Oakwood

People’s experience of using this service:

Oakwood had been developed and designed prior to Building the Right Support and Registering the Right Support guidance being published. We found the outcomes for people living at the home reflected some of these values and principles. We have made a recommendation in relation to the promotion of social inclusion and the way in which people are supported to live an ordinary life.

People were happy living at Oakwood and told us they felt safe. People continued to be protected from the risk of abuse and avoidable harm. Registered managers and staff had attended safeguarding training and demonstrated a good understanding of how to keep people safe.

Risks associated with people’s complex care needs had been appropriately assessed and staff had been provided with information on how to support people safely. People’s medicines were managed, stored and administered safely and appropriately by staff who had been trained and assessed as competent to do so.

Staff were recruited safely and there were sufficient numbers of staff deployed to meet people's needs. Staff told us they felt supported and we saw evidence that staff had received an induction, training and ongoing supervision.

Care and support was personalised to each person which ensured they could make choices about their day to day lives. Staff knew people well and had developed good relationships with people. People knew how to make a complaint and felt confident they would be listened to if they needed to raise concerns.

People's healthcare needs were monitored and people had access to healthcare professionals according to their individual needs. 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 home supported this practice.

We have made a recommendation about recording mental capacity and best interests decisions in relation to people’s finances.

People benefitted from a home that was well led. The provider had systems in place to review, monitor and improve the quality of service provided. People and their relatives were involved in making decisions about their care. The registered managers worked in partnership with health and social care professionals.

We have made a recommendation in relation to systems in place to monitor, the quality and safety of the services provided.

The home was clean, well maintained and people were protected from the risk and/or spread of infection as staff had access to personal protective equipment (PPE).

Rating at last inspection: The home was previously rated as Good. The report was published on the 17 August 2016.

Why we inspected: This was a planned comprehensive inspection that was scheduled to take place in line with Care Quality Commission scheduling guidelines for adult social care services.

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

The inspection took place on 4 May and 6 May 2016 and the provider was given a short period of notice of our arrival. We last inspected in November 2013 when there were no concerns identified with the care being provided to people.

The service had two registered managers 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. Additional management support was provided by an operations manager who worked across the residential and college service.

People living at Oakwood were happy and thriving. They were enjoying friendships and achieving skills and goals that had seemed unreachable when they first moved to the service. Some people had learned new independent-living skills, like being able to cook or get up, washed and dressed independently. Others were achieving levels of independence that meant they could pursue their vocational interests, like going to work at a local animal centre. Others had gained in confidence, so that they could participate more actively in life. For example, one person had hardly spoken when they first arrived at the college, but was now able to ask questions at their house meeting. Another could now make eye-contact with staff and friends.

People told us of their achievements with pride and confidence and were optimistic about the future. Relatives told us “I have found the level of care provided by the staff at Oakwood (both college & residential) to be absolutely outstanding.”

People said they felt happy, secure and safe living at Oakwood and relatives described it as “a happy and safe home”. One person said “My life here is perfect at the moment. I enjoy myself so much. I am safe here”. Throughout our inspection we saw people were confident and comfortable in their relationships with staff. The service had worked closely with people to ensure that they understood their right to live safely and to make sure they knew what to do if they experienced any feelings of worry or hurt.

The atmosphere in the home was warm and welcoming and we saw laughter, warmth and trust between people and staff. People felt listened to. They knew how to raise a complaint if they wanted to and were confident that staff would take them seriously. Staff understood their duty to protect people should they suspect abuse was taking place. This included notifying agencies such as the local authority safeguarding team and the police.

We found the service had a strong person centred culture where people were at the heart of everything that happened. Staff were keen advocates for people’s right to be an individual and to receive care that reflected their individuality. People’s preferences and views were constantly being sought and were instrumental in shaping the service. For instance, in relation to staff recruitment and suggestions for a basement gym.

People's likes, dislikes, interests and support networks were included in their care plans and care was planned in partnership with them. Each person met with their keyworker at least monthly to discuss their progress and wishes. Care records were accessible and people had a sense of ownership of their records. They were fully involved in their care plans and information was presented in an accessible way (such as symbols) so that they could be fully involved.

Care plans gave staff detailed guidance about how to provide care, including how to avoid triggers that may distress people. Where people were diagnosed with specific health conditions such as epilepsy, their care files held detailed information about this and what precautions staff should take to keep people safe and prevent complications. All staff we spoke with were fully aware of the guidance in each person’s care plan. Any changes were effectively communicated through daily handover meetings, email and keyworker meetings.

Care was provided by staff who were kind and caring. They treated people with great dignity, respect and equality. Staff were recruited carefully and appropriate checks had been completed to ensure staff were suitable to support people living in the home.

People were supported to have their care needs met and achieve their goals by an exceptionally motivated and skilled staff group. They were confident and knowledgeable about supporting people with complex care needs. Staff received training in a broad range of topics, including specialist areas such as autism and attachment theory (a psychological theory about how we develop and behave). Staff were enthusiastic about the training opportunities provided. One said “I can’t get enough of it. I want to do every course! It has helped me learn so much”. They told us they felt really well supported and encouraged to develop their skills through supervision, appraisal, and team meetings.

Staffing levels enabled staff to spend plenty of individual time with people and ensured their needs and preferences could always be met, as well as fostering strong and trusting relationships. Staff spoke passionately and positively about people. They acknowledged people’s strengths and were proud of the achievements young people had made. One member of staff told us about one young person who had recently been able to eat all of the components of their meal together on a plate for the first time. They commented “It is really good to know as a team that we’ve helped achieve something as brilliant as that. The small things make such a difference to people’s lives”

Where there were risks of harm to people these had been clearly identified. There were comprehensive plans in place to minimise these risks, without restricting people’s freedom. Where risks changed, this was recognised and responded to quickly. Staff used a recognised model of physical intervention to ensure challenging behaviours were managed using the least restrictive practice possible. This reduced the risk of people hurting themselves or hurting others. We noted that several people, who had come to the service with very unsettled behaviours, were now settled and living comfortably as part of the community at Oakwood.

Staff understood and respected people’s rights to make decisions about their lives, care and treatment and held these in high regard. People were supported to take risks positively, for example in relation to activities, using sharp knives safely while preparing meals, or using public transport with support. Comprehensive risk assessments for all such activities were in place to enable them to take place as safely as possible.

The registered managers and staff understood their responsibilities in relation to the Mental Capacity Act (2005). Although capacity assessments and best interests’ decisions were being reached correctly, they were not always recorded correctly. Immediate steps were taken to address this during the inspection. Where people’s liberty may need to be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS). This meant the person’s legal rights were protected.

Staff were well trained in the safe administration of medicines. People received their medicines as they had been prescribed by their doctor and knew what medicines they were taking and why. This promoted wellbeing and meant people had more control and understanding of their health.

Lunch time meals during the week were provided at the college, but other meals were cooked by young people with support from staff. Everyone was able to contribute their choices to the weekly menu and took turns in cooking for their housemates. There was an emphasis on healthy eating with lots of information available on the walls in the kitchens, as well as discussion in house meetings. People were also supported to maintain good health through regular contact with relevant healthcare professionals when they needed them.

People had access to plenty of activities every day after college and at the weekends. People were taking part in their own individual interests, such as swimming, or tai chi, or arts and crafts. They could also take part in group activities such as going to a local youth club or sports centre. Everybody had an individual weekly time table that included their specific activities and this was updated regularly. The service had built links with the local community, for instance through use of local leisure facilities. The grounds at Oakwood were large and pleasant and were well used by people for recreation with areas for football and BBQ’s, as well as beds for vegetable growing and a greenhouse. People also enjoyed caring for the animals housed outside in a large purpose built shed. Rabbits, guinea pigs, finches and other small animals were all cared for by people using the service.

There was a very high level of confidence in the leadership and management of the service expressed by people, relatives and staff. The registered managers were a visible presence in the home and were always available to offer support and guidance. The management team had made changes at the service to improve the quality of care provided. This included introducing more rigorous recruitment processes in order to ensure only people with the right skills and values joined the staff team. Managers provided regular, comprehensive supervision sessions and annual appraisals to staff which enabled t

There was a relaxed atmosphere in the service that people appeared to respond favourably to. People we met were happy and chatty with us.

People told us that they felt safe. Staff we spoke with demonstrated that they understood what abuse was, and were confident that colleagues would report any concerns that arose. The service had up to date policies and procedures in place that protected people.

Staff told us they were well supported by the manager and felt confident in their roles.

One staff said "the manager is very approachable and easy to talk to".

There was a system in place to monitor quality and safety. People were encouraged to express their views and we saw that their feedback was taken into account and used to improve the service where necessary.

We found that people's care and treatment was planned in line with their assessed needs and promoted their health, safety and wellbeing. A person told us "I love it here, my room, staff, vehicles - I feel well and I am supported". Another person said "they help me to be more independent and they respect me".

People told us that they felt safe in the home. Staff we spoke with demonstrated that they understood what abuse was and how to report any concerns. The provider had policies and procedures in place which protected people by supporting staff to work and deliver care safely.

We found that staff were properly inducted into their role and supported by managers to provide care and support to people who used the service. A staff member said "I get praised for my hard work and approach to residents - I treat people how I would like to be treated, and as adults".

We found that the provider had an effective system in place to monitor the quality and safety of the service. People were encouraged to express their views and their feedback was taken into account. We found that positive feedback had been given by people's relatives.