Oakdene Nursing Home

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• 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

We were not assured people always had the best possible outcomes because their needs were not always holistically assessed and effectively reviewed. People’s care plans had not always consistently guided safe practice. People were not always involved or consulted about the reviews of concerns, accidents, incidents, and adverse events and in planning to prevent similar incidents in the future. We were not assured people always had access to health professionals when needed. Instructions from medical professionals were recorded in people's care plans, although not always effectively communicated to staff. However, staff had training and skills to coordinate care and support for people. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the provider supported this practice. Provider had established systems to ensure that staff were up-to-date with national legislation, evidence-based good practice and required standards. Governance systems and audits were not effective in identifying or addressing areas for improvement identified during inspection. We did not assess all the quality statements within this key question. We did not identify concerns relating to these areas which we judged as being met at our last inspection.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

We received mixed feedback from relatives and people. Relatives told us: “It is recorded in [my loved one] personal file that [they] eat well but [they] have lost a lot of weight and have been prescribed nutritional drinks to boost nutritional intake. A few weeks ago, I had a phone call to say [my loved one] was going to be given a soft diet with less risk of choking as there had been some concern, and I was happy for this to happen” and “[My relative] has said on numerous occasions that [they] get lonely and don’t have anyone to talk to or see anyone. [They] do refuse to come out of [their] room and with dementia I’m not sure how accurate this is, but I do think more time could be spent with [them].”

Kitchen staff told us: “We all had training on modified diet. We ensure that presentation is always good and appetising, so modified food won't be off putting. We use beetroot or spinach natural food dyes, use different shapes. It's important to make modified food attractive looking.” The manager commented: “We introduced therapy dolls and interactive animals which evidently reduced levels of stress and distress within our dementia community.”

We were not assured people received care, treatment and support that was evidence-based and in line with good practice standards. For example, the provider had systems in place to monitor risk of malnutrition for people which were not always effective. Staff were not using screening tool to identify adults, who are malnourished, at risk of malnutrition (undernutrition), or obese correctly, leading to potentially inaccurate care plans and risk assessments. This placed people at increased risk of harm and not having their needs met.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We received mostly positive feedback from people about access to health professionals when needed. One relative told us: “I have had my concerns in the recent past that they do not explain my [loved one’s] condition properly. I like to be informed and have got involved on occasions when I think it hasn’t been handled correctly or my [loved one] needs an appointment. I feel this has already improved with the new managers and I have more confidence.” Others commented: “They will get the doctor if [my loved one] is unwell”, “Staff support [my loved one] with medical referrals” and “Most of the time they would call the doctor in to see [my loved one]. When [they] had to go into hospital for [their] operation, they supplied staff to attend the hospital with [them] as we were away, and I think that was a really nice touch.”

Staff told us: “I enjoy my work a lot as I find helping the residents in their daily lives very fulfilling and a real joy. The residents need to be as active as they are able to be. This helps them to be healthy and happy” and “We introduced display cabinets with freshly baked snacks in the communal areas and dining room. This is to encourage people to eat and keep healthy weight.”

We were not assured provider focused on identifying risks to people’s health and well-being early and providing guidance for staff on how to support people to prevent deterioration. We found a choking incident form for 1 person where first aid intervention in the form of back slaps had been administered by staff. Medical advice had not been sought despite first aid intervention and documentation relating to that incident was inconsistent. The provider later sent information referring to the incident as “coughing not choking”. However, person’s care plan had not been updated to provide clear and concise guidance for staff on risk mitigation. This placed people at increased risk of harm and health deterioration.

We received mixed feedback from people and their relatives. One person told us: “They ask me every day what they can improve on, but I cannot think of anything.” Relatives commented: “I can’t say they have asked for any feedback; I really can’t recall”, “I haven't seen satisfaction survey. They never asked for an official feedback “, “No, they have a little box at the front where we can put down someone’s name for person of the week or month, but not had any one come directly to me for feedback” and “I think training has been lacking in this area. On a couple of occasions, I have provided a list of things my [relative] prefers or things to remind [them]. A list was put on [their] wall but don’t think this is always used and it needs updating. My [relative] can be a bit fickle when sleepy and when things aren’t done the way [they] like, e.g. personal care / timings. I’m expecting this to be addressed when I have the care plan review.”

Staff told us: “The 'wish tree' definitely encourages residents to have their say about activities and community engagement. The activities team really do an incredible job of bringing a smile to the residents faces, there is always something going on.” Management told us: “Feedback from relatives is very important. We have extremely good relationship with relatives. [The manager] is very visible and accessible and all management know residents and their relatives well.”

Formal feedback from people and their relatives had been sought however the results were not always effective and used to make improvement to ensure better outcomes for people. People were not always involved or consulted about the reviews of concerns, accidents, incidents, and adverse events and in planning to prevent similar incidents in the future. We were not assured care plans were always updated to provide clear and concise guidance for staff as to how to support people in times of distress. For example, we reviewed 1 person’s records instructed staff to use distracting techniques and speak to them calmly in times of distress, and other records instructed staff to immediately retreat and find another staff member to try and engage with the person. People's needs were not always effectively monitored, and lessons learned from incidents and accidents reflected within their care plans. For example, risks associated with malnutrition and dehydration were not always clearly reflected in people’s records. Information contained in people's care plans was not always clear and some information was contradictory . For example, we reviewed 1 person’s records which stated they can mobilise independently unaided and other records instructed staff to prompt them using their walking aid at all times. This placed people at risk of not having their needs met.

We did not look at Consent to care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.