Oak Lodge

There are 60 bedrooms spread between three defined areas of the home, all with private toilet and sinks with shared showers and bathrooms. There are shared living areas, dining room, kitchenettes and a large kitchen.

We found the following examples of good practice.

- The provider had modified a large lounge area by building a Perspex wall. This enabled families to visit people with access from the outside only to one side of the lounge and service users come in from the home side. This area provided people with comfortable chairs and a visiting area in the warmth for colder days or when people were unwell.

- A wide variety of activities for people to keep them involved and lift the feelings of isolation, entertainer on the patio of the home with people in the lounge, contact with local children who sent pictures and letters and activities linked to events.

Further information is in the detailed findings below.

Oak Lodge is a residential nursing home providing nursing and personal care to up to 60 people in a specially adapted set of connected buildings.

There are 60 bedrooms spread between three defined areas of the home, all with private toilet and sinks with shared showers and bathrooms. There are shared living areas, dining room, kitchenettes and a large kitchen.

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

People received high quality care which supported them to have an outstanding quality of life and maintain their health and wellbeing as long as possible. People’s freedom and happiness was valued by staff most highly and support was personalised to meet and exceed people’s expectations.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff were proactive and confident to minimise restrictions and give people freedom.

The home had a calm, friendly, warm and welcoming atmosphere which was reflected by staff at all levels. Staff were exceptionally kind, compassionate and patient in their approach. People’s individuality and dignity was held in high regard at all times which meant people received an extraordinarily caring service.

The home was outstandingly well-led with a leadership culture of inclusivity and empowerment to staff and people. People, their relatives, healthcare professionals and other stakeholders consistently fed back how the high quality of leadership in the home promoted continuous improvement and consistently high standards.

There were a wide range of activities in and out of the home and staff were particularly skilled at encouraging people to participate and to minimise social isolation. The home was safe and ensured people’s needs were met in a way which was highly personalised and reflected their culture and personal backgrounds. People and their relatives felt particularly engaged and involved. The home had very good links with the local and wider community.

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

Rating at last inspection

The last rating for this service was outstanding (published 14 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

The service had a registered manager, who was referred to as the matron by people and staff. 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. The matron was supported by a deputy manager, who was referred to as the head of care.

Staff knew how to keep people safe and understood their responsibilities to protect people from the risk of harm and abuse. The home had identified risks to people and assessed, reviewed, recorded and managed them appropriately to minimise the risk of harm or abuse. Health professionals told us they had observed staff supporting people safely in accordance with their risk assessments and recognised best practice in relation to dementia awareness, moving and positioning, pressure area management, wound dressing, infection control and management of pain relief. Staff knew and understood the provider’s incident and accident reporting process to ensure all risks were identified and managed safely.

The matron completed a daily staffing analysis to ensure that sufficient suitable staff were available to meet people’s needs. People benefited from excellent continuity of care from ‘familiar friendly faces’, which particularly provided reassurance for older people who were confused or anxious. The home followed robust recruitment procedures to ensure that people were protected from the employment of staff unsuitable to support vulnerable older people.

The provider operated health and safety systems effectively to protect all people from harm in the home. The home had contingency plans to ensure the safe delivery of people’s care in the event of emergencies such as fire, flood or utilities failure. People were kept safe by staff who understood the provider’s procedures and their individual role and responsibility in such circumstances.

The home managed people’s medicines safely in accordance with best practice and national guidance. Staff who had completed safe management of medicines training had their competency to administer medicines assessed annually by the matron and head of care.

People consistently told us that the professional knowledge and skill of well-trained, professional staff had a positive impact on their quality of life, health and wellbeing, which was echoed by relatives. All health professionals told us they were impressed with the excellent standard of nursing care at Oak Lodge. The matron was committed to and passionate about staff training and continued professional development to improve the quality of care. People were supported by staff who had completed a thorough and effective induction into their role at Oak Lodge. The provider promoted best clinical practice through the use of lead roles, called Champions, who had completed further training in specific areas of nursing care, which they shared with colleagues.

People were protected from the risks of malnutrition and dehydration. People and relatives told us the quality and choice of food were exceptional and that their individual nutritional needs were well met, which our observations confirmed.

People were supported to maintain good health and had regular access to healthcare professionals. People requiring specialist advice or specific care to meet their changing needs were referred promptly to relevant healthcare professionals. Health professionals observed that staff implemented their guidance effectively to achieve good outcomes for people.

The environment at Oak Lodge had been purpose built to provide the ideal living accommodation for older people and those living with dementia. The home had been designed to promote people’s familiarity and support them to find their way around the home.

Extremely caring and compassionate staff had developed close and meaningful relationships with people, based on getting to know and understand them and their needs. People felt that Oak Lodge was their home and that the whole community, including staff and others was like one big family. People were consistently treated with dignity and respect by kind staff supported by managers to spend time with people. People told us the amount of one-to-one time staff provided made them "feel special". Staff had embraced the matron’s high standards and values, placing people at the heart of everything they did.

Oak Lodge had received an award from carehome.co.uk for being one of the top 20 recommended care homes in the South East of England for the past three years. The matron was a finalist for Best Care Manager in the Great British Care Awards 2015 and the staff were finalists for Best Care Team in The National Care Awards 2015 organised by Caring Times. Oak Lodge was the first nursing home in North Hampshire to engage with the Skills for Care Six Steps Programme of education and practice development. This is a national quality framework that aims to support nursing and care homes to improve end of life care for their residents and avoid inappropriate end of life admissions to hospital.

The matron and head of care were passionate about providing the best quality of life for people, which included supporting them to experience the best possible death by respecting and complying with their wishes. Relatives and health professionals told us people experienced exemplary end of life care and were supported to have a comfortable, dignified, and pain free death.

People were actively involved in planning their own care and received excellent personalised care, which was responsive and tailored to meet their individual needs. People, relatives and health professionals consistently told us that people experienced "amazing, stimulating activities" that enriched the quality of their lives and ensured they did not become socially isolated.

The managers of the service showed outstanding leadership. Feedback to improve the service was sought by the provider and matron using a thorough range of different methods to ensure people received the highest quality care. The matron was dedicated to the people living at Oak Lodge and was always looking for ways to improve the quality of their lives and the care they experienced. People and relatives made positive comments about changes that had been made as a result of their feedback, such as the improved security, increased staffing at busy times and the variety of activities.

Since our last inspection the home had received over 60 formal compliments and one complaint, which had been resolved in accordance with the provider’s complaints policy. Complaints and concerns formed part of the provider’s quality auditing processes so that on-going learning and development of the home was achieved and sustained.

Without exception staff praised the matron and head of care for creating an open and inclusive environment, where all staff felt their contribution was valued. A member of staff told us, “They (the management team) are so caring and conscientious that it rubs off on everyone. Not only are they brilliant managers but also outstanding nurses.”

Senior staff demonstrated good management and clear leadership. Visiting professionals praised the positive attitude of staff at the home, which was inspired by the matron and the head of care. The home had benefited from the stability and continuity of this partnership for the previous 16 years. One health professional told us, “(The matron and head of care) are outstanding managers. They work really well as a team and have a clear and shared vision of the quality and ethos of care at Oak Lodge”. People and relatives said the matron and head of care were “Extraordinary” and “Always there”.

There was a strong commitment to deliver a high standard of personalised care and continued improvement based on the views of people. The provider had clear oversight of the home, and fully supported developments that improved care delivery. They recognised and celebrated the achievements of the staff team, and congratulated them for their hard work.

The provider had effective quality monitoring systems to review and improve the service continually. The matron and head of care shared an excellent working relationship with partner organisations to ensure their staff were following correct practice and providing a high quality service.

We considered our inspection findings to answer questions we always ask;

Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

We found that people were cared for safely. People's needs had been assessed and reflected in their care plans. Where necessary, assessments had been completed which identified and reduced risks to people, whilst supporting them to remain independent.

Where people needed support with more complex health needs we saw there were specific plans which detailed the care needed and how staff should provide this. We found that staff had received appropriate training in relation to meeting people's complex needs from health professionals, which had ensured that people's needs were met safely.

People who use the service said they felt safe with staff, who treated them with dignity and respect. One person said, 'I couldn't wish for better care. The staff treat me like a human being. They always listen to me and have time for a chat.' Another said, 'I feel safe and trust the staff who are so kind and friendly.'

The service had ensured that people were protected from the risk of inappropriate or unsafe care. This was because the provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others in relation to incidents.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which apply to this service. The registered manager told us they had not needed to apply for DoLS authorisation for any of the people who use the service since the last CQC inspection, but they were aware of the process to follow.

Staff told us that they had received training about the Mental Capacity Act 2005 (MCA). One care worker told us, 'We care for some people with dementia and know what decisions they can make and others where they need support.' A relative told us, 'The staff always contact me before any action is taken if the GP wants to change their medication.'

Is the service effective?

We found that the service placed people at the centre of all decisions regarding their care and support. Where the service identified a person lacked capacity to make a decision, a best interest meeting had been held with people who knew and understood them, which ensured their human rights were protected. We noted that advance decisions had been appropriately recorded and had been respected by staff.

People we spoke with were complimentary about the care they received. One relative told us, 'The staff provide excellent care, with compassion and patience. Famiies and friends are encouraged to visit at any time and are made to feel welcome by the staff.' The relative of a person with complex needs told us, 'I don't think they would have made such a good recovery if they weren't at Oak Lodge. The staff are out of this world.'

People had been protected from the risks of malnutrition and dehydration.The provider had identified where people were at risk of poor nutrition and hydration or had swallowing difficulties. We observed that people had a choice of suitable and nutritious food and hydration in sufficient quantities to meet their needs.

Staff had received an induction recognised by the care sector, covering core subjects that included safeguarding, dementia awareness, the MCA 2005 (MCA),infection control, management of medicines, food hygiene and moving and positioning.

We found that staff were knowledgeable about people's specific health and personal care needs and had received training to update their skills and knowledge. Staff had also received training to meet the specific needs of people. The provider had ensured that people received appropriate care from competent staff who had been supported in their personal development by an effective system of supervision and appraisal.

Is the service caring?

People were supported by kind and compassionate staff, who spoke to people in a friendly, caring manner. We saw that care workers gave encouragement to people who were able to do things at their own pace. One person told us 'They always take their time and never rush me.' Another person said, 'It's the way that staff make you feel special that makes this home better than others.' A relative told us, 'They have definitely got it right here. It's not like other places where staff are rushing about. There is a calmness and tranquility and staff have time to deal with people as individuals.'

People were supported by kind and compassionate staff, who spoke to people in a friendly, caring manner. We saw that activity coordinators and care workers gave encouragement to people who were able to do things at their own pace. One person told us "The staff are wonderful. They keep us on our toes and help us to do things you wouldn't think were possible. I really like the 'chairobics.'

We observed that staff supported people to make their own daily living choices and to be as independent as they were able to be. This promoted people's self-esteem and gave them a sense of achievement. The care staff we spoke with enjoyed working with people they supported. One care worker told us, "I like to hear about people's life stories because it helps me to understand them and provide better care.'

Is the service responsive?

The service was organised to respond to the diverse requirements of different people. People's needs had been assessed and their care was planned and delivered in accordance with their personal preferences. Staff had a clear understanding of each person's needs and how they should be met. For example, the service had responded well to incidents where a person displayed behaviours which may challenge. The person's behavioural support plan had been updated to ensure staff knew how to respond appropriately to such behaviour in the future.

We found that the service was responsive to the changing needs of people and these had been continually reviewed. Where staff required further training this had been planned in advance or where anticipated had been arranged immediately.

Is the service well-led?

We found that the management team provided clear and direct leadership, which was recognised and appreciated by the staff. Care workers spoke positively and with pride about the service they provided for people. The registered manager or deputy manager worked every week end and the administrator worked on Saturday. The registered manager told us that they wished to show their commitment to the people they cared for and their staff. Staff told us that the manager's spoke with them about any changes planned and they felt part of a team where their contribution was valued. One care worker told us, ''If there are any problems the manager is always on call and lives nearby.' A nurse told us, 'If we need her she will always come in and is always happy for you to call her at home.' This meant that care workers felt confident to raise concerns and seek advice.

The registered manager operated systems to deal with comments and complaints which were clearly understood by people, well-publicised and reflected established principles of good complaint handling.