Oaken Holt Nursing and Residential Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We assessed a total of 7 quality statements from this key question. We identified 1 breach of the legal regulations relating to governance. The service had an action plan in place to support improvements needed for the service. Governance systems such as audits and oversight of processes were not always effective at ensuring documentation was reflective of people’s needs and actions were followed. Staff felt supported by the management team, however some felt they were not always visible, further systems had been implemented to ensure staff were supported in their role. Documentation did not always evidence staff voice. People felt communication around professional visits and changes could be better. Guidance from professionals was not always followed, and there was limited oversight in place to identify this.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff spoke positively about the involvement of senior management and the direction of the service. Staff told us they enjoyed their job, but the shortness of staff and use of agency made working for the service difficult at times.

The service had a clear plan in place to support with the direction of the service in order to improve systems, and culture. An improvement plan was in place which contained actions and follow ups. Meetings with people that use the service, and their families, to gather feedback and communicate changes, actions and plans for the service were in place.

Feedback from staff about managers was mostly positive. Staff told us they felt they could go to their managers if they had any issues or concerns and were listened to. However, not everyone felt supported by the manager as they felt they were not always visible, not all staff had met the manager who had been employed at the service for 3 months.

Due to multiple changes in management, systems had not always been in place to ensure effective leadership and support such as regular supervisions and meetings. Supervision reviewed did not evidence discussions or support provided to staff. Processes had recently been put in place to ensure oversight of systems to support staff. However, these needed time to be embedded into the service.

Staff told us they felt confident to raise concerns and were assured they would be dealt with appropriately. We also heard staff had raised concerns about the lack of permanent staffing. The provider had a plan in place to resolve this issue, but staff did not always feel they were kept updated.

Staff told us they felt able to raise concerns at team meetings. Team meeting documentation evidenced availability of senior management, discussions around open-door policy. However records did not evidence staff concerns were addressed as they were not documented.

The service had a diverse staff group with a range of age, gender and cultural backgrounds. Staff did not raise any concerns with us about workforce equality, diversity or inclusion.

Processes were in place to ensure the service protected the human rights of staff including flexible working arrangements. Risk assessments and any reasonable adjustments measures were utilised if required to support staff. Flexible work patterns were in place, to support staff with their home lives.

Staff were receiving supervision, however, were not receiving it as stated in the provider’s policy. The service had identified issues with the service and were working as a collective to address these concerns. We heard about further plans to ensure oversight of the service which involved including staff.

Systems and processes in place were not always effective at identifying concerns. For example, health and safety audits stated that serious accidents had been fully investigated and reported and there had not been any serious incidents. This information conflicted with the information recorded in the clinical meetings which stated incidents had taken place. Audits for mealtimes stated the team were clear and aware of resident’s individual dietary requirements. This did not reflect findings from the kitchen records and care notes. Care plan audits documented the action taken which included ensuring assessment were in place, however care plan audits did not identify where care planning information was conflicting. Clinical audits did not always accurately reflect information around risk. Not all accidents and incidents had been recorded or reported to the local safeguarding team. Therefore, we were not always assured governance around risk and incidents was effectively monitored. Some audits seen contained no actions despite improvements being needed and documented, and the complaints log did not always contain all complaints we had been made aware of. Policies reviewed were not always followed. The services fall’s policy stated staff were to attend falls awareness workshops, this had not been arranged by the service. There was an audit schedule in place which outlined who carried out audits and how often, we could not always see these had been adhered to as they had been recently reintroduced under new management. New governance systems such as audits had been re-introduced within the last few months to ensure effective monitoring of the safety of the service, such as daily walkarounds where actions had been followed up, and improvements made around IPC concerns.

Communication was not always effective. People we spoke to were not always aware when professionals were coming to visit them until they had arrived. We heard the service used to employ a physiotherapist who supported people with their mobility, people told us they were not informed about why this had stopped. People told us, “We have noticed that there is no transport any longer- I haven’t been in a shop for over a year, before we always went in the home’s van to Botley, once a week, every Friday morning, it was a routine that was very pleasing, but we weren’t told why that stopped, there is never any talking to us, no telling us what the future holds, I don’t know who the Manager is, we are never introduced so we cannot talk with them”.

Both care staff and the management team demonstrated effective collaboration with health professionals, including making referrals to district nurses, GPs, and pharmacies. Staff were aware of guidance in place from SALT (Speech and Language Therapist) and told us they could follow guidance easily. However during the assessment, we found that guidance was not always available in people’s records.

We received positive feedback from partners working with the home. Feedback around the services palliative care pathway and what services to use was commented as something they do well.

Records were not always consistent. For example, for three people their assessments such as Waterlow and Must recorded incorrect weights. Documentation in place did not always evidence guidance from healthcare professionals were followed. For example, one person was at risk of pressure damage. The provider had referred the person to the Care Home Support Service (CHSS) who advised changes to the persons diet and fluid intake. The person’s fluid target was not achieved, which had not been identified by the service. For another person their eating and drinking care plan stated nutritional monitoring was required by the care team and fortified meals and fluids provided. Despite the CHSS advice, we found limited evidence in the person’s care records that the care staff were offering the person fortified meals and extra snacks as advised by CHSS. We looked at the person’s records over a week and noted limited mention of snacks offered and meals offered when the person was asleep, to ensure they received the calorie intake required. We looked at the specialist dietary logs kept in the kitchen and noted this person was not listed as needing fortified meals and fluids.

Staff explained how feedback and actions in response to incidents or accidents were sometimes shared in handovers, however not all staff attend handovers. Staff told us they were responsible for completing incident forms and that they have time to complete these, however we saw that forms were often recorded days after the incident. Staff told us senior management discuss incidents with the member of staff who have completed the incident forms, however, we could not see where formal learning was shared with the team. Staff told us “We do hear back after incidents [with the individual staff member], but not with all concerns raised, for example around staffing issues.”

The provider was reviewing their plans to improve the service and had a team of internal quality leads and senior management in place at the home to support with the identified improvements. We saw one example of lessons learnt for an individual investigation. This identified the appropriate body should have been informed but documentation wasn’t always reflective of the actions taken. There was limited evidence of lessons learned being effectively communicated to the team as documentation did not always reflect discussions regarding incidents. The processes and practices still needed to be embedded into the service to further improve the oversight of the provider and improve people’s care. This included the management of audits such as clinical audits, as these were not always reflective of the clinical meetings and ensuring daily meetings were recorded daily.