Oakfield (Easton Maudit) Limited

We found the following examples of good practice.

• Oakfield ( Easton Maudit ) ensured current government guidelines in relation to COVID-19 were being followed by staff and visitors to reduce the risk of infection to people living at the home. This included comprehensive checks for visitors on arrival.

• Detailed and up-to-date policies and procedures were in place. There were several infection control audits that had been completed with actions immediately addressed.

• Staff had received training in the use of personal protective equipment (PPE), and we saw this was accessible throughout the home and staff used it in accordance with the most up to date guidance.

People’s experience of using this service:

The service worked within the principles and values that underpin Registering the Right Support and other best practice guidance. This ensured that people could live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control over their own lives, choice, and independence.

Improvements were required to ensure that the systems in place to monitor the quality of the service and drive improvements were embedded and consistently maintained.

People were cared for and supported by staff who were friendly, caring and passionate about their work; they were treated with respect and their dignity maintained.

People had detailed personalised plans of care which ensured staff provided consistent care and support in line with their personal preferences. People were encouraged to have as much control of their care as possible and to be independent.

People were supported to maintain good health and nutrition and live fulfilled lives. They were protected from the risk of harm and received their prescribed medicines safely.

Staff were appropriately recruited and there were enough staff to provide care and support to people to meet their needs. They had access to the support, supervision and training that they required to work effectively in their roles.

Staff knew their responsibilities as defined by the Mental Capacity Act 2005 (MCA 2005). The provider was aware of how to make referrals if people lacked capacity to consent to aspects of their care and support and were being deprived of their liberty.

Information was provided to people in an accessible format to enable them to make decisions about their care and support.

People knew how to raise a concern or make a complaint and the provider had implemented effective systems to manage any complaints received.

The service had a positive ethos and an open culture. The provider and registered manager were approachable, understood the needs of the people in the home, and listened to staff and relatives.

The service met the characteristics for a rating of ‘good’ in four of the five key questions we inspected and rating of ‘requires improvement’ in one. Therefore, our overall rating for the service after this inspection was ‘good’.

Rating at last inspection:

Requires improvement (report published 25th June 2018).

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned.

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

The home is registered to accommodate 18 adults with autism and/or learning disabilities, dementia, mental health and physical and sensory difficulties; at the time of our inspection, there were 15 people living in there. The service provided was not initially developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. However, people were given choices and their independence and participation within the local community encouraged.

At our last inspection in May 2017, this service was rated overall as requires improvement. At this inspection, the service remains rated as requires improvement.

The inspection took place on the 8 and 9 May 2018; the first day was unannounced and we carried out an announced visit on the second day.

There was a registered manager 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.

The systems in place to monitor the quality of care and effectiveness of the service had not been sufficiently embedded for us to fully assess their effectiveness. Although the provider had identified shortfalls in their monitoring processes, there had been a delay in establishing effective processes.

People could not be assured that they were always cared for safely as there were not always risk assessments in place to mitigate any identified risk. Infection control processes needed to be strengthened.

There was not always sufficient staff with the right skills deployed to meet everyone’s needs. People’s access to activities outside of the home could be limited at times.

Staff understood the need to undertake specific assessments where people lacked capacity to consent to their care and/or their day-to-day routines. However, there had been a failure to recognise that applications for authorisation under the Deprivation of Liberty Safeguards needed to be made to ensure that people were being supported in line with the principles of the Mental Capacity Act.

People received care from staff that knew them and were kind, compassionate and respectful. The staff were friendly, caring and passionate about the care and support they delivered. People had formed positive therapeutic relationships with staff and were treated as individuals.

Care plans were in place, which enabled staff to provide consistent care and support in line with people’s personal preferences and choices, however these needed improving to ensure all the information about people’s life history was included. End of life wishes were discussed and plans put in place.

People were cared for by staff who were respectful of their dignity and who demonstrated an understanding of each person’s needs. This was evident in the way staff spoke to people and the activities they engaged in with individuals. Relatives spoke positively about the care their relative received and felt that they could approach management and staff to discuss any issues or concerns they had.

Staff were appropriately recruited. People received their prescribed medicines safely. Staff understood their responsibilities to keep people safe from any risk or harm and knew how to respond if they had any concerns.

People’s health care and nutritional needs were carefully considered and relevant health care professionals were appropriately involved in people’s care. There was a variety of activities available for people to participate in if they wished to and family and friends were welcomed to take part in events at the home.

Staff had access to the support, supervision and training that they required to work effectively in their roles. Development of staff knowledge and skills was encouraged.

The service had a positive ethos and an open culture. People knew how to raise a concern or make a complaint and the provider had implemented effective systems to manage any complaints that they may receive.

At this inspection, we found the service to be in breach of two regulations of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. The actions we have taken are detailed at the end of this report.

Oakfield (Easton Maudit) Limited is registered to provide accommodation and personal care for up to 18 adults of all ages with learning disabilities, autistic spectrum disorder and physical disabilities. There were 16 people living in the home on the day of inspection.

There was a registered manager in post at the time of our inspection. 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.

Systems and processes in place to assess monitor and improve the quality and safety of the service were not always effective at identifying shortfalls. Where shortfalls were identified these were not always addressed in a sufficiently timely manner.

Staff recruitment procedures needed to be strengthened to ensure that all necessary risk assessments had been completed as part of the staff selection process. In the main there were enough staff deployed to keep people safe and provide appropriate support. However members of the management team and activity staff were often re-deployed to cover care shifts as there was a shortage of care staff.

Arrangements in place to ensure that staff had sufficient skills and knowledge to provide people with appropriate support required strengthening. Not all staff had been trained in mental capacity and some staff with responsibility for medicines administration did not have an up to date competency assessment. Some staff had not been provided with refresher training in key areas such as safeguarding. Staff received an induction into the home and did not work with people on their own until they understood the care needs of each person.

People felt safe in the home and relatives said that they had confidence in the ability of staff to keep people safe. Staff understood the need to protect people from harm and abuse and knew what action they should take if they had any concerns.

Care records contained individual risk assessments and risk management plans to protect people from identified risks and help to keep them safe but also enabled positive risk taking. They provided information to staff about action to be taken to minimise any risks whilst allowing people to be as independent as possible.

Care plans were written in a person centred approach and detailed how people wished to be supported and people were involved in making decisions about their care. People participated in a range of activities both in the home and in the community and received the support they needed to help them do this. People were able to choose where they spent their time and what they did.

People were supported to take their medicines as prescribed. Records showed that medicines were obtained, stored, administered and disposed of safely. People were supported to maintain good health and had access to healthcare services when needed.

People were actively involved in decisions about their care and support needs. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

Staff had good relationships with the people who lived in the home and people told us that staff were caring and respectful. Staff were aware of the importance of managing complaints promptly and in line with the provider’s policy. Staff and people were confident that issues would be addressed and that any concerns they had would be listened to.

We also identified that the registered person had not consistently implemented effective systems or processes to assess, monitor and improve the quality and safety of the services being provided. Quality monitoring systems and processes were not always used as effectively as they could be to ensure that they were meaningful and that action was taken to make improvements when required. Audits checks and satisfaction surveys had been completed but there had been no attempt to analyse or have oversight of the outcome of these in order to drive future improvement. This was a breach of legal requirements.

Following the inspection the provider sent us an action plan detailing the improvements they were going to make, and stated that improvements would be achieved by 20 May 2016. During this inspection we returned to see if the service had made the required improvements. We found that the provider was now meeting these regulations.

This report only covers our findings in relation to the outstanding breaches of regulation. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Oakfield (Easton Maudit) on our website at www.cqc.org.uk.

Oakfield (Easton Maudit) provides care for up to 18 people who have a range of needs including learning disabilities. It is situated in the rural area of Easton Maudit, close to Wellingborough. On the day of our visit, there were 18 people living in the service.

The inspection was unannounced and took place on 5 July 2016.

The service had a registered manager. 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.

During this inspection, we found that improvements had been made to the systems in place within the service, to ensure that safeguardings were reported appropriately to the local authority. Staff had strengthened their practice in respect of monitoring and overview of accidents and incidents to ensure that these should not be raised as possible safeguardings, and had worked hard to ensure the systems in place were more thorough.

We reviewed the audit and quality monitoring systems in place, and found that these had been strengthened. The processes in place were more robust and more regular audit checks were taking place of all aspects of supervisions and quality monitoring feedback. Because of this issues were now identified and addressed in a more timely manner.

Our inspection took place on 9 March 2016. At the last inspection in February 2014, the provider was meeting the regulations we looked at.

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.

Staff had an understanding of abuse and the safeguarding procedures that should be followed to report potential abuse. However, systems in place were not always followed which meant that appropriate action was not always taken to keep people safe from abuse or neglect. Potential service user on service user safeguarding incidents had not been reported to the relevant external agencies.

Staff were supported through a system of induction and on-going training, based on the needs of the people who lived at the service. However, they did not always receive regular supervisions which meant they were not always provided with consistent and formal support and there was not an accurate record of any areas discussed. Although there were systems in place in respect of the Mental Capacity Act 2005 (MCA) these were not always used appropriately which meant that the service did not consistently follow the legal requirements outlined in the MCA 2005.

Quality monitoring systems and processes were not always used as effectively as they could be to ensure that they were meaningful and that action was taken to make improvements when required. Audits checks and satisfaction surveys had been completed but there had been no attempt to analyse or have oversight of the outcome of these in order to drive future improvement.

People felt safe living in the service and showed through their actions that they were relaxed in the presence of the staff that supported them. Risk assessments within people’s care records were completed and reviewed. Staff understood how to manage risks to promote people’s safety, and balanced these against people’s rights to take risks. Staff were not allowed to commence employment until robust checks had taken place in order to establish that they were safe to work with people. There were adequate numbers of staff on duty to support people safely and ensure people had opportunities to take part in activities of their choice. Medicines were managed safely and the systems and processes in place ensured that the administration, storage, disposal and handling of medicines were suitable for the people who lived at the service.

People received a good choice of meals and were able to get snacks and fluids throughout the day. Meals were based upon their preferences and catered for any specialist dietary requirements.

People had access to health care professionals to make sure they received appropriate care and treatment to meet their individual needs.

Staff were kind and compassionate towards people. They engaged with them in a friendly manner and assisted them as required, whilst encouraging them to be as independent as possible. People and their family members were involved in planning their care. Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes. Advocacy services were accessed to enable people to have a voice when this was appropriate.

Care plans were in place for people and were based upon their individual specific needs and wishes. They were reviewed and updated regularly, to ensure they reflected the most recent and up-to-date information regarding people’s care. There were activities both inside and outside of the service to keep people occupied and stimulated. The service also had a complaints procedure in place, to ensure that people and their families were able to provide feedback about their care and to help the service make improvements where required.

The service was led by a registered manager with additional support from the deputy manager and care manager. There was an open and transparent culture within the service, which took account of people’s and staff members views in order to ensure that the delivery of care was appropriate to meet people’s needs.

We identified that the provider was not meeting regulatory requirements and was in breach of one of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We found that people were treated with dignity and respect and people's personal space was respected. We found that each person had an assessment of their needs and this was regularly reviewed. We saw that people were supported to be independent and engage in activities that engaged their interests.

We found that the home was clean and measures had been put in place in the kitchen to prevent the risk and spread of infection. We found that there were sufficient numbers of staff to meet people's needs and there was a suitable complaints procedure available.

At the time of our inspection the provider did not have a registered manager in post.