The Oaks

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

At our last inspection In September 2023, we found people were not always safeguarded from abuse and avoidable harm. Risks associated with people's health conditions were not managed effectively. Staff were not always following safe infection, prevention and control practices, and people were not always protected from the risk of infection. People's medicines were also not managed safely. These shortfalls were a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. At this assessment we found enough improvement had been made and the service was no longer in breach of regulation 12. Improvements had been made to the management of risk, medicine, infection control and people were now safeguarded from abuse and avoidable harm. At our last inspection of the service, we found the provider did not ensure there were sufficiently suitably qualified staff on duty at all times. This was a breach of regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. At this assessment, we found enough improvement had been made, and the provider was no longer in breach of regulation 18.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Care plans did not always contain information about people's life stories or their likes and dislikes. This left people at risk of not having their views considered in relation to the support they received. People using the service told us the service was well run. One person said, “I think it is very well run, the manager is always accessible and all trundles along nicely.” A relative told us, “I think it is very good, the manager is nice and approachable, and everything runs on oiled wheels.” People told us there were residents’ meetings, however, some people we spoke with told us they did not always attend. One person said, “There are meetings, but I don’t want to go.” Another person told us, “There are meetings, but I haven’t been.” A relative told us, “I have been to a few meetings, and they were very constructive, I think the improvement in staff numbers is down to our opinions.”

The registered manager demonstrated a clear understanding of their responsibility under the duty of candour. Duty of candour is the providers legal responsibility to be open and honest with people when something goes wrong. They told us they were always open and transparent with family members and professionals and took responsibility when things went wrong. Staff had identified risks to ensure people were safe and understood the importance of reporting and recording accidents and incidents. Records showed that staff took appropriate actions and sought support from health and social care professionals and referred to local authorities and the CQC when required.

Post fall management at the service was not always robust, leaving people at risk of experiencing further falls. The registered manager and deputy manager were undertaking a falls prevention programme. They were going to lead a focused action group including workers and nursing staff to focus on people at high risk of falls. The manager and deputy manager were taking part in a falls prevention programme, with the aim of leading a focus group to improve care in this area. There were good systems in place to oversee learning from safeguarding and accidents and incidents. The registered manager kept a tracking tool on all safeguarding concerns raised, the local authority’s enquiry, the providers own investigations and any outcomes including lessons learnt. Monthly staff meetings were held and any lessons learnt were shared with staff for discussion and actioned. Minutes of meetings were shared with the provider’s board. A member of staff was allocated as the service's 'speak up champion’. A ‘speak up champion’ supports workers to speak up when they feel that they are unable to do so by other routes. They ensure that people who speak up are supported, and that the issues they raise are responded to. The registered manager was the safeguarding lead for the service, and they were knowledgeable about safeguarding, their responsibilities and their duty of candour. Duty of candour is where the provider must act in an open, honest and transparent when things go wrong. There were systems in place to ensure accidents and incidents were recorded, managed, monitored and acted on appropriately. The registered manager reviewed accidents and incidents to identify themes and trends as a way of preventing reoccurrence.

People told us they had access to health care professionals when they needed them. One person told us, “The GP and chiropodist are organised for me.” Another person told us, “If I need to see a health professional, they sort it out.”

The registered manager told us people had access to healthcare services. These services included visiting chiropodists, dentists, and opticians. A GP visited the service on a weekly basis to support people with their medical needs. A staff member told us, “We have a good working relationship with the GP, if we have concerns about people’s health, we contact the practice, and they respond immediately. When the GP visits people we have everything ready for them. The registered manager told us that a tissue viability nurse attended the service and provided training to nursing staff on wound care and a speech and language therapist had trained staff on dysphagia. They also worked closely with local authority dementia teams who provided staff with training on dementia awareness. Where they made referrals to these teams the professional’s had developed care and support plans to meet peoples care needs. The registered manager told us the community mental health team (CMHT) regularly visited people using the service to review their needs. As part of the review the CMHT updated peoples care plans and risk assessments.

The service received GP visits on Mondays to support people with their health care needs. We spoke with the GP; they told us there were no issues with the service. They said, “It’s the most organised home I come to. There is good communication with the nurses. They have a list of patients they want me to see, and they have the records ready when I come. The nurses are competent, they stay on their unit which helps with consistency of care."

Evidence from care records indicated that the service had a good relationship with health and social care professionals. The service had a visiting GP who visited the service weekly which meant people got the support they required quickly. There were regular reviews of people’s health and wellbeing needs where appropriate, including health assessments and checks with health and social care professionals. Health plans were developed on admission to the service ensuring people were registered with a GP practice, dentist and optician. There were appropriate, established processes in place to ensure people's health care needs were met. Care records contained evidence of input from healthcare professionals and in the event of hospital admissions. A hospital pack/care passport was in place and could be downloaded from the providers electronic care planning system for use of hospital staff. Daily clinical management huddle (meetings) were held. These were meetings attended by nursing staff on each and led by the registered manager. The meeting covered issues arising with in the last 24 hours, for example any accidents and incidents, housekeeping, professional’s visits, maintenance, priorities of the day, fluid charts, audits, clinical issues and staff supervision and appraisals.

People using the service told us they felt safe living at the service. One person said, “I feel safe, I trust the staff completely.” A relative told us, “I feel good when I leave here knowing that my loved one is in safe hands.”

The registered manager was very knowledgeable and experienced in managing and overseeing safeguarding concerns. They told us, “I am the safeguarding lead for the service, and I have completed level 4 safeguarding training. My deputy manager has completed level 3 safeguarding training.” A member of staff commented, “The manager is very supportive and really listens to us [staff]. I have been working in care for years and know how to spot and report concerns and wouldn't hesitate. I know the whistleblowing procedure and would definitely use it if I needed to.” A second member of staff said, “Protecting the residents, making sure they are safe in their environment and free from harm, safe from injury. We make sure we always clean up any liquids on the floor to prevent anyone from falling.” A member of staff told us how they support people to make choices and decisions for themselves. They said, “I always listen to people’s choice about how they prefer to receive personal care and would not do anything against their wishes.”

We saw safeguarding and information displayed on notice boards advising staff on what to do if they suspected people were being abused or witnessed poor care practice. However, some staff we spoke to were unsure of the procedure to follow when reporting concerns outside the organisation. This meant people were potentially at risk of delayed support with safeguarding concerns, or of not receiving the required support. We fed this back to the registered manager to action. We observed that staff treated people with respect and dignity.

Some staff we spoke to were unsure of the procedure when reporting concerns found in the service to outside agencies. This meant the risk of delay in supporting people with safeguarding concerns, and put people at the risk of avoidable harm. Staff had received safeguarding training and were aware of their responsibilities to report and respond to concerns to the registered manager. Staff we spoke with understood the different types of abuse and the signs to look for. However, some staff were unsure of the procedure to follow when reporting concerns outside of the organisation. People were supported to stay safe and were safeguarded from abuse and avoidable harm. Safeguarding policies and procedures were in place and up to date with best practice and legislation to help keep people safe. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of liberty Safeguards DoLS) Some people were consulted and supported to make choices and decisions for themselves.

People and their relatives told us they were involved in planning and managing their needs and risks. They told us they felt safe with the support they received from staff. One person told us, “I have real confidence in the staff.” A relative told us, “My loved one needs two staff to hoist them. I know my loved one is not nervous about the transfer at all.”

We spoke with the registered manager on improvements that had been made to how the service managed risk to people and in specific managed the risk of falls. They told us that they were working to further develop the services falls prevention system and said, “Myself and the deputy are undertaking a falls prevention training programme from which we are going to review our current tools and lead a focused action group which includes nursing and carer staff. This will focus on people that are at high-risk of falls. It will ensure we work in a more person-centred way, detailing people’s progress and we will implement a falls reduction plan.” We will check on this implementation at our next assessment of the service.

We saw positive and caring interactions between people and staff. Staff spent time with people providing support and showing care and concern for their well-being.

Risks to people were identified, assessed, documented, and reviewed to ensure their safety and well-being. Risk assessments identified potential areas of risk to individuals, providing guidance for staff on the risks and how best to support people to manage them. Risk assessments were reviewed on a regular basis to ensure staff had up to date information about the action and support they needed to provide to keep people safe. Risk assessments were tailored to individuals and detailed ways in which people could live independently as much as possible whilst being as safe as reasonably possible. Risks to people’s safety was managed well and staff knew how to support people to manage their identified risks including known medical conditions, disabilities or chronic health conditions. Risk management plans were in place to support staff in the prevention of and to minimise the likelihood of people being harmed. Risk plans covered a varied aspects of people’s lives including, mobility and their risk of falls, skin integrity and diet and nutrition needs. For example, we saw that when people were at risk of weight loss they were weighed more frequently, had their intake of foods and fluids monitored and referrals and requests to health care professionals were made such as contact with the GP and community dietitians. Although improvements in managing risks to people had improved vastly since our last assessment of the service, further improvements were still required to ensure people at risk of falls were kept safe from avoidable harm.

The design of the premises was meeting people's needs. The service had adapted bathrooms, dining rooms, quiet areas with suitable furniture to support people with limited mobility.

The registered manager told us there were plans in place to refurbish the service. Two units were undergoing refurbishment. The service improvement plan for June 2024 recorded that en-suites bathrooms on these units were to be refurbished. Work was under way with feature colours for bedrooms and corridors to help with sign posting and aid people with orientation. There were also plans to enhance the secure garden with an artificial grassed area. A member of the service's maintenance team told us they kept on top of all the maintenance issues that were reported to them by residents and staff. The registered manager told us they had been working with the local authority dementia action co-ordinator to provide a dementia-inclusive environment for people living with dementia using the service. There were plans in place for people’s rooms to be redesigned according to their needs. Dementia friendly signage, pictures and sensory areas would be located within the service where needed. Regular residents and relatives’ meetings were held. Issues discussed at the May 2024 meeting included refurbishment at the service building and the garden.

We observed staff used personal protective equipment (PPE) appropriately and safely. PPE such as facemasks, aprons and gloves were readily available to staff. The service appeared clean and tidy with no malodours noted and housekeeping staff followed cleaning schedules to ensure all areas within the service were regularly cleaned. We saw evidence of cleaning rotas and regular cleaning audits to ensure the environment was maintained and safe. Information was easily accessible and displayed on arrival to ensure compliance with infection prevention control.

The service's maintenance log recorded recent and completed jobs. The maintenance team member showed us in date servicing certificates for the service's fire alarm system, portable appliances, gas safety and legionella testing. They showed us fire risk assessments. They also showed us checks and audits carried out on the call bell system and handsets, water temperature checks, fire drills and the fire alarm system. There were no restrictions on visitors, and we observed relatives and people visiting the service freely throughout our assessment.

Some people told us there they thought the home was short of staff sometimes, and they would support their relatives with care. One person said, "Mostly there is enough staff, but they do seem a bit short sometimes, and I do what I can to help my loved one." People and their their relatives told us there were enough staff to meet their needs. One person told us, “They have improved the staffing, and it is much better now.” A relative told us, “There seems to be staff about all the time.” People and their relatives told us they had confidence in the staff. One person told us, “I have real confidence in the staff.” A relative told us, “My loved one needs two staff to hoist them. I know my loved one is not nervous about the transfer at all.” Another relative told us, “I don’t know about their training, but the staff always look as if they know what they are doing.”

The registered manager told us that all new staff completed an induction in line with the Care Certificate. The Care Certificate is an agreed set of standards that define the knowledge, skills and behaviours expected of specific job roles in the health and social care sectors. It is made up of the 15 minimum standards that should form part of a robust induction programme. A member of bank staff that was not up to date with their training was not permitted to work until their training was completed. A staff member told us, “The registered manager has made a big difference, given us what we need to do our job properly. We get lots of training.” Another staff member commented, “I recently had training on manual handling; dementia; skin care and pressure areas; health and safety; food hygiene and safeguarding.” Staff told us they received regular supervision. A staff member said, “We have 2 types of supervision – one type to discuss if somethings not done. The other supervision is formal and takes place every 3 months. I just had one last month.” Staff had received training on dementia awareness. The registered manager told us that staff and some relatives had attended a session on a virtual dementia experience bus. They received positive feedback from staff who said it helped them better to relate to people living with dementia. The registered manager told us staffing levels were arranged according to the needs of the people using the service. They used a dependency tool to assess people’s care needs. They told us they were finding difficulty in recruiting activities coordinators for the home. They were in the process of recruiting to these posts. A staff member had been taken off reception to cover activities. The registered manager told us there was 1 nurse and no care staff vacancies. They were currently overstaffed with a view to making sure there was enough staff when new people were admitted into the service.

We saw there were enough skilled and experienced staff deployed throughout the service to ensure people's health and personal care needs were promptly met when required. However, some relatives did not think there were always enough staff to meet peoples needs timely, with 1 relative telling us they would help out with the care of their loved one sometimes because of this.

We saw the provider's training matrix. This confirmed that staff had completed training the provider considered mandatory. This included training in areas such as food hygiene, oral health awareness, infection control, dementia awareness, moving and handling, fire safety, Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Nursing staff had completed training on basic life support, epilepsy, wound care, medicines management and mental health. Training had been arranged for nursing staff to attend in July 2024 in areas such as diabetes, dysphagia and Parkinson’s disease. Robust recruitment procedures were in place. Recruitment records included completed application forms, employment references, health declarations, proof of identification and evidence that a Disclosure and Barring Service (DBS) check had been carried out. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. Records relating to nursing staff were maintained and included their up-to-date PIN number which confirmed their professional registration with the Nursing and Midwifery Council (NMC). We saw agency staff profiles that included the staff members training qualifications, experience, NMC pin number and DBS evidence.

People told us staff wore Personal Protective Equipment (PPE) such as masks, gloves, and aprons when they were provided with personal care.

The deputy manager had been delegated as the infection control lead for the service. They regularly attended local authority infection control forums where they learned about latest infection prevention information and implement what they had learned. They told us part of their role was to observe that staff carried out proper infection control practice. For example, they assessed and taught staff handwashing procedures and the donning and doffing of PPE.

We observed staff wearing personal protective equipment (PPE) appropriate to the tasks they were completing. For example, staff wore face masks, gloves and aprons whilst providing people with personal care. We observed that the home was clean and hygienic throughout.

We saw evidence to confirm regular monthly infection control audits were carried out at the service. The deputy manager demonstrated that staff's competency on infection control was assessed and recorded. People were protected from the risk of infection and procedures were in place to control and prevent the spread of infections. Staff completed training and were knowledgeable about good infection, prevention and control of infections. Staff had received training from a local Health Protection Team and the service had an infection control lead. The service appeared clean and tidy with no malodours noted and housekeeping staff followed cleaning schedules to ensure all areas within the home were regularly cleaned. We were assured that the provider's infection prevention and control policy was up to date and reflective of current best practice guidance.

People received support to take their medicines safely. One person told us, “The staff help me with my medicines, they are given to me at the same time every day.” Another person said, “There are never any problems with my medicines. Same time every day so all good.” However, at the assessment we saw staff were not always following the manufacturer's instruction in relation to the application and management of skin patches, putting people at risk of avoidable harm. The needs of people were assessed and recorded effectively. This included mental capacity assessments and best interest decisions. People’s care plans contained information that was person centred and included emotional support plans for when people were distressed and anxious. People had regular access to health care professionals including their GP.

Staff told us they received regular medicines training. New staff completed an induction which included shadowing experienced staff. Staff had also received psychological intervention training to support people who were anxious or distressed. Staff received regular competency assessments. Where errors occurred, staff felt supported, and lessons learned were shared.

Records showed staff were not always following manufacture instructions when applying skin patches by ensuring they were rotated when being replaced on people. This left people at risk of skin thinning in certain areas if patches were repeatedly placed in the same location. This was not picked up in the regular medicines audits. There were processes in place to support safe and effective management of medicines however, there were still some areas needing improvement. Staff were not always following the correct process for supplying people with medicines when they left the service during the day. Medicines were ordered and stored safely. Where medicines incidents and errors had occurred, these were investigated in line with the policy and learning was shared. However, the processes to monitor the management of medicines did not identify the concerns found at the assessment in relation to staff not always following the correct process for supplying people with medicines when they left the service for the day. Also with the lack of rotation of skin patches, putting people at risk of skin thinning.