Oakdene Nursing Home

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We found 2 breaches of the legal regulations in relation to safe care and treatment, governance and management oversight of the service to monitor quality and safety. Improvements were made to the governance systems within the service. However, they were not robust and did not identify shortfalls found during this inspection. Processes were in place to ensure the service operated safely but they were not always effective. We were not assured the service was effectively monitored to ensure continued learning and improvements. Quality assurance systems did not operate effectively to ensure people consistently received good quality care and support. Leaders did not always demonstrate a positive, compassionate, listening culture that promoted trust and understanding. We were not assured leaders took action to continually review and improve the culture of the organisation. Bullying and harassment at all levels and for all staff were not effectively prevented, not always identified or addressed. Processes to engage with and involve staff were not effective. Staff did not always feel empowered and confident that their concerns and ideas resulted in positive change to shape services and create a more equitable and inclusive organisation. We were not assured staff and leaders always engaged with people, communities and partners to share learning with each other that results in continuous improvements to the service. These networks were not always used to identify new or innovative ideas that can lead to better outcomes for people.

This service scored 39 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Comments from staff included: “Everything I tried to do myself or if I highlighted concerns, I was either overruled, told I was being negative and there was no issue or told there were other issues more important so not to deal with the issue until later. This meant I was unable to work as per CQC regulations and general good practice in adult social care” and “I feel sad and frustrated at how things have changed at Oakdene. I believe that the residents are well cared for, as much as is possible but I feel that the company itself is not committed to supporting staff and management who then are trying their utmost to support the residents” and “We were all made to put on big smiles and make a show and dance of it. I am fed up having to constantly make out we all are okay as a team. We are far from that we need proper support not being shouted at by higher above or made to feel like we are worth nothing.”

The provider had a shared vision and strategy based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and communities in order to meet these. However, we cannot be assured that staff in all areas knew, understood and supported the vision, values and strategic goals and how their role helps in achieving them. We were not assured leaders always ensured that the vision, values and strategy have been developed through a structured planning process in collaboration with people who use the service, staff and external partners . Provider’s shared vision and strategy was not actively enshrined within the service.

Support for staff from managers was inconsistent due to a lack of a registered manager at the time of our inspection. We received mixed feedback about the management team. Staff told us: “[Manager’s name] is undermining [staff’s name] in front of us all, reducing some of my colleagues to tears. A lot of the 'faults' actually occurred under [manager’s name] watch. I must also highlight how high the turnover of management staff is at the home. I genuinely do feel like we are an Oakdene team on site, which is really lovely. It's just a shame that [management] aren't as supportive of that” and “The manager [name] is really lovely. [They] genuinely care about the residents and staff. [They] are approachable to all and I am sure whoever you speak to will have nothing but good words to say about [them]. I think there is a lot of unrest with the staff though as they are worried, [they] might resign due to the higher management. [Manager’s name] really do appreciate all of the effort that the staff put into their working day and make a point of thanking people.” Staff told us there was high turnover of managers: “I’ve been through a nearly 10 mangers and [manager’s name] is by far the most supportive, caring and understanding, works extremely hard and wants to truly make a difference” and “In the last 18 months the management staff have changed immensely. This has caused much unsettlement, stress and strain.”

Leaders did not always demonstrate a positive, compassionate, listening culture that promoted trust and understanding between them, and people using the service and one which was focused on learning and improvement. We were not assured all leaders had the skills and credibility to lead effectively with integrity, openness and honesty. We were not assured leaders were alert to any examples of poor culture that may affect the quality of people’s care and had a detrimental impact on staff. Leaders were knowledgeable about issues and priorities for the quality of services. However, they were not always able to access appropriate support and development in their role.

The provider told us: “We take the feedback from all our team members very seriously and encourage our teams to raise any concerns at any point either in person, via an online portal or calling a dedicated whistle-blowing service number. There has only been 1 record for Oakdene over the last 6 months”. Staff commented: “Whenever I voice these issues to my superiors such as [managers’ names], I just get dismissed and the issues get brushed off like this is normal business. I know that [manager’s name] feels just as frustrated as I do about this” and “I used to report abuse in Acorn Lodge, with people who live with dementia because they aren't always able to speak for themselves. In the last three months, I haven't been asked to work in Acorn Lodge 1 single day. At the moment, they choose staff that never will say anything against the managers. If you don't talk about an issue, the issue doesn't exist.”

Provider had whistle-blowing policy in place and procedures for staff to actively raise concerns. We were not assured a positive culture of honesty, transparency and openness where people feel that they can speak up was fully embedded. Staff did not always feel that their voice would be heard and those who did speak up (including external whistle-blowers) would be supported, without fear of detriment. We could not be assured when concerns were raised, they were always investigated thoroughly and confidentially, and lessons were shared with the whole staff team and acted on to prevent the same happening again.

Staff told us they did not always feel empowered and confident that their concerns and ideas result in positive change to shape services and create a more equitable and inclusive organisation. Comments included: “[Manager’ name] was picking on some staff every day, to the point of tears. [They] said [their] door was always open, but no-one wanted to enter!”, “Everything bad that happens in the home, is our fault and we, as staff members, we don't do enough for the residents, and we are not able to do well our job. We feel guilty and we cannot write to CQC. I always try to talk with managers about issues and staff work conditions, but I'm never welcome in the office” and “I love my job but at times the pressure and stress that is placed on people, myself included is not fair. I feel that once you are not liked by [manager’s name] you and everyone else knows about it, as [they] cannot be particularly nice and will put staff down in front of others.”

Provider had policies and procedures supporting diversity and inclusion within the service. We were not assured processes to engage with and involve staff were effective and proactive, with a focus on hearing the voices of staff with protected equality characteristics and those who are excluded or marginalised, or who may be least heard within their service. We were not assured leaders took action to prevent and address bullying and harassment at all levels and for all staff and to continually review and improve the culture of the organisation. We cannot be assured there were effective and proactive ways to engage with and involve staff. Staff did not always feel empowered and confident that their concerns and ideas result in positive change to shape services and create a more equitable and inclusive organisation. Staff were from diverse backgrounds, and everyone was welcomed into the service. Staff told us they would care for anyone if they needed it, regardless of their background. Staff received training in equality and diversity.

Staff understood their role and responsibilities; however, they did not always feel supported and listened to by the managers. Staff comments include: “As per [manager’s name] also, we are fully staffed and could meet the residents’ needs. But it really is a struggle, especially in dementia unit where we have residents with challenging behaviour and it’s too risky to leave them even on a split second. At nighttime there will only be 2 carers” and “I am told there is an ideal ratio of carers to residents. However, residents today are needing much more assistance, especially residents with dementia. In the last couple of years, I find residents with dementia more advanced in their illness. So, the old ratio does not work now – more carers are needed.”

Quality assurance systems were not robust and did not operate effectively in helping to ensure people consistently received good quality care and support. Audits at the provider level had not identified the shortfalls found within the inspection. For example, medication audits were completed by the manager however, the audit had not always identified the concerns found during the inspection relating to the safe management of medicines. Risk associated with potentially flammable topical preparations and anticoagulant medication was not always identified and mitigated. We were not assured there were robust arrangements for the availability, integrity and confidentiality of data, records and data management systems. Requested documentation was not always available at the time of inspection. Some documents were requested and received electronically after our site visit. We found inconsistencies and discrepancies between documents we reviewed during on site visit and documents submitted after. Data or notifications were consistently submitted to external organisations as required.

We received mixed feedback from visiting professionals of people’s experience of living in the home. “There has been a number of different managers and this in return has been noted by my clients and voiced to me by them commenting all the rules change, things don’t happen or they say they will and they don’t, or they can never find staff and that management are always in meetings” and “I've been here the last [number] years, I've seen quite a few ups and downs, new managers come in with expectations of things getting better and leave.” Relatives told us: “I think they contact the GP and make appointment and I will take [my loved one] to the appointment. [They] are not registered with a doctor at the home, and I think they will call me”, “The whole situation of having to deal with my [loved one] illness was very traumatic and I can genuinely say they have been a reassuring and hands on support in this process. They worked hand in hand with my [loved one], the NHS Mental Health Unit and social services making the process clear and well managed. They have been brilliant” and “Yes, there has been advice about whether or not to continue with a hospital appointment made prior to my [loved one] moving into Acorn Lodge.” While the relatives we spoke to expressed that they were generally happy with partnership working at the service, our assessment found the provider did not fully engage with people, communities, and partners to share learning with each other that resulted in continuous improvements to the service and partnership working did not meet the expected standards.

Staff told us they worked closely and collaboratively with other professionals however they felt partnership working was not always enabled and supported by the management. Comments included: “Sometimes I come late to the daily meeting, and I tried explaining to [manager’s name] but [they] get very angry with me. I was very apologetic because I was with the resident, or I was with the paramedics or district nurse visiting the resident. I need to be there in case that they will have findings with their checks on the residents or if they need anything during their visit. I just don’t get it why [manager’s name] get really angry though I am prioritising the resident’s welfare.”

We received mainly negative feedback from professionals. Professionals told us: “My relationship with the care home has been difficult. I was refused to visit a client as I was informed, they did not have enough supporting staff to warrant my visit, which left me feeling intimidated. It can be difficult to speak to anyone on the phone and I have experienced staff tell me they cannot understand me and put me on hold for ages to then be cut off” and “Management appears to not be making sure that paperwork is being recorded and filed correctly. Appears they are not providing adequate leadership on making sure things are carried out the way they should be.”

We were not assured staff and leaders always engaged with people, communities and partners to share learning with each other that results in continuous improvements to the service. These networks were not always used to identify new or innovative ideas that can lead to better outcomes for people.

We received mixed feedback from staff about their involvement in developing and evaluating improvement and innovation initiatives. Comments included: “There are not enough staff to cater to the needs of the residents. We’ve been begging the higher management to support us with more staff, but we don’t think they hear us”, “[Manager’s name] listen to our ideas, [they] allow us to do our jobs with freedom and flexibility within set out job description. It seems that the home runs smoother under [their] leadership. Staff motivation is key” and “I feel very comfortable to speak with [manager’s name] about a problem that may arise and know [they] will listen and help. The atmosphere is happy and settled. Everyone works better together and if a problem arises, all the staff support each other better.”

We were not assured provider established effective processes to ensure that learning happened when things went wrong, and from examples of good practice. We reviewed documents evidencing staff’s involvement in various new initiatives aimed at improving people’s experiences and outcomes for example reducing numbers of falls, setting up gentlemen’s and ladies’ clubs, improving meal times experience, increasing number of outings or development of dementia provision. However, we were not assured staff were consistently encouraged to contribute to improvement initiatives, and the culture of reflective practice and collective problem-solving was fully embedded. Lessons learnt had been identified but not always effectively shared with all staff to prevent re-occurrence. For example, we found no evidence that safeguarding incidents were discussed during team meetings or supervisions meetings with all staff team. However, there was evidence that provider had group lessons learned and reflective discussions which included some staff members. Care plans and risk assessments consisted conflicting information and we were not assured people’s records were always updated to reflect new learning, or ways to mitigate risk and promote safe, person-centred support.