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Oak Farm Requires improvement

The provider of this service changed - see old profile

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 2 February 2021

About the service

Oak Farm is nursing home providing rehabilitation to people living with brain injuries. The home can support up to 32 people and at the time of the inspection was supporting 22. There is both a main building which can accommodate up to 28 people and a smaller unit supporting four people.

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

We had continued concerns around the provider’s governance structure. Only limited aspects of service delivery were audited to provide the information required for service improvement. The service needed to be more proactive at working with partner agencies and ensure it collected the views of the people they supported and their families.

We found continued concerns in that people’s care needs were not always effectively risk assessed and management plans, where developed, were not routinely followed.

Improvement had been made in both the safe recruitment of staff and the environment, which had been refurbished to allow for better infection prevention and control. Medicines were safely managed and families of people told us they were received, when needed, by staff who knew their role and were supported by a large enough team to meet their family’s other support needs.

For more details, please see the full report which is on the CQC website at

Rating at last inspection (and update)

The last rating for this service was Inadequate (published 24 October 2018) and there were multiple breaches of regulation. At this inspection we found some improvements had been made however, the provider remained in breach of two of the regulations associated with safe risk assessment and good governance. We have also given two recommendations in relation to partnership working and gathering people’s views.

The service has been in special measures since January 2020. During this inspection the provider demonstrated improvements had been made. The service is no longer rated Inadequate overall but remains inadequate in well led due to continued breaches over four inspections. As such the provider remains in special measures.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 4 and 5 November 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, fit and proper persons employed, the safe management of equipment and the premises, people’s nutrition and hydration needs and the governance of the service.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements except regulation 14 which was also breached. Whilst we did not check the entirety of this regulation, we ensured people’s nutrition and hydration needs were safely managed under regulation 12.

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.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Oak Farm on our website at

We have found evidence that the provider needs to make improvement. Please see the safe and well led sections of this report.


We are mindful of the impact of the COVID-19 pandemic on our regulatory

Inspection areas


Requires improvement

Updated 2 February 2021

The service was not always safe.

Details are in our safe findings below.


Requires improvement

Updated 2 February 2021


Requires improvement

Updated 2 February 2021


Requires improvement

Updated 2 February 2021



Updated 2 February 2021

The service was not well-led.

Details are in our well-Led findings below.