Archived: Oak Lodge Residential Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

At our last inspection the provider’s systems and audits had failed to identify risks and shortfalls in the quality monitoring of the service. At this inspection, whilst some improvements had been made, the provider's oversight and monitoring systems continued to need improvement. The service did not have a consistent quality assurance system to gain people’s views to support continuous service improvements. Whilst staff spoke of an inclusive and supportive working environment which motivated them to carry out their role, we found the provider’s processes were not always followed by staff and were not fully effective to ensure areas of risk were always identified and improvements made. This was a continued breach of Good governance.

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.

Staff described a common goal to provide good care for people. One staff member said, “[Management] encourage us, we have meetings and supervisions, they offer us training. It’s not just about the pay. If I go on holiday, I miss the residents (people) so much, I would be glad to come off holiday early. We do what we can do to make their days better. You feel good if you have helped someone. You can give them the best.”

The registered manager gave examples of how they worked with people to address communication barriers to assist in ensuring equity of access. For example, for people whose first language was not English, alternative forms of communication were used. The registered manager said, “We use translation word lists, picture cards and booklets for this.” This enabled people to be involved in their care and life at the home.
 

Processes to ensure people were provided with activities of interest to them were not effective. People told us they had limited opportunities to participate in meaningful activities they enjoyed. The provider’s “Events and Occasions” records had not been kept up to date to show people spent their time doing activities which they found stimulating and of interest.

Staff demonstrated a good understanding of the Whistleblowing policies and their responsibilities to raise any concerns immediately to keep people safe from harm.
Systems in place informed people how to raise complaints about their care and how any complaints received were managed.

Staff received support, guidance, and training relevant to their roles. Competency checks were completed to ensure they followed best practice guidance.

Staff told us they were encouraged to make suggestions for improvement. One staff member said, “[Management] ask us, and let us air our views. We suggested changing the shift pattern at the weekend and we now do more, so people are less anxious.” Staff told us they found the management team approachable. One staff member said, “You always get ‘thank you’s.” A second staff member said, “[Management] want to improve the quality of people’s lives and want them always safe and healthy, I have seen it in interactions between people and they also check with staff, too.” Staff said the registered manager worked 3 days and was on-call on other days. One staff member said, “I can call her anytime. You can clarify things with her.”

The provider was clearly committed to ensuring staff worked to their expected values to support a quality led service. The registered manager held regular meetings with staff to help drive improvement of the service. Where areas of improvement were needed, these were planned with senior staff to support the changes. However, there were some shortfalls in governance and oversight processes to demonstrate the service always ran effectively. It was not always clear quality outcomes for people were based on best practice.

Staff described working in an environment where they were encouraged to raise any concerns they may have. One staff member told us, “You can always talk with [registered manager]. I do know how to whistleblow but have not had to use this.”
Staff worked together as a team which included the registered manager and felt able to freely share their views about the quality of the service.
 

Staff told us they felt able to escalate concerns to the leadership team. Meetings took place with the staff team where they had opportunities to discuss issues relating to the operation of the care home. Notes of meetings showed action points and any staff learning required.

Relatives and people gave mixed feedback regarding opportunities to share their views of the service. One person said monthly resident meetings took place, but others could not recall them or opportunities to complete satisfaction surveys. The management team were open and receptive to our feedback and suggestions made during the inspection.

Staff told us there was a culture of inclusion. One staff member said, “I do feel all would be welcome.” Another staff member told us how their language skills had been recognised to help support a person living at the home to be able to communicate in their first language.

The provider told us, “All staff are treated the same and we have a workforce which is inclusive of all races and colour and religious belief. At Siloam Healthcare we have staff from a varied background and of varying beliefs that are all respected and valued. They all bring in different experiences and cultures that some have been very helpful in meeting our service user’s needs.” New care staff worked alongside existing staff to help support them in working to the providers policies and procedures.
 

Policies and procedures were available to staff to support workforce equality, inclusion and diversity. This included a recruitment policy which followed basic recruitment criteria. However, improvements were needed to staff recruitment practices. The provider had a set of values for staff to follow to help support inclusive care. These included, “Resident first, kind, respect, and accountable.” Staff were reminded of these values during staff meetings. Management checks of staff working practice helped to ensure they worked in accordance with the provider’s expectations, however, these checks had not identified issues we had found.

Staff said the registered manager was supportive and often talked with people and staff to check all was well at the home. Staff were positive about the level of information they had to provide good care. One staff member said, “The information technology helps, you get key information about people. It gives you confidence you are doing the right care when their needs change.” However, we found staff did not always have the level of information they needed to care for people safely and appropriately. Staff told us management checked on their practice, including hand hygiene, and medication management. Staff told us they received instant feedback, however this was not recorded to show any actions needed and if this process was effective. One staff member said, “I don’t have any formal spot checks, but I feel [registered manager] sees everything, and they are good at giving feedback.” The registered manager told us they did not visit the home to do spot checks on staff practice at night.

The registered manager told us, “There have been improvements in the care plans. We review these monthly and on changes (of peoples needs).”
 

The provider’s oversight and systems to monitor the quality and safety of the service and to support continuous improvements were not always effective. This placed people at risk. The provider had not ensured staff were recruited safely in line with their recruitment policy. For example, it was not clear gaps in employment for a staff member had been explored or that required Disclosure and Barring Service (DBS) checks had been completed before some staff started work at the home. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

Recent checks of people’s care plans had failed to identify the issues we found. This included the omission of body maps to record any skin markings or bruises, discrepancies in fluid monitoring records for a person on restricted fluids and omissions on accident records to ensure the right actions were implemented to keep people safe.

The registered manager/provider’s oversight of accidents and incidents had not always identified trends or patterns such as those associated with falls so that emerging risks could be managed. Also, records completed in response to risks, were not always sufficiently detailed. This meant the provider could not be assured new risks were effectively managed and enable learning from them to be shared.

The providers service development plan had not been updated since 2020. Systems to review premises security and risks had not identified the environmental risks we had found. This included a rippled carpet that a person could trip over, a chipped mirror and broken drawers with the potential for injury.

A fire contingency plan for the safe evacuation of people from the home did not consider all potential risks or identify an accessible safe environment for people to move to in the event of a required evacuation. For example, the venue identified for people to move to if it was not safe to return to their home was not open 24 hours a day.

Monthly checks of catering and cleaning were effective. Staff received positive feedback where this had been effectively maintained. Grounds and an exterior risk assessment were undertaken annually.
 

People’s specific needs were assessed prior to them living at the home to help ensure their needs could be met. People were supported to see health professionals when needed. There were limited opportunities for people to engage in activities of interest to them from external providers or within the community. People told us, “The atmosphere is very quiet not much goes on. I don’t think much about what I do or don’t do, I just get up in the morning,” and “I’d like to do more and maybe for staff to spend some time with me.”

It was not evident the service had worked in partnership with external providers to share good practice around dementia care to help support person centered care and ensure their needs were met effectively. One person told us, “They have a routine in looking after me, it’s always the same I think.”
 

The management team gave examples of how they involved people’s families in key decisions about the care provided. This included end of life planning. The registered manager gave us an example of a recent compliment received. This had led to sponsorship of some garden furniture for people to enjoy. The registered manager told us the service had worked with local religious groups, so people would have their spiritual needs met.

Local Authority commissioning visited the home to provide support and enable improvements to the service. An action plan had been devised to help support the service in addressing improvements. There had been some improvements made, and some were in progress.

The provider had developed some external relationships to support improvement linked to people's ongoing health and social care needs. For example staff worked inpartnership with health professionals to support people's ongoing health needs.

A new staff member stated they had completed induction training and had shadowed regular staff so they could support people safely. Other staff told us they completed regular training related to their role and were supported by management staff if they had any queries.

The registered manager told us they shared any concerns they received with staff so they could learn from them. One staff member told us, “If there are complaints or compliments, [management] do tell us, and the registered manager always welcomes ideas.”
 

Training records confirmed staff completed ongoing training to support them in their role and ensure a consistent approach to care and support. Staff meetings reinforced learning, and staff were able to discuss areas for their future development. Handover records were used as a communication record between staff and detailed any actions needed by staff to drive improvement. However, it was not always clear identified actions were taken. For example, the completion of records to show the monitoring of unexplained bruising.

Since the last inspection, the provider had implemented an electronic recording system to help improve care planning and recording of care provided. The registered manager was able to use this system to identify potential risks and actions needed to address them. Sometimes care records were not fully clear to help identify risks and areas for potential improvement.

The provider had regular meetings with the Local Authority commissioners to help support improvements of the service.