Oakhurst Lodge

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

People’s needs were assessed, and care and support were delivered in line with current standards to achieve effective outcomes. Assessments recorded people’s likes, dislikes, choices, and preferred communication methods. People benefited from a multi-disciplinary team who worked in the home each week. Staff worked well together, and with professionals both internally and externally to the home which benefited the people they were supporting. People’s rights for seeking their consent and respecting their choices were upheld. People were supported to access health care services as they needed and had annual health checks. There were hospital passports and health action plans in place to assist external healthcare professionals to understand people’s needs. Positive behaviour support plans were in place to guide staff on how to respond should people display distressed behaviours. Staff knew people well and this helped to ensure they were able to anticipate their needs and seek appropriate support or guidance.

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.

All relatives spoken to, confirmed people’s plans had been shared with them. 1 relative told us, "We had the review yesterday. It was very thorough, and all staff showed good knowledge of our relative with their key worker having a particular understanding of them. They understand what causes our relative anxiety and they all work together.” Another relative told us, “If staff know our relative and how to interact with them it works. Staff have supported our relative to go bowling and trampolining. We are pleased to know they are encouraging our relative with more activities.” Another relative told us, new staff are slowly introduced to their relative until their relative is confident enough to allow the new staff to support them.

The staff members confirmed assessments were up to date, described people’s communication needs and they had the time to read them. 1 staff member told us, “I have sufficient time to read the care plans, often when the people are settled and when they are sleeping, is a good time to look at the care plans and read them.” Another staff member told us, “You always have to read the assessments when they are reviewed or they are updated say from the GP attending, immediately all staff will receive a circular to access the care plan to read what has been added or removed.” The registered manager gave us a comprehensive response detailing how assessments were carried out, this included using an MDT approach. They told us care plans and risk assessments were devised with input from psychiatrists and Occupational therapists. When asked, how do you ensure that people’s assessments were comprehensive, inclusive, and described how people’s cultural needs or protected characteristics should be met, the registered manager told us, “This is asked within the assessment document, we would be gathering any information related to people’s protected characteristics from the start.”

We reviewed 3 people’s files. The files reflected people’s preferences and choices throughout. We reviewed evidence of people’s likes and dislikes. The registered manager told us, people’s choices, and preferences were observed and documented daily to inform the care plans and ensure people had choice and control over their lives. We reviewed systems in place for updating care plans. We reviewed the MDT’s notes which detailed the support they were giving to people and their staff team to improve outcomes for the people. They then updated plans to reflect this. There was a keyworker system within the home which was working well for people. The keyworkers were also responsible for sending a weekly update to relatives; sharing key information on how their relative’s week had been and what they had participated in. Feedback we received from relatives told us this was well received. People’s needs were assessed using an MDT approach and detailed information about people’s protected characteristics was documented. The keyworker system in place was working effectively. Staff had read care plans and had the opportunity to comment on them, they received updates relating to changes in care plans. We were assured people, and their relatives were involved in assessing their needs.

We were unable to gain evidence from people relating to whether they enjoyed the food, were involved in decisions about the menu or if their cultural needs in relation to their diet were met. We did find evidence of this elsewhere and were assured people enjoyed the food and were involved in the menu planning process which included a weekly meal from an alternative culture which was researched, and a meal devised. When asked if the home supported people to stay healthy and access their GP, a relative told us, “If my relative is ill, the staff contact the doctor and tell us straight away. My relative has had health checks and eye tests, all that is up to date, which is so important when they are unable to tell us exactly how they feel.”

Staff we spoke to, told us training was in place to ensure they were following best practise guidance. Staff told us, they record in people’s daily notes what people had been eating and drinking throughout the day. When asked about people’s specific dietary needs, 1 staff member told us, “We support a resident who is allergic to certain food types, there are guidelines around this. For example, what alternative options should be offered, which is recorded in their care plan.” When asked, how do you ensure that you were keeping up to date with best practice and evidence-based care, the registered manager told us, “Patient safety alerts come through externally and internally. I receive datex safety alerts which is our internal incident forms. Some notifications / newsletters from CQC for updates.” When asked about innovative practise, the registered manager gave us 2 examples of this. 1 example was around a new communication system which had been implemented with a person and was so effective it needed to be added to. Although 2 staff members told us they had not been encouraged to do any research about conditions affecting people, training records evidenced staff had completed training in learning disabilities, autism and Makaton which related to the people they are supporting, therefore we were assured staff were encouraged to learn about conditions affecting people. We were assured staff were completing the appropriate recording documents which could be reviewed to ensure people maintained healthy lives.

The provider had an on-site MDT which included a Speech and language therapist (SALT), Clinical Psychologist, Assistant Psychologist and Occupational Therapist. The MDT also included a Psychiatrist who worked off site. They were required to keep themselves up to date with current legislation and national guidance. There was also support from an advocate. The registered manager told us they received the appropriate patient safety alerts and guidance from the government, their local authorities and CQC. They also belonged to the registered managers’ network. We were assured leaders were keeping up to date with best practise and evidenced-based care. We could see evidence in team meetings and in the ‘must read’ folder of information being shared with staff which ensured they remained up to date with current guidelines. The registered manager was passionate about the service and the people living there and shared areas of innovation with us. We did not have any concerns during the inspection about people’s nutrition and hydration. We were assured the provider’s systems ensured staff were up to date with national legislation, evidence-based good practice and required standards. People’s nutrition and hydration needs were met in line with current guidance. Staff and leaders were encouraged to learn about new and innovative approaches to improve the way their service delivers care. Therefore, we were assured people received care, treatment and support that was evidence-based and in line with good practice standards.

We were unable to gain feedback from people relating to a person transitioning into the home.

We spoke with staff members who told us they felt they were provided with adequate information prior to a person moving in. For example, 1 staff member told us, “Prior to the newest resident moving into the house, the managers went out to where they previously lived several times, to understand what care was needed, the resident also visited the home and was introduced to things like the sensory room which they loved.” When asked, if they receive adequate training, support and competency checks from healthcare professionals with performing more complex clinical tasks, staff told us, they do support people with epilepsy, and they were trained in epilepsy and the administration of rescue medicines. The registered manager was able to describe to us the importance of working effectively across teams, the registered manager told us, “We work effectively across teams to ensure information is shared. When a person is assessed, it is important for us to know the person and their needs prior to them moving into the home. We can then make sure we have input from the right professionals for example SALT and psychology, to ensure we are able to meet the person’s needs and the staff team are given any additional training they may need to support the person. If a person moves out of the home, it is important we share the information we have about the person with the new home to ensure they have all the information to help support a smooth transition for the person. We work effectively across to teams to ensure information is shared.”

We spoke with 3 professionals. When asked if the service worked effectively to provide co-ordinated care, 2 professionals confirmed they did. 1 professional told us, “I will be provided information about a person as the team receive it once an agreement has been made for someone to move in. I will work closely with the Oakhurst team to ensure the transition is as person-centred as possible. The Oakhurst team will work closely with all parties connected to the person, gathering as much information as possible and striving to ensure continuity of support and care.” However, another professional told us, information gathering could be better. When asked if the service works well with other health professionals to support people with complex needs, 1 professional told us, “The Oakhurst team is made up of multi-discipline professionals and effectively collaborates between themselves and with external agencies to provide a holistic support network. The staff team understand when and how to refer to allied professionals and worked effectively with them.” Although the feedback received was mixed, from assessing all the evidence we have reviewed, we were assured the service worked effectively to provide co-ordinated care and works well with other health care professionals to support people with complex health needs.

The registered manager told us, the approach to admissions was an MDT approach. A member of the on-site MDT will support the registered manager to carry out an initial assessment. We reviewed the assessment documentation which confirmed this. We received feedback from an advocate who worked closely with the home, and they detailed their input in this process. The registered manager understood the importance of effectively working across teams and services to support people. Staff were provided with adequate information and the relevant training when new people move into the home. Therefore, we were assured the provider had a collaborative approach to ensure staff teams and services worked together to provide the best outcomes for people.

Most of the relatives we spoke to, told us they felt the staff understood their relative’s health needs. 1 relative told us about a health concern which they were told was due to anxiety, they told us their relative now felt safe, they were more relaxed, and the health concern had therefore become resolved. Another relative told us, “My relative gets to see the doctor if they need it, all is ok there.” When asked if staff recognised when people were in a low mood, we received feed back from relatives describing to us, staff did know when their relative was in a low mood and the actions the staff took to support their relative during this time.

The staff members we spoke to were able to give us examples of when they worked with a range of different healthcare professionals to meet people’s needs. 1 staff member told us, “Psychologists will help with positive support plans. Occupational Therapists help with sensory aspects of the residents, SALT nurse is involved with the eating plans for the residents.” All members of staff spoken to, told us they felt suitably skilled to recognise and respond to changes in a person’s mood or mental well-being. They told us they would look for verbal and non-verbal cues, also at the people’s level of engagement. They told us, what they would do to support the person through this and who they would report concerns to. The registered manager also told us how they share information about people’s changing healthcare needs effectively with other agencies. The registered manager was able to confidently describe how they support people to live healthier lives which included, exercise, diet and managing health conditions. The registered manager was able to give us 3 examples of how people had been involved in decisions about their health and well-being. This included discussing healthy snack choices for a person and giving another person the opportunity to spend time out in open spaces. The registered manager told us, their staff team knew people well and will pick up any health deterioration and report it. They gave us an example of this. When asked how you ensure healthcare advice was followed by staff, the registered manager told us, “We have a 72-hour monitoring form which staff have to follow and document. Teams would communicate on the handover form and daily feedback form from seniors and team managers to each other. We can review these and see what has happened over the month.”

We reviewed 3 people’s healthcare records. We noted people were supported to attend GP appointments, dental appointments and to have their vision checked. Health action plans and hospital passports contained the relevant information and had been recently reviewed. We reviewed Malnutrition Universal Screening Tool (MUST) screening and Disability Distress Assessment Tool (Dis Dat) had been completed. We reviewed Oral and Nail and Foot screening tools. There were also seizure and weight recording charts in place for the people who required these. Through reviewing information, observations and talking to staff and the registered manager, we could see evidence of the MDT’s involvement with the people living in the home. We observed the benefits to people and the staff team supporting them of having this additional support on-site. We reviewed reports which detailed the sessions MDT staff had with people to help them learn new skills and manage their anxieties more effectively. There was continued evidence throughout our assessment of joint working with MDT members including with external MDT members. Feedback from external MDT was mostly positive. Therefore, we were assured people were supported to live healthier lives by a staff team who knew them well. People benefited greatly by having an on-site MDT of professionals who knew them well, who built positive relationships with them so they could support them with all relevant aspects of their care, which included involving them and seeking their preferences. We were assured most relatives felt staff knew their relatives well and confirmed they received the appropriate medical support when needed, the staff team supported people to have the relevant health checks and the registered manager had good oversight of this. The health documentation we reviewed was all in date.

We spoke to relatives about this, 1 relative told us, “My relative did not want to go out previously. But the staff give them choice and support, and they will now go out to the shop. They worked together towards this, and we are very happy they are doing this.”

We spoke to staff members. When asked about monitoring for people, 1 staff member told us, “We monitor, food and fluid intake, residents have recording charts in their care plans. Any concerns I would raise with the manager, for example, swallowing, coughing or any worry about choking, MDT will come and speak with you, and they will want to observe and do what is necessary to help.” When asked to provide examples of any people they support who they think have improved since you started providing support, the staff members gave us several examples, 1 staff member told us, “There has been a big change for some of the residents, they are using more verbal words and some people are going out who never went out and they are smiling. Their parents are happy.” The registered manager gave us a comprehensive list of how they monitor people’s care and support, which included, daily notes, spot checks, spot checks by the MDT and incident analysis reviews. When asked, have you got any success stories of how you have improved outcomes for people, the registered manager described in detail the moving of bedrooms for a person who was having some challenges, following the move, observations took place, then a review and the challenges for this person had now stopped.

We reviewed the provider's most recent compliance audit which took place over 2 days. The audit included looking at people’s care files and health files. Reviewing staff files, incidents, safeguarding concerns and Health and Safety (H&S). There were 22 actions identified in this audit and there was an action plan for completion. During our assessment we reviewed evidence most of these actions had been completed. The provider shared with us they celebrated with the staff teams when an internal audit came back as compliant in all 5 key questions. We were assured people experienced positive outcomes and the staff members, registered manager and the provider were monitoring and improving outcomes for people.

When asked, relatives were not sure or didn’t know if staff asked their relatives for consent. We were unable to gain this information from people themselves, however, from reviewing information and observations carried out by CQC we were assured staff gained people’s consent before providing care and treatment.

All staff members spoken to, were able to articulate how they sought consent, these included, not using long sentences but using simple words and trying different approaches with different people. All staff told us they had Mental capacity act (MCA) training, and all staff could describe how this was relevant to their role. We spoke to the registered manager about consent to care and treatment. The registered manager was able to describe to us how they ensured people were supported to make decisions about their care and have involvement in their care plans. This included documenting people’s preferences and dislikes as they become known, completing MCAs, and seeking information from friends and family members who knew the person well. The registered manager had good knowledge of the MCA and when to undertake assessments. They also understood the importance of holding best interest meetings where needed, following an MCA assessment. When asked, how do you demonstrate you are acting in the best interests of people lacking capacity to consent to aspects of their care and support. The registered manager told us, “We hold best interest meetings, after MCA’s have been completed. We get the relevant people involved, we look at past and present choices made, I will go through the daily notes, we will also revisit the decision if we think something has changed and we update the preferences.

We reviewed 3 people’s files. The files reflected people’s preferences and choices throughout. We reviewed evidence of people’s likes and dislikes. The registered manager told us, people’s choices and preferences were observed and documented daily to inform their care plans and ensure people have choice and control over their lives. We reviewed MCA and Best Interest meetings for all 3 people. We reviewed MCA relating to the use of closed circuit television (CCTV). The assessment detailed how the team had approached the topic with the person, which included 2 attempts and the use of easy read information. When it was assessed, the person did not have capacity, a best interest meeting was held which included the persons relatives and an advocate. Staff understood and put in practise gaining consent to care and treatment from people. The registered manager had a good understanding of MCA and was ensuring gaining consent to care and treatment was embedded in the staff teams work ethos. Therefore, we were assured the provider was following the correct procedures in relation to consent to care and treatment.