About the service:

Oak Lodge Care Home is a nursing home which is able to provide care and accommodation to up to 47 people. The home specialises in providing care to older people. At the time of the inspection there were 26 people living at the home.

People’s experience of using this service:

The provider had made improvements to ensure people lived in a home which met legal requirements. They had an action plan in place to further develop and improve the service. People, staff and visitors were positive about improvements made.

People benefited from a new management team who were committed to providing person centred care and continually seeking people’s views on the care they received. One visitor said, “Since [manager’s name] has been here there has been change. They are trying to make the home meet the residents needs rather than residents meet the home’s needs. It is a complete new state of affairs, putting residents first.”

People’s needs were assessed and care plans were in place. However, the care plans did not always give clear information about people’s wishes and preferred routines. This meant there was not always clear guidance for staff to make sure people received care and support in accordance with their wishes and preferences. The provider was working to address this.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were cared for by adequate numbers of appropriately trained staff to ensure their safety. People felt safe at the home and with the staff who supported them. One person said, “I haven’t had any reason not to feel safe.” A visiting relative said, “Quite happy, I’ve never worried about safety, those girls [staff] are marvellous.”

People were cared for by staff who were kind and patient. Staff helped people to maintain and develop relationships and friendships and visitors were always made welcome.

People’s well-being was monitored by staff and trained nurses ensured people’s healthcare needs were met. Where people required specialist care, referrals were made to appropriate professionals outside the home.

There were some organised activities but a number of people felt this was an area which could be improved. The provider informed us they were in the process of re-structuring the activities team and they hoped this would lead to improvements for people.

Ratings at last inspections:

At the inspection published 17 November 2017 the home had an overall rating of inadequate and was placed into special measures.

The service was rated Requires Improvement with one inadequate domain at our last inspection. (Published 16 October 2018.)

Following the last inspection, we met with the provider to ask what they would do and by when to improve the key questions; safe, effective, responsive and well led to at least good. We also imposed three conditions on the locations’ registration to require them to provide regular updates on the progress being made to comply with the regulations and improve standards of care for people.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any key question. Therefore, this service is now out of Special Measures.

Why we inspected:

This was a scheduled/planned inspection based on previous rating;

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We undertook an unannounced inspection of Oak Lodge Care Home on 20 and 21 June 2018.

Oak Lodge Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Oak Lodge Care Home is registered to accommodate up to 47 people who require personal and nursing care. At the time of the inspection there were 27 people living at the home.

When the service was last inspected in October 2017 we found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had failed to ensure sufficient improvements had been made in relation to the safe management of medicines, where there were identified risks to people, measures that could be taken to reduce these risks were not always in place or clear, exposing people to risk. No incident analysis was completed to identify patterns or trends to reduce any risks that may be present.

There were not enough staff consistently deployed to meet people's needs, poor staffing levels had resulted in people's care needs not being consistently met and their dignity being compromised.

The service had not met their responsibilities with regard to the Deprivation of Liberty Safeguards (DoLS), the service had not complied with the principles and legislation set out within the Mental Capacity Act 2005.

The quality and detail of people's care plans was inconsistent and the provider had failed to ensure that sufficient governance systems had been implemented to monitor the health, safety and welfare of people.

As a result of the findings of the inspection in October 2017, we served a notice of decision to vary the conditions of the provider’s registration. We required the provider to report to the Care Quality Commission detailing their assessment of the dependency of the people living at Oak Lodge Care Home, and an associated staffing level assessment, and provide us with an audit confirming that appropriate and accurate assessments had been undertaken for people living at Oak Lodge Care Home. We also placed the service in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Whilst we found some improvements had been made since our last inspection, we identified the provider had not ensured there were sufficient improvements in relation to the safe management of medici

We undertook an unannounced inspection of Oak Lodge Care Home on 3 October 2017. When the service was last inspected in September 2016 we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During the September 2016 inspection, we identified the provider was not doing all that was reasonably practicable to reduce identified risks to people and the provider had not ensured that people’s medicines were always administered in line with their needs. In addition to this, we found there was not always sufficient staff to meet people’s needs and governance systems to monitor the health, safety and welfare of people were not used effectively.

We set requirement actions in relation to the breaches of regulations we identified in September 2016. The provider wrote to us in December 2016 to tell us how they would achieve compliance with these requirements. During this inspection, we found that insufficient action had been taken to meet the requirements of the three regulations the service had breached at the inspection in September 2016. In addition to this, we found breaches in other regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Oak Lodge Care Home provides a service for people who require personal and nursing care. The service is able to accommodate up to 47 people. The building is divided into two parts. The main part provides nursing care to older people and The Acorns provides care for up to eight people who are living with dementia. At the time of the inspection there were 37 people living at the service.

There was no registered manager was in post at the time of inspection. The registered manager in post at the time of our previous inspection was no longer employed at the service. A new manager had commenced employment prior to this inspection in August 2017, but was not available on the day of the inspection due to annual leave. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. In addition to this, the deputy manager in post at the previous inspection was no longer employed at the service. A new deputy had commenced employment approximately one week prior to our inspection.

The provider had failed to ensure sufficient improvements had been made in relation to the safe management of medicines. Current practice did not ensure people were fully protected against all risks associated with medicines. We found that where the service had identified risks to people, measures that could be taken to reduce these risks were not always in place or clear, exposing people to risk. We found that fire evacuation plans were unsafe, with the current record of people living at the service being inaccurate and no guidance for staff on how to escort people during an evacuation.

Accident and incidents were recorded, however no analysis was completed to identify patterns or trends to reduce any risks that may be present. We requested an analysis of historical incidents which were sent to us following the inspection, however these records were dated after the inspection so had been produced retrospectively at our request. People gave mixed feedback on staffing, however from examples we were given it was evident the provider had not taken sufficient action since our last inspection to ensure that sufficient staff were consistently deployed to meet people’s needs.

The service had not met their responsibilities with regard to the Deprivation of Liberty Safeguards (DoLS). DoLS is a framework to approve the deprivation of liberty for a person when they lack the mental capacity to consent to treatment or care and need protecting from harm. People can only be deprived o

This inspection was unannounced and took place on 13 September 2016.

Oak Lodge Care Home provides a service for people who require personal and nursing care. The home is able to accommodate up to 47 people. The building is divided into two parts. The main part provides nursing care to older people and The Acorns provides care to up to eight people who are living with dementia. At the time of the inspection there were 40 people living at the home.

There was a manager at the home who was awaiting registration with the care quality commission to become the registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Although people said they felt safe, we found some examples which placed people at risk of unsafe and inconsistent care. For example, the service did not always have enough suitable staff to consistently meet people’s needs in a timely manner. A relative, who visited the home most days, said although they felt their relative was safe and well cared for, there were times when the home was short staffed and people had to wait some time to be assisted. The clinical director and manager accepted staffing arrangements needed to be explored due to the high dependency of some people living at the home.

Staff told us they did not get enough quality time to spend time with people. They said whilst they did talk with people during tasks they were unable to give them any extra time. Staff spoken with raised concerns that they did not have time to, “Just sit and have a chat”, they felt the main social interaction was left to the activity coordinators. During the inspection call bells were often ringing for more than seven minutes and staff were seen to be busy delivering care and carrying out tasks only.

We looked at the way people’s medicines were managed and stored. Medicines were administered by registered nurses and care coordinators. Medicines were kept securely in locked medicine trolleys which were stored in locked treatment rooms when not in use. However we checked people’s records and stock levels during our inspection and found some of these to be incorrect. The manager carried out an immediate investigation.

Some people who required assistance to take their medication told us sometimes they did not receive their medicines when they were due. One person said “I waited until 10pm and they still didn’t come”. Staff told us not all staff were trained to administer medication, which meant people had to wait until the registered nurse or care coordinator were available to administer the medicines. This meant people were at risk as medicines were not administered in accordance with the prescriber’s instructions and at the suitable times.

There were inconsistencies and inaccuracies in people’s care records, including how people’s risks were monitored. This meant people may not have received the care they required. The provider’s quality assurance system had not operated effectively in identifying and making changes without delay when improvements were needed.

Throughout our inspection staff showed kindness and consideration to people. When staff went into any room where people were they acknowledged people. Staff had a good rapport with people and were seen to be friendly. When staff supported people they spoke to them in a kind and calm manner. One member of staff took time to play a few tunes on a piano in a lounge area; this gave enjoyment to a person sat in the room, who had received little interaction throughout the day.

“One person said, “Staff are very good on the whole, I love it that they all know my name and say hello [name] how are you today”.

Staff had the skills and knowledge they needed to meet people’s

This inspection was unannounced and took place on 3 February 2015.

Oak Lodge Care Home provides a service for people who require personal and nursing care. The home is able to accommodate up to 47 people. The building is divided into two parts. The main part provides nursing care to older people and The Acorns provides care to up to eight people who are living with dementia. At the time of the inspection there were 43 people living at the home.

There is a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The registered manager told us the ethos of the home was to provide a friendly environment for people and their friends and family, with a professional standard of care. Their vision and values were communicated to staff through staff meetings, formal one to one supervisions and appraisals. Many people commented on the friendly and welcoming atmosphere.

People received effective care and support from staff who had the skills and knowledge to meet their needs. However some improvements were needed to make sure people’s legal rights were protected. Some people had pressure mats in their rooms which were linked to the call bell system and alerted staff when the person was moving about in their room. Although the reason for the pressure mat was documented there were no records to state if the person had the mental capacity to agree to its use or if a decision had been made in the person’s best interests.

The registered manager was not fully up to date with changes to the law about how to keep people safe when they lacked the mental capacity to make a decision for themselves. This meant that some people may have restrictions placed on them without legal protection.

People told us they felt well cared for. One person said “I’m looked after so well I never have to ask for anything. They don’t hesitate to help you.” Another person told us “I feel very well looked after, no doubt about that.”

People said they felt safe at the home and with the staff who supported them. There was a robust recruitment process in place which minimised the risks to people and all staff had received training on how to recognise and report abuse.

Some people who were living in the part of the home called The Acorns were unable to fully express their views to us due to their dementia. We observed there was a calm and relaxed atmosphere in this area and people were comfortable with the staff who were supporting them.

People and visitors expressed confidence in the staff and their ability to do the job. One person told us “The staff here are excellent.” Another person said “They seem to have all the right skills.”

In the main part of the home there was always a registered nurse on duty who was able to monitor people’s healthcare needs and ensure they received appropriate treatment. People also had access to a range of healthcare professionals from outside the home according to their specific needs.

People received their medicines from staff who were competent in this area of practice. One person told us “I always get my tablets on time, no problems there.” Another person said “System works well. Right tablets, right time.”

People’s nutritional needs were assessed to make sure they received a diet in line with their needs and wishes. At lunch time people were able to choose where they ate their meal. People were offered choices of meals and received appropriate support and encouragement to eat. Opinions about the quality of food were varied. Comments included “Food is always nice,” “It’s half good and half bad” and “Food isn’t very well cooked.”