St Anne's Community Services - Oxfield Court

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The care service has 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 and were embedded within this service which worked to ensure people could live as ordinary a life as any citizen.

There was a registered manager in place. 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.

Staffing levels were based on the needs of people at the home and were under constant review. Staff told us they had the time to support people and numbers of staff were increased when people had outings and appointments to ensure there were always sufficient numbers of staff available to support people. Staff had been trained and were confident to recognise safeguarding issues which meant people were protected from harm.

Risks were assessed and well managed to ensure people's freedoms were not overly restricted and risk assessments were based on positive outcomes for people.

Staff received ongoing support from the management team through a programme of regular supervisions and appraisals and they had been trained to ensure they had the knowledge and skills to care for people. Staff were required to undertake an annual programme of training and specialist training was provided when it was needed to ensure staff had the skills required to support the complex health needs of people living at the home.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice

We found decision specific capacity assessments had been carried out for people who lacked mental capacity to consent to aspects of their care delivery. These were compliant with the Mental Capacity Act 2005 (MCA). Staff understood the principles of the MCA and how to ensure people's human rights were respected when making decisions on their behalf.

We found all the staff to be caring in their approach to the people who lived there and treated people with dignity and respect. Staff knew the people they supported very well, and we observed people were very happy in the presence of staff and there was a very positive and friendly atmosphere. Relatives were confident about the love and care provided to their relation and spoke consistently about the caring staff.

The support people received from staff was tailored to their individual needs and staff had worked extremely hard to get to know people and understand what was important to them. People were given opportunities to live fulfilled and meaningful lives regardless of their complex needs.

The service had excelled in supporting people at the end of their lives and worked closely with the local hospice. They had taken an active role in developing a tool to help support people with a learning disability at the end of their life. They had shared their learning with other organisations and presented at various conferences and groups. This truly demonstrated their passion for improving this aspect of care delivery for people with a learning disability.

People were supported to be fully involved in how their support was provided. Information was provided in an easy read format to ensure people with different abilities were provided with information in a format they could understand. Clear, easy read plans were designed to help people manage health conditions that needed monitoring. Health and social care professionals were involved with people's support when needed and their advice was included in the care provided. There was clear evidence of person-centred care and records contained information detailing people's life histories, preferences and choices to enable staff to support them. People were involved in activities based upon their established routines and preferences.

Systems and processes for ensuring the quality of the service included nationally recognised evidence-based standards to ensure they provided a quality service to people living there. The service was well-led by a registered manager who aspired to develop the service continuously and who kept abreast of best practice and developments in this field.

Oxfield Court supports adults with learning disabilities with additional complex health needs. Accommodation is provided in four separate bungalows, each of which has a manager who oversees the provision of care for people. On the day of the inspection there were 22 people living at Oxfield Court. Three of the bungalows were at full occupancy with six people and one had four people with two vacancies.

There was a registered manager present on the day we inspected. 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.

People were safe as staff demonstrated an in-depth understanding of people’s individual needs based on their experience and knowledge gained through care records. Staff knew what constituted a safeguarding concern and were aware of how to report such issues. The service had robust and rigorous risk assessments in place to minimise the likelihood of harm whether through the use of equipment or people’s behaviour. These were regularly reviewed and updated.

Staffing were appropriate on the day we inspected and ensured that people had their needs met in a timely manner. Medicines were administered, recorded and stored safely.

We saw in records and by speaking to staff there was an ongoing supervision and training schedule which supported staff to develop and progress in their own development. Staff were encouraged to challenge and offer new ideas if they could see areas for improvement.

The service was acting in accordance with the requirements of the Mental Capacity Act 2005 by ensuring that people who lacked capacity to make specific decisions had appropriate assessments in place to support staff to make decisions in their best interests. Where people were not able to assess risk to themselves or did not have the freedom to leave, Deprivation of Liberty Safeguards were in place.

People were supported with their nutrition and hydration needs, whether by being encouraged to prepare their own food as far as possible or through specific nursing input. We found that people had regular access to external agencies as required and regular meetings and information was shared when needed between such services to maintain people’s optimum care.

Staff were patient, caring and kind and people responded well to attention. There was evidence of a good rapport between staff and people using the service and we saw that people were encouraged to make as many decisions for themselves as possible during the day. The service demonstrated a consistent culture of respecting people’s privacy and promoting their dignity.

People had access to a wide range of activities both within and outside of the service. We saw care records were clear and detailed, emphasising key attributes and information about how best to support someone. Records were easy to navigate and it was evident from staff discussions that they were used regularly as staff knowledge was current.

The service had a complaints policy, although had not received any complaints. However, they had received many compliments and positive feedback.

People and staff were content and enjoyed being at the service. Staff felt supported and encouraged to offer new ideas and develop new ways of working if this resulted in better outcomes for people in the service. The registered manager provided consistent and transparent leadership which was reflected in the approaches between each of the bungalows on site.

Quality assurance measures were effective and sought to drive forward improvement with people at the heart of the service.

On the day of our inspection we arrived at the service at 10am and met with the registered manager. They explained each of the four bungalows had a manager in post whose main duties were to manage the day to day running of their bungalow. These managers were also registered learning disability nurses. We spoke with two of them during our visit, two other nurses (one of them from an agency) and a support assistant. The registered manager explained they oversaw the management of the service. On the day of our inspection there were 22 people living at the home.

We looked round the four bungalows and saw all of the bedrooms had wash-hand basins. We saw that soap dispensers and paper towels were also available for staff that provided personal care to people in their bedrooms. Toilet facilities were available near to the bedrooms and communal areas. We saw that people's bedrooms had been personalised and contained items such as photographs and soft toys.

We saw areas in all four bungalows that required attention. They had been damaged by the equipment used to care for people, such as wheelchairs. We saw that people who lived at the home had a range of complex health needs as well as a learning disability. We also saw that many of the people displayed behaviours that challenge.

As people living at the home had complex needs this meant they were not able to tell us about their experiences. After the visit we spoke to two people's relatives who told us they were very happy with the care provided at the home. One of them told us, 'I've never had a complaint whatsoever. All the staff have been brilliant, even the temporary ones. It's all very good.' The other relative said, 'It's absolutely marvellous; I can't fault them. They take her out quite a lot and she's very very happy there ' even though she can't talk I can tell.'

During our visit we found evidence that suggested people's needs were not always being met due to shortages of staff in some areas. We also noted that some people's care records were not up to date and fit for purpose.

The staff we spoke to told us that they enjoyed working at the unit. They enjoyed the variety of the work. They felt that the people who used the service were treated with dignity and respect. They felt they were being supported by their manager and by their colleagues within the team.

We saw that the care plans of the people who used the service had been developed in a way that ensured their health and well being. We saw that risk assessments that had been developed were regularly updated and reflected the needs of the individual.

We saw that staff received regular supervision and annual appraisals, where their training needs would be identified.

All the staff we spoke to told us that they had received training in Safeguarding and we saw that there was a corporate policy in place to support staff.