Oaktree 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

People received a service that was safe. The registered manager and staff understood their role and responsibility to keep people safe from harm. People were supported to take risks, promote their independence and follow their interests. Risks were assessed and plans put in place. Capacity to make decisions was assessed and recorded and staff respected people’s choices. There was enough staff to safely provide care and support to people. Checks were carried out on staff before they started work to assess their suitability to support vulnerable people. They received regular supervision and the annual training programme equipped them with essential skills and knowledge. Medicines were well managed and people received their medicines as prescribed. The home was clean and staff followed the providers infection control policy and procedures. Some areas of the home required redecoration and ongoing maintenance and the provider had an action plan in place with timescales.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The daily management presence had helped form relationships with people and their relatives where they felt confident to express their views, felt they would be listened to and treated with respect. Comments included, “My mum is always treated with the utmost respect and kindness, and it's clear that her well-being is their top priority”, “I have no concerns, staff help me when needed”, “The manager is incredibly patient and all the care staff have been just fabulous, their dedication, and professionalism are evident in everything they do”, “I’m really happy I have no concerns” and “Staff are always willing to answer all of our questions. We live overseas, so having access to information about our relative is very important to us.” People looked comfortable and relaxed with staff and the people they lived with; staff interactions were positive.

Staff told us the management team were open and shared learning with them. They felt able to raise concerns and share new ideas where care and peoples experience could be improved. Staff were confident that actions would be taken where necessary to manage risks and make improvements. Comments included, “We are listened to at all times and a reply action is carried out immediately or as soon as possible”, “We always communicate to the residents by talking through things asking questions and letting them feel secure by letting them know how things should and are done”, “I feel extremely comfortable raising concerns and know actions will be taken where possible.” The registered manager and the deputy gave many examples of where learning had taken place to improve the care and support for people.

The provider had processes to monitor standards and identify, record and learn from incidents that happened within the home. This included regular audits, supervision, meetings and external checks. This helped to ensure staff could make changes where necessary to improve care for people.

People confirmed they were supported to attend health care appointments. One person told us they were going to a hospital appointment that afternoon and they were a little anxious. The registered manager was present and provided the person with assurances and explained the importance of attending, they appeared more relaxed after the conversation.

The service ensured everyone had prompt and effective access to primary care including preventative screening and vaccinations, routine checks, GP call outs and access to emergency services. The registered manager recognised the importance of seeking expertise from community health and social care professionals so that people's health and well-being was promoted and protected. The registered manager completed thorough assessments for those people who were considering moving into the home. The information gathered was detailed and supported the service and prospective ‘resident’ to decide as to whether the service was suitable and their needs could be met.

There were no concerns shared by community health and social care professionals.

The service had suitable systems and procedures to support staff when working with other professionals. Policies and processes about safety reflected joint working with other key partners to promote shared learning and drive improvement. Hospital passports provided records of people’s health needs and were shared with other professionals as required. This helped to keep people safe when receiving treatment and promoted continuity of care.

People told us they felt safe and happy with the care and support they received. Relatives felt people were in ‘safe hands’. Comments included, “If I am concerned about anything I can talk to the manager, in the office downstairs”, “This was the primary reason for moving our relative to a home, she feels very safe”, and “The staff are all very good to us.”

Staff were kind and took every precaution to help keep people safe from unnecessary harm. They encouraged people to make choices to reduce risks and stay safe, whilst respecting people's rights to make their own decisions. Staff told us immediate action would be taken to keep people safe should any abuse or neglect be suspected. This included working in partnership with other health and social care professionals. Comments included, “I have no concerns whatsoever. I know that my colleagues do their best with everyone living here. I will always report to the manager if I see anything to do with people’s safety”, “I would report anything that I feel is unsafe practice to my manager, if action wasn’t taken, I would take it further and raise a safeguard concern with the local authority and the CQC” and “I protect others within the service by following the correct protocols.”

People appeared to be happy, comfortable, and safe in their surroundings. They told us staff responded to requests for help when they pressed their call bells and these were in easy reach of people. Equipment such as moving and handling equipment was in place to support people safely. Those people that required assistance with moving and handling were always supported by two members of staff.

Staff understood what constituted abuse and the processes to follow to safeguard people in their care. Policies and procedures were available, and staff had attended safeguarding training updates to refresh their knowledge and understanding. The registered manager and staff recognised their responsibilities and duty of care to raise safeguarding concerns when they suspected an incident or event that may constitute abuse. They notified the relevant agencies including the local authority, CQC and the police. People’s capacity to make decisions was assessed. Assessments were discussed with relevant parties and outcomes recorded. Staff understood the principles of the Mental Capacity Act (2005) and had received training to ensure they knew how to apply these in practice.

Staff took every precaution to help keep people safe from unnecessary harm. They were supported to take risks balanced on their safety and their health care needs. People's capacity had been considered and their right to take informed risks was respected. We saw good examples where extensive work, re-evaluation, monitoring, and support had enabled people to be as independent as possible, whilst respecting there may be a degree of risk. This included, improving mobility, attending appointments and exploring services within the local community. The registered manager and staff provided examples of a positive, person-centred approach to the management of risk and this was reflected in individuals’ achievements.

Everyone who worked at the home knew and understood the risks to people well. Staff told us risk assessments contained up to date information to support people safely and effectively. They had a good level of understanding when identifying potential risks, managing actual risks, and keeping these under review and their responsibility to report accidents, incidents, or concerns. They had the knowledge and skills to protect people safely without being restrictive. Comments included, “I access people's risk assessments via their care plans, they provide all the information I need to know. When someone is new to the service a risk assessment will be competed upon arrival” and “I encourage people to take positive risks by promoting independence, when possible, this may include things like personal care and making their own choices.” The registered manager spoke with us about a recent incident in the community. One person had become disorientated whilst they were out and was helped back to the home by a member of the general public. Action had been taken to review the risk assessment with the person in order to minimise any further risks to them. Subsequently the person made the decision to go out with a member of staff in the future.

People were being supported safely by staff. There was a staff presence within communal areas. Where people needed assistance with eating, they were supported in a dignified manner. We saw a member of staff sitting with a person clearly describing what the person was eating and this was done at the person’s pace. One person was reminded to use their walking frame. Foot plates were in place on wheelchairs to help prevent injury to people when in use.

Processes and systems such as handovers, care record reviews, people, their relatives and staff meetings helped ensure risks continued to be managed safely and were effective in enhancing people’s lives. In addition, the service worked alongside families, significant others and health and social care professionals to help provide a holistic approach to risk management. Written accident and incident documentation was comprehensive. There was evidence of learning from incidents and changes were implemented. Monthly audits helped staff identify trends to avoid further recurrences.

People and relatives spoke positively about the environment. Comments included, “I have recently moved rooms and I am much happier; I have all I need”, “The environment is warm and inviting, impeccably clean and well-maintained” and “The outside courtyard is a favourite spot.”

The provider and registered manager spoke with us about the external work completed on the property, this included a new roof, windows and works to the front of the house. This was to enable ambulances to park outside the home in the event of an emergency. Their priorities had now transferred to the inside of the property.

The service was a large converted Victorian building which had been adapted over the years. Some bedrooms were not conducive to people who required equipment for example wheelchairs and lifting equipment, these were occupied by people who were fairly independent with their mobility. Adaptations and modifications had been made where possible to promote people’s independence. A lift provided access to all four floors and stair lifts were available in case the lift was out of action. The service had a homely feel and people had access to two lounges, a conservatory and a large dining room. Some areas of the home required redecorating and we saw a refurbishment plan was in place. We saw two fire doors did not close effectively. This was discussed with the registered manager and the provider who confirmed this had been picked up at a recent audit of the fire doors. Records were seen confirming this. After our visit an email was received confirming the doors closures had been replaced. In addition, there was a small toilet on the second floor that had a radiator behind the door that was not covered. This posed a risk in the event someone fell in this small area. This was removed and made safe. All other radiators were covered. Window restrictors were in place for the areas that we viewed.

Process and systems in place had helped the provider identify where improvements externally and internally could be made.

People we spoke with and evidence from surveys confirmed people and relatives felt there were enough staff to support individuals. Comments included, “Staff offer fantastic support, they get 10 out of 10!”, “Staff help me when needed”, “I’m not feeling great today but the staff are keeping an eye on me” and “It’s a family atmosphere with nice staff.” Call bells and requests for help and support were answered in a timely manner. The atmosphere in the home was calm. The registered manager was very much hands on during our visit and working alongside staff. They worked well together; the mealtime was organised with catering staff and care staff working alongside each other.

Staff told us there were enough staff working in the home to support people safely and respond to their needs. Comments included, “For most areas of the home staffing is a very high standard. I feel that we are adequately staffed but at busy times of the day when people want to get up or mealtimes we would benefit from an extra person”, “There are enough staff, otherwise I would not work here.” Morale amongst the staff was positive. Staffing levels were determined using a dependency tool which was reviewed monthly, when new people moved to the home or if a person’s needs changed. Staff worked additional shifts and regular agency staff helped to ensure consistence and continuity in care. Staff received training and updates to help ensure they were suitably skilled. Collectively they had the skills and confidence to carry out their roles and responsibilities effectively and were supported to access additional topics to help enhance the care people received. Comments included, “We are given the opportunity to opt into extra training should we want to. Mandatory training covered everything I needed to know and to ensure I was confident”, “We are continually doing training as people’s needs change” and I have no concerns about the training, the induction was really good.” Staff were supported daily by the provider, registered manager, and colleagues. Any additional support/supervision was provided on an individual basis and these were formally recorded. Staff told us, “We have regular supervisions and I would not feel afraid to ask for a meeting If I had any concerns. The manager is outstanding, I feel very lucky to have her here as she is very supportive” and “I meet regularly with my manager and feel very supported and can raise any concerns I have.”

Systems and processes helped ensure training and supervisions were up to date and supported best practice. Recruitment was seen as an essential part of keeping people safe whilst ensuring they were cared and supported by staff of good character. Safe recruitment procedures were followed. Pre-employment checks had been completed and written references were validated. Disclosure and Barring Service (DBS) checks had been carried out for all staff. A DBS check allows employers to check whether the applicant has had any past convictions that may prevent them from working with vulnerable people.

We received positive comments from people and their relatives about how clean the home was. One relative told us, “The building is not the easiest for staff or residents, but improvements are being made and it is always clean.”

Staff confirmed they had received training in respect of infection control as part of their induction and ongoing training programme. Infection control and health and safety were standard agenda items in staff meetings. They had plenty of supplies including personal protective equipment such as gloves and aprons.

The home was clean and free from odour. The domestic told us that cleaning was completed regularly. Improvements had been made under the new provider with the addition of two more domestic staff and this had had a positive impact on the cleanliness. Laundry improvements had been made and safe systems were in place.

Monthly audits were conducted to ensure compliance with infection control requirements. Daily cleaning schedules were followed by both domestic and support staff. During the pandemic, the service implemented enhanced protocols, the service remained prepared to reinstate these strategies, if necessary, in the future. Records of daily and deep cleaning were regularly checked by the management team. The service had an infection prevention and control policy which reflected relevant national guidance.

People received their medicines safely and as prescribed. People and their relatives told us they were satisfied with the support they received and expressed no concerns.

Controlled medicines were signed and checked by two members of staff. They were able to demonstrate that since the last inspection they had reviewed the application of pain patches and clear guidance was in place for staff to follow. There had also been improvements with the administration of topical medicines (creams and lotions). Records were in individual bedrooms and signed by staff who had supported the person with their personal care. Medicines were supplied by the pharmacy in their original boxes. This is in line with current NICE guidelines. Care plans contained details of the ways in which people preferred to take their medicines. Arrangements were in place to return unused medicines to the pharmacy. The registered manager completed checks to ensure stock levels of medicines were as expected. This would give opportunity to identify any errors that had occurred.

At the inspection of October 2022, we found no evidence that people had been harmed, however improvements were required to protect people through safe medicines management. During this assessment we found that improvements had been made and the provider was no longer in breach of our regulation. Policies, procedures, records and practices demonstrated medicines were managed safely. There had been no significant errors involving medicines in the last 12 months. Staff completed safe medicine administration training before they could support people with their medicines. The registered manager completed practical competency reviews with all staff to ensure best practice was being followed.