We carried out an unannounced inspection of Oak House on 9 February 2017. Oak House provides care and accommodation for up to 11 people who require accommodation and personal care. Nursing care can be provided through the local community nursing services if appropriate. At the time of the inspection 11 people were living at Oak House. There was a registered manager who was also the provider. They were supported by an assistant 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.
At the last inspection in October 2015 we found improvements should be made to ensure processes followed legislation to ensure people’s legal rights were protected. This had meant that some people at that time may have been deprived of their liberty without the correct authorisation. Since the last inspection, we found that the provider had followed the requirements in deprivation of liberty (DoLS) authorisations and related assessments and decisions had been appropriately taken. All staff and the registered manager/provider demonstrated a good knowledge and understanding of the (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff clearly understood the importance of seeking people's consent and offering them choice about the care they received. Therefore, at this inspection we found the service was meeting all regulatory requirements and we did not identify any concerns with the care provided to people living at the home. One relative said, "It’s lovely here. They really understand [person’s name]. They can do what they want and be themselves.”
On the day of the inspection there was a calm and relaxed atmosphere in the home and we saw staff interacted with people in a friendly and respectful way. People were able to choose what they wanted to do and enjoyed spending time with the staff who were visible and attentive. People were encouraged and supported to maintain their independence. There was a sense of purpose as people engaged with staff, watched what was going on, read newspapers, played games and
pottered around the home or went out. The majority of people were living with dementia and were independently mobile or required some assistance from one care worker. Staff engaged with them in ways which reflected people's individual needs and understanding.
People were provided with an excellent variety of opportunities for activities, engagement and trips out. These were well thought out in an individual way, with opportunity for spontaneous outings to buy a magazine for example or go for a drive. People could choose to take part if they wished. Activities were not only organised events such as trips out and external entertainers but on-going day to day activities. For example, there was always something for people to do for stimulation such as chatting with staff, playing games, looking at books, household chores or arts and crafts sessions.
People and relatives said the home was a safe place for them to live. Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns. Staff were confident that any allegations made would be fully investigated to ensure people were protected. There had not been any safeguarding concerns in the last 12 months. People said they would speak with staff if they had any concerns and seemed happy to go over to staff and indicate if they needed any assistance. Staff were vigilant about protecting each person from possible negative interactions with other people living at the home, recognising frustrations and misunderstandings between people due to them living with dementia. People and relatives knew how to make a formal complaint if they needed to but felt that issues would usually be resolved informally. One relative said in the recent quality assurance survey, “Since my mother has been at Oak House I feel I do not have to worry knowing she is in safe hands.”
People were well cared for and were involved in planning and reviewing their care as much as they could, for example in deciding smaller choices such as what drink they would like or what clothes to choose. Where people had short term memory loss staff were patient in repeating choices each time and explaining what was going on and listening to people’s stories.
There were regular reviews of people's health, and staff responded promptly to changes in need. The providers were retired health professionals and were well thought of in the community. The local GP told us, “I have had many of my patients residing [at Oak House] over many years now. I have felt able to recommend the home to professional colleagues whose parents have needed this type of residential care and know from their subsequent testaments that the placements have been very successful. The home appears well organised with only appropriate calls for medical attention.” People were assisted to attend appointments with appropriate health and social care professionals to ensure they received treatment and support for their specific needs. For example, a GP visited one person during our inspection and was happy with their care and there were visits from a regular chiropodist.
Medicines were well managed and stored in line with national guidance. Records were completed with no gaps and there were regular audits of medication records and administration and to ensure the correct medication stock levels were in place.
Staff had good knowledge of people, including their needs and preferences. Care plans were individualised and comprehensive ensuring staff had up to date information in order to meet people's individual needs effectively. Staff were well trained and there were good opportunities for on-going training and obtaining additional qualifications. The staff team was very stable and vacancies were filled by word of mouth, most staff were trained health professionals in their country of origin and clearly had good knowledge in identifying people’s changing needs and providing appropriate care. Comments about staff from one GP included, “I can confirm that the staff are very caring and empathic to their residents.” The provider said, “The staff are very good. [Staff member’s name] is excellent and clinically very good, they all know when people are not feeling well. I can be sure people are looked after well.”
People's privacy was respected. Staff ensured people kept in touch with family and friends. Two relatives told us they were always made welcome and were able to visit at any time. People were able to see their visitors in communal areas or in private.
People looked comfortable and happy moving around the home, some people stopping for rests or a nap, other people enjoyed having a late breakfast, doing a crossword or reading the newspaper. Staff were always visible to interact or sit with people. Staff said it was important they were also involved in ensuring people had something to do or someone to talk to. The registered manager/provider showed great enthusiasm in wanting to provide the best level of care possible and valued their staff team. For example, providing on-going training in a variety of courses to make the training more interesting. Staff had clearly adopted the same ethos and enthusiasm and this showed in the way they cared for people in individualised ways. Staff were very positive about working at the home. Comments included, “It’s so nice here, there are lots of things for people to do. The provider comes in a lot and she knows which people have had visitors and who, they remind people what they have been doing.” One person told us, “We get looked after very well.”
Observations of meal times showed these to be a positive experience, with people being supported to eat a meal of their choice where they chose to eat it. Staff engaged in conversation with people and encouraged them throughout the meal, noting who liked to sit with whom. Nutritional assessments were in place and special dietary needs were catered for.
There were effective quality assurance processes in place to monitor care and plan on-going improvements overseen by regular provider audits. The registered manager/provider was supported by an assistant manager who managed day to day care. The registered manager/provider visited the home on a regular basis. We met them during a visit to the home and people knew who they were and enjoyed spending time with them. There were systems in place to share information and seek people's views about the running of the home, including relatives and stakeholders. All responses were positive from the recent quality assurance questionnaire. For example, “The care is fantastic, I feel my mother is safe and well cared for” and “I am very impressed with the care my mother receives.” People's views were acted upon where possible and practical, and included those living with dementia. Their views were valued and they were able to have meaningful input into the running of the home, such as activities they would like to do, which mattered to them.