Oaklands Court Nursing 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

People felt safe with staff who knew them well and understood the risks to their health and safety. There were enough staff deployed in the service to meet people’s needs. Staff had been recruited safely, although a volunteer needed a CRB and this was undertaken. Agency staff did not have suitable records in place, and this was rectified immediately. An accurate record for registered nurses continued registration with NMC was not up to date and was re checked and updated immediately. Staff training had fallen behind and was being re-established along with regular supervision for all staff. This was reflected within the service’s improvement plan. The management of medicines was safe, and we observed good infection control practice was being followed. Records relating to safety checks and routine maintenance were not clear and did not demonstrate effective systems were in place. Information on accident incidents safeguarding and complaints did not feed into a learning strategy to improve outcomes and learning across the service and organisation. Transitions in care pathways were managed well and staff worked effectively with other health professionals and services to optimise support for people.

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.

People and their relatives were comfortable to raise any issues directly with staff and managers and any concern was resolved quickly. One person said’ I love it here; everyone is so friendly and there is usually someone around you can go to ask for something. No need to complain.’ There were regular resident’s meetings to formalise any feedback. One person told us ‘They do have residents’ meetings which I have attended, and they do listen to you.’

Staff told us they had the opportunity to attend regular training and to develop further areas of expertise or areas of interest. Staff worked within a team with differing levels of responsibility and a strong team spirit was evident. Less experienced staff worked with senior staff with an emphasis on learning and development.

Records showed that accidents and events were recorded. There were also records to support learning was shared within group meetings. For example, following a safeguarding investigation improvement to moving and handling practice was agreed. However, records were not always full and complete and did not always feed into a learning strategy. The service’s own improvement plan was updated and now includes improvements to this area. Throughout the assessment process the management team were open to any feedback and implemented a number of improvements immediately. This demonstrated a commitment to a learning culture.

People told us the transition into the service was smooth and well managed. One person said, ‘I came in here for a trial and stayed a month, it was like being in a hotel but have now decided to stay here for good. I have been here two weeks now.’

Any possible admission to the service is fully assessed by a senior registered nurse and usually by the deputy manager to ensure an appropriate and planned admission. This takes account of people’s individual needs, and any specialised equipment and nursing required.

Referrals were made to specialists when further expertise and advice was needed. Staff were able to give us examples of individuals and the specialist teams they used such as the SALT team. Staff spoke about the excellent relationship with the hospice team who were readily available to support.

Any possible admission to the service is fully assessed by a senior registered nurse and usually by the deputy manager to ensure an appropriate and planned admission. This takes account of people’s individual needs, and any specialised equipment and nursing required.

People told us they felt safe. One said, ‘I am very comfortable here, I feel safe, and the staff are so lovely. Having the staff around makes me feel safe, that they are caring and having the call bell.’ People were relaxed and comfortable in the company of staff. It was clear from our observations staff knew people well, and there was a cheerful and friendly atmosphere in the home.

Staff had received training on safeguarding and understood they needed to respond quickly if any safeguarding concern was raised. Staff were confident with internal reporting systems and senior staff took appropriate action when safeguarding concerns were identified. The management team worked with the local authority to safeguard people and respond to any concern quickly and effectively.

People were relaxed and comfortable in the company of staff. They sought out staff to talk to and we spend time with.

Staff had information on safeguarding and the referral system to use if needed. Records on safeguarding were held but did not clearly record the lessons learnt. However, the most recent safeguarding investigation did result in changes to practice to ensure moving practice followed by staff was reviewed and improved.

People and their relatives told us they were involved in how any risks and care was managed. One person told us, ‘They have also told me not to go to the toilet on my own because of the risk of falls, but I do!’ A relative said, ‘Crucially they work with us and are very honest’.

Staff told us how they had completed specific risk assessments and described the assessment for one person to support the use of an electric mobility scooter.

Risks associated with people’s reduced mobility were also fully assessed and responded to. Moving and handling assessments were completed, and people were moved with appropriate equipment when needed. We observed staff supporting people to move safely.

People’s risks were fully assessed and responded to. Those associated with health and well-being were routinely assessed and reviewed. For example, everyone had a nutritional assessment completed. This ensured any possible risks was identified quickly and promoted people’s health. Records supporting on going monitoring were seen in people’s rooms. For risks associated with eating we saw suitable measures were in place to reduce these risks. People had been referred to a SALT and modified and textured foods were provided along with eating utensils to aide safe eating.

People told us they felt safe in the environment. One person said, ‘I am very comfortable here, I feel safe, and the staff are so lovely. Having the staff around makes me feel safe and having the call bell’. Another commented on the availability of maintenance. ‘There are two chaps here who do maintenance, and they are very good too, all part of the team. They always come and say hello’.

Staff told us anything needing attention in the service was dealt with quickly and there was an easy way to report any maintenance or safety issue to the maintenance team. Regular environmental safety checks were completed by staff. For example, safety checks on bed rails.

The maintenance team ensured the service was well decorated and maintenance issues raised were responded to quickly. An annual fire risk assessment was completed, and all fire equipment and services were maintained. Each person had a Personal Emergency Evacuation Plan (PEEP) to support safe evacuation if needed. An emergency evacuation bag with relevant information and equipment was available in the front entrance area of the service.

Schedules to ensure all safety checks and all required servicing and maintenance were in place. However, records were not complete and did not demonstrate these schedules were followed and completed in a systematic way. This was raised with the operations director as the provider could not be assured all checks were completed. They were able to source some further certificates from the servicing companies, but agreed further checking and monitoring including an external audit was to be progressed to ensure robust systems were followed all the time.

People and relatives said there were enough staff with appropriate skills to meet people’s health and support needs. One person said, ‘I feel safe here. There is always someone around, you are never on your own and at least one person at night. I have used my call bell they came quickly.’ A relative reflected on the staffing and said, ‘I would recommend it here to anybody. I am here every day, usually twice a day. Everyone here is so approachable, some regular agency staff but we are starting to get to know them too.’

Staff told us there were enough staff to support people in a safe way. One said, ‘There are enough staff, and we can get extra staffing. We use agency if we need to. There are always 2 registered nurses working sometimes 3 during the day supported by team leaders.’ Another said, ‘Yes, we have enough staff and regular agency staff are used. We can attend to the call bells quickly, there was a time when it was more difficult to get round to them.’ The duty rota seen confirmed staffing numbers were maintained and included a skill mix to meet people’s individual support and nursing needs. Staff talked about the staff team working together and supporting each other. One said, ‘It’s a very caring home, it feels like a home, we all care for each other. Care staff are brilliant some have been here a number of years.’ Another said, ‘There’s a homely feel with the staff and a good team spirit. I have been supported through a difficult time that meant I reduced my working hours.’ Staff told us there was plenty of training and this supported them in their roles. The registered nurses told us how their clinical skills were maintained. ‘We have lots of training I have recently had training on the use of a syringe driver and tissue viability.’ Staff training and supervision records indicated that both these had fallen behind planned schedules. The managements team were aware and were addressing this shortfall which had been included within the service’s own improvement plan.

People’s needs were attended to in a timely way. Staff had time to interact and chat with people.

The recruitment process followed ensured safe recruitment practice. Appropriate checks were completed and included, references, Disclosure and Barring Service (DBS) checks and employment histories. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. However, we found not all volunteers working in the service had a DBS and agency staff deployed did not have records to support appropriate skills and checks had been completed. These matters were raised with the management team and were addressed immediately. An accurate record for registered nurses continued registration with NMC was not up to date and again was reviewed and updated immediately.

People and relatives were positive in feedback about cleanliness of the service and their individual rooms. One said, ‘My room is usually cleaned every day’. Rooms were attractive clean and tidy. People were able to have their own personal possessions, and these were looked after by staff. For example, plants and flowers brought in as gifts were watered and arranged.

Staff received training on infection control with cleaning staff having specific training that included the use of cleaning substances. Practice observed confirmed staff followed good infection control procedures. For example, red bags were used in the laundry room to separate laundry that was contaminated. There was liquid soap and paper towels at hand washing areas and additional hand sanitizers throughout the service.

The standard of cleanliness around the service was high and staff followed good infection control practice. There was a team of housekeepers working in the service and a senior housekeeper organised the team and reviewed cleaning standards and schedules. The housekeeping staff were committed to keeping the service and the laundry well managed. A recent equipment failure had resulted in staff having to deal with a back log in laundry. Staff had worked hard to respond and maintain good infection control practice.

Infection control audits were completed and reviewed practice, equipment and standards of cleanliness. For example, a hand hygiene assessment was completed along with a check on the storage of cleaning substances. There was a good supply of PPE (Personal Protective Equipment), and staff were seen to use this when needed.

People received their prescribed medicines as and when they needed them. One person said’ I have used my call bell when I had a pain in my back. They came quickly and got me painkillers.’ A relative told us, ‘The only medication he is on is for arthritis, painkillers which he just has as needed.’

The registered nurses managed the medicines and told us they completed on-going training and competency assessments to support their practice. There was a designated nurse that organised medicines and said, ‘We have plenty of training and recently had an update on the use of the syringe driver for end-of-life medicines.’ They described the processes in place to administer medicines safely. For example, how as required (PRN) medicines were managed which included following individual guidelines and ensuring accurate records of what was given when why and its effectiveness. We observed a registered nurse administering medicines safely and adhering to best practice guidelines. For example, the medicines trolley was used to dispense medicines individually. They asked the person first if they were ready for their medicines and waited for the person to take it before completing the medication administration records (MAR).

Storage arrangements for medicines were well managed. This included stock control and ensuring medicines were stored at the correct temperatures and in the correct cabinets. Medicine audits were completed to identify any concern, and the nurses worked with the local pharmacy advisors to support the best use of medicines and outcomes for people.