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We are carrying out a review of quality at Oak Farm. We will publish a report when our review is complete. Find out more about our inspection reports.

Inspection Summary


Overall summary & rating

Requires improvement

Updated 12 October 2018

This unannounced inspection took place on 3 September 2018. At the last inspection carried out on 31 May and 2 June 2017, we found that there were areas which required improvement including three breaches of regulations. At this inspection, we found that the service had made some improvements, however there remained areas which required improvement. We found that there remained a breach relating to good governance and quality assurance systems.

Oak Farm is a ‘nursing home’ and a rehabilitation support unit which provides care and support to people who are living with a brain injury. At the time of our inspection there were 36 people living at Oak Farm. The provider has on site a multi-disciplinary team which includes a physiotherapist and two part-time occupational therapists as well as therapy and activity assistant staff, nurses and care staff. People in care homes receive accommodation and nursing, personal care or rehabilitation as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Oak Farm accommodates people in two adapted buildings across a one floor. There were 36 people living in the home when we inspected, many of whom were living with complex health conditions including the effects of traumatic brain injury.

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 registered manager was not available at the time of our inspection, and we were supported to carry out the inspection by other members of staff, such as administration, the area manager, the care coordinator and the clinical lead.

At our last inspection of 31 May and 2 June 2017, we found that staff did not always obtain consent from people. Improvements were needed with regards to the management of medicines, staff training, mealtimes and systems for monitoring the service.

At this inspection, staff obtained consent from people before delivering care. Staff understood people’s mental capacity and supported them to make decisions.

There had been improvements in the management of medicines, and there were protocols in place when needed. However, further improvements were needed in the administration of topical medicines.

We found at this inspection on 3 September 2018 that further improvements were needed in respect of the quality monitoring of the service. The systems for identifying issues and monitoring the service were not fully effective. Medicines audits had not identified that there was limited and inconsistent recording around some prescribed items, and the auditing process did not include checking the medicines administration records (MARs).

Improvements were needed to ensure that care plans remained up to date and relevant, as they did not always contain sufficient information about people’s needs. For example, in some areas such as communication, skin integrity and activities or occupation.

There were enough staff to keep people safe and they had received some further training related to supporting people living in the service. However, further improvements were needed in this area, as some poor practice remained relating to manual handling. Staff felt supported in their roles.

There were improvements in staff supporting people in a caring way, however some poor practice remained. Staff were caring towards people’s families.

Staff knew how to report safeguarding concerns and there were health and safety checks which contributed to keeping people safe.

People received a choice of food and enough to eat and drink. They were also supported to access healthcare. People received in house treatment from nurses, physiothera

Inspection areas

Safe

Requires improvement

Updated 12 October 2018

The service was not always safe.

Risks to people had not always been fully identified and mitigated, and there was not always accurate guidance for staff.

Medicines were administered as they had been prescribed, with the exception of topical creams.

There were staff available to people when they were needed.

Effective

Requires improvement

Updated 12 October 2018

The service was not always effective.

Staff received training related to their role, however there was limited specialist training relating to the management of long term, complex health conditions. There were also concerns about whether the training was always effective.

People’s mental capacity had been assessed for individual decisions relating to their care. Best interests’ decisions and consent had been sought regarding aspects of people’s care.

People had enough to eat and drink and were given a choice.

People were supported with access to healthcare when they needed.

Caring

Requires improvement

Updated 12 October 2018

The service was not always caring.

Not all staff supported people in a dignified and respectful way.

People, family members and staff developed good relationships.

Responsive

Requires improvement

Updated 12 October 2018

The service was not always responsive.

Care planning was not always done in a person-centred manner, and care records were not properly reviewed and kept up to date.

There were activities on offer, however there was little evidence that these were based on people’s hobbies or interests. There were not always care plans around activities for individuals.

There was a complaints process and concerns were investigated thoroughly.

Well-led

Requires improvement

Updated 12 October 2018

The service was not always well-led.

The quality assurance systems in place had not identified the issues and concerns that were raised during this inspection.

The staff team worked well together and the management team were approachable.