Archived: Oakley House

We undertook this focused inspection on 10 August 2017 in response to information of concern we received about the service including, an allegation of abuse that the provider had referred to the relevant local authority, which was currently being investigated, a sudden change in the homes management and outstanding fire safety issues identified in the provider’s previous CQC inspection report. The aim of the inspection was to check that the people who still lived at Oakley House remained safe and the service continued to be well-managed.

This report only covers our findings in relation to this inspection. You can read the report from our previous comprehensive and focused inspections, by selecting the 'all reports' link for ‘Oakley House’ on our website at www.cqc.org.uk.

We have reduced the services last ‘Good’ rating to 'Requires Improvement’ overall because we found the provider to be in breach of the regulations and fundamental standards we looked at during this inspection. Specifically, the provider had failed to assess and review risks relating to people’s health and welfare and nor did they establish and operate good governance systems to monitor the quality and safety of the care and support people living at the home received.

Oakley House is a care home which provides personal care, support and accommodation for a maximum of 11 adults. The service specialises in supporting people with mental health needs. At the time of our inspection there were four people aged 40 and over living at the home. Four people who had previously lived at Oakley House had moved out in that last two months and another person was currently in hospital.

The service used to be managed by an individual who was the registered provider. A registered provider is a person who has registered with the Care Quality Commission (CQC). Registered providers 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 provider left the service in July 2017 at which point the deputy manager was appointed interim manager. At the time of this inspection our records showed that the current provider had applied to cancel their registration. A different limited company has applied to become the registered provider of Oakley House. We are waiting to hear the outcome of their registered provider application to the CQC before we process the current provider’s application to cancel their registration. This is because we cannot allow a home to operate and provide care without a person or corporate body having legal responsibility for the service. In this report we refer to the current provider as the individual who although, is no longer in day to day control is still legally responsible. Where we mention the proposed provider we are referring to the company who has applied and is still going through our assessments process. Where we just refer to providers we mean both the current and the proposed providers.

During this focused inspection, we found that the current provider had taken on board the comments made in their previous CQC inspection report about fire safety and had improved these arrangements. People and their relatives told us Oakley House was a safe place to live. There remained robust procedures in place to safeguard people from harm and abuse and staff were still familiar with how to recognise and report abuse. There also remained enough staff deployed in the home to keep people safe.

However, the current and proposed provider’s had not ensured risks people might face due to their health care needs or lifestyle choices had been identified and routinely reviewed. Although the interim manager and staff demonstrated a good understanding of how to manage assessed risks, the current provider had not considered all the risks people might face and nor had existing risk assessments been reviewed. This put people living at the home at unnecessary risk of harm or injury because risk assessments either did not exist or the information they contained for staff to follow in order to keep people safe was inaccurate.

In addition, the current and proposed providers did not always operate effective governance system to assess, monitor and improve the quality and safety of the service. Although there were some good systems in place to monitor and review the quality of service delivery, we found limited documentary evidence checks and audits were routinely undertaken and the outcomes formally documented. We also identified a number of issues during our inspection which had not been picked up by the providers around monitoring finances handled on behalf of people living in the home by staff, and the assessing and reviewing of risks people might face. This meant the providers had always sufficiently monitored and improved all aspects of the service so that people experienced good quality, safe care.

These failings represent two breaches of the Health and Social Care (Regulated Activities) Regulations 2014 in relation to safe care and treatment, and good governance. You can see what action we told the providers to take with regards to these breaches at the back of the full version of the report.

Oakley House is a care home which provides accommodation and personal care for up to 11 people, who have learning disabilities including autism and other complex needs. At the time of our inspection there were eight people living there.

The service is a detached house with communal lounge, dining room, kitchen and bathroom facilities. There was also a spacious and secure garden for people to use.

During our inspection the registered provider was present. The registered provider is also the registered manager for Oakley House. 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 relatives told us they were safe at the home.

Staff had a good understanding about the signs of abuse and were aware of what to do if they suspected abuse was taking place. There were systems and processes in place to protect people from harm, although we noted there were inconsistencies in the arrangements to reduce fire risks for people who smoked. The provider took immediate action and informed us shortly after the inspection that a risk assessment had been completed and safety equipment had been obtained.

There were sufficient numbers of staff deployed who had the necessary skills and knowledge to meet people’s needs. Recruitment practices were safe and relevant checks had been completed before staff started work.

Medicines were managed, stored and disposed of safely. Any changes to people’s medicines were prescribed by the person’s GP and psychiatrist and administered appropriately.

Fire safety arrangements and risk assessments for the environment were in place to help keep people safe. The service had a contingency plan that identified how the home would function in the event of an unforeseeable emergency such as fire or adverse weather conditions.

Staff were up to date with current guidance to support people to make decisions. Staff had a clear understanding of Deprivation of Liberty Safeguards (DoLS) and the Mental Capacity Act (MCA) as well as their responsibilities in respect of this.

The provider ensured staff had the skills and experience which were necessary to carry out their role. Staff had received appropriate support that promoted their development. The staff team were knowledgeable about people’s care needs. People told us they felt supported by staff.

People had enough to eat and drink and there were arrangements in place to identify and support people who were nutritionally at risk. People were supported to have access to healthcare services and healthcare professionals were involved in the regular monitoring of their well-being. The provider worked effectively with healthcare professionals and was pro-active in referring people for assessment or treatment.

Staff treated people with compassion, kindness, dignity and respect. People’s preferences, likes and dislikes had been taken into consideration and support was provided in accordance with people’s wishes. People’s privacy and dignity were respected and promoted when personal care was undertaken.

People’s needs were assessed when they entered the home and on a continuous basis to reflect changes in their needs. Staff understood the importance of promoting independence and choice. People were able to personalise their room with their own furniture and personal items so that they were surrounded by things that were familiar to them.

People and relatives were encouraged to voice their concerns or complaints about the service and there were different ways for their voice to be heard.

People had access to activities that were important and relevant to them. There were a range of activities available within the home and outside.

People’s care and welfare was monitored regularly to ensure their needs were met. The provider had systems in place to regularly assess and monitor the quality of the care provided.

People and relatives told us the staff were friendly and management were always approachable. Staff were encouraged to contribute to the improvement of the home. Staff told us they would report any concerns to their manager and felt supported by the registered provider.

We spoke with the five people on the day of our inspection and conducted observations throughout the visit. We looked at records and spoke with the two staff on duty which included the registered manager of the service.

We saw that staff spoke with people respectfully and offered choices, such as going out to the local shops and choosing when to get up and what to wear.

People told us that most staff were very good. We were told 'Most of the staff approaches are very good and commendable.'

Most people were aware of their care plan and met regularly with the key worker to have discussions about their care.

People were mainly satisfied with the food and described a variety of different meals. During our visits we saw that there was plenty of food available, however, there were few fresh vegetables.

People told us that they felt safe and had good relationships with most of the staff. Staff we spoke with were clear about their responsibilities in relation to safeguarding people who used the service.

We saw that appropriate training and supervision was provided to support staff in their role.

We noted that regular quality and safety checks took place.

On the day of our inspection there were ten people who lived at the service.

During our inspection we spoke with four people about their care and observed people being supported by staff throughout the day. We also spoke to two staff and the registered manager.

We saw that people were spoken to politely and with respect. Most people told us that they felt safe at the service and that staff were kind. One person said that 'Staff are polite.' Another person told us that 'Staff are nice to me.'

We saw that people were helped to engage in community activities and during our visit people went on a shopping trip with staff.

We saw that some people helped to prepare a cooked lunch, which they told us that they enjoyed. People were not routinely offered choice in relation to meal planning.

We noted that there had been improvements made to the environment, although some rooms still lacked storage and personalisation.

There were improvements to staffing which included staff appraisals. We also saw some improvements in relation to record keeping and quality assurance. For example, the service had carried out a quality assurance review and care plans had been updated with review dates set to evaluate the care.

During our inspection we observed people were supported by staff in daily living tasks and involved in activities. We observed that staff interacted well with people and encouraged people to participate in everyday activities such as helping with tidying after lunch and washing clothes. We saw that people were helped to engage in community activities and during our visit people went to the local shop and on a bowling trip with staff

We spoke with five people who were positive about the service. One person told us 'I like it here.' Another person said that it was 'alright' here.

We saw three care plans were due to be reviewed but that this had not taken place. Staff told us that they were due to update the care plans.