The Oakleaf Care Group (Hartwell) Limited

Oakleaf Care Group (Hartwell) Limited is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service provides a range of specialist assessment and rehabilitation programmes for people with acquired brain injuries, other neurological conditions or early onset dementia. They may also have other associated complex cognitive impairments or physical disabilities. Oakleaf Care Group (Hartwell) is registered to provide accommodation, nursing and personal care for up to 16 people in two adapted buildings. The accommodation consists of Mosley House, which focusses on providing active rehabilitation and Mosley Lodge, which is designed to accommodate people requiring a higher level of support. At the time of the inspection there were 11 people living at the service.

At the last inspection, on 2 and 3 March 2016, the service was rated ‘Good'. At this inspection we found that the service was now rated ‘Outstanding’.

There was a registered manager in post. A registered manager is a person who has registered with the CQC 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.

The service demonstrated an excellent commitment to providing outstanding support, which put people at the heart of everything. The provider and registered manager led the staff to deliver person centred care, which had achieved consistently outstanding outcomes for people.

Staff continuously went beyond expectations to ensure that people received truly individualised care that was flexible and responsive to their needs. Staff respected people's individuality and empowered people to express their wishes and make their own choices.

Staff demonstrated the provider's values of offering person centred care that respected people as individuals in all of their interactions with people. Staff at all levels had a strong belief that they were providing the best possible support for people, and were confident and empowered in their roles because of the strong leadership and management across the service.

Staff were innovative in their approach to support, and were enthusiastic about supporting people to overcome life’s challenges. People and their relatives consistently told us that the service provided exceptional care and support to people.

There was a very effective system of quality assurance that ensured people consistently received exceptional care and support. The people receiving support from the service had an enhanced quality of life because the service worked innovatively to respond to people’s feedback and enable people to have meaningful experiences.

Staff had an understanding of abuse and the safeguarding procedures that should be followed to report abuse. Detailed risk assessments and behaviour management plans were in place to manage all risks within a person’s life. Staff were confident in supporting people with complex needs and behaviours and enabled and empowered people to live as independent a life as possible safely. There were arrangements in place for the service to make sure that action was taken and lessons learned when things went wrong, to improve safety across the service.

Staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service. People could be assured that they would be supported by sufficient numbers of staff with whom they had developed positive relationships.

Staff were provided with an extensive induction and on-going training was available to ensure they had the skills, knowledge and support they needed to perform their roles. Staff were very well supported by the registered manager and senior management team, and had regular one to one supervisions.

People received their medicines as prescribed and their health and well-being was monitored by a multidisciplinary team of staff. People were supported to access health professionals in a timely manner when they needed to. People were supported to have sufficient amounts to eat and drink to maintain a balanced diet.

Staff knew their responsibilities as defined by the Mental Capacity Act 2005 (MCA 2005). 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 consistently gained people’s consent before providing support.

People were involved in planning how their support would be provided and staff took time to understand people’s needs and preferences. Care documentation provided staff with appropriate guidance regarding the care and support people needed to maintain and develop their independence.

Further information is in the detailed findings below.

The inspection took place on 2 and 3 March 2016.

The service had a registered 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.

We found a progressive, extremely caring and highly positive atmosphere which resonated throughout the service and within the delivery of care provided by staff. People and their relatives were placed firmly at the heart of the rehabilitation pathway, with all aspects of care, recovery and rehabilitation being focused on them, their therapy goals and aims.

The service was led by a dedicated and passionate registered manager, who was tremendously well supported by a resilient and optimistic management team within the provider organisation. The culture and ethos within the service was open, encouraging and empowering; staff were openly proud to work for the service and wanted it to be the very best it could be. Staff and the registered manager were exceptionally well motivated and inspired by the role they were employed to do. They were very committed to their work and faced up to any challenges and used these to improve the delivery of service. Each member of the staff team had exceptionally strong values with a shared vision. They strived to give people a constructive and meaningful care and rehabilitation experience and provide high quality care.

Staff attended regular meetings, which gave them an opportunity to share ideas, and exchange information about possible areas for improvements to the registered manager. Ideas for change were welcomed, and used to drive improvements and make positive changes for people. Quality monitoring systems and processes were used robustly to make positive changes, drive future improvement and identify where action needed to be taken. All staff, irrespective of their role, wanted standards of care to remain high and so used the outcome of audit checks and quality questionnaires to enable them to provide excellent quality care.

People felt safe and secure in the service and were calm and relaxed in the presence of staff. Staff demonstrated an awareness of what constituted abuse and understood the relevant safeguarding procedures to be followed in reporting potential abuse. They had a good understanding of how to support people when they became anxious or distressed. Potential risks to people had been identified, and plans implemented to enable people to take positive risks and to live as safely and independently as possible.

Robust recruitment checks took place in order to establish that staff were safe to work with people before they commenced employment. There were sufficient numbers of staff available to meet people’s care and support needs and to enable them to participate effectively in their rehabilitation programme. Safe systems and processes were in place to protect people from the risks associated with medication.

Staff received a robust induction at the start of their employment and went on to receive regular training, based upon best practice in acquired brain injury, which provided them with the knowledge and skills to meet people’s needs in a holistic and person centred manner. They were very well supported by the registered manager and the rest of the senior management team, in respect of supervision and appraisal. They told us this enabled them to remain motivated and responsive to people’s individual needs.

Staff consistently sought people’s consent before they provided care and support. Where people were unable to make certain decisions about their care, the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were followed. Where people had restrictions placed upon them, staff ensured people’s rights to receive care that met their needs was protected, and that any care and treatment was provided in the least restrictive way.

People were supported to access suitable amounts of nutritionally balanced food which was designed in conjunction with a dietician to ensure that an appropriate nutritional intake was received. A variety of meal options were available for people, which included specific health and cultural dietary requirements and which were based upon their specific dietary needs.

Staff worked closely with other professionals within the multi-disciplinary team to ensure people’s health and well-being needs were fully met and to ensure that where possible, any rehabilitation goals were met.

People and their relatives were fully involved in the planning of their care and felt included in discussions, being able to have their say at each step of the way. Staff listened and respected people’s views about the way they wanted their care, treatment and rehabilitation to be delivered. Staff were passionate about their work and driven by a desire to provide high quality care.

People were supported to develop and maintain life and social skills and regain some independence, using individually created rehabilitation programmes. The support for this was provided by a passionate and highly skilled, multi-disciplinary staff group, who shared a strong person centred ethos. Staff supported people to move forward, adapting these when their needs changed and working to overcome any barriers.

Within the staff team, there was a strong understanding of people’s interests and preferences and the team worked to provide a wide range of activities that were not only tailored to people’s individual needs but which worked on rehabilitation goals, often in an unassuming way. People were actively supported to integrate within the local community, using local facilities to avoid social isolation. To facilitate this, the service had developed links with local schools and churches.

We spoke with two members of staff that worked at the service and they both told us that they were well supported in their roles. We spoke with a professional who was the allocated worker for a person that used the service and they told us that they were very happy with the care and treatment that the service provided and they had no concerns with any aspects of the service.

We found that before people received any care or treatment that they were asked for their consent and where people did not have the capacity to consent to their care and treatment the provider ensured that they acted within the legal requirements. We found that people's care needs were assessed and care and support plans had been put in place to ensure that their needs were met. We found that risks relating to people's care and treatment were identified and action plans put in place to ensure that risks were reduced.

We found that there were arrangements in place to ensure that risks relating to the management of medicines were appropriately managed. We found that there was a detailed recruitment and selection policy in place relevant checks were carried out on staff prior to them commencing work to ensure people's safety. Records were accurate, appropriately maintained and kept securely.

We spoke with three staff members who told us that they felt well supported in carrying out their roles. One staff member told us 'We try and support the people that live here to have the best quality of life'.

We found that people's needs were assessed and that their care and treatment was planned and delivered to ensure that their needs were meet. We saw that risks were assessed and that people had care plans in place to ensure that risks were managed.

We saw that the provider had an effective complaints system in place and that people's complaints were investigated thoroughly. We found that people who lived at the service felt safe and that when any allegations of abuse were made that the provider acted appropriately. We saw that staff were supported through training, appraisals and in obtaining further qualifications.