Oak Tree House

Oak Tree House is a residential care home providing personal care to up to 4 people in 1 adapted building. The service provides support to autistic people and people living with learning disabilities. At the time of our inspection there were 3 people using the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

People had detailed risk assessments in place that guided staff how to meet their needs and mitigate risk to them. Staff understood how to manage risk to people. People were supported by a sufficient number of staff to meet their needs safely. People’s care records identified the level of 1:1 support they needed and people were allocated time for 1:1 activities.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Medicines were stored and administered safely. The principles of STOMP (stop over medicating people with learning difficulties) were applied when people were prescribed 'when required' medicines.

Right Care: People told us they felt safe. People were supported by staff who knew them well and knew how to meet their needs and manage risks. Staff were recruited safely.

Right Culture: We received mixed feedback regarding the management of the home and the role of the registered manager. Staff and relatives did not always find the registered manager to be fully visible or responsible for their role. Staff and relatives spoke positively about the support provided by the nominated individual and deputy managers. Since the last inspection, relatives had been asked for feedback regarding the home and regular staff meetings had taken place to enable staff to input. The provider had acted on feedback received following the last inspection. Systems had been put in place to ensure lessons were learnt from any accidents or incidents to reduce the risk of reoccurrence.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 19 September 2023). The service remains requires improvement. This service has been rated requires improvement for the last 2 consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. We undertook a focused inspection to review the key questions of safe and well led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the well led sections of this full report.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Oak Tree House on our website at www.cqc.org.uk.

Recommendations

We have made a recommendation in respect to the provider requesting appropriate employment references when recruiting staff.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Oak Tree House is a residential care home providing personal care to up to 4 people in 1 adapted building. The service provides support to autistic people and people living with learning disabilities. At the time of our inspection there were 4 people using the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

People did not always have risk assessments in place to guide staff how to manage their clinical needs. People were not supported by a sufficient number of staff to meet their needs safely and effectively. People did not always receive 1:1 support when needed and insufficient staffing levels impacted upon their ability to engage in activities of their choice. People were not always encouraged to do things for themselves and did not always have their independence promoted. Care records did not always identify the level of 1:1 support people required which meant the provider could not ensure people were receiving the care they needed.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Mental capacity assessments had not been completed when needed and Deprivation of Liberty Safeguards (DoLS) authorisations were not in place despite people being prevented from leaving the home on their own.

Staff followed procedures in place to ensure medicines were stored and administered safely. The principles of STOMP (stop over medicating people with learning difficulties) were applied when people were prescribed ‘when required’ medicines. Where risk assessments were in place, they provided detailed guidance to staff about how to manage risks to people.

Right Care:

People were not always supported in a person-centred way. Staff did not always communicate with people using strategies set by professionals. Professionals told us staff were caring towards them but didn’t always have the knowledge to meet their needs effectively. Staff had undergone training but did not always feel adequately trained to meet people’s specific needs. People’s preferred activities had been identified but activities were not always planned in advance. People were not always able to do the activities they wanted when they wanted. People’s care plans were detailed but care was not always delivered in line with their care plans. People had assessments in place completed by professionals but there was little evidence of regular review.

People were supported by staff who promoted their dignity and respected their privacy. People were supported to choose their own furniture and were enabled to decorate their bedroom how they wanted it. People told us they were supported by staff who generally treated them well. People were supported to see their families and maintain relationships that were important to them. People were supported to access employment opportunities if they wished.

Right Culture:

The provider did not encourage a culture that promoted positive outcomes for people. Professionals told us there was a closed culture at the home. Systems in place to check the quality of the service had not yet been fully embedded and audits were not effective in identifying risks. A safeguarding procedure was in place and staff understood the types of abuse. However, the registered manager lacked knowledge regarding safeguarding procedures and when to submit statutory notifications to the CQC which placed people at risk of harm. Professionals told us the home lacked leadership and oversight and people and relatives did not always have confidence in the management of the home. Relatives were not asked for feedback or input regarding the home. Lessons were not always learnt when things went wrong. Professionals told us the provider regularly made referrals to them but did not always ensure staff followed their strategies to promote optimum outcomes for people.

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

Rating at last inspection

The last rating for this service was good (9 March 2018).

Why we inspected

We received concerns in relation to safeguarding, quality assurance and the management of the home. As a result, we planned to undertake a focused inspection to review the key questions of safe and well-led only. However, when inspected we found there were additional concerns which related to all other key questions, so we widened the scope of the inspection to become a fully comprehensive inspection.

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 COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Oak Tree House on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safeguarding, mental capacity and people being unlawfully deprived of their liberty, person centred care, staffing and the governance of the service.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We inspected this service on 15 February 2018. Oak Tree House 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 care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

Oak Tree House provides accommodation and or personal care for up to three people with learning disabilities and autism. . The accommodation is provided in an adapted detached house with a garden. At the time of our inspection, three people were living at the home.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People continued to receive safe care. People were protected from the risk of avoidable harm by staff who understood their responsibilities to identify and report any signs of potential abuse. We saw that incidents and accidents were investigated thoroughly to ensure lessons were learnt. Risks associated with people’s care and support were managed safely and relatives were confident their family members were safe and well cared for. People received their medicines when needed and there were suitable arrangements in place in relation to the safe administration, recording and storage of medicines. There were sufficient, suitably recruited staff to meet people’s needs.

People continued to be cared for effectively. People enjoyed a wide range of food and drink and were encouraged to be involved in meal preparation. Staff received training to meet the needs of people at the service and were supported and encouraged to develop their skills and knowledge. 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 care people received remained good. People had positive, caring relationships with the staff who were kind and caring and supported people to make choices about their care. People’s privacy, dignity and independence were promoted at all times. People were encouraged to maintain their important relationships.

The service remained responsive. People received personalised care that met their individual needs. Staff understood people’s diverse needs and encouraged them to achieve their goals and aspirations. People and their relatives were able to raise and concerns or complaints and were confident these would be acted on.

The service remained well led. There were suitable systems in place to assess, monitor and improve the quality and safety of the service. The provider encouraged people, their relatives and professionals involved in the service to give feedback on how they could make improvements in the service.

Further information is in the detailed findings below.

Oak Tree House provides personal care for up to three adults with a learning disability and associated conditions. There were two people living at the home on the day of our inspection.

There was a registered manager at the home. 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.

Staff understood their responsibilities to keep people safe from the risk of abuse. There were systems and processes in place to protect people from the risk of harm. Staff received the training and support they needed to meet people’s needs and an induction programme was in place to support new staff to understand their role. There were enough staff to meet people’s needs and checks were made to confirm staff were suitable to work in a care environment. People received their medicines as prescribed.

People made decisions about their care and staff helped them to understand the information they needed to make informed decisions. People were supported to eat and drink enough and staff monitored people’s health to ensure they had access to other health professionals when needed.

Staff had caring relationships with people, supported their privacy and dignity and encouraged them to maximise their independence. People had opportunities to work and were supported to follow their interests both at home and in the local community. People were supported to maintain relationships with people that mattered to them.

There were processes in place for people to raise any complaints and express their views and opinions about the service provided. There were systems in place to monitor the quality of the service to enable the provider to drive improvement.