Archived: The Oast

The home was owned by a family partnership. The property had been extended in recent years to provide additional rooms. A passenger lift was added at the same time to enable people to move between floors with ease. The accommodation provided was available over two floors with bedrooms downstairs and upstairs. Some of the rooms had en-suite toilet and washing facilities and those that did not had a washbasin in the room. There was one larger bedroom, which was used mainly for people requiring respite care. This could be when people or their family members need a short break, rather than long-term care. For example, where a family carer had planned a holiday and not able to take their loved one with them. The room could also be used as a double room, for instance if a couple wanted to stay together.

A large lounge was split into two sections, one side a quieter area to sit and relax or read a book or newspaper. The other side had a TV and patio doors leading onto a verandah/patio area and garden. The dining area had plenty of space for everyone to sit at a table to have their meals if they wished.

A registered manager was employed at the service. 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 and their relatives spoke of a home where they felt safe and would be able to say if they were worried about anything. The staff had a good understanding of safeguarding procedures and what their responsibilities were in relation to keeping people safe.

People’s medicines were managed safely by staff who were trained and competent. People who were able to manage their own medicines and wanted to do this were supported to remain independent while being assisted by staff when necessary.

People’s care needs were assessed before moving into the home to make sure the staff were able to cater for their specific requirements. People and their family members were involved in the care planning process. Care plans were person centred and comprehensive enabling staff to support people well and in the way they wanted. Individual risk assessments were carried out to ensure people were safe when everyday tasks and personal care were being undertaken. Independence was carefully protected to preserve people’s health, wellbeing and dignity.

Environmental risks were assessed and managed well to keep people, staff and visitors to the service safe. Checks and plans were in place to make sure the premises were safe including fire safety and prevention.

The registered manager and staff liaised closely with health and social care professionals. Good working relationships had been developed which supported the close monitoring of people’s health care needs.

The registered manager had safe recruitment practices in place to make sure only suitable staff were employed to support people. All relevant training was provided for the staff team, with regular refreshers to ensure their skills and knowledge were up to date. Staff had regular one to one supervision meetings to monitor their working practice and to support and plan their personal development.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Restrictions imposed on people were only considered after their ability to make individual decisions had been assessed as required under the Mental Capacity Act (2005) Code of Practice. The registered manager understood when an application should be made. Decisions people made about their care or medical treatment were dealt with lawfully and fully recorded.

There were enough staff to ensure that people’s assessed support needs were fully met. This was evident by our own observations as well as feedback from people, their relatives and others. The staff team had the time to sit and chat with people. This was encouraged by the registered manager who ensured there were enough staff to enable the important contact of conversation as well as providing care and support.

The home had a friendly and relaxed atmosphere where the staff and people living there were chatting together with smiles and laughter. Staff had a caring approach, taking their time with people and allowing them the opportunity to maintain their dignity and independence as far as possible. This enabled the staff to get to know the people living in the home very well and therefore be able to care for them with an individual approach that supported their wellbeing.

An activities coordinator had a wide range of interesting activities on offer for people to take part in if they chose. These were well planned and included both group and individual activities, with staff encouraging and supporting people to take part.

The registered manager had comprehensive systems in place to monitor the good quality and safety of the service. The home was well run and people, their relatives and others we spoke to were very complimentary about the registered manager and their team.

At our inspection on 2 June 2014 we found that the provider was not fully compliant with the Regulations. Following our inspection the provider sent us an action plan telling us the action they were taking in order to achieve compliance. This inspection took place over 2 days during which we checked to see that improvements had been made. We found that the regulations were met.

We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service checked to e safe? Is the service effective? Is the service well led?

Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe. They were protected from harm because risks to people's health and welfare had been assessed and guidance provided for staff about how to minimise risk of harm to people who used the service. Risks were identified and managed to ensure people were protected from risk of harm. For example a fire safety risk assessment carried out in November 2013 identified a number of moderate risks to people who lived in the home in the event of a fire. The provider had completed the required actions to make sure people were protected.

The home had a safeguarding policy in place which had been reviewed and updated in 2014 so that staff had up to date information, including contact numbers for reporting abuse to relevant agencies. This meant that staff had the information they needed to be able to report abuse in the event that abuse was suspected or occurred.

People did not have to wait for the support and attention they needed because there were enough staff on duty to meet their needs. People who we spoke with told us that they felt there were enough staff.

Is the service effective?

People were protected against risk of abuse because staff had been provided with appropriate training about how to safeguard people who lived in the home. The manager had ensured that all staff had completed training concerning safeguarding vulnerable adults, Mental Capacity Act (2005) and Deprivation of Liberty Safeguards training.

People's health and care needs were assessed in consultation with them. People had regular appointments with GPs and other health care professionals as required. Records showed that appropriate medical assistance was sought where there were any concerns about people's health. This meant that people's health needs were met.

Is the service caring?

People were treated with dignity and respect. They were supported by staff who were kind and patient in their approach. We saw that people were comfortable with the staff who were supporting them.

People were involved in planning their care when they first moved into the home. Care plans we looked at were up to date and had been reviewed regularly in consultation with the person or their representative. This ensured that people's needs continued to be met by staff who had the information they needed to provide appropriate support and meet people's changing needs.

People's individual care plans were signed by them, or their representative to show their agreement. This showed that people were asked for their agreement to their care plan and any changes needed to the way their care was delivered.

Is the service responsive?

Care plans were based on people's individual assessments and included information about people's choices and the way they wanted their care to be delivered in accordance with their wishes.

An activities coordinator provided a range of activities for people to take part in on four days each week. People told us they enjoyed the activities on offer.

The numbers of staff needed were decided on the basis of an analysis of the levels of care and support people who lived in the home needed. This meant that there were was a system in place to make sure there were enough staff on duty at all times to respond to the changing needs of people who lived in the home.

Is the service well-led?

The manager was accessible and approachable. We saw that people were comfortable talking with staff and the manager during our visit.

People's views were sought concerning how the service was run through surveys and forums where people who used the service were encouraged to express their views and make suggestions about how the service was delivered.

The service had an effective quality assurance system. Records seen by us showed that shortfalls were identified and addressed promptly. For example care plans and risk assessments were reviewed regularly to make sure they were up to date, staff supervisions and appraisals were carried out and staff meetings were held regularly to make sure that staff had the opportunity to express their views, make suggestions and provide feedback to the manager.

There were systems in place to audit and monitor the service to make sure there were no shortfalls that could impact on the safety and welfare of people who lived in the home.

You can see our judgements on the front page of this report.

During this inspection we set out to 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. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe. However risks to people's health and welfare were not always identified and managed to ensure people were protected from risk of harm. For example a fire safety risk assessment carried out in November 2013 identified a number of moderate risks to people who lived in the home in the event of a fire. The provider had not completed the required actions to make sure people were protected.

The manager had not ensured that all staff had completed training concerning safeguarding vulnerable adults. This meant that people were not adequately protected against risk of abuse because staff had not been provided with appropriate training about how to safeguard people who lived in the home.

Not all risks to people's health and welfare had been assessed or guidance provided for staff about how to minimise risk of harm to people who used the service. This meant that people were not always protected from risk of harm.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to identifying, assessing and managing risks to the health, safety and welfare of people who live in the home and safeguarding them from abuse.

Is the service effective?

People's health and care needs were assessed in consultation with them, However care plans were not kept up to date to ensure that care was provided in a way which met their needs in accordance with their wishes.

There was no forum for people who used the service to express their views or make suggestions about how the service was delivered. This meant that people's views were not taken into account concerning how the service was run.

The home had a safeguarding policy in place. However this had not been reviewed since 2012 therefore contact numbers for reporting abuse were out of date. This meant that staff did not have the information they needed to be able to report any abuse to the appropriate agencies to make sure people were protected in the event that abuse was suspected or occurred.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to enabling people to express their views about the service.

Is the service caring?

People were supported by staff who were kind and patient in their approach. We saw that people were comfortable with the staff who were supporting them. This meant that people were treated with dignity and respect.

Throughout our visit there we saw that people had to wait for the support and attention they needed because staff were busy with other people or tasks such as giving out medication. For example people had to wait for some time for their meal, a cup of tea when they asked for one, or for support with daily living tasks such as shaving. People who we spoke with told us that they did not think there were enough staff.

People were involved in planning their care when they first moved into the home. However not all the care plans we looked at had been kept up to date or reviewed since people moved into the home. For example there had been no reviews of one person's care plan since they moved to the home in July 2013 even though there had been significant changes in their life since that time. This meant that staff, particularly new staff, did not have the information they needed to provide appropriate support or meet people's changing needs.

There was a document in people's personal care files which was signed by the person or their relative when they first moved into the home agreeing to 'have care plans updated by staff and manager to sign for updated care plans'. This meant that people were not asked for their agreement if changes were made to the way their care was delivered.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring that people are involved in decisions about their care and treatment and that the planning and delivery of care meets people's individual needs.

Is the service responsive?

People had regular appointments with GPs and other health care professionals as required. Records showed that appropriate medical assistance was sought where there were any concerns about people's health. This meant that people's health needs were met.

An activities coordinator provided a range of activities for people to take part in on three days each week. People told us they enjoyed the activities on these days but found the remaining four days very quiet as there was not much to do. People told us they would like to go out in the community but had not been able to do so because there were not enough staff to take them.

The numbers of staff needed were not decided on the basis of an analysis of the levels of care and support people who lived in the home needed. This meant that there were was not a system in place to make sure there were enough staff on duty at all times to respond to the changing needs of people who lived in the home.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring there are sufficient numbers of suitably qualified and experienced staff to meet people's needs.

Is the service well-led?

The manager was accessible and approachable. We saw that people were comfortable talking with the manager during our visit.

The service did not have an effective quality assurance system. Records seen by us showed that shortfalls were not identified or addressed promptly. For example care plans and risk assessments were not kept up to date, staff supervisions and appraisals were not carried out and staff meetings were not held regularly to make sure that staff had the opportunity to express their views, make suggestions and provide feedback to the manager.

There was no system in place to audit or monitor the service to make sure there were no shortfalls that could impact on the safety and welfare of people who lived in the home.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring there are systems in place to regularly assess and monitor the quality of the service.

There were effective recruitment and selection processes in place. Appropriate checks were undertaken before staff began working with people who used the service. This meant that people were protected and could be confident that staff who delivered their care were suitable.

We spoke with people who lived in the home. They told us were pleased with the way they were cared for. They said, " "I like to spend time in my room, I choose what I want to do.", "Everyone is very friendly, they always stop and have a chat with me.", "They look after us all very well."

During this inspection we found that people were asked for their consent before any care was given.

People were provided with appropriate care and support that met their needs and promoted their wellbeing.

People received the medication they needed at the time they needed it.

Recruitment procedures were not used effectively to make sure that people were protected through the appointment of suitable staff.

People knew who to talk to if they had any concerns about the service and were confident they would be listened to.