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Inspection carried out on 20 November 2017

During a routine inspection

The inspection visit took place on the 20 November 2017. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

We last inspected the service on the 3 November 2015 and we rated the service as Good. At this inspection we found the service remained Good.

Oxbridge House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Oxbridge House accommodates up to 13 people in one adapted building providing support for people with learning disabilities who may also experience mental health needs. At the time of our inspection visit there were eight people using the service.

The care service had been developed and designed in line with the values that underpin the Building the Right Support and other best practice guidance. It underpins principles of choice, promotion of independence and inclusion. People with learning disabilities and autism using the service were living as ordinary a life as any citizen.

There was a registered manager in post. 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 saw for two people who had moved to the service in 2017, they did not have Health Action Plans in place. A Health Action Plan is a requirement from the Department of Health for people with a learning disability and it supports people to remain healthy. We were contacted straight after the inspection by the team leader at the service who informed us these were now in place.

There were systems and processes in place to protect people from the risk of harm. Staff were aware of different types of abuse, what constituted poor practice and action to take if abuse was suspected. People told us they felt safe living at and receiving from the service.

Accidents and incidents had been appropriately recorded and monitored and risk assessments were in place for people who used the service and staff so that they remained as safe as possible.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety standards were maintained. We also witnessed staff using appropriate personal protective equipment and cleaning schedules were in place so that risks relating to infection control were well managed.

There were sufficient staff on duty to meet the needs of the people and the staff team were trained and supported to manage any behaviour that may challenge. Medicines were stored and administered in a safe manner.

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.

We saw that staff were recruited safely and were given appropriate training before they commenced employment. Staff had also received more specific training in managing the needs of people who used the service such as positive behaviour support (PBS) and diabetes.

There was a regular programme of staff supervision in place and records of these were detailed and showed the home worked with staff to identify their personal and professional development. However, some records in relation to staff induction and mandatory training were not instantly accessible as they were in different locations and although we saw staff were trained, records required collating to show they met the regulations.

We saw people’s care plans were person centred and had been well assessed. The home had developed care plans to help people be involved in how they wanted their care and support to be delivered. We saw people were being given choices and encouraged to take part in all aspects of day to day life at the home, from going to work placements to helping to do household cleaning tasks.

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of visits to and from external health care specialists demonstrating that people’s physical health was supported.

The service encouraged people to maintain their independence. People were supported to be involved in the local community as much as possible and were supported to independently use public transport and access facilities such as the local G.P, shops and leisure facilities.

We also saw a regular programme of staff meetings where issues were shared. The service had an easy read complaints procedure and staff told us how they could recognise if someone was unhappy. This showed the service listened to the views of people.

The service regularly used community services and facilities and had links with other local organisations. Staff told us they felt very supported by the registered manager and team leaders and were comfortable raising any concerns. People who used the service, family members and staff were regularly consulted about the quality of the service. People told us that management were approachable, supportive and understanding.

The service had a comprehensive range of audits in place to check the quality and safety of the service and equipment at Oxbridge House and actions plans and lessons learnt reviews were part of their on-going quality review of the service.

Inspection carried out on 3 November 2015

During a routine inspection

The inspection visit took place on the 3 November 2015. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

We last inspected the service on the 7 April 2014 and found the service was not in breach of any regulations at that time.

Oxbridge House is a 13 bedded residential service providing support for people with learning disabilities who may also experience mental health needs.

There is a registered manager in post. 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.

There were systems and processes in place to protect people from the risk of harm. Staff were aware of different types of abuse, what constituted poor practice and action to take if abuse was suspected. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.

There were policies and procedures in place in relation to the Mental Capacity Act and Deprivations of Liberty Safeguards (DoLS). The registered manager and staff had the appropriate knowledge of how to apply the MCA ,when an application should be made and how to submit one. This meant people were safeguarded.

We saw that staff were recruited safely and were given appropriate training before they commenced employment. Staff had also received more specific training in managing the needs of people who used the service such as epilepsy and schizophrenia. There were sufficient staff on duty to meet the needs of the people and the staff team were supportive of the management and of each other. Medicines were also stored and administered in a safe manner.

There was a regular programme of staff supervision in place and records of these were detailed and showed the home worked with staff to identify their personal and professional development.

We saw people’s care plans were person centred and had been well assessed. The home had developed care plans to help people be involved in how they wanted their care and support to be delivered. We saw people were being given choices and encouraged to take part in all aspects of day to day life at the home, from going to work placements to helping to make the evening meal. One person had very recently transitioned into the home and we saw this had been planned and assessed so it was as smooth as possible.

People’s nutritional needs were met, with people being involved in shopping and decisions about meals. People who used the service told us that they got enough to eat and drink and that staff asked what people wanted. Staff told us that they closely monitored people, would contact the dietician if needed and carried out nutritional monitoring.

People were supported to maintain good health and had access to healthcare professionals and services. Professionals we spoke with confirmed the service supported people well and there was good communication between the service and themselves. People told us that they were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments.

The service encouraged people to maintain their independence. People were supported to be involved in the local community as much as possible and were supported to independently use public transport and access facilities such as the local G.P, shops and leisure facilities.

We also saw a regular programme of staff meetings where issues where shared and raised. The service had an easy read complaints procedure and staff told us how they could recognise if someone was unhappy. This showed the service listened to the views of people.

Inspection carried out on 7 April 2014

During a routine inspection

Our inspection team was made up of one inspector. We gathered evidence against the outcomes we inspected to help answer the five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us that they were happy with the care and support delivered to them. Comments made to us included, “If I had any problems I would speak with the staff, they are approachable and they listen to me.”

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards and there was evidence to show that this had been followed appropriately. Staff had been trained to understand when an application should be made, and in how to submit one and this training was updated annually. This meant that people were safeguarded as required.

Recruitment practice was safe and thorough. Policies and procedures were in place to make sure that unsafe practice is identified and people are protected.

Is the service effective?

People’s health and care needs were assessed with them, and they were involved in the development and updating of their plans of care. People said that they had been involved in them and they reflected their current needs. Their care plans were very comprehensive and clearly person centred.

Staff knew how and when to involve other health and social care professionals. We saw lots of evidence of this during our inspection.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff engaged with people in a positive way and showed respect and kindness. People commented, “The staff are brilliant, I love it here.”

People’s needs had been assessed and care plans put in place which detailed people’s needs and preferences. These records provided guidance to staff on what care and support was needed.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People had regular opportunities to be involved in a range of activities in and outside the service, which provided development of a range of skills and of their independence. These were well recorded within people’s care plans along with regular evaluations and updates. The home has its own transport, which helped to keep people involved with their local community.

There was clear evidence contained within people’s care plans to show how they worked with other health and social care professionals. We observed people being supported to attend appointments on the day of our visit.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The home had a registered manager, who was supported by regional staff and the directors. Audits and checks were completed regularly to monitor the quality of service provision.

People using the service, their relatives, friends and other professionals involved with the service completed a six monthly satisfaction survey.

Staff were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and were knowledgeable about people’s needs. This helped to ensure that people received a good quality service at all times.

Inspection carried out on 8 May 2013

During a routine inspection

At the time of the inspection the people who used the service did not require staff to support them with personal care. Last year we discussed the continued registration of the home with the owner because we had found personal care, as defined by the Health and Social Care Act 2008 was not provided. The owner told us the intention of the home was to offer services to people who would require assistance with personal care needs.

During the visit, we met seven people who used the service. All were extremely complementary about the staff and the service. People said “They have been great here, I have learnt so much”, “I go to college now and that is down to the staff being so helpful” and “It is great here.”

We found that staff continually sought people’s views and asked their opinions. We saw they worked in partnership with people and tasks such as cooking were completed in a collaborative manner. Staff told us the home was run much like a large family. We found that staff had a good understanding of how to best meet each person’s care needs.

We found that the provider had ensured staff were equipped to meet people’s needs. Staff understood the requirements of the Mental Capacity Act 2005 and Mental Health Act 1983 (amended 2007). A system was in place for dealing with concerns and the complaints procedures were well understood by all.

Inspection carried out on 10 May 2012

During a routine inspection

During the visit, we spoke with six of the people who used the service and as it was a routine visit we asked specifically about the choices they were offered; what the care was like; and what people thought about the staff. People told us that they felt the service was very well-run. People told us how moving to the home had been a wise decision, as they had learnt skills, which would assist them to live independently in the community. People said ‘’It is fantastic here’’, ‘Since coming here, I have been able to get to a point where I have successfully completed most of the stages to join the army’’ and ‘’I love it here, the staff are superb and we are fully involved in the running of the home’’. People told us that the service was run as a joint effort and everybody contributed to making sure it worked well. We were shown the home’s business plan that is written in accessible formats so each person can discuss if the plan is moving in the right direction. We were told that all the staff were competent and supportive. People said ‘’The staff have supported me to learn the skills I need to live on my own’’, ‘’I’m taking it at a steady pace and at the minute doing college courses but want to look for employment soon’’ and ‘’The staff sit down with me and go through my plans to see how we can make these happen’’.

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