Oakdown House

Immediately following the inspection, we received some information of concern about infection control and prevention measures. These concerns were acknowledged and explored. To respond to these concerns, we looked at the evidence being reviewed as part of the inspection and were satisfied that Infection Prevention Control (IPC) practice is being followed.

We found the following examples of good practice.

Oakdown House was separated into four buildings. Each unit had its own dedicated staff team to try to contain the outbreak of Covid-19. Staff had worked hard to support people’s wellbeing during the pandemic by providing in-house activities and also spent time with people to help ensure they did not feel isolated. People who had tested positive for Covid-19 were cared for, as far as possible, in their bedrooms to minimise the risk of spreading the virus. Not everyone living at Oakdown House understood the need to safely socially distance due to their learning disability. Staff provided support and guidance to help minimise risk of cross infection as much as possible.

There were adequate personal protective equipment (PPE) supplies in the service. This was located at designated points in communal areas and throughout the home to ensure staff had access to required PPE at all times. We observed staff donning, doffing and wearing PPE appropriately.

The registered manager was currently managing the home remotely, supported by the director and managing director who were both working at the home. The home had experienced pressures relating to staffing due to Covid-19. Staffing levels were being reviewed daily as part of the contingency plan being implemented by management. Staff had changed their usual work patterns and bank staff had been used to cover shifts to ensure people remained safe. The management were aware of the pressures this had put on staff and acknowledged this had impacted on staff wellbeing. Support was provided for staff this included wellbeing checks and access to designated mental health first aiders.

The home was clean and tidy and had designated cleaning staff. Housekeeping and care staff were documenting cleaning being carried out within the home. All staff ensured regular disinfection of frequently touched surfaces of the home for example handrails and bannisters.

The registered manager had followed current guidance in relation to infection prevention and control. The home was currently closed to non-essential visitors and admissions. Measures had been implemented to ensure people entering the home did so following current guidance regarding PPE and social distancing. This included temperatures being taken on arrival and PPE being used. Further measures had been implemented to protect people and staff. For example, staff were no longer able to share computers, and hand held devices used to document care and support provided were disinfected.

Regular Covid-19 testing was taking place regularly for people and staff. Staff had access to guidance and policies regarding Covid-19 and infection prevention and control. The registered manager and directors carried out a number of competency checks and audits in relation to infection prevention and control and implemented any actions identified.

Further information is in the detailed findings below.

Oakdown House is a residential home providing accommodation and personal care for up to 45 people. People were living with a range of learning disabilities and health issues for example, diabetes and epilepsy. The service provides living accommodation in four buildings on the same site. At the time of the inspection there were 43 people living at the home who ranged in age from 19 to 83.

The service had been developed and designed in line with most of the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service and what we found

The outcomes for people using the service reflected the principles and values of Registering the Right support by promoting choice and control, independence and inclusion. People’s support focussed on them having as many opportunities as possible for them to gain new skills and become more independent.

People were mostly unable to tell us whether they felt safe but we observed people and staff together and saw that people were cared for and looked after well. Staff knew and understood safeguarding and were able to tell us what they would do in various circumstances. Relatives and professionals told us the service was safe. We saw multiple risk assessments within care plans that were bespoke to people’s needs. Staff were recruited safely and there were enough on duty throughout the day and night to look after people. Medicines were stored and given safely.

New staff were provided with a comprehensive induction and ongoing support was maintained through regular supervisions and appraisals. Staff training was up to date and regular refreshers were in place and staff could chose to attend course relevant to their work. People had access to health and social care professionals and were supported to attend appointments off site. People were encouraged to be involved in food preparation and were provided with a nutritious and varied diet. Some people lived with diabetes and others required puree meals, these were prepared and provided freshly each day. Mental capacity assessments and best interest meetings had taken place when there was a recognised need. Deprivation of Liberty Safeguards were in place. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were treated with respect and dignity. A relative said, “It’s a beautiful home. The best thing is the love they give, there is a culture of supporting each other.” Equality and diversity needs were respected and promoted. People’s privacy was respected but safety never compromised. Everyone living at the home was encouraged to be as independent as possible, in all aspects of their lives.

We saw numerous interactions between staff and people and in every case, it was clear that staff knew people well. Person centred care was documented and practiced. A range of activities were provided seven days a week. We saw small group activities and people being given one to one support. Most people were able to go out on short trips to local shops, recreational facilities and places of worship if they chose to. A complaints policy was in place and we saw that complaints had been correctly recorded and managed in a timely and appropriate way. End of life training took place and staff knew the important aspects of care at these times.

The registered manager was well thought of by everyone we spoke with. They provided a visible presence throughout the service and it was clear that people and staff knew the registered manager well. Auditing processes were in place which were overseen by the registered manager. Opportunities for learning and capturing best practice were in place and a regular series of meetings with staff and people allowed this information to be shared. Feedback was sought from people, staff and relatives and continuous learning was apparent from the feedback. The service is set in a rural location but maintained strong links with the local community.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

Good. (Report published 12 May 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service had 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Some people were not able to communicate with us using speech, we therefore spent time observing how staff and people interacted and gained feedback from people's relatives. One relative told us, "It is a lovely place to live and the carers are all kind.” People also told us how they enjoyed living at Oakdown House. One person told us how they enjoyed tapestry and had recently been out for fish and chips and was looking forward to the morning activity of seeing the farmer and making things.

People were encouraged and supported to eat and drink well. Care plans included clear guidance on people’s nutritional needs and the level of support required. People’s weight was monitored, however, it was not consistently clear how it was decided how often people should be weighed. We have made a recommendation for improvement.

The provider was not consistently working within the principles of the Mental Capacity Act 2005. It was not consistently clear if people had consented to their care plans, taking of photographs and sharing of information. Where restrictive practice was in place, appropriate applications had been under the Deprivation of Liberty Safeguards (DoLS). For those applications which had not yet been authorised, the provider was unable to demonstrate whether the person had consented to the use of restrictive practice or not. We have made a recommendation for improvement.

The management of risk was safe. Risk assessments were in place and actions were in place to address specific risks such as the risk of choking. We identified concerns in relation to the easy accessibility of latex gloves, but the registered manager took appropriate action to address this concern.

Peoples' health was monitored and they were referred to health services in an appropriate and timely manner. Any recommendations made by health care professionals were acted upon and incorporated into people's care plans. Care plans were person centred and provided clear guidance for staff to follow on how to provide person centred care.

Staff treated people as individuals with dignity and respect. Staff were knowledgeable about people's likes, dislikes, preferences and care needs. They approached people in a calm, friendly manner which people responded to positively. Staff also spoke with people in a dignified way and knew how people liked to receive care.

People told us they liked the staff and were always treated with respect and dignity. We observed good care, a gentle manner and what looked like genuine friendship between people and carers and among people themselves.

People received a personalised service as staff knew people well enough to care for them in a way that met their needs and preferences. People’s preferences and social needs were respected. Activities were many, stimulating and varied and people were supported to maintain links with the community and their relatives.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, including autism, behaviour that may challenge, and the care of people living with dementia.

There was an open, transparent culture and good communication within the staff team. Staff spoke highly of the registered manager and their leadership style. There were sufficient numbers of staff to meet people's needs and to keep them safe. The provider had effective recruitment and selection procedures in place.

There were suitable arrangements in place for the safe storage, receipt and management of people's medicines. Medicine profiles were in place which provided an overview of the individual's prescribed medicine, the reason for administration, dosage and any side effects.

There was a complaints process in place and all complaints had been responded to appropriately and within a reasonable time frame. There were regular resident and staff meetings and an annual service user satisfaction survey. People said they felt listened to and that their opinions counted.

The people we spoke with told us they were happy living at Oakwood house. One person who used the service told us 'I love it here, I like everyone and we have fun activities'. Another person we spoke with told us 'I enjoy the activities we do together and painting is my favourite'.

Staff we spoke with were happy in their roles and felt fully supported by their manager. One member of staff told us 'We are a great team at Oakwood house, person centred care is so important and we provide great activities in the day centre that all the people enjoy'.

We looked at care plans, staff records and observed levels of staff. We saw the service had enough experienced and skilled staff to meet the people's needs.

The provider had suitable arrangements in place to ensure that people were safeguarded against the risk of abuse. Staff were trained in how to recognise and respond to any concerns and there were policies and procedures in place to ensure that people were supported nutritionally and being given their medicines safely.

We saw that there were overarching policies, complimented by clear, effective, accessible processes for dealing with and learning from incidents, accidents, complaints and safeguarding concerns.

The people who we talked with told us they were happy living at the home and that they liked the staff who looked after them well. One said: "it's good living here" and another said "staff ask me nicely to do things" and "they are nice." People were encouraged to make their own minds up and supported to make decisions about their needs and how they wished cared to be provided.