Little Oaks Residential Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

This is the first assessment for this care home since a change of provider on 14 October 2021. This key question has been rated Good.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The provider maintained records of any incidents and accidents reported by staff for the service. Investigations of these incidents were undertaken, and these identified any actions taken to prevent recurrence of events such as falls. The investigations included information about reporting concerns to relevant authorities where this was required, as well as any referrals required for further health professional support.

The provider undertook lessons learnt practices to share any learnings and changes made, with staff in staff meetings. We saw records of these. Staff also told us any concerns and outcomes were discussed during daily handover meetings with the care team.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The provider had systems in place to support people to move between services. This included records of care plan overviews which included details of peoples' physical and emotional health, contact details for family and their preferences for support. These were shared with health professionals and new care services to ensure consistency of care could be provided to people.

Staff communicated effectively with health professionals and shared accurate, timely information to support safe decision-making and continuity. Health professionals consistently described good collaboration and had confidence staff would act promptly if risks emerged when supporting safe transitions across care pathways.

The provider ensured care staff visited people whilst staying in hospital, where appropriate to provide support to them, their family and health professionals. This supported positive outcomes for individuals. A relative told us; “An example was the [registered manager] accompanying [person] and I to hospital for a [procedure] and staying with [person] for this because of concerns about anxiety - this was entirely successful and I'm in no doubt that [the registered manager’s] involvement really helped”. This demonstrated the provider's commitment to ensuring positive outcomes for people.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Safeguarding processes were clearly understood by staff, and notifications to appropriate bodies were made in line with regulatory expectations. Staff understood the importance of keeping safeguarding-related training up to date to ensure people were protected and risks were managed appropriately. Systems were in place to discuss safeguarding regularly through meetings and supervision.

Staff told us they were familiar with the safeguarding policy and knew how to report concerns. Comments from staff included, “If I had a safeguarding concern or I needed to report an incident I would speak to my manager/deputy about it first” and “I would report an incident or safeguarding concern to the manager or senior on duty and follow the home's procedures.”

People told us they felt safe at the home, and this was supported by feedback from relatives. One relative told us, “[Person] is very safe” and another said, “They are absolutely safe”.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found that staff and management worked within the MCA.

Where appropriate the provider had applied to the local authority for DoLS authorisations. Details of all DoLS applications were included in care plans, including details of any conditions to the authorisations.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risks to people were assessed, and comprehensive care plans were in place to help staff support people safely. Staff knew the risks that were important to each person and provided support in a way that promoted independence while reducing the risk of harm. Staff told us care plans and risk assessments were easy to access and understand. They said changes to people's needs were shared promptly through daily handovers and team meetings, helping staff provide consistent care.

People were involved in decisions about their safety and were supported to take positive risks that improved their quality of life. Staff took a person-centred approach, balancing safety with people's rights, choices and independence. The provider supported people to continue doing activities that were meaningful to them. For example, 1 person who had previously worked in kitchens and enjoyed baking was given their own apron and name badge and supported to help kitchen staff with baking activities each morning. As the person's health needs changed, staff adapted the activity so they could continue to take part safely. This helped the person maintain a sense of purpose and continue doing something they enjoyed.

Staff demonstrated their understanding of risk in feedback provided to us, "To help an individual make a decision for themselves I try to offer them all the information including highlighting the risks or benefits. Individuals are allowed to make their own choices even if these are unwise".

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

There was a fire risk assessment, and regular fire drills to help manage the risks around fire, ensuring staff took part and had good knowledge of fire safety procedures. Every person had a personal emergency evacuation plan (PEEP). The purpose of a PEEP is to ensure staff knew the support people needed to evacuate the building safely and promptly in the event of an emergency, regardless of their level of mobility or other health conditions.

Equipment, such as wheelchairs, were available and maintained to meet people’s needs. Fire equipment, lifting equipment and electrical safety checks were completed as required.

During the assessment, we observed 2 air flow mattress settings were not accurately set for the weight of the people using them and 1 mattress required a service. The provider took immediate action to address this. They advised although staff were expected to check on these, they acted by setting up automated reminders for staff to check these on a weekly basis on their electronic system.

The provider undertook various regular environmental checks such as daily walkarounds and call bell checks to ensure the environment was safe.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. However, improvements were required to ensure records relating to staff recruitment and support were up to date and in line with best practice and guidance.

We found staff who had been working at the home for a long period of time had been supported to have a job role change. However, no interview process had been undertaken.

People were supported by staff who had been recruited using robust processes. There were staff available to support people when they needed assistance. There were sufficient staff deployed around the building to meet people’s needs. We observed people being supported at various times throughout the day and saw their needs were met in a timely manner.

Staff recruitment files contained full and robust checks, including a Disclosure and Barring Service check. This checks for criminal convictions and inclusion on lists of people who would be unsuitable to work with people at risk.

The provider used agency staff to fill any gaps in rotas to ensure there were enough staff to support people. We found the process for ensuring agency staff had the right skills and experience could be improved. The registered manager gave assurances that agency staff would provide evidence of their skills prior to working with people.

The provider had forged links with a local school and offered work placements for senior students. The provider ensured risk assessments were in place and clear guidance on what activities the student could undertake. It was clear people enjoyed having students in the home, we observed some animated conversations between them and people.

Staff were supported to have training to ensure they were skilled to work with people. The registered manager and deputy manager had systems in place to monitor staff training. We provided the registered manager with some feedback about how their system could be improved. Staff felt the training equipped them to support people. Staff told us, “The training is comprehensive. We use a mix of e-learning and face-to-face sessions, which helps cover the mandatory requirements effectively”.

People told us that they felt safe and thought staff were appropriately trained and skilled in their roles. People told us they felt staffing levels were sufficient and staff were available to provide support.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The provider had processes in place to assess and manage the risk of infections. The environment was clean and well maintained. A dedicated housekeeping team kept comprehensive records of regular cleaning tasks. The kitchen kept comprehensive good records of cleaning tasks, and we observed they had followed advice from food hygiene professionals to ensure areas of risk were mitigated. For example, ensuring hand washing and food washing basins were clearly signed.

There were designated Personal Protective Equipment (PPE) Stations throughout the service available for staff use, as well as posters displayed to remind staff and visitors of the importance of using PPE appropriately.

During mealtimes, we observed some staff did not follow IPC practices in washing their hands prior to supporting people. This was fedback to the registered manager who took immediate steps to address this by discussing this with staff and ordering a supply of antibacterial hand wipes for people to use if they did not want to wash their hands. We observed some good practices during mealtimes where staff kindly and discreetly supported people to clean their face or hands where required.
 

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Medicines were stored correctly and there was a clear disposal process. We observed staff administering medicines safely. The provider had recently introduced an electronic medication management system. During our review of records held within this system, we identified some shortfalls in the quality of information recorded for people who required ‘when required’ (PRN) protocols and the use of body maps for recording where to apply prescribed creams. We shared this feedback with the registered manager, who acknowledged our concerns and explained that paper-based records were still being maintained while information was being transferred onto the new system. The registered manager took immediate action and subsequently demonstrated records were in place on the new electronic medication system and information had been shared with medicine administration staff to improve accuracy and completeness.