Oak House

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 – 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.

This service scored 58 (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, care, wellbeing and communication needs with them.

Whilst people had their needs assessed before moving to the service, we identified some areas where the provider had not ensured people’s needs were fully assessed and recorded after they had moved in. One person had moved into the service 1 week prior to our assessment visit. There was no care plan in place for the person. The provider told us this was because the person did not wish to engage in the care planning process. The registered manager told us they were awaiting information from the person’s relative.

Whilst the person did not wish to engage in their care planning, there is still a requirement for the provider to identify and mitigate risk. Whilst some assessments had been completed for this person, they were not all accurate, for example in relation to a falls score. A risk assessment around catheter care had not been completed to reduce the associated risks.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

We saw evidence the diverse range of people’s needs had been assessed, including their communication needs, and documented in a person-centred way. Records showed the service had a good liaison with professionals such as occupational therapists and speech and language therapists which ensured good outcomes for people. Clear health visit records were maintained evidencing discussion around specialist equipment.

Records showed concerns about weight loss were escalated to relevant professionals. Nutritional care plans were in place and detailed any dietary requirements. This information was recorded in the kitchen and the catering staff we spoke with had a good understanding of individual people’s nutritional requirements.

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 had access to people’s care and support plans to understand people’s needs and deliver their care. There were weekly consultations with a nurse who, where required, escalated concerns with the person’s GP. The service was also supported by members of the multi-disciplinary team.A healthcare professional told us, “[It] appears well managed, and staff appear responsive and caring.”

Staff told us they worked well together, with shift change handovers taking place so information was passed on to the team on duty. One commented, “The team culture is cooperative and supportive. Staff usually work well together and assist each other to ensure residents receive safe and consistent care.”

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.

Records evidenced staff monitored people’s health and escalated concerns appropriately. Staff were knowledgeable about people’s health needs and understood how they wanted to be supported.However, we raised concerns with staff regarding a decision as to where one person spent their time at the end of their life. Staff had liaised with the person’s GP but had not contacted other appropriate agencies to ensure the decision was in the person’s best interests. The person’s advanced care plan did not reflect this decision.

People who may have been at greater risk of malnutrition had regular weights recorded. We saw recent weights for people that appeared consistent.

The provider did not consistently monitor people’s care and treatment to continuously improve it. They did not always ensure outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

There was oversight of people’s needs during daily handover meetings, and records supported this. However, records did not always evidence care was consistently monitored to support identifying emerging risk. Whilst there was no impact to people, we saw examples of where food records had not been monitored or reviewed, meaning unexplained loss of appetite or weight loss may not be identified. We identified examples within care records where some information had been ‘copy and pasted’ by staff and were not fully reflective of that person’s needs. This was highlighted to the registered manager.

People and their relatives told us people were supported to improve.A person we spoke with said, “There are never any issues getting medical help.” A relative told us, “I think they would notice if he was unwell.”

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment. We identified improvements were required in relation to consistent record keeping.

At our last assessment, the provider breached the consent regulation as ‘blanket’ capacity assessments and best interest decisions for some aspects of care were being made where there was no identified need. At this assessment we found the provider was no longer in breach of this regulation, but improvements were still needed.

Consent to care was not always recorded clearly within people’s care records. Whilst we identified best interest decisions had been completed for most people where required, we identified there was no recorded best interest decision for a pressure mat in use for a person without capacity. Whilst this did not directly impact the person, it did not evidence systems and process were fully effective. Where people had a Lasting Power of Attorney in place, the provider had copies of the supporting documents.

Throughout our onsite assessment people were offered choices and staff were consistent in communicating choice and consent when offering care and support.