- Care home
Oakdene Nursing Home
Important:
We served warning notices on Dorset Healthcare Ltd on 21 June 2024 for failing to meet the regulations related to management’s oversight, quality assurance and good governance at Oakdene Nursing Home.
All Inspections
31 March 2023
During an inspection looking at part of the service
Oakdene Nursing Home is a care home, providing accommodation for up to 71 people who need nursing or personal care. The service provides support to older people and people who are living with dementia. At the time of our inspection there were 41 people using the service, all of whom required personal care rather than nursing.
The home consists of two separate buildings within the same grounds, one of which specialises in providing care to people who live with dementia.
People’s experience of using this service and what we found
This was a targeted inspection that considered staffing and infection control.
Based on our inspection of staffing and infection control we have no concerns.
There were sufficient numbers of staff to support people on day and night shifts. People and staff confirmed this. People described staff responding in good time when they needed help. Staffing levels had improved in recent months. Robust recruitment procedures were used to help ensure people were supported by staff of a suitable character and conduct.
We were assured by infection prevention and control processes at the home. The home was visibly clean and free from malodours. People spoke positively about the cleanliness of the home.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was requires improvement (published 8 July 2022).
Why we inspected
The inspection was prompted in part due to concerns about staffing. A decision was made for us to inspect and examine those risks.
We found no evidence during this inspection that people were at risk of harm from this concern.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Oakdene Nursing Home on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
12 April 2022
During an inspection looking at part of the service
Oakdene Nursing Home is a care home, providing accommodation for up to 71 people who need nursing or personal care. The service provides support to older people and people who are living with dementia. At the time of our inspection there were 43 people using the service, all of whom required personal care rather than nursing.
The home consists of two separate buildings within the same grounds, one of which specialises in providing care to people who live with dementia.
People’s experience of using this service and what we found
People received their medicines as prescribed. However, we identified some shortfalls in the management of medicines, which the management team immediately addressed. The medicines policy in place during the inspection did not reflect national guidance for covert medication; the provider has since revised their policy.
Risks to people’s safety and wellbeing were identified, assessed and regularly reviewed. However, we found some discrepancies and lack of detail, which the management team addressed when drawn to their attention.
A new audit programme covered all aspects of the service. The management team had identified some areas for improvement through their new audit system and were working to address these, which were broadly consistent with issues we observed. However, audits to date had not identified all the exceptions we found, which robust auditing should have done. The management team was prompt to address matters when we highlighted them. We have made a recommendation about the governance systems within the service.
People and relatives told us they or their loved one felt at ease with kind, caring staff and had confidence in their abilities. Interactions between staff and the people they were supporting were positive and respectful. Recruitment checks helped ensure new staff were of good character.
The premises were kept clean and in good repair. Relatives told us their loved ones had the equipment they needed to help keep them safe.
Call bells were answered promptly. Relatives held the impression that staff did not rush care. Staffing levels exceeded the minimum staffing level calculated by the provider’s staffing dependency tool.
The service’s infection prevention and control policy and procedures, including visiting arrangements, reflected current national guidance. There were ample supplies of PPE which staff used safely.
People and relatives saw the management of the home as caring, approachable and efficient, with no concerns about the recent change in manager. They felt comfortable to raise concerns and complaints, in the confidence that they were listened to and that action would be taken.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk.
Rating at last inspection
The last rating for this service was good (published 2 June 2018).
Why we inspected
We received concerns in relation to the management of the service leading to the neglect of people’s care. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.
The manager of the service had recently changed and actions were already in place to address the concerns raised.
We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Oakdene Nursing Home on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
19 April 2018
During a routine inspection
At the last inspection, the service was rated ‘Good’. At this inspection we found the service remained ‘Good’ although some improvement was required in management oversight.
People were protected from avoidable harm as staff understood how to recognise signs of abuse and the actions needed if abuse was suspected. There were enough staff to provide safe care and recruitment checks had ensured they were suitable to work with vulnerable adults. People had their risks assessed and actions to minimise risks were understood by staff and respected people’s freedoms and choices. Medicines had been administered safely by trained staff that were aware of the actions needed if a medicine error happened. Staff had completed infection control training and followed procedures that protected people from avoidable infections. The service was responsive when things went wrong and reviewed practices in a timely manner.
People had their needs and choices assessed prior to living at Oakdene and this information had been used to create care plans that recognised people’s diversity and lifestyle choices. Care plans had been developed in line with current legislation, standards and good practice guidance. Staff had completed induction and on-going training that enabled them to carry out their roles effectively. People had access to healthcare when needed and working relationships with health professionals enabled effective care outcomes for people. The principles of the Mental Capacity Act 2005 were followed which ensured people had their rights protected.
The environment and use of technology met people’s needs and helped them maintain their independence. People had personalised their rooms and some had memory boxes which contained photos and memorabilia that represented past interests and hobbies.
Staff were caring and showed patience and kindness when interacting with people, ensuring people had their privacy and dignity respected. They understood people’s individual communication needs enabling people to be involved in decisions about their day to day lives.
Social opportunities included one to one time with staff, group activities in the home and community and fund raising events. Links with the community included providing a place of safety for people with a dementia experiencing a crisis.
Oakdene had not always met their legal responsibilities to share information with CQC in a timely manner. They also were not able to demonstrate processes had been followed to meet regulatory standards when dealing with complaints prior to February 2018. A complaints process was in place that people were aware of and felt able to use. A complaints log had been commenced from February 2018 which demonstrated people’s complaints had been investigated and the appropriate actions taken.
A whistleblowing and grievance procedure was in place but staff had not always felt empowered to use them to report concerns about their wellbeing in the work place. Management changes had taken place which had created a more open and positive culture, improved communication and teamwork.
Further information is in the detailed findings below.
02, 04 and 22nd December 2015
During a routine inspection
This unannounced inspection took place on 02, 04 and 22 December 2015. The home is a nursing and residential care home and provides support and personal care for up to 70 older people, some of whom had dementia. The home has two separate buildings within the grounds. One is called Acorn Lodge. Acorn Lodge provides care and support for up to 26 people who have dementia and less physical needs whereas the nursing home provides support for up to 44 people with similar needs but who also have nursing needs. At the time of our inspection there were 67 people using the service, 24 people at Acorn Lodge and 43 people in the nursing home. Both buildings at Oakdene Nursing Home and Acorn Lodge have a ground floor and a first floor which is served by a lift and stairs. There are large landscaped gardens surrounding Oakdene Nursing Home and Acorn Lodge with secure gardens to the south and east of Acorn Lodge.
The home was last inspected on the 10 December 2013 and found not to be meeting the standards in the care and welfare of people and managing records. We found that there were ineffective systems in place to ensure people were protected from the risks of skin damage and people's care records did not always contain sufficient information to guide staff on how to meet their needs. These records were not always complete.
At this inspection improvements had been made to the care and welfare of people and in how their records were maintained. Staff told us they visited people in their rooms more frequently to reduce the risk of skin damage and we saw this happen during our inspection. Care records were complete and contained relevant information.
The manager who was a registered manager had been at the service since 2009 and registered in 2012. 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.
There were enough staff to care for people. We saw sufficient staff available to assist people with their care and support needs and staff were present to help people carry out their activities. Four people and one relative told us that staff were present and available but sometimes took time to respond to people’s call bells. One staff member told us that staffing was good across days and nights but that there had been recent staff sickness and leave agreed for staff for other reasons and this meant that existing staff then agency staff were used to fill the gaps. One person said, “The staff get quite busy and I’ve had to wait for some time for them to respond”. Recruitment processes were followed and newly appointed staff were employed only once all the appropriate checks had been made.
People were at reduced risk of abuse and kept safe because staff were aware of how to report abuse and protect people from harm. One staff member told us that physical harm and neglect would be reported to a senior staff member like a nurse or the head of care or social services and would be recorded in the notes. People told us they felt safe living at the home. One person said, “I feel quite safe living here”.
People received care from staff that showed an understanding of the risks to people. One person required re-positioning to safely eat their meals. A staff member said, “We carry out regular assessments especially where people may be at greater risk of accidents”.
Medicines were managed safely. Medicines were ordered, received, checked, administered and discarded safely. People told us that staff visited them in their rooms when administering their medicines and staff remained with them until they had taken their tablets.
Staff received training, support and had annual development plans. This included moving and handing to support people with managing their posture and movement and safeguarding adults. Nurses had to demonstrate that they had met their professional responsibilities; this is known as re-validation with their professional body.
People were offered nutritious meals and could choose between hot and cold foods. People who needed help with their meals were supported by staff and on occasion by their families. People told us that the food was “good”, “tasty” and “you get plenty”.
Some people living at the home did not have the mental capacity to make decisions about their care and where they lived. We looked at records and spoke with the local authority to confirm that people had received mental capacity assessments and where necessary Deprivation of Liberty Safeguard (DoLS) authorisations. Some people were still waiting to be assessed for DoLS authorisations due to a backlog of applications by the local authority. The registered manager explained that staff at the home had contacted the local authority to identify people where the arrangements for their care may deprive them of their liberty.
People were cared for by staff that showed empathy and carried out their role with respect for people. In the communal areas we saw staff engaging with people in a relaxed manner.
People received personalised care and support from staff who communicated important changes through shift handover meetings. One person told us that staff respected their choice to remain in bed and in their room. This person had capacity to make this decision.
Improvements were made following learning from incidents. On one occasion someone was at risk of harm relating to their posture and newly provided equipment. Since the incident new agency staff were expected to sign a record that they had familiarised themselves with the home’s induction process.
The deputy manager explained how complaints were managed through the complaints procedure and these were fully explored and investigated before being addressed.
Quality and safety checks were carried out at the home and actions were taken to improve the standard of care people received. However one system used for monitoring call bell response times were not effective in identifying trends or in producing sufficient detailed information and the management team told us this would be addressed following the inspection.
10 December 2013
During a routine inspection
People told us that their needs were met. One person told us, 'I cannot fault the care at all.' However, we found that the home did not have effective systems to protect people from the risks of skin damage.
Staff received training in appropriate topics and were supported to carry out their roles. One person's visitor told us, 'They seem to know what they are doing.'
People felt comfortable raising concerns and complaints and the provider had a system to manage these complaints. One person's visitor said, 'I've had the odd niggle which I have complained about and they have explained the actions they have taken.'
People's care records did not always contain sufficient information to guide staff how to meet their needs. Records relating to the management of the home were effectively maintained.
25 March 2013
During a routine inspection
We saw recent compliments that the home had received from relatives of people who had lived there. One relative had written 'Mum was so well looked after and enjoying life as best she could'.
Another relative wrote 'Mum herself valued the life you gave her and so did we'.
People were given appropriate information, their needs were assessed and care planned and delivered to meet these.
Staff had appropriate professional development and were well supported through supervision and team meetings. This meant that people were cared for by competent staff.
The provider monitored the quality of the service. People and staff were able to express their views and these were acted upon. Lessons were learnt from incidents to improve care for the individual person involved as well as the wider group of people using the service and staff.