High Oaks

High Oaks is a residential care home providing accommodation and personal care. It is registered to accommodate up to 18 people but had 16 people living there on the day of our inspection. People at the service lived with mental health needs. The service accommodates both older and younger people.

People’s experience of using this service and what we found.

Staff assessed and reduced most areas of risk, however not all fire doors were safely used. They reported possible abuse and knew what to do to keep people safe. There were enough staff to meet people’s physical and mental health needs. The provider obtained key recruitment checks before new staff started work. People received their medicines and staff knew how these should be given. Staff used protective equipment, such as masks, gloves and aprons, and reduced the risk of transmission of infection as much as possible.

The service was proactive in sharing information with other health and social care partners. The registered manager and Director had implemented a range of assurance systems to monitor the quality and effectiveness of the service provided. This included an annual assessment undertaken by an independent consultant. Systems were in place to seek feedback from people, relatives and health care professionals who used the service as a means to develop and improve service delivery.

The service had a registered manager and people received consistent support from a regular staff team. Staff were positive about the service and the levels of support and training they received. The registered manager was described as supportive and responsive.

Rating at last inspection and update

The last rating for this service was Good (published 30 May 2018).

Why we inspected

We carried out a targeted inspection to look at the infection control and prevention measures the provider has in place. During the inspection we identified concerns about one person and we therefore changed the inspection to a focused to review the key questions of Safe and Well led.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the

service can respond to coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those

key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has not changed. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Safe and Well-led sections of this full report.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

You can see what action we have asked the provider to take at the end of this full report.

Following the last inspection the provider completed an action plan to show what they would do and by when to improve the service. The service required improvement in safe and well led. Concerns were identified in relation to the inadequate maintenance of the premises and equipment. Concerns identified by the inspectors had not been identified by the provider. We also identified a breach to Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. This was because we found that the service had not always notified us of safeguarding incidents as required.

During our most recent inspection on the 10 November 2017 we did not identify any breaches and found this to be a well led and well managed service with a good rating in all the domains.

At the time of our inspection there was a registered manager who had been employed at the home since 2008. She was promoted to manager in 2010 and her registered manager status followed in 2011.

A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 summary we found the service was managed well and benefited from a very experienced registered manager, and support manager. The director for the provider regularly supported the service and was familiar with people’s needs and the needs of the service. Staff said they felt well supported and felt staffing levels were mostly adequate. However we felt staffing levels were not always sufficient to meet people's individual needs. One person required 1-1 support to go out during the day due to restrictions in place and others liked to go out with staff but at times in the day there were only two staff at the service. The director for the provider explained that some people had very poor mental health and lacked motivation to go out. They told us staffing levels were flexible and people had opportunities to go out some independently and additional staffing could be arranged where people needed support. People's access to the community was limited by the remoteness of the location and limited public transport, although the service had two cars it could use.

There were systems in place to ensure the service was clean and the risk of cross infection minimised. Equipment was serviced as required and there was a programme of refurbishment and replacement. Some of the bedrooms had ensuite facilities, and there were also shared bathrooms/toilets.

People received their medicines safely and as intended. Staff were aware of people’s health care needs and supported people to help ensure positive and stable mental health. People’s needs were reviewed and care and support plans carefully documented people’s needs and were reviewed regularly. People were consulted and involved in their plan of care.

Staff knew people well and were quick to act upon and report any changes including safeguarding concerns.

Staff received regular opportunities for support and training and demonstrated a good understanding of their role and people’s needs. Induction for new staff was good. We found recruitment records did not show how staffs suitability for their role had been robustly explored and recorded which meant they had not followed their own processes.

Staff supported people lawfully and had a good grasp of the Mental Capacity Act 2005 (MCA). People received care, support and treatment after giving their consent. Staff engaged regularly with people and other health care professionals when providing people with support.

People were supported to eat and drink in sufficient amounts. The chef took a passion in the food they prepared and tried to encourage healthy eating. People had the opportunity to prepare light meals for themselves.

Support for people was provided by staff who were familiar with their needs. Activities were promoted but these were not always taken up by people using the service.

There was a clear complaints procedure and people’s feedback was acted upon. There was an established quality assurance system which sought feedback as a mechanism for improvement.

The service was well managed with good leadership and oversight of risks and issues affecting the safety and wellbeing of people using the service were monitored and managed.

There was good engagement with professionals and some community engagement.

We inspected this service on 16 and 17 December 2016. The inspection was unannounced.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Areas of the service and equipment was dirty and poorly maintained which placed the people using the service at risk of acquiring infections or at risk of harm.

Staff had a good understanding of systems in place to manage medicines, safeguarding matters and behaviours that were challenging to others. People were supported to take their own medicines. Protocols were in place to guide staff when medicines prescribed on an ‘as required basis’ should be administered. This meant people were receiving their prescribed medicines when they needed them. The registered manager had worked well with the police and local authority where safeguarding concerns had been raised to ensure the safety and welfare of the people involved. However, they had not always reported these incidents to CQC in accordance with regulations. Risk profiles and crisis management plans were detailed and gave staff clear direction as to what action to take to minimise incidents of challenging behaviour. This was done in a consistent and positive way and which protected people's dignity and rights.

Staff had a good understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). These safeguards protect the rights of adults who used the service by ensuring that if there are restrictions on their freedom and liberty these were assessed by professionals who considered whether the restriction is appropriate and needed. The registered manager had made appropriate DoLS applications to the local authority to ensure that restrictions on people's ability to leave the service were lawful.

There was sufficient staff on duty to keep people safe. A thorough recruitment and selection process was in place, which ensured staff recruited had the right skills and experience, and were suitable to work with people who used the service. Staff knew the care needs of the people they supported well. This was because staff had received training that gave them the skills and knowledge to meet people’s specific needs.

People were involved in determining the kind of support they needed. Staff offered people choices, for example, how they spent their day and what they wanted to eat. These choices were respected. People were supported to carry on with their usual routines within the service and when accessing places of interest in the community. People were provided with sufficient to eat and drink to stay healthy. People had access to health care professionals, when they needed them.

Staff felt supported by the management team and felt there was good leadership in the service. Staff were clear about the vision and values of the service as set out in the staff code of conduct. These referred to providing a service where people were empowered and treated with dignity, respect and equality. We observed staff putting these values into practice during our inspection.

The registered provider had a range of systems in place to assess, monitor and further develop the quality of the service. However, these had not identified the issues that were identified in this inspection in relation to the risks to people’s safety and welfare and the poor cleanliness and maintenance of the premises and equipment.

We found a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. You can see what action we have asked the provider to take at the back of the full version of the report.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with two people using the service, the manager, and two staff and from looking at records.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people. People commented, 'The staff are good. ' One person said 'Staff help me to look after myself; they know when I am down.'

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic. Staff had received appropriate training and guidance to use the equipment safely.

Records contained detailed assessments of people's needs that had been carried out prior to them moving to the home. Any training needed for staff to support people safely was identified and provided prior to the person moving to the service. This ensured that the staff had the relevant skills and knowledge required to meet the individual's identified needs.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Although no DoLS applications had been made, staff were able to describe the circumstances when an application should be made and knew how to submit one.

There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies.

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew the people well.

People's health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary needs had been identified in care plans where required. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

The training that staff had received equipped them to meet the needs of the people living at the home.

Is the service responsive?

People knew how to make a complaint if they were unhappy. The service held daily resident meetings where people had an opportunity to provide feedback on the service.

People using the service, their relatives and staff completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

Is the service well led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system. Records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities and that they received excellent support and supervision from the manager. Staff had a good understanding of the ethos of the home. This helped to ensure that people received a good quality service at all times.

People using the service told us they had been involved in agreeing the care, support and treatment that they needed. One told us, 'I was involved in developing my care plan'. We looked at some of these plans. They were clear and up to date. People told us that they felt safe and happy. One commented that it was, 'Very nice living here'.

Care was taken to ensure that people received the medication they should have, and had agreed to take, at the times required. All medication was safely stored.

Effective recruitment procedures, with appropriate checks, ensured staff were of good character and had the required skills, qualifications and experience to carry out their work. People confirmed that staff were, 'Friendly and understanding', and we observed good professional relationships between support workers and service users. There were enough staff to meet people's care needs.

Effective systems ensured that people received appropriate and good quality care and support. However the service had been slow to identify some shortcomings in cleanliness. We noticed a lot of flies in the kitchen and found some greasy and stained surfaces and utensils. Some action had been taken and we assessed the risk to people as minor, but we asked that the standards of cleanliness were improved, particularly in the kitchen and dining area.

Two of the people we spoke with told us about their support plans. One of these people said "I helped with my support plan when I first moved here." Another person told us their support plan was "Reviewed quite often." They also told us that they had discussed plans for their future as part of their review.

People told about some of the things that they did during the day. This included shopping, cooking, art, music and walks. One person we spoke with told they liked helping with the cooking and said "It is helping me to be more independent."

Two of the people we spoke with told us that they knew what to do if they thought they were being abused or witnessed anything they thought was wrong. They told us that they would tell staff or the manager. One person told us that "Staff never shout at us, that would be wrong."