Oak Lodge Care Home

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• 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

We assessed a total of 3 quality statements from this key question. We have combined the scores for these areas with scores based on the rating from the last inspection, which was good. Our rating for this key question has remained the same. We found the provider was in breach of 1 regulation and failed meet their legal requirements around people’s medicines. Shortfalls we identified included storage, administration and the robustness of people’s care records. We were not assured leaders, and staff were always aware of relevant best practice guidance or that practices were always carried out in-line with these. The provider used tools to support them identify the staffing levels people required to meet there needs and rotas demonstrated sufficient staff were deployed in-line with this. However, we received feedback from staff that staffing levels could be improved and we made some observations at this assessment where staff were not always visible or easy to find. The provider had effective processes in place to ensure the care environment was safe and suitable to meet people’s needs and where required. Where people required equipment to support their needs, such a mobility aids, these were in place and staff understood how to ensure equipment was safe and fit for purpose.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

People using the service told us they had no concerns about the environment. Comments included, “It’s a nice place”, “I like my room quite a lot” and, “They keep it clean. There’s always someone cleaning.” People’s relatives told us when they had raised issues with leaders about the environment, they were dealt with. For example, one person’s relative said, “The one wall in the bedroom wasn't the best. The paint was looking faded and there were holes in the wall from pictures. I spoke to [management team] about it and it was repaired and painted.” People and their relatives we spoke with told us they did not notice any odours. Comments included, “It always smells fresh” and, “It’s clean, and fresh. I have no concerns about that. I’ve been in other homes when the smell hits you as soon as you go in.”

All staff we spoke with said they had completed fire training and knew what actions to take if the fire alarm sounded. One staff member said, “A month or so ago we did fire training where we had to do role play and be the lead if there was a fire.” Staff told us they had been trained to use moving and handling equipment. Staff told us how they kept people safe. Comments included, “I will keep equipment packed away, keep wires safe so people don’t trip, check sensor mats are in place, and check they have appropriate footwear on and make sure the lights are on” and, “We risk assess everything, make sure people have the care they require, check that the building is secure, that all plugs/electricals are PAT tested, make sure there is a safe number of staff and check that windows are secure.” Staff had been trained to use equipment safely. One staff member said, “I would check the battery to make sure it’s charged, and the hoist is working properly. I will make sure the sling is intact and for the correct person and I would make sure the person is safe to be hoisted.”

We observed the environment was well maintained. The provider took steps to ensure the environment was safe and suitable for people, for example we observed all necessary windows had restrictors in place in line with national guidance. We observed appropriate equipment was in place and was fit for purpose. The environment was visibly clean.

The provider took appropriate steps to ensure the environment was safe and suitable to meet people’s needs. We noted the local fire service had carried out an assessment earlier in the year and actions had been identified with a completion date of 01 August 2024. We spoke with the provider’s fire safety officer who went through the action plan with us and told us which actions had been completed. Where we found there was one remaining action to be completed, the service had kept the fire service informed of their progress. We saw communication from the fire safety inspecting officer that this action should be completed by 01 March 2025, and were assured the provider had a plan in place to meet this. In the event of an emergency, the provider ensured people had personal emergency evacuation plans (PEEP) in place. We found people’s plans had been regularly reviewed to reflect their support needs in the event of needing to evacuate the building in an emergency. We reviewed other records of checks carried out by the provider to ensure the premises were safe. This included gas, electrical checks and regular checks of equipment which were carried out in line with their requirements.

We received mixed feedback from people about staffing levels. Some people had no concerns, and others felt the service was short staffed. Comments included, “No, there’s not enough staff. They’re answering other calls, you just have to wait”, “It’s a fine line. They could do with more staff. You wait sometimes” and, “They would come quicker to help me and stay longer if they had more time and there were more of them. There are not enough carers.” One person’s relative said, “[Loved one] needs help now with eating and drinking. I have been in late, and the drink will still be there on the table. I have to keep an eye that [relative] is getting the help [they] need now [their] care needs have changed.” Other people and their relatives said, “Yes, from what I’ve seen, there’s enough” and, “I visit every other day and always see plenty of staff around. [Relative] wouldn't use the call bell, but my great grandson rang it once and someone came very quickly.”

Relatives felt their loved ones received good care and support from staff who knew them and their needs well and staff had built positive rapports with people.

Staff we spoke with gave mixed feedback of their experience of staffing levels. Some staff felt that they were not always able to respond to people’s needs in a timely way. Comments included, “I do think the residents feel the impact of staff levels as when they’re buzzing, we’re often telling them they need to wait a minute” and, “We don’t’ have enough staff. We’re not able to give the person-centred care they [people] deserve. It feels like a production line.” Another staff member said, “To do really basic care we have enough staff, but for anything extra, even like supporting with meals, I do not feel we have enough. From a safety and nutrition perspective, I think we need more.” Whilst other staff members told us, “Everyday it’s different, some days we are doing well and other days it’s a struggle” and, “I think [staffing levels] are quite high. No concerns, I’m happy.”

Leaders of the service told us they had no concerns regarding staffing levels. The registered manager said, “I have no major concerns about staffing. I remind all staff to answer call bells; it doesn’t have to be just care staff who do it. I do tell staff to use [electronic documentation system] better. If they log support as 10 minutes, and it took longer, they need to record that. If they don’t, the system won't tell me we need more staff.”

Staff told us they had regular supervisions. One staff said, “The nurses do supervisions with us. I find them useful because then you can see where you’re going right or wrong.” Another staff member said, “We have one every six weeks. We discuss where I’m currently at, where I’d like to go, reflect on my role, ask questions on what I’d do in different situations and whether or not I feel supported.”

Staff told us they were encouraged to progress professionally. One staff member said, “I have allocated hours to do my [training qualification] and every time I take this time, [deputy clinical manager] will come and help out on the floor to cover for me."

At times during the on-site visit the inspection team found it difficult to locate a member of staff. At other times, such as mealtimes we saw there were enough staff supporting people in the communal dining areas.

The service used a dependency tool to calculate staffing levels based on people’s care and support needs. The staff rota showed that staffing levels were maintained.

The service audited response times to call bell alerts to help ensure that appropriate numbers of staff were in place at key times of the day, such as mealtimes. We reviewed the provider’s recruitment processes which demonstrated they met their legal requirements. This included completing the relevant pre-employment checks to ensure staff employed were suitable for their role. The provider had effective processes in place to ensure staff undertook relevant training for their role. Where the provider identified any learning at the service, we saw training was provided to staff in areas to ensure they were skilled and knowledgeable to undertake tasks.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us staff supported them with their medicines. Comments included, “They [staff] bring it [medicine] every time, four times a day” and, “Yes. I take a lot [of medicine] and they come regularly with what I’ve got to take.” People told us staff asked them if they needed additional medicine such as pain relief. One person said, “The nurse always asks in the morning if I have pain.” Relatives we spoke with did not raise any concerns regarding medicines support provided to their loved ones, although most relatives commented they were not usually present at medicines administration times. Where a relative had been present they said, “I’ve been there when they have given [loved one’s] medication, and it seemed fine; I have no concerns.”

We spoke with staff and leaders about our findings in relation to oxygen use and storage. During our discussions, we were not assured that they were aware of the relevant best practice guidance. We spoke with staff about medicines administration for people at the service, and they told us that they were drawing a medicine up from a pen cartridge into a syringe as they lacked the pen for the cartridge. Leaders told us they had discussed this with the prescriber; however, leaders were not aware of a Patient Safety Alert which discourages this method of administration. Following discussions with staff the homes senior leadership they told us they would review our feedback and action this.

The registered manager told us they had ensured a safe space for staff to discuss incidents and that this supported staff to speak up if they had any concerns. They said, “We've learnt so much from [medicines] incidents” and, “Processes have changed, internally and externally. It feels robust, an immense amount of work has gone in.” Learning from medicine incidents was shared with staff and through conversations with these staff we saw that learning was embedded.

Leaders and staff were not always aware of or following best practice guidance for oxygen storage or a person’s diabetes management. For example, we found an empty and out of date oxygen cylinder that was not segregated from the other full or in use and in date cylinders in line with guidance to reduce the risk. We found some examples where in-use medicines had not been correctly labelled when opened. This meant there was a risk that medicines could be used outside of the manufacturer’s guidance. We found some examples where care plans failed to captured all the relevant medicine information. This included where people were prescribed variable dose medicines or medicines as required as well as a positive behaviour support plan not being available for a person prescribed a medicine to manage their anxiety. The provider’s recording practice of topical cream administration was not in-line with best practice guidance. For example, when care staff supported people with topical creams, they recorded the application in the care record, and then reported the administration to the nursing staff. Nurses then created a duplicate record in each person’s medicines administration record, although the nurses had not administered the topical cream. This increased the risk of recording errors. We reviewed the medicines storage at the service and found some of the controlled medicines cupboards were not compliant with the correct storage regulations. We raised this with the provider who took action to address this.