The Oaks & Woodcroft

About the service

The Oaks & Woodcroft are two residential bungalows registered as one location and provide personal care for up to 12 people with a learning disability, mental health need, physical disability and/or autistic people. The service had 6 people living at The Oaks and 6 people living at Woodcroft at the time of our inspection.

People's experience of using this service and what we found.

Right Support: Some facilities were shared which did not maximize people’s choices and independence. For example, both bungalows had their own kitchen but the fridge in Woodcroft was almost empty, and inspectors were told staff could take food from The Oaks fridge which did not enhance choice for people, as they were reliant on staff to anticipate their needs and needed support to access the kitchens. We observed people and staff walking through each other’s bungalows without using the front door and waiting to be invited in. At least 1 person living at Woodcroft was using the bathroom at the other bungalow. This should be considered in terms of the rights and privacy of everyone using the service. One bungalow was for men and the other for women and there had been sexual safety concerns in the past which needed careful consideration.

Staff did not support people in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People’s access to parts of their home were restricted and we found other restrictive practice and limited choices for people around their daily routines and activities.

Some key aspects of people’s lives had not been reviewed for a long time, for example: control and support people needed to manage their finances and medicines and support with day-to-day tasks which would maximize people’s independence. People were supported to discuss their wishes and have goals and objectives in place to show how they would like to spend their time and what they would like to do. For example, go on holiday.

Right Care: Staffing was not consistently safe to ensure people’s needs were met. A high number of incidents had resulted in more staff being employed across the day shift. We had concerns about shift patterns as there was a reduction of staff from 7pm which could impact on people’s choices of activities and routines.

Staff needed additional training to help ensure they understood how to support people safely and in the least restrictive way. People’s records required improvement to help guide staff as to the actions they should take to reduce incidents and know how and what to record. Staff showed a limited understanding of the function of behaviour, possible triggers, and consequences.

Right Culture: We found cultural changes were necessary to ensure people had their rights upheld and people were treated with dignity and respect. We found some of the terminology used in people’s records, such as ‘challenging behaviour’ was not person centred and staff did not address people in a dignified or person-centred way.

Audits and surveys were used to identify areas for service improvement and development, but these were not yet fully effective as we identified areas of concern which could compromise people’s care and treatment. Staff worked in conjunction with other professionals and families to ensure the care was as holistic as possible, but health care professionals and family members stated the service could be slow to act on their concerns.

Several incidents had not been reported to CQC to ensure we could assess if appropriate actions had been taken. During our inspection we found information governance was poor but accepted that the provider was migrating records from paper to electronic systems which should improve accessibility. However, we found information was not always up to date, accessible or known by all staff. This could compromise people’s care.

The registered manager, the regional manager and the senior team were working hard to improve the culture of the service and ensure staff through training, supervision and induction had the right skills and attitude.

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

Rating at last inspection and update –

The last rating for this service was Requires improvement (published 22 December 2020.)

Why we inspected.

We undertook this focused inspection to follow up on concerns raised by the Local Authority and in response to a recent coroner’s inquest which required the provider to take certain actions.

The provider submitted us their report. We initially looked at Safe and Well-led but opened the inspection up to look at Effective as well due to some concerns about the performance of the local medical practice and the potential impact this might have on people using the service. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains Requires improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and recommendations.

We have identified breaches of regulation 11 consent, regulation 12 safe care and treatment, regulation 17, good governance regulation 18 staffing.

For more serious breaches of regulation 12 Safe care and treatment and regulation 17 we have served Warning notices.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Oaks & Woodcroft on our website at www.cqc.org.uk.

The Oaks & Woodcroft is a residential care home for younger adults with a learning disability, physical disability and, or autism. It is registered for 12 people but at the time of our inspection there were 10 people using the service. Accommodation is provided in two separate bungalows on the one site accommodating six people each.

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

The service had not completed advanced care plans which would consider people’s wishes, preferences and priorities for their long-term care needs and end of life care. This is particularly important as some people are unable to verbalise their preferences, and this would need to be discussed with staff most familiar with them as well as family members and other professionals. Advance care planning would improve the outcomes of people with learning disabilities at the end of their lives to allow them to die with dignity and choice. We have made a recommendation about this.

Information about people’s life history and goals and aspirations for the future were also poorly developed and if in place would help to demonstrate greater personalisation. We have made a recommendation about this.

The Operations Director had met with the commissioning manager to discuss people’s needs and had asked for a whole service review. Increase in night staffing was being considered to better support people’s changing needs. We observed staff regularly engaging with people and staff told us there were enough staff to meet people's needs. Agency staff were used most days and the registered manager tried to block book them to help ensure better consistency

Staff recruitment processes had improved to ensure only suitable staff were employed, and staff were supported through induction, training and supervision of their practice. Annual appraisals recorded staff development and training and there was up to date guidance.

The service had a dedicated maintenance person and we saw improvements both in the environment and the health and safety records. The recent fire risk assessment identified a number of remedial actions but we were assured of the actions the registered manager has taken.

Some improvement was required to the homes infection control procedures and these were implemented immediately. Staff understood how to reduce the spread of infection and risk assessments had been completed to allow safe visiting.

People received their medicines as intended by staff who were trained. Daily checks on medicines helped ensure any errors were quickly identified and rectified and any potential harm to people was identified. Medicines guidance was robust and included how people liked to take their medicines, and any potential side effects. Communication plans indicated how people might state if they were in pain

Both care plans and risk assessments for people were clearly written and reviewed in line with changing need and risk. Although a key worker system meant all staff had responsibility to oversee people’s care, most of the documentation had been written by the deputy manager. Not all the documentation demonstrated a collaborative approach or showed who had been involved in collating information or who was involved in best interest decisions.

The registered manager was strengthening relationships with the local surgery and everyone’s health needs had been recently reviewed which was addressing previously unmet health care needs.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The service had improved since the last inspection and were no longer in breach of any regulation. Some people had additional funding for one to one support and these hours were accounted for. During the pandemic people’s usual activities were suspended and although some people were going out this was limited in scope. Daily activities were taking place, but this could be extended further to ensure they were in line with people’s individual needs and reflected their interests and developed their skills.

The culture, values, attitudes and behaviours of leaders and care staff helped ensure people had meaningful lives and poor practice within the service was quickly identified and managed. Staff had opportunity to contribute to the overall development of the service and relatives felt well informed.

Since the last inspection a manager had been appointed to work solely at this location whereas previously one manager oversaw two separate locations. There were good overarching governance processes and the registered manager was well supported. Audits helped to identify any areas for development and there was a robust action and development plan in place. There was oversight of accidents, incidents, safeguarding and near misses. These were reported and analysed to help identify actions taken at the time and to ensure these were appropriate so lessons could be learnt. The outcome of which were shared with staff.

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

Rating at last inspection and update.

The last rating for this service was Requires Improvement (26 February 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations. We inspected three key questions as we did not have any concerns raised about the other questions. Although the rating has changed for two out of the three individual questions, we were unable to change the overall rating

Why we inspected

Concerns were received about this service which meant we brought the inspection forward and looked at three key questions where we had previously identified breaches of regulation. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has not changed and remains as Requires improvement.

We looked at infection, prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make some improvements.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Oaks & Woodcroft on our website at www.cqc.org.uk.

Follow Up. We will keep the service under review We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Oaks and Woodcroft is a residential care home providing personal care to up to 12 people aged 18 and over. There were 11 people at the time of the inspection. People using the service had a physical and or learning disability including autism and dementia. Accommodation is provided in two single story houses.

The service has not been fully developed or designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This would help ensure that people who use the service could 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 this service did not always benefit from a well-planned and co-ordinated person-centred support that was appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 12 people. This is larger than current best practice guidance. However, accommodation was split accommodating six people in each house. The two houses had separated communal facilities and a large shared drive way and gardens. The size of the service did not have a negative impact on people and the building design was in line with other residential dwellings in the area. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

There were not always enough staff to meet people’s individual needs. Agency staff were regularly deployed at the service to cover vacancies but at times the service ran short and there was a high number of vacant hours.

People had their physical care needs met but there was limited opportunity for people to engage in regular activity or opportunity to pursue their interests and go out individually. Some people had one to one funding but at the time of our inspection the service was not deploying staff effectively to ensure people got the support agreed in line with individual funding.

Staff roles and responsibilities were not being fully carried out because senior staff were spending time covering staff hours rather than carrying out some of their other administrative duties.

Care plans were difficult to navigate and were not updated when people’s needs changes which exposed people to the risk of receiving care which was not appropriate to people’s needs.

We recently inspected another service with the same provider, registered manager, area and regional manager. At this service we identified significant issues with their records and care plans and were assured that these were being reviewed and new templates were being introduced. However, we found similar issues at this service which meant that lessons were not being learned.

Recruitment processes were adequate, and staff had an induction and probationary period. Staff training was provided but there was limited role specific training. Supervision and appraisals were carried out but there was limited evidence of direct observations of practice outside staff’s probationary period. Not all staff training was up to date but was being addressed.

Risks were not effectively managed because record keeping was poor and there was insufficient management and oversight of risk and staff practice.

The environment was mostly suited to people’s needs but the gardens were not fully accessible and there were a number of minor environmental hazards identified during our inspection.

Staff understood what constituted abuse and actions they should take. The registered manager worked with the local authority with any investigation. Incident management was not sufficiently robust and governance processes were not adequately developed. Events affecting the health and welfare of people using the service were not always notified to the Care Quality Commission as required.

Medicines were managed effectively and administered by staff who had received appropriate training. Daily audits helped to determine if medicines had been given as prescribed and any errors could be quickly rectified reducing any risk of harm to people. The use of prescribed medicines for ‘as required use’ was not being monitored.

People had complex health care needs and feedback from health care professionals was the service had been fragmented at times and the staff did not always act on professional advice.

People were supported to eat and drink in sufficient quantities and staff kept a daily record but there was no clear overview or regular review of people’s needs. This meant changes in need or risk factors might not be identified in a timely way.

Staff were caring but we found they worked long hours and worked alongside agency staff which meant they could not always allocate duties. This could potentially impact on the level of care they could give and acknowledged that people did not have the same level of opportunity to pursue their interests as they had previously.

The service was not effectively managed, and the oversight of the service was poor which meant people did not get the care they needed, and staff were not appropriately supported.

Rating at last inspection

The last rating for this service was Good (published 03 August 2017)

Why we inspected

This was a planned inspection based on the previous rating.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. and found four breaches of regulation. There were breaches for Regulation 9, Person centred care, Regulation 12, Safe care and treatment, Regulation 18, Staffing, Regulation 17, Good governance and Regulation 18 Notifications of other incidents.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Oaks & Woodcroft on our website at www.cqc.org.uk.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At this inspection 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.

The services Oaks and Woodcroft can accommodate up to twelve people in single rooms. There are two bungalows on each site which are adjacent to each other. People had a diagnosis of a learning disability.

The service was well staffed and staff met people’s needs in a timely way. We saw a lot of engagement and people having individual time with staff. Risks were well documented with good guidance for staff to follow to minimise the risk. Training was provided to staff to help them meet people’s individual needs and help to reduce risks.

Staff recruitment files were being updated to demonstrate how the provider was following an effective recruitment process.

Medicines were well managed and people received their medicines as intended. There were robust systems in place to ensure medicines were correctly accounted for and administered by suitably qualified staff.

Staff were supported to recognise the risk of potential or actual abuse and knew what steps to take to ensure people were fully protected.

Staff were well supported through induction and received regular training and supervision of their practice. The staff team were confident in the management of the service and felt listened to and empowered to make decisions.

People were supported to access the kitchen and be involved in food preparation. Staff monitored people’s food and fluid intake to ensure it was sufficient to their needs. Unplanned weight loss was investigated to help ensure the person did not continue to lose weight.

People’s health care needs were documented and in the main met. However we identified gaps in records in relation to the monitoring of a certain healthcare condition.

The Care Quality Commission is required to monitor the operations of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) which applies to care services. People did not have any restrictions and staff acted lawfully to support people.

We found the environment could be improved and would help people to access the outside space if improvements were made. These were made immediately following our inspection.

Staff were caring and knew people well. Staff encouraged people to make individual choices but did not make the best use of technology to help aid communication. Some people did not have verbal skills and staff used limited ways to help them communicate effectively with people.

People were encouraged to be independent and have opportunities but we could not always see if goals set were achieved or if they were of the person’s choosing. We found a number of people at the service very able and questioned the appropriateness of the setting or the support being provided. We understood that different funding levels affected the levels of support people received but this limited some people’s opportunities. This was an issue for commissioning and being raised by the provider.

Support plans were well written and showed consultation with people about their needs and how they should be met according to people’s preferences.

We found the manager open, friendly and realistic about what they had achieved and improvements still required. The staff team were working hard to meet people’s needs and we saw the service was well planned and well managed.

There were systems in place to judge the safety and effectiveness of the service which meant the manager knew what was working well and what they still needed to address and had prioritised according to risk.

This report only covers the findings in relation to that notice.

We have not changed the overall rating for this service as a result of this inspection, which was only to follow up our enforcement action. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Oaks & Woodcroft on our website at www.cqc.org.uk.

The Oaks & Woodcroft is a care home that provides accommodation and personal care for up to 12 people. There were 11 people living in the home on the day of the inspection.

At the time of the inspection, the home did not have a registered manager. 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 and associated Regulations about how the service is run. The manager currently overseeing the service from another of the providers services had applied to have The Oaks & Woodcroft added to their registration. This application was currently being considered at the time of this inspection. This person has been referred to as the service manager in this report.

At the previous comprehensive inspection effective monitoring systems were not in place to ensure quality and safe care was provided. This had resulted in some people receiving poor care and being at risk of harm.

At this inspection we saw that improvements had been made and that effective systems had been introduced since our last visit. These systems were to monitor the quality of care and the safety of people living at the service, and to reduce the risk of harm and poor care.

The service manager had identified where improvements were needed and had taken action to achieve them. A number of new auditing schedules had been introduced and a number of audits had regularly taken place to identify if any shortfalls had occurred.

The Warning Notice we issued had been complied with.

The Oaks and Woodcroft is registered to provide accommodation and personal care for up to 12 people who are living with learning and physical disabilities. At the time of our inspection there were 11 people living at the service.

This unannounced inspection took place on 19 and 20 April 2016.

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. The registered manager had been away from work for a number of weeks and the service was being overseen by a registered manager from another of the provider’s services.

The provider was not taking appropriate action to manage risks. Risks were not always identified and risk assessments were not reviewed appropriately. Risks around the use of equipment were not identified and action was not taken in a timely way to reduce the risks to people living at the home. Moving and handling techniques were not always in line with current recommended practice.

Staff had an understanding of abuse and safeguarding procedures. They were aware of how to report abuse as well as an awareness of how to report safeguarding concerns outside of the service. Staff undertook safeguarding training providing them with knowledge to protect people from the risk of harm.

Care plans were not up to date; the information within them was not current and was contradictory in some instances. We could not be confident that people always received the care and support they needed.

The Care Quality Commission is required to monitor the operations of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Staff had some knowledge of the MCA and DoLS. Not all DoLS applications required had been submitted.

The service was poorly managed. The provider did not have an effective governance system to monitor the quality of the service and identify the risks to people. Care records were out of date. Effective audits were not being carried out. The provider had not picked up issues that were identified in this inspection.

The provider conducted a survey for people using the service. However we saw no evidence in the records or in the information we reviewed documenting that the survey was made accessible to people in the form of an ‘easy read’ version.

The provider had a recruitment procedure in place. People were supported by staff who had only been employed after the provider had carried out checks. Once employed, however, staff were not supported in their role through regular training and supervision.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.

Overall we found that the provider had taken sufficient action to address the shortfalls in relation to record keeping and was now compliant with regulation 20 of The Health and Social Care Act 20018. People's care records now held up to date information about them, and their needs and risks to their welfare had been reviewed regularly by staff.

Below is a summary of what we found. The summary describes what people using the service, relatives and staff told us, what we observed and the records we looked at.

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

This is a summary of what we found:

Is the service safe?

People living at the home, their relatives and an advocate said that The Oaks and Woodcroft was a good place for people to live. They told us that the staff were kind, friendly and polite and provided the people living at the home with the care and support they needed.

Staff personnel records contained all of the information required by the Health and Social Care Act 2008. This meant that the staff members employed were suitable and had the qualifications, skills and experience needed to support people living at the service.

There was a process in place in relation to the Mental Capacity Act (2005) and Deprivation of Liberty Safeguarding (DoLS). Policies and procedures were held. There had been no reason to submit a DoLS application. Staff had been trained and knew when a DoLS application was needed. The manager knew how to submit a DoLS application.

Is the service effective?

People's health and care needs were assessed with them or their family member. Specialist dietary, mobility and equipment needs had been identified in care plans when required. Relatives told us their family member received the care and attention they required in a way that met their needs. Through our observations and speaking with staff we noted that the staff understood the care and support needs of each person. One person told us. 'This is a nice home and the staff will do anything to help you.' Staff had received training to meet the needs of people living at the home.

Is the service caring?

People were supported by staff who used a kind and attentive approach. We saw that the staff were patient and encouraged people to be as independent as possible. Relatives told us that the staff were sometimes busy but did not rush people. Our observations confirmed this. A visitor told us. 'I am happy with the care given to my family member. The members of staff are polite and respectful.'

Is the service responsive?

Care and risk assessments had been completed but not all had been recently reviewed. The care and support provided was adjusted to meet the needs of each person. Improvements were being made to ensure that any change in care and support was recorded in the person's plans of care. A record was held of people's preferences, interests and diverse needs. Relatives told us that staff members consulted their family member and encouraged them to make their own decisions. People had access to a range of planned activities that they said they enjoyed.

Is the service well led?

Staff spoken with had an understanding of the ethos of the home and quality assurance processes were in place. Relatives told us that they had been asked for their feedback on the service their family member received. Visitors and staff said that they had felt listened to when they had made a suggestion or raised their concerns. People told us that the manager was approachable.

We were provided with various pieces of information by the manager of the home and found that the necessary improvements had been made.

We observed staff interacting with the people they were caring for and saw that staff knew the people they were caring for well. For example, they talked with the people about the activities planned for the day. Staff and people living at the service got on well together and we noted a happy, relaxed atmosphere.

However, we were not confident that people's needs were always appropriately identified and met.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We spent some time touring the building and looking at the general cleanliness. We found that it was generally clean and free from unpleasant odours. The dining room was clean as were bathrooms and toilets.

However, we found that risks in relation to a refurbishment at the premises were not being appropriately managed or monitored.

We told the provider to make improvements and during this follow up, desk-based inspection, we found that they had.

We observed the care and support delivered during lunch time and found that staff were respectful and encouraged people to eat independently. Staff members positively engaged with the people they were supporting, involving them in conversations and discussing plans for the day. People were enabled to eat at their own pace and offered choice such as what crisps and yoghurts they wanted to accompany their meal.

During our inspection we also saw that people were supported to undertake activities which they enjoyed to do. For example, one person liked table games, such as completing puzzles. We saw that an area had been allocated in the home so the person could enjoy their chosen activity whilst maintaining social contact.