Oak Lodge Care Home

We found the following examples of good practice.

The provider was following best practice guidance in terms of ensuring visitors to the home did not spread COVID-19. Staff were adhering to personal protective equipment (PPE) guidance and practices.

Communal areas were well spaced and people, with support from staff were encouraged to maintain social distancing. Clear plans were in place for those who were required to self-isolate, and arrangements were in place for telephone or video contact with relatives. For those people who struggled with isolation additional support was provided.

The provider had created a safe visiting area within the home to allow people to see and speak to their friends and relatives. The room was well-ventilated and cleaned between visitors. For those who were nursed in their own rooms there were also clear visiting arrangements in place.

Staff continued to support people to access healthcare, and arrangements were in place should people need to attend hospital safely.

Oak Lodge Care Home provides nursing and personal care for up to 41 people. Most of whom are older people. The home is situated on a main road, close to all local amenities and with easy access to public transport. At the time of the inspection there were 38 people living at the home.

People’s experience of using this service and what we found

We found action had been taken to address the breaches found at the last inspection. Governance systems were in place to monitor and review the service provided. The management team and staff worked with other professionals, so people received the care and support they needed. Feedback received from third parties was positive about the management of the home.

The service had introduced an electronic medication management system. Staff responsible for the administration of medicines felt this was more effective and minimised the risk of error. Relevant training and assessments of competency were completed to check staff practice was safe.

We received a mixed response from people and staff about staffing levels. The registered manager was mindful these were to be kept under review to meet the current and changing needs of people. Further recruitment was taking place.

Feedback from people and their relatives was positive about their experiences. From our observations interactions between people and staff were polite and respectful. One relative told us “I would recommend this home because it is excellent all round, I would go in there myself.” This was supported by other comments received.

Staff spoken with felt morale had improved. Newly appointed members of the team said they had been well supported in joining the team, the team worked well together and there was good communication.

Safe systems continue to be maintained in other areas, such as recruitment, health and safety checks and safeguarding people from harm.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published April 2019) and there were two breaches of regulation.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service in January 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve medication management and governance systems at the home.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions of safe and well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Oak Lodge Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Oak Lodge Care Home provides nursing and personal care for up to 41 mainly older people.

People’s experience of using this service:

People’s medicines were not safely managed and accurate care and monitoring records were not always in place or able to be located. The manager took immediate action to resolve the concerns we identified.

People told us that they felt safe at the service. Staff were overall safely recruited to ensure they were safe to work with vulnerable people.

There were sufficient staff available to support people however we did see that people were left in the communal lounge areas without support and had to wait for assistance. This was brought to the attention of the manager who said they would address this immediately.

The environment was clean and free from unpleasant odours.

The new manager had made improvements to the attendance of staff training and ensured that where appropriate any outstanding deprivation of liberty safeguards (DoLS) had been made since they took up post.

People told us they enjoyed the food provided and their dietary needs had been catered for. They had access to the healthcare support they needed.

People were using the main communal area as both a lounge and a dining room. This was because the home was in the process of being refurbished. Work was well underway into changing the former dining room into a new spacious, open plan conservatory type lounge for people to use. Most of the bedrooms and corridors had been refurbished.

There was a calm and friendly atmosphere at the home. Overall people spoke positively about the staff. They told us they were treated with dignity and respect and their independence was promoted.

An activities co-ordinator who also had the role of quality assurance manager for people who used the service and relatives had recently returned to the home. People had started to see an improvement in activities and further developments were planned and would be put in place once the new lounge area was finished.

Feedback about the manager was very positive. The management structure had changed with two staff members supporting the manager in day to day operations and quality assurance.

One of the manager’s priorities for continuous improvement was promoting wider accountability and responsibility, which should in turn will strengthen the staff team.

The manager had made many improvements. They had introduced new management systems that had improved day to day oversight and communication at the home. The manager was in the process of ensuring that staff consistently incorporated the changes they had into routine everyday working practices.

However, we found shortfalls in the safety of medicines management for nursing patients at the home and in nursing patient records. The manager took immediate action to rectify the issues including contact with the supplying pharmacy and the local clinical commissioning team for support to make the improvements needed as quickly as possible.

Because of these issues identified we have changed the rating from good to ‘requires improvement.

Rating at last inspection: At the last inspection the service was rated Good (July 2016)

Why we inspected: This was a planned inspection based on the rating of the service at the last inspection.

Improvement action: Please see the ‘action we have told the provider to take’ section towards the end of the report

Follow up: We will continue to monitor the service and carry out a further inspection within 12 months.

Following that inspection, we received an action plan from the provider telling us what action they intended to take to make improvements to the service provision in these areas.

This report only covers our findings in relation to what action the provider has taken to make the necessary improvement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Oak Lodge’ on our website at www.cqc.org.uk.

At this inspection, we found that the service had met these breaches.

Oak Lodge is registered to provide accommodation for up to 41 older people who require support with nursing and personal care. There were 38 people living at the service at the time of our inspection.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We saw at this inspection that, where people lacked mental capacity to consent to their care in Oak Lodge, the necessary action had been taken to authorise their placement in the home. This should help to ensure their rights were protected.

We saw that the provider had retained the majority of staff that employed at the home at the time of our last inspection. These staff had completed the most of the training they needed to support people safely and effectively and any outstanding training was planned.

At this inspection visit we found that the service had met these breaches.

Oak Lodge is registered to provide accommodation for up to 41 older people who require support with nursing and personal care. There were 36 people living at the service at the time of our inspection including people who were using respite care. Oak Lodge also had three places that could be used exclusively by the local authority Crisis Response Team. These beds were used to help prevent unnecessary admissions into hospital.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At this inspection we found two breaches in the regulations that we reviewed. This related to deprivation of liberty safeguarding authorisations being in place for some people who lacked capacity and the need to ensure that all staff had received the training and supervision they needed to help ensure they supported people safely and effectively.

You can see what action we asked the provider to take at the back of the full version of this report.

People we spoke with told us that they thought that the service provided a safe environment for them to live in. People said, "I can't say that I don't feel safe. It can be noisy at night," "I feel safe, I'm well fed and I'm warm" and "The home is brilliant. You can't beat it." The staff we spoke with told us that they knew what action to take if they thought a person who used the service was being abused or at risk of harm.

Relatives we spoke with commented on the cleanliness of the home and lack of unwanted smells. They said "It's kept clean. [My relative] is absolutely 100% safe here." "They do pretty well. Cleanliness wise they are good. We are more than happy." We saw that the service was clean and tidy and no malodours were detected during our inspection visit.

We found that the systems in place to manage people’s medicines was safe.

People who used the service told us about the food that was offered. They said,"I can't complain about the food. They do their best for you," "The food here is incredible, the quality and the fact that they do what you ask for. I'm a vegetarian and they meet my needs," and "The food is excellent. I have a diet, which they help me with."

People had access to the healthcare professionals that they needed to support them with their health needs.

People and their relatives told us that the care given by staff was very good. We saw good interactions between people who used the service and staff, which demonstrated close relationships and kindness.

The home employed an activities organiser who came into the home two days a week and provided the opportunity for people to participate in games, music and other activities. The activities organiser was highly thought of by people who used the service and family members. Plans were in place to increase the activities provided by the home through the employment of an additional staff member.

People who used the service, their relatives and staff told us that they thought the registered manager was doing an excellent job.

' Is the service safe?

' Is the service caring?

' Is the service effective?

' Is the service responsive to people's needs?

' Is the service well led?

Below is a summary of what we found. The summary is based on a visit that took place on a Sunday afternoon, our observation of what was happening, speaking with eight people who used the service or their relatives, speaking with four staff members and looking at records.

Is the service safe?

People we spoke with said that they felt safe living at the home. They said if they had any worries or concerns they could speak to staff about them and were confident that action would be taken to address their concerns.

We saw that, although the lounge area was very busy, it was free from unnecessary clutter that could pose a potential trip hazard. We saw that when wheelchairs were in use foot plates were always used to prevent injury.

Is the service caring?

Everyone we spoke with confirmed that they were happy with the support they received from the staff team. They made the following comments, 'I can't fault them', 'I have no trouble with them', 'They are fantastic' and 'When I need them they are there'.

Is the service effective?

The operations manager confirmed that there had been a number of staff changes recently with the departure of two qualified nurses and seven members of the care staff team. We were told that all the staff had been replaced and were undergoing induction.

Is the service responsive to people's needs?

People we spoke with gave us examples of how the staff team were responsive to their needs. One person told us they had been 'very' poorly when they had moved into the home and had not anticipated the recovery they had made. Another person who had been at the home for a short time following a fall at home gave an example of how they were being supported to mobilise again.

Is the service well led?

The operations manager for the home had come in on the day of our visit to provide additional support to the staff team which included two new members of staff.

We were told that both the named providers had visited the home on the day of our visit as they did most days to ensure the home was running smoothly.

The home has been without a registered manager since October 2013 and no registered manager application has been received by the Care Quality Commission (CQC). We were told that the present nurse manager came to work at the home on 31 December 2013 and was in the process of making arrangements to register. It is a condition of registration that the provider must ensure that a manager with the necessary skills and experience is employed by the home and is registered with the CQC.

In this report the names of two registered managers appear who are no longer in post and were not managing the regulatory activities at this location at the time of the inspection. Their names appear because they were still registered managers on our register at the time.

The relative of one person told us 'My sister and I make all the decisions for our relative. We work with the staff, particularly the registered nurses and the manager but we also speak with the ordinary carers who all feedback information. I feel staff do respond to my input.'

We found that people were asked for consent and the provider acted in accordance with peoples' wishes. People who use the service received care in a way that met their needs and preferences.

The people we spoke with told us they were happy with the care received and that they were looked after well. One person told us 'The staff are absolutely lovely. They look after us perfectly. I shout if I need help and they come as soon as they can. There couldn't be a better place than here.'

The people we spoke with told us they were happy with the staff. One person told us 'The staff are marvellous. I don't have to wait a long time for help.'

The relative of another person told us 'I think the staff are lovely. They are really, really caring and considering the age of some of these young carers, they're marvellous.'

We found the environment in the home to be clean, safe and well maintained. People were cared for by staff that had been through the appropriate recruitment checks. There was an effective complaints system available, in case anyone wished to raise a complaint.