The Oaks Residential Care Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

The key question of Responsive was last inspected in September 2019. The rating for the key question of Responsive has improved too Good. People and their relatives were involved in planning and making shared decisions about their care and treatment. Care plans were basic and lacked guidance for staff on how to provide care and support to people. These needed further development to ensure people were at the centre of their care. Managers and staff worked well with other healthcare professionals. Improvements were needed to ensure the communication needs of people with a disability or sensory loss were met, including access to information in a format suited to their needs. Managers and staff were aware of people’s protected characteristics and knew how to tailor their care and support to meet their individual needs. Systems in place to listen, involve people and respond to complaints had improved. However, further action was needed to reflect how the outcome of complaint investigations were used to improve the service. Refurbishment of the premises was in progress. Equipment needed to ensure people’s safety was available and accessible. The registered manager recognised improvements were needed in relation to end of life care documentation. Work was in progress, in conjunction with the hospice to ensure people and their relatives were involved in making important decisions about their end-of-life care.

This service scored 68 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives were confident they were kept up to date about their family members care, including any changes in their health and wellbeing. One relative commented, “We are provided with useful updates, even when we visited the day before.”

The registered manager told us they completed regular audits of care plans to ensure these were up to date and reflective of people’s needs. They provided examples of how they had supported people to access care and treatment which met their personal circumstances, such as attending a beauty salon, which had had a positive impact on their wellbeing. The audits reflected people and their relatives were regularly involved in planning and making shared decisions about their care and treatment. However, the care plans were basic and lacked guidance for staff on how to provide personalised care centred around their specific needs. For example, the registered manager acknowledged care plans needed further development to ensure people were at the centre of their care. They told us plans were in place to review care planning system

Staff were passionate about the service, and the people living there. This came through when observing the interactions between people and staff. However, staff lacked understanding on how to support people, with advanced dementia and limited speech. We observed where these people communicated their needs, emotions, or distress through their behaviour, staff lacked confidence in how to effectively communicate with them.

Feedback from relatives and records confirmed care and treatment overall was delivered in a way which met people’s different health and social care needs. Referrals for healthcare support were made via a single point of access managed by a team of NHS administrators who signposted referrals to the relevant healthcare services.

The registered manager knew people who used the service well and understood their needs in terms of their protected characteristics, such as age, disability, and religious beliefs. They and staff were aware of people’s beliefs and the support they needed to continue being part of their existing religious communities. The registered manager had recently welcomed church services back into the service, enabling those who wished to, the opportunity to attend a church service. Additionally, a person had a church service recorded and streamed live on their tablet.

People’s records showed they received input from various health and social care professionals. Information provided to CQC in the provider information return (PIR) reflected the actions taken to ensure people’s personal, cultural, social, and religious needs were understood and met. However, this highlighted due to increasing demand, availability and provision of services had sometimes been a barrier to people accessing support from external agencies. Long waiting times and access to services such as the SaLT team and OT at times had delayed support for people requiring these services.

The providers service users guide informed people this document and other information about the service, including how to raise concerns was available in alternative formats, to ensure they had access to information in a way they could understand. Details about Southend, Essex, and Thurrock safeguarding board and the ‘right to live in safety, free from abuse and neglect’ was available on the notice board. This provided the details of how to raise safeguarding concerns. However, there was no easy read or large print version available for people to access should they wish to raise concerns, without having to ask for assistance. Pictorial menus, and photographs of meals had been developed to aid people to visually choose what they would like to eat for their daily meals. However, we did not see these being used across both visits to the service, or how people were being offered choices.

Staff who did not speak English as a first language, told us, information and guidance had been translated into their own language to assist them to complete their duties, and help with breaking the language barrier. Staff told us they had also been provided with the opportunity to enroll on an English course at college. The provider told us they had made adjustments for staff, offering additional support to ensure they had access to training and information. They were in process of changing their training provider, moving to a digital learning platform, which had various features such as changing background colours to assist staff who may have dyslexia, and for questions to be presented in an audio form for those who may struggle with reading.

Information relating to people’s needs including how they communicated was collected at pre-assessment stage. However, care plans did not always indicate how staff were to effectively communicate with people. For example, 1 person’s care plan stated, they communicated better when someone ‘is standing close to me’. Although we saw staff doing this, their plan did not mention, most of their communication was non-verbal. Additionally, there was limited information within people's care plans on aids needed to support communication, such as glasses or hearing aids. Hospital passports contained relevant information about people’s needs, including how they communicated, allowing professionals to be aware of their needs and how to provide their care. A COVID -19 outbreak in January 2024 had been escalated appropriately with relevant partners, including agencies, people using the service and visitors. Information was shared with relatives in a newsletter and at the entrance to the service, with a supply of PPE, hand gel and face masks.

People and their relatives told us they knew how to raise concerns if they needed to.

The registered manager told us they had improved systems to ensure people and their relatives were able to provide feedback about their experiences of care and how to raise any concerns. They had implemented a feedback book at the entrance to the home and a suggestion box for staff or visitors to complete anonymously.

Systems and processes to respond to complaints had improved. Seven complaints had been raised in the last 12 months, about poor communication amongst staff. Action had been taken to improve communication, including more regular staff meetings, and ‘culture is key’ training. This training had helped staff understand the importance of good communication. Communication and handover books had also been implemented for to improve information sharing. The Complaints log showed the nature of complaint, impact on people, why things went wrong, what could have been done differently, how to avoid in future, the improvements made, and action taken. However, there was no follow up to reflect if the complainant was satisfied with outcome or if the improvements made had been successful and embedded into practice. This would help ensure improvements were made following complaints

The providers statement of purpose reflected the service is a relatively small care home for older people, including those living with dementia, mental health, physical disability, and sensory impairments. The premises were old and were not specifically designed for people living with dementia, however ramps and handrails were in place to support accessibility for those with physical disabilities. Further work was needed to ensure the service met the needs of people with sensory impairments and those living with dementia. Equipment needed to ensure peoples safety was available and accessible. People were supported to access appropriate care and support services to suit their individual needs. One person told us, “I’m here because I had a fall at home. I am waiting for a knee operation, and I am coming back here after the operation.”

Staff were aware of people’s right to equity in accessing care, treatment, and support. They understood discrimination and inequality could disadvantage different groups of people in accessing care, treatment, and support. Staff were aware of people’s protected characteristics and knew how to tailor their support and make adjustments depending on their individual needs. Staff told us they were expected to read policies and procedures, and received training about equality and diversity, as part of their induction and ongoing training.

The provider had an equality, diversity and inclusion policy setting out how they ensured peoples’ diverse needs and human rights were upheld. This included consideration of the needs of people with different protected characteristics and how to make reasonable adjustments to ensure equity in the care, support, and treatment they received. The policy also set out how the provider ensured the process for recruiting staff was fair and made based on merit and ability. This ensured the service employed a diverse staff team, with the knowledge and skills to meet the needs of the people using the service. Our previous inspections identified concerns about the safety and accessibility of the passenger lift between the ground and first floor. The provider confirmed plans for the replacement of a 6-passenger lift, as part of a refurbishment, which will ensure the premises and facilities will be more accessible

Managers and staff were not always aware of the differences in people’s experiences. For example, the communal lounge, café and dining area was open plan. A person identified as shouting or calling out had been seated in the café area, on their own because other residents complained about the noise. Although people sensitive to noise were offered a quieter area to sit and offered headphones, the impact of too much noise from the television, radio and activities taking place, including singing, all at the same time had not been identified. Further consideration was needed to ensure people with sensory needs and those expressing themselves vocally experience the same opportunities to enjoy socialising in communal areas, as other people.

Staff told us they supported people to maintain important relationships and engage with community activities and services which met their individual needs and preferences. Staff were aware of people’s protected characteristics, and told us, they had completed training about dementia training which included learning about the LGBT community and dementia. This had explored people’s care needs now and, in the future, and the potential implications around their memory and sexual orientation as their dementia progressed.

The providers equality, diversity and inclusion policy contained relevant information for staff to follow, to protect people’s rights to equality and their human rights. The policy guided staff on ensuring equality, diversity and inclusion was embedded into practice. A member of staff was being trained to become an equalities champion to guide staff on best practice and ensure people were supported to express their individuality in line with their protected characteristics.

Relatives told us, people nearing the end of their life received good care. Comments included, “I genuinely think staff are superb. My (family member) has been on end-of-life status for the last 2 years. The dedication and support staff have given to them and to the whole family has been amazing,” and “(Family member) is going on to palliative care tomorrow. I made that decision taking advice from the doctor and manager. It is by far the best decision for (family member). I am going in tomorrow to talk through the palliative care package. I have always found staff and the manager to be extremely good, caring and kind.”

The registered manager recognised improvements were needed in relation to end of life care documentation. They told us they were working with their local hospice, who had developed staff training over 6 sessions which had been built around the needs of service. The training had been developed to support staff to improve their knowledge and skills, in relation to advanced care planning, communication, and having uncomfortable conversations about death and dying. Staff confirmed they were in the process of completing this training. One member of staff commented, “The Hospice have provided new training for end-of-life care and palliative care. It’s good and relevant to The Oaks.”

People’s care planning arrangements and discussions relating to end of life mostly focused on after death care, such as preference of burial/cremation and funeral. People's preferences and choices about care delivery at the end of their life had not always been communicated and clearly recorded. Meaningful conversations with people and their relatives had not always been part of an ongoing assessment to help prepare a plan for the delivery of the persons end-of-life care, including arrangements for rapid access to support to ensure they experienced a dignified and pain free death. The registered manager confirmed work was in progress, in conjunction with the hospice to ensure people and their relatives had enough time to make informed decisions about their future, including important decisions about their end-of-life care.