Oak Cottage

Oak Cottage provides accommodation and personal care for a maximum of seven people with complex needs. The accommodation consists of six self-contained flats with a shared kitchen and lounge and a separate self-contained apartment to the rear of the main building.

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

Right Care

People’s needs and risks were not adequately assessed or managed to mitigate the risk of avoidable harm. Staff lacked clear information about people’s needs and risks. Some of the support provided was not always well planned to ensure that people’s emotional wellbeing was supported appropriately.

Medication management was unsafe. There were no effective systems in place to account for medicines administered to people. This meant it was impossible to tell if the balance of medicines in the home was correct and people had been given the medicines they needed. Medicines were not always stored at a safe temperature and there was a lack of safety checks around the competency of staff to administer injectable medicines.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. People’s consent was not sought in line with the principles of the Mental Capacity Act 2005.

The checks in place to prevent legionella bacteria developing in the home’s water supply were not completed properly to mitigate risks. Other aspects of maintenance were also not completed in a timely manner. A smoking shelter situated in the garden area was in poor repair and not fit for purpose.

Accident, incidents and safeguarding events were recorded and reported. However safeguarding risks were not always safely assessed or managed. Sometimes the response to people’s emotional distress was not carried out in such a way as to de-escalate distress and any impact on the person’s mental wellbeing.

Improvements were needed with regards to the recruitment of staff. Agency and bank staff covered gaps in the rota but not some did not have staff profiles in place to show what training, skills and competencies they had.

Right Support

Everyone living in the home was funded for a certain amount of one to one support hours, but the system in place for to monitor how this was delivered was unclear.

The home was satisfactorily clean, and people were supported with daily living tasks as required. People told us they liked living in the home and that staff supported them. One person told us “Staff are good, firm but fair”. A relative told us the staff were kind and that they communicated with them well.

Staff spoke warmly about the people they supported and had a good understanding of the social activities people liked to do and how people liked to spend their time. During our inspection we saw that people were supported to access activities in the community and do the things they enjoyed. This helped reduce social isolation. People were supported to maintain good family relationships and relatives visited the home without restriction. This was good practice.

Right Culture

The systems in place to assess the quality and safety of the service including service culture were not robust. They had not identified most of the concerns we found during the inspection. Managerial oversight by the manager and the provider was ineffective. This placed people at risk of avoidable harm as risks to their health, safety and welfare were not safely managed.

The culture of the home was for the most part relaxed but there were aspects of service culture that were appeared institutional. There were certain routines and language used by staff that appeared restrictive. Changes to people care were not always adequately planned for to mitigate the impact on people's wellbeing and to ensure positive outcomes were achieved. We spoke with the manager and nominated individual about this.

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

Rating at last inspection and update )

The last rating for this service was good (published August 2017. At this inspection, we found that the quality and safety of the service had significantly declined. Breaches of the regulations were found, resulting in a rating of inadequate for both safe and well-led. At this inspection, breaches of regulations 11 (Need for Consent); 12 (safe care and treatment); 17 (Good governance) were identified.

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

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

Why we inspected

The inspection was prompted in part due to concerns received regarding the quality of care. A decision was made for us to inspect and examine those risks and review the previous rating. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

Enforcement

We have identified breaches in relation to the safety of people’s care, the implementation of the mental capacity act, deprivation of liberty safeguards and the management and governance of the service.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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.

We found the following examples of good practice:

Staff and people using the service all undertook a regular programme of testing to keep everyone safe and free from infection. Staff and visitors were subject to a range of screening procedures such as providing a negative test before entering the premises. Staff used appropriate PPE and people who lived at the premises were encouraged to wear surgical masks when leaving and re-entering the building.

We observed staff wearing appropriate PPE when supporting people and saw there was ample amounts of PPE available for staff, people using the service and also their visitors.

People were able to move around the building freely and easily whilst maintaining social distance from others. Communal areas were well spaced and hygienically clean.

We saw a suite of comprehensive processes and procedures in place to manage risks associated with the Covid-19 pandemic. These included how to care for staff and people using the service who were Covid positive. There were management plans for those people required to self-isolate and additional support available for people who may struggle with isolation.

Oak Cottage was first registered in September 2016. It is a residential service which provides accommodation and personal care for a maximum of seven people with complex health and care needs. At the time of the inspection six people were living at the service. The accommodation consists of six self-contained flats with a shared kitchen and lounge and a separate self-contained apartment to the rear of the main building.

A registered manager was in post, but not available at the time of the inspection. 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 living at the service and their relatives told us that they felt safe because of the manner in which care was delivered.

Risk to people living at the service was appropriately assessed and recorded in care records. Each of the records that we saw contained a risk matrix to provide staff with an overview of the risk associated with each person.

Staff had been recently trained in adult safeguarding procedures and understood different types of abuse and neglect and what signs to look out for. Staff also knew what action to take if they suspected that abuse was taking place.

Accidents and incidents were recorded in appropriate detail and assessed by the registered manager. The registered manager was required to submit a copy of the information to the provider. However, there was no clear evidence of analysis to establish patterns or trends which might have reduced risk going forward.

The service had sufficient staff to meet the needs of the people living there. Five care staff were deployed between 8:00am and 10:00pm. Staff were recruited safely subject the completion of appropriate checks. This included a requirement for two references and a Disclosure and Barring Service (DBS) check.

The service had a robust approach to safety monitoring and employed contractors to service and check; gas safety, electrical safety and fire equipment. We saw that checks had been completed in each area as required.

People’s medicines were stored and administered in accordance with good practice. Staff received regular training and had their competency assessed by the registered manager. Controlled drugs were stored safely and with one exception, records were completed correctly.

Staff had the skills and knowledge to meet the needs of the people living at the service. Staff told us that they were well-supported by the provider. They were given regular formal supervision which was recorded on their staff file.

Applications to deprive people of their liberty had been submitted appropriately and the service operated in accordance with the Mental Capacity Act 2005. We saw evidence that some decisions had been reviewed and changes made to prevent restrictive practice from continuing unnecessarily.

People living at the service were actively involved in choices about food and drink and had free access to the shared kitchen. Each person also had a well-equipped kitchen in their own flat. We saw that people were supported to shop for and prepare their own food in accordance with their support plans.

People were supported to maintain good health by accessing a range of community healthcare services. We saw evidence in care records that people had a GP, optician and dentist and had regular check-ups.

Throughout the inspection we observed staff interacting with people living at the service in a manner which was knowledgeable, compassionate and caring. People spoke positively about the caring nature of the staff and the positive impact that they had.

The provision of care and support was not task-led. Staff promoted a relaxed and flexible approach to the provision of care and support. We saw examples where plans changed quickly and staff adapted to people changing their minds about activities.

Relatives were free to visit at any time and people were encouraged to maintain contact with friends and family members. The decoration, fixtures and furniture in the shared kitchen and lounge made the building feel homely, modern and welcoming.

The records that we saw showed clear evidence that people were consulted and involved in the development and review of care plans.

Assessments and care records were sufficiently detailed to instruct staff on how best to support people. The language used was person-centred and gave the staff a good understanding of people’s goals, aspirations and needs.

The people living at the service were supported to follow their interests. Events had also been organised to bring people together, for example birthday parties, seasonal activities and trips out.

The service had a complaints procedure and a complaints book available to people living at the service and visitors. Each of the care records that we saw also contained a copy of the complaints procedure. The records that we saw indicated that no formal complaints had been received since the service opened.

People spoke positively about the manner in which the service was managed and the quality of communication.

The deputy manager supported the inspection process in conjunction with colleagues from other services. We spoke with the managers about responsibilities in relation to reporting to the Care Quality Commission (CQC) and the regulatory standards that applied to the service. Each manager was able to explain their responsibilities in appropriate detail. We saw that reference was made to the relevant regulations in key documents and important information about the service’s registration was clearly displayed.

The service had been developed with input from the people living there, their relatives and the staff team. Communication between people living at Oak Cottage, staff, relatives and the management team was open and regular.

The management team and other members of staff that we spoke with described the service’s values in similar terms. Each person spoke about providing a homely environment and promoting people’s independence. We saw that these values were applied in communication with the people living at the service and in the delivery of care and support.

Staff understood their roles and demonstrated that they knew what was expected of them. The service also had an extensive set of policies and procedures for staff to refer to. Staff were required to sign to confirm that they had read and understood important information.

The provider promoted a robust approach to the auditing of safety and quality. The management team had a clear understanding of the need to monitor safety and quality through regular audits.