and well.

People felt they received good care and support but there was limited evidence of personalised dementia care based on best practice standards. There were limited opportunities for people to engage in activities that were of interest to them.

People spoke positively about the food and drinks they received. One person said, “The food is beautiful, they give a choice.” A relative told us, “They offer a good variety of drinks.” We noted during lunchtime staff did not always remind people what they were serving to confirm this was what they had chosen. This was particularly important for those with dementia who may not recognise their meals. Meals provided contained meat already cut up not enabling people to independently choose to do this for themselves. Some people required assistance to eat, and 1 staff member alternated between supporting 3 people at the same time putting food on their fork and giving the person the fork to eat. Supporting 3 people at once was not dignified or good practice.

Care staff recognised if people did not eat their food, they may want something different and did offer them alternatives.
 

Staff were knowledgeable of some best practice initiatives they were involved in including a remote health monitoring tool. This can help in supporting people’s healthcare needs. Staff told us they completed ongoing training to ensure the care they provided was effective and based on good practice standards.

Staff with responsibilities for supporting people with medicines knew about the National Institute for Health and Care Excellence (NICE) guidelines and told us they accessed GP’s and pharmacists for additional guidance.

The registered manager kept up to date with best practice guidance through reading, working with Local Authority commissioners, and being alerted to legislative changes through updates to policies and procedures.
 

Policies and procedures provided staff with the guidance they needed to help them provide safe care to people.

Systems were in place to monitor people’s food and fluid intake. However, fluid records for 1 person were conflicting as 1 showed they had received minimal fluids, and another showed they had received sufficient fluids. We found the electronic records were not always being completed accurately. This meant it was difficult to confirm people were having sufficient to drink consistently.

Training records showed staff completed regular training to update their skills and knowledge.

A red bag system was used to support a safe and effective transfer of people to hospital. The bag went with the person when they left the home and included the person’s care records to ensure their care continued to be supported safely following the transfer.

People received the support they needed to manage their health conditions and were able to access health professionals when needed. One person said, “The carers do things very well, I’ve no complaints. ”A relative told us, “They work very well in supporting her and work very well with her [health condition] and care, never any issues.”

Staff were positive about their working relationships both internally and externally. One staff member said, “The staff team here is good, we all understand each other and teamwork makes the day better for us and people.” Staff shared examples of how they worked with other health and social care professionals to support people’s health. This included GPs, to ensure people had their care needs reviewed when needed. One staff member told us how they had accessed the speech and language service for 1 person who they felt needed support.

The registered manager told us, “The GP comes in every week. We have a very good relationship with the GP. I feel we have a lot of input. The chiropodist comes in every 6 weeks, the district nurses and optician come in on an ad-hoc basis. The optician comes in yearly, too. We were also used for an oral health pilot, everyone has an assessment and has a care plan for oral health.”
 

No concerns were raised by partners regarding how the service worked with them.

The provider had processes to support the management and staff team to work effectively with their colleagues and external health and social care providers.

During our visit people were observed sitting in communal areas of the home with the television on. There was limited engagement or activities of interest to support people’s wellbeing. Whilst some people appeared content with this, others were not. One person said, “We don’t do any games or anything, it would be nice to do something. I’ve never gone out, I’d like to, but I am not really very independent.” A relative told us they had seen their family member playing a game with staff they had not played before which they had enjoyed.

The registered manager monitored people’s weight to ensure their nutritional needs were met. Where people experienced weight loss, staff told us people were provided with dietary supplements. The registered manager told us, “We get the GP involved, to establish what is wrong and what is right for the person.”

Despite people’s feedback, the registered manager said they supported people’s well-being through daily activities in the afternoon such as knitting and drawing. There were also 2 weekly visits from an outside provider to do gentle exercises with people.
 

Care plans contained information about people’s healthcare needs and preferences. However, some information linked to people’s health and welfare was not sufficiently clear to ensure potential risks were identified and managed. This included monitoring of specific behaviours.

People felt staff knew about their needs including the medicines required to maintain their health. One person said, “I think they (staff) are all well trained, I have good feelings about them.”

People had shared preferences regarding their care, but it was not clear these were regularly checked to ensure people’s wishes remained the same. For example, 1 person told us, “I have a body wash, they help me. I haven’t had a shower for ages, I wouldn’t mind one.”
 

Staff and leaders were able to explain how they supported people in their daily lives to maintain their health. The registered manager told us how 1 person’s physical wellbeing had improved since they had been providing their care.

Staff confirmed they accessed health professionals to ensure any treatment people required was provided.
 

Processes supported the monitoring of people’s health and outcomes, but these were not always consistently followed. People had care plans detailing their needs and how to manage risks associated with their care. Care plans contained guidance to staff on how to monitor people’s specific healthcare needs and what to do if their health deteriorated or changed. Staff used recognised monitoring tools to enable them to identify concerns and act upon them in a timely way. This included tools for monitoring people’s weight.

The registered manager had implemented a range of processes to help monitor people’s care including the implementation of the ‘react to red’ campaign. This educates staff about the risks of the development of pressure ulcers on the skin. This campaign enabled staff to complete training so they could recognise people at risk of developing sore skin and could take steps to prevent pressure ulcers from developing. However, some records had not always been completed to show staff were monitoring people’s skin.
 

People’s mental capacity had been assessed to determine if they were able to make their own choices and decisions. Where people had been assessed as not having capacity to consent, arrangements were in place for people to be supported such as by family members. A relative told us, “Consent is difficult as [Family member] can’t do that, we do that when the home asks us. They are not restricted (in what they can do) but [Family member] can’t make choices.”

People were given daily living choices such as where to sit, what to eat, and what to drink. People did not feel restricted in their experience of living in the home and the care provided. One person told us, “I’ve never been restricted ever.”
 

The registered manager and staff understood their responsibilities around gaining people’s consent to care and treatment. Staff understood people could consent to care provided in both verbal and non-verbal ways. The registered manager said since the last inspection they had received support to help them to better understand their responsibilities under the Mental Capacity Act (MCA). The registered manager told us, “I know more about questions being specific now (in relation to specific decisions being made).” They understood the need to regularly assess people to check people’s ongoing capacity. Referrals had been made to external professionals to enable assessments and support for those people considered unable to consent to their care.

Mental capacity assessments (MCA’s) were completed to assess people’s capacity and determine if they may need support in making decisions which impacted on their health and welfare.

Following MCA’s, Deprivation of Liberty Safeguard (DoLS) applications had been completed (as appropriate) to seek authorisation where it may be necessary to deprive a person of their liberty. The DoLS process ensures people who cannot consent to their care arrangements are protected if those arrangements deprive them of their liberty.

Where authorisations had been granted for a time limited period, the registered manager had a system in place to help them identify when any re-applications may need to be made.