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Inspection carried out on 7 May 2019

During a routine inspection

About the service:

Oak House is a care home registered to care for six people who have a learning disability. At the time of the inspection six people were using the service.

People’s experience of using this service:

The service reflected the principals of Registering the Right Support guidance, providing person-centred care and support. The service had a homely feel with care and attention to ensuring each person had a bespoke living environment taking into consideration their likes, preferences and sensory needs. There was space for people to spend time alone, and to socialise with others. The service promoted people’s choice, control, independence and inclusion. People’s support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People were safe and protected from avoidable harm and relevant risk assessments were in place. People who used the service communicated to us that they felt safe living in the home. Their relatives we spoke with spoke positively about the standard of care and support their family members received. People's medicines were managed well, and the home was seen to be clean and tidy throughout.

There were enough staff and they had been recruited in a way that helped to keep people safe. There were enough staff on duty to ensure people’s needs were met. New staff received support to help them learn their role. All staff received appropriate training, support and supervision.

People were supported to eat and drink. Where people had specific dietary needs, these were provided for. Communication was effective within the staff team and people were supported to access other healthcare professionals as needed.

People were supported to make day to day choices and decisions about their lives and were able to participate in their hobbies and interests. 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.

Staff were kind and caring towards people and had developed very strong relationships with them, knowing them well, including their histories, likes and dislikes. People were treated with dignity and respect, they were involved in making daily decisions and encouraged to develop and maintain their independence.

Care plans were personalised and detailed. They included information about people’s preferences and abilities. Staff supported people to participate in a range of activities. There was a focus on treating people with equality. Bespoke techniques were used to involve and empower those with communication difficulties to ensure their voices were heard and valued. There was a system in place to manage complaints.

Leadership and management were of good quality and people who used the service, their relatives and representatives were fully involved in how the service was run and operated. Systems of governance were in place to continually monitor the quality of the service provided and staff felt supported and spoke positively about the registered provider and the registered manager.

Rating at last inspection:

The service was rated good at the last inspection in 2016 (published 17 November 2016).

Why we inspected:

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

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

Inspection carried out on 2 November 2016

During a routine inspection

The inspection took place on 2 November 2016 and was unannounced. This meant prior to the inspection people were not aware we were inspecting the service on that day.

Oak House is a care home registered to care for people who have a learning disability. Oak House can accommodate up to four people. The Acorns is a separate annexe that accommodates two people.

There was a manager at the service who was in the process of registering with CQC. 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.

Oak House was last inspected on 4 March 2015. Following the inspection the service was rated as Requires Improvement. We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because there was no robust system in place for staff training to be monitored and there was insufficient oversight to ensure staff had the requisite training for their roles. Also the registered person had not protected people against the risk of abuse or improper treatment. We asked the provider to take action to make improvements and these actions have been completed.

People who used the service communicated to us that they felt safe living in the home. Their relatives spoke positively about the standard of care and support their family member received.

People's medicines were managed well and the home was seen to be clean and tidy throughout.

People received care that was delivered in line with the Mental Capacity Act (MCA) because people were supported to make day to day choices and decisions about their lives. Appropriate and timely applications to ensure that restrictions on people’s liberty to leave the home had been made for everyone that needed them.

People enjoyed the food provided and were supported to receive adequate food and drink to remain healthy.

Staff employed at the home had been recruited in a way that helped to keep people safe because thorough checks were completed prior to them being offered a post.

Staff were receiving regular training and supervision so they were skilled and competent to carry out their role.

Staff knew the people they were supporting and provided a personalised service. Support plans were in place detailing how people wished to be supported and people were involved in making decisions about their care.

We saw people participated in a range of daily activities both in and outside of the home which were meaningful and promoted independence.

People and their relatives had been asked their opinion of the quality of the service via surveys and by the regular meetings with the managers.

Staff said communication in the home was good and they always felt able to make suggestions. There were meetings held for all staff and additional meetings for groups of staff, for example, senior support workers.

Inspection carried out on 4 March 2015

During a routine inspection

The inspection took place on 4 March 2015 and was unannounced. Oak House was last inspected on 8 October 2013 and was meeting the requirements of the regulations that were inspected at that time.

Oak House is a care home registered to care for people who have a learning disability. Oak House can accommodate up to four people. The Acorns is a separate annex that can accommodate two people. At the time of our inspection, four people were living in Oak House and one person was living at The Acorns.

There was a registered manager in place at the service. However, at the time of our inspection the deputy manager was managing the service as the registered manager was undertaking a period of absence which we had previously been informed about.

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.

Although staff told us they received training there was no management oversight and effective system to monitor that staff were trained to meet the needs of the people they supported. One person’s risk assessment required staff trained in a specific technique to intervene at certain times when needed. The staff we spoke with at the time of the inspection were not up to date with this training and the acting manager was not able to say who was currently trained in this. This meant there was a risk that people were supported by staff that did not have the required skills to meet their needs.

The principles of the Mental Capacity Act (MCA 2005) and Deprivation of Liberty Safeguards (DoLS) were not always being followed. We observed a form of restraint being used with no evidence to show risks had been considered, whether this was in the best interests of the person or that less restrictive options had been considered. Consideration was required as to whether people living at Oak House needed to have any DoLS authorisations in place in accordance with current criteria.

We saw good systems in place to minimise risks of medicines being handled or administered unsafely. People had support with nutritional needs and to maintain good health and we saw evidence of involvement with various health professionals.

Although there were vacancies, staffing levels were managed, maintained and of a suitable level to meet people’s needs. Observations showed staff were visible and present to support people where required. An effective recruitment process was in place so that people were assessed as being suitable to work at the service. Staff completed an induction and then worked alongside another member of staff prior to supporting people on their own at the service. Staff and management spoke positively about how the staff team worked and supported each other.

Care records were reviewed regularly and contained information about people’s support needs and preferences, and how these were to be met. People and relatives we spoke with were positive about the care they or their family member received. Observations showed that staff were kind, caring and patient in their interactions with people although we did witness a situation where people’s privacy was not maintained

We saw activities take place at the service and people were supported to access various activities in the community. One person told us about a holiday they were planning to go on with staff. Feedback from people living at the service was sought by way of regular meetings. Relatives said they were kept informed about their family members wellbeing and had opportunities to give feedback. There was a complaints procedure in place although there were no complaints at the time of our inspection.

Incidents were logged on a recording system and overseen by management and head office so that themes or trends could be identified.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which correspond to two regulations 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.

Inspection carried out on 8 October 2013

During a routine inspection

We spoke with two people living at the home who were able to verbally express their views. The other four people living there at the time of our inspection were unable to tell us their experiences due to their complex needs. We spoke via telephone with six relatives who each had a family member that lived at the home.

People�s views and experiences were taken into account in the way the service was provided and delivered in relation to their care. Relatives said about staff, �They�re definitely respectful and polite� and �They try and give [my relative] choice, they know them, I feel secure that staff are nice.�

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. One person said �I like living here�. A relative told us �I�m extremely pleased, I�m happy [my relative] is in the right place and confident they�re looked after, its home, not a care home.�

People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

There were enough qualified, skilled and experienced staff to meet people�s needs. People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. A relative told us, �I think the staff are trained, they�re up on things.�

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

Inspection carried out on 9 November 2012

During a routine inspection

We were not able to speak with people using this service because most had complex needs and they were not able to tell us their experiences. We used a number of different methods to help us understand the experiences of people who used the service.

This included observing care, looking at records and talking to staff. We also spoke with the relatives of two people using the service. They told us they were happy with the care provided and had no concerns. They told us where they had raised concerns they had been listened to and the issues dealt with swiftly.

Throughout our visit, we saw that staff treated people with dignity and kindness. We observed that a friendly and positive approach was used, to ensure that the wishes and needs of people using the service were respected.

We found people were cared for, or supported by, suitably qualified, skilled and experienced staff. Staff were able to demonstrate different methods of communicating with people to ensure their wishes and beliefs were respected.

We found medication was administered safely to people. People were given appropriate support, to ensure they had taken their medication as prescribed.

Inspection carried out on 5 January 2012

During a routine inspection

Due to the communication needs of people living in the home, we used informal methods of observation during the site visit. We sat with people in the lounges, observed care practices and saw how staff and people interacted with each other. Throughout our visit, we saw that staff treated people with dignity and kindness. We observed that a friendly and positive approach was used, to ensure that the wishes and needs of people using the service were respected.

Reports under our old system of regulation (including those from before CQC was created)