Oaktree Care 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

We assessed all the quality statements within the key question of safe. People told us they felt safe living at the service, and they appeared comfortable in the company of staff. Systems were in place to ensure staff acted when necessary to ensure people were protected from abuse and neglect. People, relatives and staff felt able to raise concerns or report incidents and the management team investigated these and took actions to keep people safe. The staff team and managers knew people well and demonstrated an understanding of the risks individuals could face. These were documented in care records, and assessments and care plans were up to date, clear and person centred. People and their relatives spoke positively about the staff team. The numbers and mix of staff matched the needs of people using the service. Staff were safely recruited and received supervision and training to ensure they had the skills to keep people safe. Staff supported people safely with their medicines in the way individuals preferred. Medicines were well organised and regularly monitored. People’s health and wellbeing needs were met, and staff received support from other health and social care professionals when necessary. Improvements had been made to the environment, décor, equipment and infection control risks. The service had effective infection prevention and control measures. Some ongoing maintenance was required, but a plan of repairs and decoration was in place. The environment was safe and met people’s needs. Significant changes had been made in the unit which supported people who were living with dementia. This was now welcoming, stimulating and met people’s needs.

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.

People and their relatives told us they felt able to raise concerns or give feedback. One person said, “They’re very understanding when you’ve got problems.” Relatives told us they had provided feedback in a questionnaire. One said, “I have nothing to complain of. I go to the office if I have any concerns – they will listen, the staff are really good, they have lots of patience.”

Staff knew how to raise concerns and record incidents, and this helped keep people safe. Staff said the management team were good at sharing information with them. They explained that incidents, accidents, or safeguarding concerns were shared during handovers or team meetings to ensure lessons were learned and improvements made when needed. The registered manager was aware of the requirements of the duty of candour and the importance of sharing information with family and other stakeholders. This included making apologies when things went wrong. We saw evidence of this in notifications we received.

The provider had processes to monitor standards and identify, record and learn from incidents. This included regular audits, supervision, meetings and external manager checks. This helped to ensure changes could be made where necessary to improve care for people. Brief meetings were held every day to review key issues such as risks relating to staff, environmental issues, incidents or accidents and concerns regarding people's health and wellbeing. Staff from different departments attended to ensure there was a whole home approach to sharing information and managing risks.

People and their relatives were confident that any health or wellbeing needs would be met, and other professionals were consulted as necessary. Several relatives told us they were involved in discussions about their family member’s care plans and risk assessments.

The management team described the assessment process which was used to ensure staff had sufficient information to support the person during their transition from hospital or home. This included speaking to family and professionals involved in the person’s care. Staff knew people well and shared information to ensure they always received safe care.

Feedback from health and social care professionals was positive. Professionals were complimentary about how the service worked with them to ensure people were safe and received the support they needed. Two GP surgeries carried out weekly visits to the home.

People’s care plans showed that a comprehensive assessment was completed before they moved to the home. This informed care plans, and these were regularly reviewed and updated as people’s needs changed. Daily handovers informed staff of people’s care needs, risks, or changes to their presentation as well as appointments.

People told us they felt safe living at the service. During our visit, people appeared relaxed and comfortable with the staff who supported them. Relatives felt their family members were safe living at the home. One relative told us, “He is safe and being well supported. Staff love him.”

Staff we spoke with confirmed they received safeguarding training. They could describe different safeguarding concerns and knew how they should respond. Staff were confident to report poor practice and felt the management team would address any concerns. Staff we spoke with had no concerns about the care and support people were receiving. Staff demonstrated an understanding of the Mental Capacity Act and the importance of involving people in decisions. Not all staff knew who was subject to Deprivation of Liberty safeguards, but they understood the principles of keeping people safe whilst protecting the individual’s rights. A member of staff said, “If a person is known to lack capacity, we would still involve them in day-to-day choices but would involve family or speak with the nurse if we were concerned.” Another staff member told us, “People are usually on a deprivation of liberty safeguard if they lack capacity.” The registered manager was aware of their responsibility to liaise with the local authority and notify the Care Quality Commission if safeguarding concerns were raised. The registered manager acted to keep people safe with the support of other health and social care professionals.

We saw staff supporting people in ways that kept them safe from harm or unnecessary risks. People appeared to be comfortable, staff were responsive to individual’s needs and interactions were positive.

The provider had effective systems and processes to help protect people from abuse and neglect. Policies were in place and up to date, and safeguarding materials were displayed for people, visitors and staff to see. People’s mental capacity had been assessed and decisions which had been made in the individual’s best interests were documented in their care notes. When people were subject to restrictions to keep them safe, these were closely monitored to ensure they were necessary and remained relevant.

Where possible, people were informed about risks, and they understood staff had responsibilities to keep them safe. Staff were proportionate in their approach to risk and respected people’s choices. Some people’s relatives were involved in making risk decisions in their best interests. Many relatives told us they were updated and involved in discussions about people’s care plans and risk assessments, although some did not feel they had been consulted. One relative said, “I have been involved with the care plan, and it has been reviewed”, although another relative noted, “I don’t think we have been involved with care plan, but they keep us in the loop.”

The staff team and managers knew people well and demonstrated a good understanding of the risks people faced. For example, staff knew what to do if someone fell. They knew who was at higher risk of falling and described how they ensured an individual was safe. This included making sure walking aids were near the person, rooms were clutter free and regular checks were carried out. One staff member said, “We check everyone regularly throughout the day, but especially people who remain in their bedroom.” Staff also told us about people who faced risks associated with losing weight. People’s weight was monitored regularly and discussed with a GP and dietician if necessary. A member of staff showed us a snack trolley which was taken to people’s rooms twice a day and the chef regularly spoke with people individually about their preferences and food choice. Food and fluid charts were used to monitor people’s daily intake if there were concerns, and staff knew individual needs and restrictions.

Our observations raised no concerns about staff practice. We saw staff supporting people safely and in line with individual risk assessments. For example, we saw 2 staff helping a person to move. They clearly explained to the person what was happening, gave specific instructions to each other, and used appropriate techniques.

Risks which affected people's daily lives, such as those related to mobility, communication, nutrition, skin integrity, and continence were identified and documented. Assessments described the risks which might be faced by people, and what staff should do to reduce these risks. The assessments were clear, person centred and were regularly reviewed. We saw that people, or their relatives, were involved in reviewing assessments where possible.

People and their relatives all spoke positively about the environment, its condition and cleanliness. The unit which supported people who were living with dementia followed good practice by adapting the environment to help orientate people and meet their sensory needs. For example, a lounge area had large shop front murals, some bedroom doors looked like traditional front doors, and there were items to touch and interact with in corridors, such as pictures, hats and games.

Staff were proud of the changes that had been made to the environment since the last inspection. They were keen to share these with us. Lots of changes had been made on Buttercup unit to make it more homely and dementia friendly. Staff received training to keep people safe, such as in fire safety and the use of different types of equipment. This training along with buildings and equipment which were well-maintained helped staff to deliver safe and effective care which met people’s needs.

At the last inspection, we identified a breach of regulations relating to the premises and equipment. At that time, we found shortfalls had not been identified relating to the standard of décor and infection control risks in the building and equipment. At this assessment we found improvements had been made and the provider was no longer in breach of regulations. Improvements had been made since the last inspection, and the environment was safe and met people’s needs. There was an ongoing programme of maintenance and improvement to ensure the building, fixtures and equipment remained in good working order. We saw equipment, such as hoists and wheelchairs, were clean and well maintained. Significant changes had been made in the unit which supported people who were living with dementia. For example, clear signage was in place, some people had memory boxes by their door, bathrooms and toilets were not cluttered, and communal areas were more homely and welcoming than during our previous visit. People were supported to personalise their bedrooms with their own furniture, photos and pictures, and there were many items of interest on corridor walls. People could access safe and attractive garden areas.

Systems were in place to detect and control potential risks in the environment. This included building safety and equipment checks. A process for identifying and rectifying issues was in place. We received evidence that necessary checks and safety certificates were in place. The provider had taken steps to reduce the impact of the service on the environment by installing solar panels.

People and their relatives spoke positively about the support they received from staff. One person said, “It’s very good here, [staff are] very helpful”. A relative told us, “They know exactly how to handle him now. They are very kind, they kneel down beside him and are so gentle.” We received mixed feedback from people and their relatives about staffing levels and responses to call bells. People told us, “Sometimes you have to wait [for the call bell to be answered] but if they are helping other people you have to wait. Sometimes there is an apology”, and “In an emergency, they are like lightning.” A relative said, “I’ve been with dad when we had to wait 40 minutes for the call bell to be answered.” As detailed below, the registered manager reviewed and analysed responses to call bells.

Since the last inspection there had been a considerable reduction in the use of agency staff. The registered manager told us in the week before our visit, no agency staff had been used. There was now a pool of bank staff who could support the team at short notice. Staff told us, “Going really well, lovely bunch (staff) to work with”, “There’s less agency now, it’s absolutely fine. We have been short staffed on a few occasions, but we pulled together, and people were safe. No concerns” and “The staffing levels seem better than they were before. There’s better staffing and better activities. We could always use more staff, but I think it’s ok.” Staff confirmed they received an induction when they started at the service, and ongoing training. A member of staff told us, “Yes regular training, face to face and e-learning”. Another staff member of told us they recently completed face to face training about life support, fire awareness and moving and handling. They continued by saying “I review my training fortnightly, but the manager is really good at chasing. There is a list of required training that staff need to complete.” Nurses told us they had regular clinical training to enable them to keep up to date and meet their professional registration requirements.

On the day of our visit, we saw there were enough staff to provide people with the support they needed and in line with what had been assessed by the provider. There was a calm atmosphere in the home. Call bells and requests for help and support were answered by staff in a timely manner. We observed positive interactions between people and staff and staff were attentive to people’s needs. People were not rushed and were supported at their own pace.

We saw copies of rotas and a dependency tool which was used to review people’s needs and ensure these were consistently met. Since the last inspection there had been an increase in the nursing staff on the unit which supported people who were living with dementia. There were now two nurses working on this floor during the day. Staffing was monitored during the daily head of department meetings and checks by the management team. Regular audits of call bell activations monitored response times and ensured people received support in a timely manner. Analysis of this information helped to ensure suitable staffing was in place at peak times. Training records showed staff received with essential training in subjects such as fire, manual handling and safeguarding. They attended regular refresher courses to ensure their knowledge and skills remained up to date. Staff were recruited safely by the provider, and relevant checks were carried out before new staff started working at the service. This included criminal record and employment checks, which helped confirm staff were suitable to care for people.

People and their relatives told us the home was clean and tidy and no concerns were raised. When describing the home, relatives described it as, “Very clean” and “Spotless”.

Staff received training and had a good awareness of infection prevention and control principles. Housekeeping staff could clearly describe safe systems which helped ensure the home was clean and clothes were laundered following current good practices.

The concerns we found at the last inspection had been rectified. During our visit, we found the service to be clean and free from clutter and unpleasant odours. Deep cleaning was being carried out, and new routines for domestic staff were being introduced. We observed staff wearing and disposing of personal protective equipment (PPE) appropriately. We were assured the provider was protecting people, relatives, staff and visitors from the risk of infection.

There were policies and procedures which gave staff guidance and followed current best practice. Regular infection prevention and control audits were carried out by the management team in response to our findings at the last inspection.

People received their medicines safely and as prescribed. People and their relatives told us they were satisfied with the support they received with medicines. One relative told us their family member had refused to take medicines, so staff worked in partnership with them to find different solutions in the person’s best interests. People's care plans contained information about how people preferred to take their medicines. We observed staff offering people their prescribed medicines. They were aware of people’s needs and preferences.

Nurses confirmed they could only administer medication if they had completed the training and had been assessed as being competent. They told us this was reviewed annually. The nurses we spoke with were confident about medicines processes and practice. They described robust systems for the ordering, administration and disposal of medicines.

The service had quality assurance measures to ensure medicines were managed safely. This included staff training and competency assessments, audits and daily stock checks. Regular checks of the environment and temperatures were carried out. These measures help to ensure medicines were safe and any errors would be promptly identified. Medicines were stored in locked trolleys which could only be accessed by staff who had been assessed as competent to administer medicines. Medicines trollies were well organised, and items were clearly labelled. There was additional security for medicines when necessary. The practices we saw were in line with current best practice guidelines. Medicine administration records were clearly written and were signed by a nurse when medicines had been given to people. Homely remedies, such as medicines for colds and coughs, were discussed with the GP to ensure they were suitable for the person. The medicines policy was up to date and reflected current and relevant best practice and professional guidance.