CQC report explained · a residential care home
What the CQC found at Oakwood Lodge
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Requires improvement
- Inspectors found risks were recorded in care plans, monitored and regularly reviewed. They also found enough staff and suitable infection control arrangements, but the full Safe question was not reviewed.
- Effective?
- Good
- Inspectors found that people's needs and choices were assessed, staff were trained and people were supported with food and drink. The full Effective question was not reviewed.
- Caring?
- Good
- Caring was not assessed in this targeted inspection.
- Responsive?
- Good
- Responsive was not assessed in this targeted inspection.
- Well-led?
- Good
- Inspectors found audits, incident reviews and management support for staff. The full Well-led question was not reviewed.
What inspectors found, June 2023
Inspected but not rated; inspectors found risks were monitored and staff responded to concerns about an unexpected death.
This was a targeted inspection after a concern about the unexpected death of someone using the home. The inspector spoke with one person, one staff member and managers, and checked care plans, risk assessments, medicines, training and quality records.
Inspectors found that risks were recorded, monitored and reviewed. They found enough staff, suitable training, infection control arrangements and support for people to eat and drink safely. Staff recorded care and shared information with colleagues and other professionals when appropriate.
The home had recorded incidents and taken action to reduce the chance of them happening again. Managers used audits and discussed the incident with staff. The service was not given new ratings because this inspection did not cover the full key questions. Its overall previous rating remained Good.
Risks were monitored
Care plans included risks linked to people's health conditions and other needs. These risks were reviewed regularly.
“Risks to people were assessed, monitored and managed.” from the report
Staffing and training
Inspectors found enough staff to keep people safe and saw training in areas including basic life support, medicines and specialist emergency equipment.
“There were enough staff to meet people's needs.” from the report
Learning from incidents
Incidents were recorded and management identified actions to reduce the chance of them happening again. Managers also discussed what could have been done differently.
“Lessons were learnt when things went wrong.” from the report
Food and drink support
People's nutrition and hydration needs, food preferences and relevant health conditions were recorded. Inspectors found food was stored correctly and in date.
“People were supported to eat and drink and maintain a balanced diet.” from the report
Quality checks
The home used audits covering areas such as medicines, infection control and care plans. Care plans were reviewed regularly.
“Quality assurance measures were in place to ensure people received person centred care.” from the report
The full safety picture is not current
needs fixingThe previous inspection rated Safe as Requires Improvement. This targeted inspection did not review the whole Safe question, so that earlier rating was not changed.
“At our last inspection this key question was rated requires improvement.” from the report
- 01What has changed since the previous Safe rating of Requires Improvement?
- 02How are risks linked to each person's health conditions reviewed and updated?
- 03What actions were taken after the unexpected death, and how do you check that those actions remain effective?
- 04What specialist training do staff have for the needs of the person who would live here?
- 05When will the next comprehensive inspection review all five key questions?
This was a targeted inspection about a concern following an unexpected death; it did not assess the full key questions, so previous ratings remained in place, and the report also records inspection activity and the visit as taking place on 4 May 2023. This explanation was written from the published report of 9 June 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, July 2022
Rated Good overall, but inspectors found that safety needed improvement, including gaps in medicines guidance and risk management.
This was the home’s first inspection since registering in 2020. It was unannounced and took place on 13 June and 21 June 2022. One inspector spoke with four people and two staff, observed care, and reviewed four care plans and other records.
The home supported eight people with mental health needs. Inspectors found kind and respectful staff, personalised care plans, suitable staffing, good training and support, and regular activities. People were involved in decisions and were supported to stay independent.
The overall rating was Good. Safe was rated Requires Improvement because one person’s risk assessment was not fully followed, PRN medicines did not have written protocols, and an electrical safety service was overdue. The electrical service was completed immediately after the first inspection visit.
Kind and respectful care
People were treated with kindness, dignity and respect. Staff understood people's needs and preferences.
“People received care from staff who were kind and compassionate.” from the report
Good staffing and training
Inspectors found enough staff available to respond to people. Staff had completed essential training and felt supported.
“We saw staff were available when people wanted them and they responded to people's requests quickly.” from the report
Personalised support
Care plans covered people's support needs and were reviewed regularly. People were involved in decisions about their care.
“People were involved in decisions about their care.” from the report
Activities and independence
People were supported to take part in activities, go out and develop or maintain relationships. Staff encouraged people to do tasks for themselves.
“People were supported with activities.” from the report
Positive management
The home gathered feedback through meetings and had quality monitoring systems. Staff felt able to raise concerns with managers.
“There was an effective system to gather people's and staff feedback on the service.” from the report
PRN medicines guidance
seriousMedicines given only when needed did not have written protocols. Inspectors recommended following best practice so staff could give them safely and monitor side effects.
“PRN protocols were not in place to ensure that PRN medicines were administered safely and to ensure there were no side effects.” from the report
Risk assessment not followed
seriousOne person's risk assessment said fruit should be placed in their room, but this was not happening when inspectors visited.
“However, for one person we found their risk assessment was not being followed.” from the report
Overdue electrical safety check
seriousThe electrical service had expired 12 months earlier. The report says this was completed immediately after the first inspection visit.
“We found the electrical service had expired 12 months ago and a service had not been carried out to ensure the premises were safe.” from the report
Care plan audits
needs fixingThe registered manager reviewed care plans, but there was not yet a separate system for auditing them. The management team said this would be put in place.
“There was no system in place to carry out care plan audits as the registered manager completed and reviewed them.” from the report
- 01What written PRN medicine protocols are now in place, and how do you check they are followed?
- 02How do you make sure each person's risk assessment is followed in day-to-day care?
- 03Has the electrical safety service been completed, and when is the next check due?
- 04How are care plans audited separately from the manager's regular reviews?
- 05How do you use people's feedback and resident meetings to make changes?
This was the first comprehensive inspection of the newly registered service and covered all five CQC questions, including infection prevention and control. This explanation was written from the published report of 13 July 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Oakwood Lodge
4 rated inspections over 7 years: the service has held its Good rating throughout.
- June 2023Inspected but not ratedcurrent ratingSafe: Inspected but not ratedEffective: Inspected but not ratedWell-led: Inspected but not rated
- July 2022Goodstayed GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- January 2020Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- June 2017Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- April 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- April 2020
Registered with the Care Quality Commission on 8 April 2020.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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