The Oaks Residential 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

The rating for the key question of Safe has improved to Requires Improvement. Managing risk was still not always seen a as priority, by the provider. Where people communicated resistance to care through agitation or distress, staff lacked knowledge and guidance on how to support them to manage their anxieties in a positive way. Improvements had been made to the process of reporting and managing safeguarding concerns, but further staff training was needed to ensure they knew how to report concerns outside of the organisation. There were enough staff to meet people's needs during daytime hours, however further work was needed to ensure there were sufficient staff at night. Overall people’s medicines were managed well. Significant improvements had been made to infection prevention and control (IPC) resulting a cleaner and safer environment. New systems had been introduced to monitor the safety and upkeep of the premises and equipment. Staff had been recruited safely and their training had improved. New staff had received an induction and their skills had been assessed.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives told us, any concerns about safety were listened to, investigated, and managed to ensure people’s safety. However, we found the provider did not have a robust culture of safety and learning. They had not always taken prompt action to address safety concerns, which had exposed people to the risk of harm. Where safeguarding concerns had been raised by relatives, they told us these were used as an opportunity to put things right.

Staff confirmed they could raise concerns with the senior managers and were confident their concerns or suggestions about people’s safety were listened to and acted on. However, staff told us they were not always kept up to date following incidents, about what lessons were learned, and if changes had been made to a person’s care as a result.

Some safety issues were not always given top priority or learnt from. For example, radiators in people’s en-suites were not covered which exposed them to the risk of burns and scolds from exposed hot surfaces, and pipework. The risk of people coming to harm had been identified at our previous inspection and by the registered manager in a risk assessment dated February 2023. No action had been taken to mitigate the risk until we raised concerns at this visit. Incidents and complaints had been investigated. However, more work was needed to demonstrate how learning from incidents or complaints had achieved better outcomes for people and were being embedded into good practice.

Relatives told us, people’s care was managed well. One relative commented, “My (Person) had to go into hospital for a short period. They had a bed sore when they arrived back at the home, and the district nurse was called immediately and within no time it had healed.”

The registered manager was aware of the risks to people’s health across services. They had implemented new systems for communication which had led to better partnership working with health professionals. Where people had been discharged from hospital with pressure wounds, they had taken appropriate action raising concerns to the local authority about the poor quality of care.

People’s records confirmed care and support was planned and organised with health professionals. Their care records reflected recommendations made by social workers and health professionals which were followed by staff at the service. This ensured people received safe and continuous care.

All relatives we spoke to considered their family members to be safe whilst living at the service. One relative commented, “The manager and their staff team make it the resident’s home and it feels like home. I never feel (family member) is not safe. I always feel secure and confident that they get the respect and love they deserve. The Oak’s doesn’t look the best but it’s the way the staff react is what counts.” Although, relatives told us their family members were safe, staff did not have the skills to support people during times of agitation, especially when trying to provide personal care. This placed people at risk of harm and receiving poor care.

The registered manager demonstrated a commitment to keeping people safe from abuse. They had completed additional safeguarding training and were now the designated safeguarding lead and champion for the service. The registered manager was aware of their responsibilities to report concerns to the local authority safeguarding team. They had worked well with the local authority to investigate concerns and used outcomes as an opportunity to change practice and drive improvement.

Staff demonstrated a commitment to keeping people safe. They worked well with people, providing reassurance when they expressed worries or concerns about their safety, however we observed they lacked knowledge and experience on how to support people at times of distress and anxiety.

Safeguarding systems, processes, and practices had improved to ensure people were protected from abuse and neglect. Since the previous inspection, the providers safeguarding policy had been amended and now reflected national guidance and legislation governing safeguarding to guide staff on how to protect people from abuse. However, not all staff understood how to raise concerns outside of the service, including how to submit a referral to the local authority safeguarding team. Where people were subjected to deprivation of liberty safeguards (DoLS) to restrict leaving the building for their safety, these had been assessed and authorised, or were in the process of being authorised by the local authority. People’s care records reflected, where they lacked capacity, the relevant people were identified as holding power of attorney for their finances, and or health and welfare to ensure their rights were upheld.

Relatives told us staff knew their family members well and kept them informed with useful updates about their wellbeing, including risks to their safety. Relatives were confident their family members were just as well looked after when they left the premises as when they were visiting. However, we were not assured people were always protected from the risk of harm. For example, a review of incident reports found 2 occasions where a person had been assaulted by other people using the service, due to the way they communicated with others. Their care records lacked information to guide staff on how to support the person to understand the risks to themselves and to stay safe.

Staff understood the need to constantly assess risks to people’s safety, looking for hazards and taking action to minimise the risk of harm, such as falls. This included making regular checks on equipment, including walking frames and ensuring people were wearing appropriate footwear. The registered manager told us they had made improvements to people’s personal emergency evacuation plans (PEEP's). However, these had not considered if there was adequate staff on duty at night to safely evacuate people in the event of an emergency.

Where people communicated their needs, emotions, or distress, through their behaviours this was not always being managed in a way which protected their rights and dignity. Although staff were observed to be intuitively kind, they lacked the skills to help people manage feelings of distress and anxiety in a positive way.

We reviewed incident and accident reports from September 2023 onwards. The reports reflected patterns where people were identified as becoming agitated and aggressive towards staff during the delivery of personal care or moving and handling. Records reflected these incidents were not being managed well. There was limited detail as to the strategies used to de-escalate people’s distress, find out what worked well and find a more positive approach to managing such incidents. Further analysis with regards to incidents of challenging behaviour would ensure better understanding of people’s needs and how to manage risks to their safety in a more holistic way.

People and their relatives provided positive feedback about the improvements being made to the premises. They told us the redecoration to communal areas and people’s individual rooms had made the service feel more ‘like home’. People had been involved in choosing their own wallpaper and colour schemes for their rooms which had made them more personalised. However, the providers failure to continuously assess, and take action to ensure the safety of the premises, including fire safety and exposed radiator continued to place people at risk of harm.

Previously there had been a lack of expenditure and investment in the service, which had been reflected in the poor upkeep of the premises. The provider told us about plans to improve the premises, including replacing the passenger lift and fire systems. However, the timeliness of carrying out the improvements had not been seen as a priority to ensure the premises were safe and fit for purpose. For example, a fire risk assessment carried out in November 2020 and again in May 2023 by an external company, made recommendations to check old fire doors were fire resistant. This had not yet been completed. This meant that people may be at risk in the event of a fire.

Although we observed improvements had been made to the fabric of the building, further improvements were needed to ensure the premises and equipment were maintained in line with current safety regulations. Intumescent strips fitted around fire doors to seal gaps and prevent the spread of smoke and fire had been painted over. This reduced the fire resistance of the material and prevented it from expanding, therefore increasing risk of fire spreading and endangering lives. Following discussion with the provider they took immediate action to replace the intumescent strips and test fire doors to reduce the risk to people. Equipment used to deliver care, such as hoists and slings, were available, stored securely and staff were observed using these correctly.

New systems, checks and audits had been introduced monitoring the safety and upkeep of the premises and equipment. Quarterly environmental audits, and monthly bedroom, mattress, and equipment safety checks had been implemented July 2023 onwards. However, these needed further development, as they had not always identified immediate risks to people, including the effectiveness of fire doors, and unprotected radiators in en-suite facilities. Other safety checks included, portable appliance testing (PAT), gas and electrical installation, the fire alarm system and firefighting equipment.

Feedback from people and their relatives about staff was consistently positive. Without exception relatives told us there always seemed to be plenty of staff on duty, whatever time of day they visited. Comments included, “There are enough staff, they are always calm and nice,” and “There are enough staff they always have time to chat to you when you visit, and they are always interacting with the residents.” Relatives were confident staff had received the training they needed to care for people. A relative told us, “I feel the staff are trained well, they interact with all the residents, they are really lovely.”

Staff told us the numbers and skill mix of staff ensured people were receiving safe, good quality care. Comments included, “Staffing has improved, at the moment it’s perfect, it’s nice to have time for a chat, we get to know people, learn about them, and communicate with the families,” and “I think we have enough staff; we don’t use agency and staffing numbers have stayed the same despite the reduced number of residents.” Staff confirmed they received the support they needed from senior managers to deliver safe care, including regular supervision and appraisal. Staff told us improvements had been made to ensure they received appropriate training, relevant to their role. New staff confirmed they had completed a robust induction, which included shadowing an experienced member of staff. A member of staff commented, “I completed an induction, it was all about the rules and regulations, the organisation, and the foundation of the job. I read the handbook, learnt about residents, protocols, and job roles.”

There were enough staff available to give people the care and support they needed, keep them safe, cook and keep the service clean, during the daytime hours. However, people's emergency evacuation plans reflected a high number of people who required 2 staff to evacuate the building using an evacuation sledge in the event of an emergency. This had not been factored into the staffing dependency tool to ensure sufficient staff were on duty at night.

Recruitment practices had improved, however further action was needed to ensure all the relevant documentation, including the right to work in the UK, was in staff’s files and readily available for managers. Improved recruitment practices ensured staff were safely recruited and suitably experienced, to carry out their roles. The mandatory and enhanced training matrix showed staff had completed a range of training, including dementia awareness. However, not all staff had a good understanding about dementia and associated behaviours. This had been identified by the registered manager who was in the process of arranging enhanced dementia training for staff.

Infection prevention and control measures had significantly improved leading to better outcomes for people. Relatives told us the cleanliness of the home was much better since the previous inspection. A relative commented, “The new cleaner is much better, they work very hard, and they do a good job with the laundry as well. They take pride in what they do.” People were encouraged to take part in cleaning activities, as this helped to provide a sense of purpose and routine to their day. One relative told us, “My [Family member] likes to clean so staff give them a duster and they go around very happily dusting away, they are in the right place, they are safe.”

Staff were aware of their roles and responsibilities around IPC. A new housekeeper had been appointed as an IPC lead and was in the process of completing additional training to become the IPC champion. They were enthusiastic about making sure staff followed safe IPC practice to ensure people, and visitors were protected from catching, and spreading infection. Staff were positive about improvements made to the environment, including the enhanced cleanliness. One staff member commented, “The housekeeper does the laundry as well, they have extra hours for this. Everything is in much better order now, the home looks better, they have spent hours cleaning, and is keeping on top of it now, so the home is cleaner and fresher.” Staff confirmed they had received additional IPC and food hygiene training and had their competency assessed to ensure they were following safe IPC practice.

Significant improvements had been made to the level of cleanliness throughout the service. Personal protective equipment (PPE) was now being kept in plastic, wipeable containers to reduce contamination and wastage prior to use. Signage around the service had been either laminated or placed inside plastic pockets to prevent them becoming contaminated. There was a programme of replacing old / stained sinks and toilets in bathrooms, and new flooring. Covered toilet roll holders had been installed in every bathroom and toilet, and light pull cords had been changed to plastic wipeable alternatives. Reorganisation of the laundry room, including deep cleaning and redecoration had improved these facilities. All these measures had improved hygiene throughout the premises, reducing the risks of people acquiring infections and associated implications to their health.

Since the last inspection, improved IPC systems and processes had been implemented. These were being used to effectively manage the risk of infection in line with current relevant national guidance. The providers IPC policy had been updated to reflect the health and social care act (HSCA) 2008 code of practice on the prevention and control of infection and related guidance. The changes in the policy had been shared with the staff at handover, within their supervisions and written in the communication book. Audits were being completed monthly to assess and monitor cleanliness of the service. All staff, irrespective of their role or position had competed additional IPC training, including the correct use of PPE, with additional spot checks being carried out by the management team. The housekeeping team had undergone further training provided by an external company about the safe management of cleaning products, in line with the control of substances hazardous to health (COSHH) regulations, and best practice guidance.

People and their relatives were involved in making decisions about medicines. One relative told us, “I am always involved in any changes in care and medication, I am totally involved and included at every level.” Where assessed as able to do so, people were supported to manage their own medicines.

Staff were aware of the support people needed to receive their medicines safely, including where medicines were prescribed covertly and to manage anxiety and agitation. Staff confirmed medicines were only ever administered as a last resort for controlling people’s behaviours, referring to distraction techniques used instead. One member of staff commented, “[Person] is prescribed a regular dose of a sedative medicine at lunchtime and can have up to 3 extra does per day but we rarely give that amount.”

Overall people’s medicines were being managed well. However, improvements were needed to ensure 2 staff booked in new medicines in line with the providers medicines policy. Creams and ointments were not routinely being signed for by staff to reflect these had been applied. The registered manager took immediate action creating a chart reflecting where on the person’s body creams / ointments were to be applied and ensure they were signed for. Protocols were in place to guide staff on the steps to take to de-escalate a situation prior to administering sedative medicines on an as required basis, however these needed to tie in with strategies to de-escalate people’s distress, to reflect what worked well, or not so well. People’s medicines were being managed in line with current national guidance and legislation, including the mental capacity act 2005 (MCA). Where people lacked capacity and were identified as reluctant to take their medicines, MCA assessments had been completed with the relevant people to agree it was in their best interests for their medicines to be administered covertly (disguised in food or drink).