The Oaks Residential Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

The key question of Effective was last inspected in September 2019. The rating for the key question of Effective has improved too Good. People’s health, care, wellbeing, and communication needs had been assessed. Introduction of a new communication and handover book had improved sharing of information with health professionals. This had led to improvements in the continuity of people’s care. Managers, staff, and health professionals worked together to support people to live healthier lives. A new chef, improved training, and input from speech and language therapy team (SaLT) had led to improved processes ensuring people’s nutrition and hydration needs were being met. People’s rights around consent to care and treatment had been assessed, and their views considered when planning their care. MCA assessments and best interest decisions were in place but needed more detail to reflect how the assessor had determined the person lacked capacity.

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.

Relatives told us they were involved in the development of their family member’s care plan and were kept up to date with any incidents or changes to their medication or treatments. One relative commented, “I am always kept informed of what [family member] is doing. I am quite happy with the care when I go and visit, they are always clean, neat, and tidy.”

Staff knew the people using the service well and were able to describe their current needs, and how to support them accordingly. Staff told us, sometimes when a new person was admitted to the service, they did not always have enough information about them from families, or the hospital and had to learn about the person themselves, and feedback to the registered manager to update their care plan.

People’s needs were assessed using a range of assessment tools to ensure their needs were identified and understood. Review of pre-admission assessments for 3 people who recently moved into the service confirmed they and or their relatives had been involved in the assessment of their needs. People’s health, care, wellbeing, and communication needs had been assessed, and scored as high, medium, or low depending on the level of care and support they required. From the initial assessment a basic care plan had been developed with guidance for staff on how to meet the persons current needs. Care plans were kept under review and amended as people’s needs changed to ensure information remained current and up to date.

People were involved in planning their care and treatment, including what was important to them. One person told us, “It’s very good here, I’m well looked after.” Relatives told us people’s nutrition and hydration needs were being met. People and their relatives provided positive feedback about the food. Comments included, “The chef makes special food for those that request it. For example, my (family member) likes a sauce with fish so the chef now makes them a parsley sauce each time,” and “My (family member) had a very poor diet before going in the home now they have a varied diet and looks forward to their mealtimes.”

Staff, including the chef were aware of the international dysphagia diet standardisation initiative (IDDSI) standards, with definitions to describe texture modified foods and thickened liquids for people with dysphagia. They were aware of the people who required specialised diets, and how to prepare foods and fluids to the correct consistency. Staff told us they had received training which had given them a better understanding of how to support people who had difficulties swallowing and at risk of choking. One staff member commented, “We’ve had training on dysphagia. We went to a course and completed online training, and there is a lot more information in the kitchen about the different food levels.”

The provider had a range of policies to promote safe practice, such as a ‘moving, handling, and transferring service users’, which referenced the relevant legislation and best practice guidance. People’s dietary needs had been assessed, and where they were identified as at risk of being underweight a malnutrition universal screening tool (MUST) assessment had been completed and used to develop their care plan. Since the last inspection, new systems were in place to ensure the chef, and staff were aware of people’s nutrition and hydration needs. A ‘Resident nutrition and fluid requirements’ sheet was displayed in the kitchen for staff reference, reflecting each person’s dietary needs, level of support required and fluid needs. This clearly identified where people were at risk of choking, their IDDSI level as assessed by the speech and language therapist (SaLT), foods to avoid and people who required fortified diets and high calorie snacks.

Relatives told us, where their family members received care from a range of different staff, teams, or services, this was managed well. They told us staff worked well with health professionals to ensure their family members received the right care.

Staff provided examples, of how they had worked well with other health professionals, such as the GP, district nurses, SaLT, physiotherapist, and occupational therapists (OT) to meet people’s needs. For example, 1 staff member commented, “We have worked with the physiotherapist and OT to find a suitable chair to enable a person, who due to deterioration in their physical health was on permanent bed rest. We feel proud of how we’ve worked with the physiotherapist and OT to get them a chair that can be pushed into the lounge, as the person loves being in the lounge, and being with other people.”

Introduction of a new communication and handover book had improved sharing of information between staff and health professionals. The handover book was being used to ensure concerns about people’s health were referred to the appropriate specialists and health professionals. The log also had space for feedback and outcomes of visits by health professionals to ensure staff managed people’s care consistently, and safely. Hospital passports were used for sharing information about people’s needs when they moved between different services. However, records showed, people’s transition and discharge between services had not always been managed well. This was due to a lack of information about people’s health and symptoms on discharge from hospital. The registered manager had raised safeguarding referrals about the hospital in accordance with the providers safeguarding policy.

Relatives told us, their family members were supported to live healthier lives. People were provided with information and encouraged to make healthy choices. Where people had capacity to make unwise decisions about their health this was respected. The service worked well with other networks, such ‘Friends and Neighbours (FaNs)’ who offered people the opportunity to take part in exercise classes to help with their mobility. This had a positive impact on their physical wellbeing. Staff had also completed training to help people improve their mobility and flexibility as they got older.

Staff confirmed people were referred to healthcare services, via an NHS care co-ordination hub. A staff member commented, “We have lots of outside people come in, such as social workers, SaLT, and the dietician. They are really good, and we have a good relationship. The lead diabetic nurse comes to the home to do the training, the other nurses do the diabetic checks. They check care notes, and staff knowledge while they are here.” Staff told us where possible people were supported to manage their own health care and visits to the GP in person.

Systems were in place to identify risks to people’s health and wellbeing early. People at risk of malnutrition were being weighed monthly. Where people were identified as losing weight they were referred to the dietician. Analysis of people’s weights over a 3-month period reflected their weights were stable.

Relatives confirmed they were involved in regular reviews to ensure their family members health and wellbeing needs were being met.

The registered manager told us, ‘Snapshot’ meetings had been introduced daily and used to discuss a range of topics to ensure people who used the service experienced positive outcomes. Topics included, but were not limited to, changes in people’s needs, feedback from professionals, diet, and nutrition

Care plan audits were completed monthly by senior staff. Any significant changes to people’s care, support or treatment were reviewed, and updated. Handover logs and daily report logs were being used to record and monitor people’s health and wellbeing. The computer-based care system had a facility which enabled the registered manager to check people’s care plans were being reviewed on a regular basis to ensure they contained the most up to date information about their care and treatment.

People’s rights around consent to care and treatment had been assessed. Their views and wishes had been considered when planning their care.

Staff confirmed they had completed MCA training and understood the importance of obtaining people’s consent before delivering care. Staff understood they needed to consider everyone had capacity to make decisions about their care and support unless it could be shown otherwise. A staff member commented, “Where people can make their own choices, we respect them. When that depletes, and they can’t make decisions for themselves, best interest decisions are recorded in their care plans.” Staff told us, where people had capacity, but made unwise decisions, their wishes were respected. One staff member commented “If a resident has capacity to decide for themselves, but makes poor choices, that is their right. I would give them information to help make the decision, but I would respect the decision of the resident.”

People’s ability to consent to their care and treatment had been assessed. Where people did not have the capacity to make decisions about their care and treatment the relevant people and professionals had been involved to ensure decisions were being made in their best interests. However, people’s MCA assessment records needed more detail to reflect how the assessor had determined the person lacked capacity. Assessment forms contained little information to reflect how the persons understanding, and reasoning skills had been assessed to determine if they had capacity to make decisions for themselves. Where people had capacity, their right to make decisions against professional advice was respected, and measures had been put in place to minimise the risks to their health.