CQC report explained · a residential care home
What the CQC found at The Oaks & Woodcroft
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Inspectors found that risks, incidents, medicines and infection control were not always managed safely. They said there was an increased risk that people could be harmed.
- Effective?
- Requires improvement
- Care and support did not always achieve good outcomes. Consent and best-interest decisions were unclear, staff lacked some essential skills, and people's health, food and activity needs were not always met.
- Caring?
- Requires improvement
- This key question was not inspected during this focused visit.
- Responsive?
- Requires improvement
- This key question was not inspected during this focused visit.
- Well-led?
- Requires improvement
- Management systems, records, audits and notifications were not reliable enough. Inspectors found that improvements were being made but were not firmly embedded.
What inspectors found, August 2023
The Oaks & Woodcroft was rated Requires Improvement; inspectors found risks in care, medicines, staffing, consent and management, with warning notices issued.
This was a focused inspection following concerns from the local authority and a recent coroner's inquest. It was unannounced on 13 June 2023 and announced on the second visit on 19 June 2023. Inspectors spoke with people, staff, managers, relatives and health professionals, and checked care records, medicines, staffing, training and the home.
Inspectors found that risks were not always properly recorded or managed. There had been 74 incidents in six months. They also found medicines errors, out-of-date creams, infection control problems and unclear guidance for staff. People did not always have enough choice about food, activities, routines or access to parts of their home.
The home was rated Requires Improvement overall. Safe, Effective and Well-led were all rated Requires Improvement. Safe and Well-led had fallen from Good at the previous inspection, while Effective remained Requires Improvement. The report says improvements had started, but were not yet firmly established.
Recruitment checks
The home had satisfactory recruitment checks for permanent and agency staff. Inspectors also found that there were enough staff to meet people's needs at the time of the inspection.
“Recruitment checks were in place and satisfactory for both permanent and agency staff.” from the report
Management improvement work
Inspectors recognised that the management team was working to improve the home's culture, training and leadership.
“The registered manager, the regional manager and the senior team were working hard to improve the culture of the service” from the report
Family contact
Staff supported people to keep in contact with their families, including visits and transport to parents' homes.
“Staff supported people to stay in contact with family and arranged visits and supported with transport to and from parents' homes.” from the report
Medicines
seriousInspectors found out-of-date creams, a medicine error, and one medicine unavailable for four days. Some instructions for as-required medicines were incomplete or had not been reviewed.
“Medicines were not always managed safely. We found several creams out of date.” from the report
Consent and restrictions
seriousThe home did not always show that restrictions were lawful, in people's best interests or the least restrictive option. Some people could not access kitchens without staff support, and other daily choices were limited.
“Records did not clearly demonstrate how decisions had been made in people's best interest and in the least restrictive way.” from the report
Staff skills
seriousStaff did not consistently have the skills needed to support anxiety and distress safely. Inspectors found that staff training and positive strategies to reduce incidents needed improvement.
“Staff did not have the necessary skills to meet people's needs particularly around managing people's anxiety” from the report
Food and activities
needs fixingPeople had limited meal choices and limited opportunities for activities, especially in the evening. Inspectors also found that the Woodcroft kitchen had very little food and needed refurbishment.
“People had limited options. For example, all but 1 person had crisps and a sandwich at Woodcroft, and this was the case for most lunch times.” from the report
Records and oversight
seriousRecords were not always current, accessible or understood by staff. Audits had not identified important problems, and some incidents had not been reported to CQC in time.
“information governance was poor, so we were not assured of the quality and accuracy of the data we reviewed.” from the report
- 01What specific steps have you taken to reduce the 74 incidents reported in the six months before the inspection?
- 02How do you now check that medicines are in date, available, correctly recorded and supported by clear as-required instructions?
- 03How do you make sure restrictions, such as kitchen access or smoking limits, are lawful, reviewed and the least restrictive option?
- 04What training have staff completed to support anxiety, distress and behaviour safely, and how do you check that they can use it in practice?
- 05What changes have you made to evening activities, meal choices and access to food at Woodcroft?
This was a focused inspection that initially looked at Safe and Well-led and was expanded to Effective; Caring and Responsive were not inspected, and ratings for uninspected questions carried over from the previous inspection. This explanation was written from the published report of 17 August 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, December 2020
Rated Requires Improvement; inspectors found safer care and stronger management, but planning for individual needs and future care was not complete.
This was an inspection visit on 13 November 2020, brought forward after concerns were received. One inspector looked at Safe, Responsive and Well-led. The inspection included visits to the home, observations, records, medicines, infection control and staff recruitment, followed by discussions with staff, relatives and health professionals.
The home was rated Good for Safe and Well-led. Inspectors found that risks and medicines were managed safely, staff recruitment had improved, and managers had better oversight. Infection control arrangements were mostly effective, although a daily cleaning schedule was put in place immediately after the inspection.
The home was rated Requires Improvement for Responsive. Inspectors found that care plans did not always explain how people's individual goals would be achieved. There was also no adequate advance planning for future care and end of life wishes. Activities had improved but were still limited and needed to reflect people's interests and skills more closely.
The overall rating remained Requires Improvement, although the home was no longer in breach of regulations. It had improved from the previous inspection, but not enough to change the overall rating. CQC said it would keep the home under review and return as part of its re-inspection programme.
Safer medicines
Medicines were administered by trained staff, with clear guidance about what each medicine was for, when it should be taken and possible side effects. Regular audits helped identify and review errors.
“Medicines were well organised and administered from the original packaging.” from the report
Better risk management
Care plans and risk assessments were detailed, regularly reviewed and cross-referenced. Short profiles helped new and agency staff quickly understand important risks.
“Risk assessments gave detailed information about any risks associated with people's care and what actions were necessary to reduce risk.” from the report
Improved leadership
The home had a manager based solely at this location, supported by senior staff and regular governance meetings. Audits and action plans helped identify and monitor improvements.
“There was a new experienced manager in post, the regional manager had left but continuity of support was being provided by senior management.” from the report
More meaningful activities
Activities had improved since the previous inspection. The home had introduced a sensory room, used a flexible weekly planner and evaluated activities against people's physical and sensory needs.
“Improvements were noted at this inspection in terms of how people experienced the service and were occupied across the day.” from the report
No complete future care planning
needs fixingThe home had not completed advance care plans covering people's long-term and end of life wishes. This was particularly important for people who could not communicate their preferences verbally.
“The service had not completed advanced care plans which would consider people's wishes, preferences and priorities for their long-term care needs and end of life care.” from the report
Care plans not always specific enough
needs fixingSome plans identified what mattered to a person but did not explain clearly how staff would achieve the required support or when and who would take action.
“Care plans needed to be developed further to demonstrate what actions were needed.” from the report
Limited activities and technology
minorActivities were mostly indoors during the pandemic and needed further development around individual interests and skills. People were not supported to use the internet or modern technology to keep in touch with family and friends.
“Currently no one had access to the internet, and people were not supported to use modern technology although one person had a tablet.” from the report
Use of agency staff
needs fixingAgency staff were used most days because of staffing difficulties. A relative said a stable workforce would be better, as staff needed time to build relationships with people who communicated non-verbally.
“A relative raised a concern about the use of agency staff and said the ideal would be to have a stable workforce.” from the report
Some infection control records missing
minorDaily cleaning schedules were not available when requested, so inspectors could not confirm whether frequently touched areas were cleaned regularly. A schedule was put in place immediately after the inspection.
“Daily cleaning schedules were not seen although requested, so we could not ascertain if frequently touched items such as door handles were cleaned regularly” from the report
- 01How have you completed advance care plans covering my relative's long-term and end of life wishes?
- 02How do you record exactly how my relative's personal goals will be achieved, and who is responsible for each action?
- 03What activities are now available that match my relative's interests, communication style and skills?
- 04How many agency staff are currently used, and how do you ensure consistency for people who need time to build relationships?
- 05Can you show me the current daily cleaning schedule and explain how its completion is checked?
This was a focused inspection of Safe, Responsive and Well-led; the ratings for Effective and Caring were not inspected at this visit, and previous comprehensive inspection ratings were used in calculating the overall rating. This explanation was written from the published report of 22 December 2020 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 The Oaks & Woodcroft
5 rated inspections over 7 years: the service has held its Requires improvement rating throughout.
- August 2023Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- December 2020Requires improvementstayed Requires improvementSafe: GoodWell-led: Good
- February 2020Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- August 2017GoodSafe: GoodEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Good
- February 2017Inspected but not ratedWell-led: Inspected but not rated
- August 2016Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- January 2015
Report published without a new overall rating.
- July 2014
Report published without a new overall rating.
- January 2014
Report published without a new overall rating.
- August 2013
Report published without a new overall rating.
- May 2013
Report published without a new overall rating.
- September 2012
Report published without a new overall rating.
- January 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 18 January 2011.
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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13 live-in carers within about an hour of Norfolk
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Most charge £990 to £1,120 a week. 9 can care for a couple. 14 years' experience on average.
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