Archived: The Oaks Care Home

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service: The registered manager had ensured improvements were made to medicines storage and administration practices in light of our previous inspection. Auditing and oversight of medicines and other aspects of the service were in place and effective. Staff demonstrated a good understanding of people’s medicinal needs.

The registered manager continued to be supported by a team of dedicated staff, including an administration officer with comprehensive knowledge of the service. People spoke highly of the registered manager, as did staff. People were comfortable in the presence of the registered manager and staff had evidently developed strong bonds with them.

Regular meetings were held with staff and people who used the service. These meetings were an opportunity to openly discuss a wide range of topics, from safeguarding and complaints to activities and menus. People who used the service and staff confirmed they could raise queries or suggestions in a welcoming, inclusive atmosphere.

Good community links remained in place, particularly with a local community centre, where people attended a range of activities. The registered manager ensured people had opportunities to engage in their local community and beyond.

Records were accurate, up to date and person-centred.

The registered manager had been in post for several years and demonstrated an excellent knowledge of the needs people. Relatives and external professionals spoke of their confidence in the registered manager and staff team.

Turnover of staff remained low and staff morale was high.

Staff at all levels continued to deliver the caring, homely environment the service advertised and we found the culture remained focussed on ensuring people felt at home.

The care service was managed in line with the values that underpin Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities using the service can live as ordinary a life as any citizen.

Rating at last inspection: We previously inspected The Oaks in February 2018, at which time the service was rated requires improvement. At this inspection the registered manager had made the necessary improvements and the service was rated good.

Why we inspected: We inspected the service in line with our scheduled programme of inspections and to see if the registered manager had made the required improvements identified at the last inspection.

We previously inspected The Oaks in November 2015, at which time the service was meeting all regulatory standards and rated good. The service was rated requires improvement at this inspection.

The Oaks is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The Oaks provides care and support for up to nine people who have a learning disability, in one adapted building. Nursing care is not provided. There were nine people using the service at the time of our inspection.

The service had a registered manager in place. 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.

Pre-employment checks of staff were in place, including Disclosure and Barring Service checks, references and identity checks. The registered manager did not have in place processes to formally risk assess the suitability of persons for whom there may be relevant information on pre-employment checks. We have made a recommendation about this area of risk assessment.

The ordering, storage, administration and disposal of medicines was generally safe, although we identified areas of poor practice that the registered manager’s audits had not identified.

Auditing arrangements in place required improvement, with some areas of inaccuracy and poor practice identified in the inspection not picked up in the registered manager’s audits of the service. We have made a recommendation about this.

People who used the service interacted in a relaxed fashion with staff and told us they felt safe, whilst relatives and external professionals raised no concerns about the service.

There were sufficient numbers of staff on duty, day and night, in order to keep people safe and meet their needs. Staff had received appropriate safeguarding training and were able to tell us what types of abuse they were mindful of and how they would raise concerns if they needed to.

All areas of the building were clean and staff adhered to cleaning schedules to reduce the risks of acquired infections. The registered manager agreed to improve hand-drying facilities on the first floor, which were limited, during the inspection. The premises were generally well maintained, with external servicing of equipment in place.

Risk assessments were person-centred and staff had clear guidance regarding how to manage the risks people faced. There were detailed strategies in place to help people reduce specific risks.

People had access to external healthcare professionals such as GPs, psychiatrists, nurses and occupational therapists to get the support they needed.

Staff told us they were well supported and we saw they received a range of mandatory training, such as safeguarding, health and safety, moving and handling, fire safety and infection control, and this was monitored by the administration officer.

People were encouraged to have healthy diets and were protected from the risk of malnutrition, with staff adhering to external advice from speech and language therapists.

The premises had been adapted to people’s needs, with a wet room, bathroom, shower room and a number of w/c’s accessible to people and a chairlift in regular use.

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 service supported this practice. The registered manager had ensured care plans relating to Deprivation of Liberty Safeguards were detailed and encouraged the least restrictive way of keeping people safe.

People who used the service benefitted from a continuity of care from staff who had built strong, trusting relationships with them, with the help of a low staff turnover and a keyworker system. Relatives and external professionals confirmed this to be the case. People’s inclusion in their local community was respected and promoted, and the risk of social isolation reduced.

The atmosphere at the home was inviting, inclusive, and communal. People who used the service were keen to share in their achievements and staff ensured people could contribute to the running of the service.

Person-centred care plans were in place and regular house meetings took place. Regular reviews of care plans took place and people were also involved in these via a weekly diary review.

The service had good links with a local community centre, where a range of activities took place, as well as the local church, where a number of people visited on a weekly basis.

Staff, people who used the service, relatives and external professionals we spoke with were positive about the registered manager’s accountability and hands-on approach to the service. They and staff had maintained a caring culture that valued people’s individualities.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found -

Is the service safe?

Risks to personal safety were assessed and managed. This enabled people's care to be given safely and prevented them from being harmed. A relative told us, 'X always has someone with him when he goes out. He feels safer that way'.

People were cared for in a safe and comfortable environment that was adequately maintained.

Staff were checked and vetted to make sure they were suitable to be employed to work with vulnerable adults.

Is the service effective?

People living at the home were provided with care and support that was well planned and met their needs. People and their relatives told us they were satisfied with their care. They said, 'I am happy here'; 'He gets all the support he needs'; and, 'The staff are lovely, she's treated very well'.

The service supported people to meet their nutritional needs and sought specialist advice when necessary. People were given choices of food and told us they liked the meals.

Is the service caring?

We saw people's care was focused on their individual needs and promoted their independence. Staff were patient and encouraged people to do things at their own pace. Relatives told us, 'The staff have been super, they're very good in the way they look after her', and, 'I find them (staff) to be very caring and helpful'.

Is the service responsive?

Care was provided according to people's preferences, interests and diverse needs. When people's needs changed, their care was adapted to make sure their welfare and safety was protected.

People were able to access a range of activities to meet their social needs. They were supported to be involved in the community and to maintain relationships with their families.

Is the service well-led?

The manager and staff had good understanding of the ethos of the service and their roles and responsibilities. Quality assurance processes were followed to check on the standards at the home and get people's feedback. People and their relatives told us they were satisfied and had no complaints about the service.

We saw detailed and specific information had been recorded about how people expressed their wishes. This meant staff had a good understanding of people's communication methods, so they could ensure people had given their consent before staff provided any care. Where people did not have the capacity to consent the provider acted in accordance with legal requirements. People told us staff respected their wishes. One person said, "The staff listen to me. I don't have to do anything I don't want to.

There were enough staff available to meet people's needs. One staff member said, "Staffing is good here. We never work with less than we should. Fiona (the manager) has no hesitation in bringing more staff in whenever she needs to. There are three of us working tonight to make sure that people can go to the disco, but that there will also be someone at the home for the people who want to stay."

Records were well maintained and there were appropriate arrangements in place to manage medicines.