The Oaks

The Oaks is a residential care home providing personal care to adults who have learning disabilities and complex needs, including behaviours that may challenge, autism and other associated issues. The main home has accommodation for up to six people and the separate ground floor apartment with its own facilities accommodates two people. There were eight people using the service at the time of our inspection.

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

We observed positive interactions between people and staff. There were enough staff to meet people’s needs and keep them safe. Staff had a good understanding about safeguarding and were passionate about safeguarding people from the risk of abuse.

People received care and support from staff that were recruited safely and had received training. People received their medicines as prescribed. The registered manager and staff worked with and sought external healthcare professional support when required.

We observed staff wearing appropriate personal protective equipment (PPE) in line with current guidance.

Staff told us they were able to debrief following any incidents. The management team reviewed any accidents and incidents ensuring any lessons learnt were acted on and shared with the staff team.

Quality assurance audits were in place. Regular audits were carried out to ensure good standards were maintained, and where improvements were needed, these were actioned. The service was currently undertaking some environment work.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The Model of care and setting maximises people’s choice, control and independence. Care is person-centred and promotes people’s dignity, privacy and human rights. The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.

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 the service under the previous provider was good, (published on 02 March 2018).

Why we inspected

We received concerns in relation to the health and safety of the people living at the home. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this 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 not changed. This is based on the findings at this inspection.

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 The Oaks on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

All people we spoke with felt safe in their home and when the staff were with them in case they needed some guidance or assistance with their care needs. Staff knew who to report to if they felt a person was at risk of potential abuse and were confident that any reported incidents would be addressed by the registered manager.

People told us they were encouraged to monitor and manage potential risks and what they felt able to do and were comfortable with. Staff knew how to encouraged people to learn and try new things safely. There were enough staff when people needed them and people medicines were administered and recorded when they had received them.

Staff were knowledgeable about people they supported and were confident in their roles and responsibilities. Staff told us they received regular training and supervisions that helped them provide care to people they supported.

People are 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. People were involved in making decisions about their care and their consent was appropriately obtained by staff when caring for them. People who could not make decisions for themselves were supported to have a decision made about their care and support which was in their best interest.

Care plans detailed what support people needed and provide guidance for care staff on how best to meet the care people wished to receive. People were supported to make their meals or staff prepared them where needed. People were involved in planning their meals which included their favourite choices. Healthcare appointments were arranged for people and care staff went with them.

People told liked the staff and told us their care needs were supported well. People were encouraged to be in control of their decisions and choices. Staff respected people’s dignity and privacy. People spoke with us about the registered manager being accessible and provided examples of when the registered manager had listened to them.

Everyone we spoke with felt the management team were available to talk with and would listen and act of any feedback provided on the service. The management team had kept their knowledge current with support from the provider and external professionals. The staffing team felt the provider and management team led by example and that they regularly checked on the quality of the care that people received and continually looked to improve these.

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?

Staff we spoke with were clear about what was meant by abuse and what actions they would take should abuse be suspected. Families of people who used the service expressed confidence that could raise any issues with the registered manager and the staff team. A senior member of staff was on call at all times in case of emergencies. The provider had a policy for safeguarding adults from abuse. This was communicated to staff during their induction, was available in a policy file and on display in the office. This meant that people could feel confident that they would be protected from abuse.

Staff employed by the home had been recruited effectively. The manager demonstrated that appropriate checks had been obtained and that staff were trained and supported in their role. Staff completed one week of theory based training, and one week working with experienced staff to familiarise with the complex needs of people living in the home. The team leader monitored and checked staff to ensure they understood their roles and responsibilities before they began work unsupervised. Staff we spoke with also confirmed that they had worked with experienced staff until they had felt confident to carry out their role. Monthly supervisions were completed by team leaders, and annual appraisals were completed by the registered manager.

We saw that people were treated with dignity and respect by staff. Staff told us they called people by their preferred name, and ensured people had privacy when they were being supported with personal care. One relative we spoke with told us that: "They (staff) are respectful....just outstanding".

Systems were in place to ensure that the provider learnt from events such as accidents, incidents. This meant that risks to people were reduced and helped the service to improve.

Is the service effective?

An advocacy service was available and had been used by people living in the home. This meant that people had access to additional support if they needed it.

People's health and care needs were assessed with them, and they were involved in planning their care. The care plans had been reviewed regularly and there was evidence that the provider had worked closely with other health professionals such as the community learning disability team, social workers, psychiatrists and occupational therapists.

Families were able to visit at any time and one relative told us: "I always visit unannounced".

Is the service caring?

People were supported by kind and attentive staff. We saw interactions that were thoughtful and which supported and encouraged people to make their own decisions. We saw that people were supported with a range of activities to help them achieve their full potential.

A health professional we spoke with was complimentary about the service and told us: "They really understand person centred care, and have embraced and implemented what we have taught them, they offer fantastic support".

People who used the service, families, external professionals and staff were all invited to participate in an annual satisfaction survey. Actions were taken in response to any concerns or shortfalls identified.

Is the service responsive?

People completed a range of activities in and outside of the service on a daily basis. A person centred approach meant that each person living in the home had services and opportunities available based on their current and perceived needs.

People or their families knew how to complain, and there were copies of the complaint procedure in people's care files.

The manager worked well with other health professionals who provided support with training and recommendations which would be incorporated into the care plans. A health professional from the community learning disability team expressed their view that the staff provided an excellent service and were committed to quality improvement.

Is the service well led?

The provider had an auditing and quality monitoring programme in place. The programme included completion of internal and external audits. Action plans from these audits were completed and progress was monitored the following month.

Unannounced nights checks were completed periodically which meant that people could be confident that the quality of the service was monitored over a twenty four hour period.

The views of people who used the service were taken into account. For example, people participated in staff recruitment, had representation on the health and safety committee, and provided feedback for the monthly visit by the director. There were also 'service user' meetings which were recorded, and any actions documented. This demonstrated that the people using the service were enabled to contribute to the running of the home.

Care documentation was reviewed formally on a six monthly basis by the management team or more frequently if there were any changes.

Accident and incident reports were completed by staff, and the registered manager had a process in place for analysing all information on a regular basis. This ensured that any required actions or identified trends could be addressed.

Complaints and compliments were monitored and recorded and all people living in the home had a copy of the procedure in their file.

Positive comments had been received about the staff from families and health professionals about the quality of the service provided, and the commitment of the management team to provide the best possible care for the people who used the service.

We watched staff as they cared for people. Staff always asked for permission before providing personal care. Some people had been supported by their relatives to make decisions about care and support they needed. Information about people's consent had been recorded in their care plans.

Staff provided care and support that met people's needs. We found that staff knew about the needs of the people they cared for. We looked at care records for three people and found that these contained guidance for staff on how to meet their needs. We saw that people's needs had been reviewed regularly. When it had been necessary staff had co-operated with medical professionals.

The registered manager had taken reasonable steps to ensure that suitable people had been employed to work at the home. Records had been maintained appropriately and stored securely.