Archived: Oak Lodge Residential 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

At our last inspection the provider's quality monitoring systems were not always effective in recording how people received safe, individualised care. The provider did not always operate a safe system to ensure staff were recruited in line with their recruitment policy. At this inspection, improvements had been made but there remained some areas of risk management requiring further improvement.

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.

Relatives were confident information was shared with them when their family members were involved in any accidents or incidents and any staff learning was taken from these. People and relatives felt they were involved in decisions relating to potential changes in people’s support to help prevent accidents or incidents from happening again. One person told us, “[Senior staff member] talks me through things and explains.”

Staff told us any learning from incidents was shared. One staff member told us how moving the medicine trollies (when administering medication) into the dining room had reduced the potential for distractions and errors because it was a quieter environment. Another staff member told us, “We give extra support for people after falls, so staff accompany them (when they move around the home).” This demonstrated learning was used to reduce the risk of recurrence.

The registered manager said, “Reflection and learning outcomes are shared with staff.” They told us there were regular staff meetings and they also produced a weekly report of any areas of learning they needed to discuss with staff.
 

The provider had systems and processes to help share any learning from accidents and incidents with staff. However, these were not fully effective as the registered manager and provider oversight had not always identified trends and patterns. For example, those associated with emerging risk such as repeated falls.

A relative told us how their family member was supported to settle into the home. They told us they were kept informed if there was a need for their family member to attend medical appointments so they could support this process. They said, “They always keep me up to speed with how [family member] is doing. We discuss their needs.”

Staff told us they contacted emergency services when required. One staff member said, “All staff members who find an emergency are told to call 999 and put it (record) in a remote health monitoring tool.” Staff knew information needed to be provided to other health and social care professionals if people temporarily left the home. This included information on people’s care needs and medicines. Staff told us they re-checked key information about people’s needs when they transferred from other services into the home. One staff member told us, “We will have special handovers and look at hospital discharge [notes], and any calls between us and the hospital. It is important to communicate things.”

Partners had no specific feedback on this area.

Electronic care plans were used by staff and a ‘hospital pack’ printed with information from care plans should the person be admitted to hospital. This was so key information about the persons health and support needs could be shared with other healthcare professionals. However, some of the information shared from care plans was limited in detail. People were supported to have regular contact with a visiting GP to ensure their healthcare needs were reviewed and met.

People felt safe living at the home. Comments included, “I feel safe, I know they can look after me well. The staff are nice and helpful, never nasty ever,” and “I’m very safe here, I’m looked after. They definitely know what they are doing, if I had a problem I would talk to [senior care staff member]. A relative said, “I have no concerns about [Family member’s] safety here.”

Staff told us how they would recognise symptoms of abuse and said they had received training on how to safeguard people. Staff explained what internal processes they would follow should they have any concerns about people, such as any unexplained bruising). One staff member said, “I have not seen anything like this here, but I am confident [senior care staff member] would do something about it, and [registered manager] would also protect people.” Some staff did not know which external organisations could also provide support to protect people which meant there was a risk procedures may not be followed to keep people safe. This was shared with the registered manager to ensure this was addressed.

Staff said they were kept informed of any safeguarding incidents at the home and we saw records of reflective learning following incidents to help prevent them from happening again. Staff had completed Mental Capacity Act (MCA) training and knew about Deprivation of Liberty Safeguards (DoLS). One staff member told us, “I would not judge anyone, but most have dementia…. They have capacity unless proven not.”

The management team understood their responsibility to report any concerns to the Local Authority and to the Care Quality Commission. The registered manager told us, “Staff are trained in safeguarding, and this is refreshed every year. We discuss safeguarding at staff meetings, and we repeat this. We have a form at the front (entrance area) with all of the telephone numbers.”
 

During our visit we saw friendly interactions between people and staff although these were mostly task focused as staff had limited time to sit and chat with people. However, people were not rushed and received their care and support in a safe way. Staff provided encouragement when people’s anxiety levels were raised to help them feel comfortable such as when they were being assisted to move.

The provider had procedures in place to help keep people safe, but some staff were not fully aware of these, for example, how to raise safeguarding concerns externally. Staff had not always completed detailed records in accordance with procedures when potential concerns were identified. Guidance for staff on safeguarding included posters of the safeguarding procedure which were displayed in the entrance area of the home. Staff were provided with training to help them recognise abuse. Applications to apply for Deprivation of Liberty Safeguards (DoLS) had been completed where appropriate.

Discussions regarding safeguarding were included on staff meeting agendas to help ensure any updates or changes in practice required were communicated to staff.
 

People and their families gave mixed feedback about their level of involvement in the management of risks. Comments included, “They told me about [Family member’s] infection also about when they have falls ….they called paramedics, [Family member] was ok,” “I take tablets for [health condition], I don’t recall them discussing it with me,” and “They discuss my care every day, I’m very informed.”

A hoist was available to support people to move safely, however we were unable to confirm 1 person using this had been assessed by a health professional to confirm the equipment should be used, and how, to ensure the person was supported safely.
 

Staff had an understanding of people’s individual risks, however, staff confirmed a risk assessment had not been completed for 1 person who used the main kitchen to ensure they were always safe. A risk assessment was completed following our visit.

Staff gave examples of risks people experienced, such as falls. One staff member told us some people, “Have slips out of chairs, experience loss of control (when walking)… some we have to assist to mobilise.” Staff explained risk reduction methods they used which included the use of sensor mats to alert them when people moved.
 

We observed staff did not consistently provided appropriate person-centred support to manage risks. Where people needed support with eating, to manage risks associated with nutrition, this was not always person centred such as on a one-to-one basis to support their wellbeing. However, we saw some good practice too. We saw staff noticed when a person had moved into an uncomfortable position in their chair in the dining room. A staff member immediately sought help for the person to prevent the risk of them falling.

We saw some areas of the home had tight turning circles when assisting people in wheelchairs. Staff were mindful of this and made sure people’s feet/legs were safely positioned before completing moves.
 

Processes were in place to help support good risk management. Procedures were in place for the monthly review of people’s emergency evacuation plans, and this was seen to be completed. Care plans and risk assessments contained information to show people were involved in sharing information about themselves to help manage risks associated with their care.

Some people who mobilised independently had experienced unwitnessed falls when moving around the home. Some had fallen near the steps between the communal areas and it was not clear from records if the steps were the cause of these. A ramp was available between the lounge and toilet and staff knew some people would need assistance to use this. Staff were aware of the potential for people to come to harm and took their time to ensure people were supported safely. There were no restrictions in place such as locks or door codes that people would need to use to enter areas of the home.

Staff recognised the challenges linked to the environment but told us they ensured people were supported safely. One staff member told us, “I think the premises are alright, and the lift helps.” Another staff member said, “It’s a bit of a struggle but we manage. We squeeze in there” (when using the hoist and wheelchair to access the downstairs toilet).

The provider had systems to ensure the environment was safe and equipment was serviced. This included a monthly check of window restrictors and weekly checks to ensure fire doors closed correctly. The provider told us a fire officer had visited the home and confirmed they were satisfied the required fire safety actions from a previous fire risk assessment had been completed.

People’s bedrooms were clean and personalised. However, some environmental risks had not been identified to support a safe environment. For example, a drawer in 1 person’s bedroom was broken and a glass top table in a communal area had a leg missing making it unsafe. The table was removed following our visit.

The provider had systems and process to monitor the health and safety of the environment, however these were not fully effective as they had not identified issues we had found. For example, records to show firefighting equipment had been regularly checked had not been completed consistently. A fire contingency plan informed staff of the actions they needed to take if it was unsafe to return to the home. However, the plan did not provide staff with all the contact telephone numbers they may need.

Some of the providers processes for managing the safety of the environment and fire risks were working effectively. For example, external fire contractors undertook fire alarm system checks, and weekly fire alarm tests and emergency lighting tests had been completed. Fire evacuation drills were conducted annually. A grab pack for staff was available containing items that may be needed in the event of an emergency such as a torch, foil blankets, and high visibility vests.
 

People provided mixed feedback about staffing levels. People told us they were supported by enough staff and were never rushed. Comments included, “There is always plenty of staff and I know where to find them,” and “I never feel I’m rushed, they are very patient. I get all the support I need always.” However, 1 person told us, “There are only two people (staff) on at night, it’s not enough.” The person explained this resulted in them having to wait over the due time for their medicines. People experienced very little social engagement or activities. One person told us, “I sit here most of the time, I could go to my room if I wanted, I think, but I don’t want to.” A second person said, “I just sit here every day, I don’t do much.”

There appeared to be enough staff on duty on the day of our inspection visits to provide basic care. Staff were visible walking through communal areas and acknowledged people.
 

Staff provided mixed feedback about the staffing arrangements at the home. One staff member told us there were not enough staff in the afternoon and this impacted on social activities being provided and people’s wellbeing. Another staff member said, “I think we should have more staff on in the afternoon. It’s not a safety issue, it is just because of the double ups (referring to tasks requiring 2 staff to support people) which take time.”

Staff told us the use of temporary staff was minimal and stated senior care staff supported care staff when needed. Staff explained they were not allowed to work with people until appropriate employment checks had been received and they had completed an induction programme. One staff member said this included familiarisation with the layout of the home, people’s needs, and safeguarding.
 

We saw staff were mostly available to support people who spent their time in the communal lounges. There were occasions when the lounge was left unattended for short periods of time. Constant staff supervision in these areas was important to keep people safe due to some people having dementia and potential environment risks.

The provider’s procedure to ensure safe staff recruitment was not always followed. For example, records were not always sufficiently detailed to show employment history gaps had been explored, and staff’s employment date recorded.

Duty rotas indicated how many staff worked each day, but information was not always sufficiently clear to show how many hours were allocated specifically to care and to ancillary tasks. This meant it was difficult to determine if there were sufficient hours allocated consistently. Duty rotas did not show the hours worked by the registered manager, to evidence consistent management support was provided to the home.
 

People and their family members felt that the home was maintained in a clean condition. One person said, “They clean my room every day, never miss. I come back from the lounge, and it’s all done.”

People told us staff wore personal protective equipment (PPE) when supporting them to help maintain good infection prevention and control. A relative told us, “I see them wearing gloves and aprons when they are looking after [Family member].”
 

Staff told us they were observed by management staff to make sure they followed safe infection, prevention and control practice. One staff member said, “We always have enough PPE (personal protective equipment).” Staff were aware of how to identify potential signs of infection. They knew the importance of seeking health professional advice to ensure any infections were managed promptly and safely.

Risks related to the management of infection, prevention and control were not always managed in line with the providers policy and procedure and good practice. For example, fabric towels and flannels had been left in the wet room. This increased the potential for cross infection as these items could be used by other people.

PPE was seen stored on top of a toilet cistern where cross contamination could occur. The registered manager assured us this would be addressed.
 

Processes to ensure infection, prevention and control was managed safely were not fully effective as completed audits had not identified the issues we had found.

Staff had guidance on infection prevention measures and had access to an infection prevention, and control policy. Hand hygiene posters were displayed in key areas of the home to support staff.
 

People provided mixed feedback about support with medicines. One person told us that sometimes, particularly at night, their medicines were delayed. They said, “Sometimes I have to wait over an hour for my medication when they (staff) are busy.” They went on to say this was because there were, “Only 2 staff on at night.”

People told us they received their medicines including pain relief medication. A relative told us, “They update me with [Family member’s] medication changes, and they contact me if their health changes, and if the doctor comes in. They also inform me of any hospital appointments.”
 

Staff who administered medicines had completed the necessary training and had their competency assessed to ensure they were able to administer medicines safely. Staff had a good understanding of the medicines people needed to remain well and were aware of risks associated with some medicines. One staff member explained how a liquid form medicine was requested and made available for 1 person to help them take their medicine safely.

Staff told us they stayed with people until they were assured people had taken their medicine. We saw this happened. Staff were informed of changes in people’s medicines during handover meetings at the beginning of their shift. One staff member said, “You check the MARs (medicine administration records) to see if there have been any changes, such as the time (to administer).” Staff had an awareness of the guidance around safe administration of medicines.

Staff recognised some people needed support with their communication to consent to medicines prescribed “as required”. One staff member said “You see the person’s presentation, you notice, you offer medicine, you listen, and you go back later to check if they are in pain. Having protocols helps you to know of you can administer (medicines).”

Staff knew what action to take in the event of a medicine error. One staff member said, “They [management staff] support you, they know you are anxious to get it right.” They went on to explain a supportive approach of retraining and checking of competencies.

The registered manager completed weekly checks of medicines to ensure they were managed safely. These checks included the correct recording of medicines issued, and stock checks.

The provider had policies and procedures to ensure medicines were ordered stored and administered safely. However, some aspects of these were not always followed, for example, all healthcare professionals had not been involved in a decision to administer medicines covertly (medicine disguised in food).

Systems were in place to securely store and dispose of people’s medicines safely. This included a medicines fridge for medicines that needed cool storage. Staff recorded the medicines they had administered to people on medicine administration records. Staff used an electronic system to set alarms for time specific medicines to ensure these were given as prescribed.