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Inspection carried out on 5 February 2018

During a routine inspection

The inspection of Oakwood took place on 05 February 2018 and was announced.

Oakwood 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. The service is registered to provide accommodation for up to six people who require support and care in their daily lives.

At the last inspection the service was rated Good. At this inspection we found the service remained good and achieved a rating of outstanding in the safe domain.

The care service had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. We saw that people with learning disabilities and autism who used the service were able to live as ordinary a life as any citizen.

During the inspection the home demonstrated that they worked in innovative and creative ways to support people to lead as independent a life as possible. We saw that accidents and incidences were closely monitored and the service changed its environment and staff practice to meet people’s needs safely. This had resulted in very positive outcomes for people and improvements to their daily lives and well-being.

We found examples where staff had supported people with their medicines and worked closely with medical professionals to ensure that people were receiving the correct medication at the correct time that enabled them to live as independently as possible, reduce hospital admissions and be cared for in the environment that they preferred when they were unwell.

Staff were recruited safely and people who lived in the home were involved in the process. A stable, consistent staff team provided quality care to the people who lived in the home. Staffing levels were consistent and were adapted to meet people’s needs.

Staff spoken with and records seen confirmed training had been provided to enable them to support the people with their specific needs. We found staff were knowledgeable about the support needs of people in their care. We observed staff providing support to people throughout our inspection visit. We saw they had positive relationships with the people in their care as they had been supporting them for a long time.

The registered manager and the staff team understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Their competency and understanding was checked on a regular basis. This meant they were working within the law to support people who may lack capacity to make their own decisions. We saw that people were supported to make their own decisions when possible and their choices were respected.

Care plans were person centred and driven by the people who lived in the home. We saw clear care profiles that gave appropriate information about the most important aspects of their care for that person. They detailed people’s wishes and care needs. They were regularly reviewed and updated as required.

The registered manager and the provider used a variety of methods to assess and monitor the quality of the service. These included regular audits of the service. The staff team were consistent and long standing. They demonstrated that they were committed to providing the best care possible for the people living in the home.

Inspection carried out on 27 October 2015

During a routine inspection

We carried out an announced inspection of Oakwood on Tuesday 27 October 2015. We also inspected staff recruitment records at the provider’s regional office on Friday 13 November 2015.

Oakwood is a five bedroomed detached house in a residential street in the Rock Ferry area of Wirral. The home was registered to provide care and accommodation for five people. The home provides support for people who have a learning disability.

The building was over two floors, four bedrooms were upstairs and one accessible bedroom was downstairs, an additional room served as an office on the first floor. The home had a large lounge, separate dining room, kitchen, utility room and two bathrooms. There was a garden to the rear of the building and a driveway at the front. The home was fully occupied.

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.

Everybody who lived at Oakwood was home at some point during the day of our visit. We were able to communicate with them and observe their support. We were able to see how the care staff communicated and interacted with people, we also observed support during one lunch time.

Oakwood was homely with a friendly atmosphere. We observed that people living at Oakwood were relaxed and happy. People were supported in all areas of their day to day life at home and in the community. People were enabled to pursue individual interests and were encouraged to try new things.

We noted the relationship between the manager and the care staff was supportive and positive. We saw from records and were told, that the staff team had a history of learning about the people they cared for, respecting and listening to their needs and preferences.

We found the care staff to be knowledgeable, supported by the manager and well trained. Regular supervisions, team meetings and informal discussions as a team had led to new ideas and learning. The team challenged themselves and each other in making sure they followed best practice in their care.

The home was well decorated, well maintained and safe. Regular checks, repairs and audits had been completed. Each person’s room was in an individual style chosen by the person and decorated with personal items. The gardens were well kept.

We found that people’s care files were comprehensive, creative and person centered. These documents showed how the individual wanted to be supported and ensured that their health needs were met. Documents were in different formats, such as pictorial and easy read and individualised to the person.

Inspection carried out on 20 April 2014

During a routine inspection

We gathered evidence to help us answer our five 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.

Is the service safe?

We saw in each person’s care plan staff had completed mental capacity forms for treatment and appropriate deprivation of liberty assessments. We saw staff were knowledgeable about each person’s deprivation of liberty. We saw the provider was able to minimise risks of harm and protect people from abuse.

The way in which staff were recruited was found to be correct and safe. Staff showed evidence of previous experience and continuing professional development within healthcare.

Is the service effective?

We saw staff completed assessments and reviews on the activities the people were involved in. The assessment comprised of reviewing what aspects of the activity that worked, aspects that didn’t work, non-verbal signs the person showed to support this and then an overall review of whether the person enjoyed the activity.

We saw the provider kept up-to-date with best practice and recent evidence to ensure the service was of high quality. The provider had recently introduced ‘One plans’. These were developed to be very detailed yet a quick easy guide for staff. We were told by staff and saw these were effective especially if agency staff were used or if the person was in hospital.

Is the service caring?

We saw staff engaged well with the people who used the service and spoke to them in a respectful, friendly and caring manner. We saw staff were knowledgeable about people’s needs and chronic illnesses. We saw the environment as kept very clean and free of clutter. We saw the home had been tastefully decorated and each person’s bedroom was very individualized. When asking the staff about the team of care assistants they told us they “Worked well as a team”, “Caring” and “Always have the peoples best interest at heart”.

Is the service responsive?

We observed staff during meal times and saw they were knowledgeable about those who were high risk of choking and monitored them closely. This was also supported in the people’s care plans. We saw people’s dignity was maintained during meal times. For those who needed their nutrition intake monitored we saw this was documented every meal time. We saw they were seen by the dietician and were weighed regularly.

Is the service well-led?

When asking staff about the provider they all felt that they would deal with any complaints promptly. The staff told us the registered manager was “Very supportive”, a “Good manager” and “Approachable”.

Inspection carried out on 29 August 2013

During a routine inspection

We used different methods to help us understand the experiences of people who used the service. This was because the people living at Oakwood had complex needs which meant they were not able to tell us their experiences. We contacted Wirral Department of Adult Social Services (DASS) contracts and quality monitoring team who told us they had no concerns about how the service supported people.

There were policies and systems in place to make sure as much as possible people who used the service and their relatives were involved in the development of the care and support offered to them. Records showed that the service continued to seek advocacy support for those people who had no family involvement to ensure support offered reflected people’s needs and as far as possible wishes.

Care records showed that each person had a communication support plan this provided the staff team with information and guidance as to the most effective way to communicate with each person. The care records also showed and discussions with members of the staff team confirmed that people were supported to access health and social care services when needed.

A tour of the building showed people lived in an environment that was safe, well maintained and met their needs.

Records showed that support plans and risk assessments were regularly reviewed and where appropriate updated.

Inspection carried out on 24 January 2013

During a routine inspection

We used a number of different methods to help us understand the experiences of people using the service, because the people who used the service had complex needs which meant they were not able to tell us their experiences. We observed support workers supporting people to access the local community facilities and to take part in activities at the service. We spoke to one relative who told us they were very happy with the service their relative received. Some comments made were:

“They provide a good service to my relative and keep me informed about how they are.”

If I needed to speak to someone at the home I would speak to the manager or my relative’s key worker.”

Care plans showed how the needs of the people who used the service were to be met, including any risks to their well-being. We looked at the health and medication records for two people. We found each person had a medication administration support plan and risk assessment.

Records and discussions with the manager and two support workers showed there were enough qualified, skilled and experienced staff to meet people’s needs.

The provider had systems in place to monitor the quality and safety of the service provided at Oakwood. There was a complaints procedure in place that used pictorial prompts to aid understanding. Records showed the provider had a system in place to encourage the staff team to support people who used the service to raise issues or complaints on their behalf.

Inspection carried out on 25 November 2011

During a routine inspection

Due to the complex needs and different communication methods of the people who used the service the verbal information given to us was limited.

We observed people being supported in a respectful and supportive manner.

We requested information about the service from Wirral Department of Adult Social Services (DASS) contracts and commissioning team. They did not provide information about Oakwood.

We observed support workers supporting individuals who were experiencing difficulties in a supportive and structured manner in line with information held in the person's care plan and risk assessment.

People who used the service appeared to be relaxed and comfortable with the staff team who were supporting them.