Oak Cottage

People's experience of the service and what we found:

People were not always protected from the risk of abuse. Incidents were identified and reported, but not investigated or reported to the local authority. There was not always evidence of learning following incidents. However, people told us they felt safe.

People said staff were not always deployed appropriately to support them when needed. Medicines management required improving to ensure people received their medicines. Risks were not always fully assessed and documented. Improvements were needed to some infection controls practices and maintenance of the property in the service.

People's health needs were not always fully planned for, so staff did not always have detailed guidance. Staff told us they received training, however we found key gaps in their training records. Some areas of the service needed refurbishing to meet the needs of people living there.

Feedback about the food provided to people was mixed. The chef did not have the required training to support people’s specific dietary needs. Weights had not been monitored as required, and fresh fruit and snacks were not always available.

People were not supported to have maximum choice and control of their lives. Staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Although we did see staff asking people consent before supporting them.

Quality assurance systems in place were not effective at monitoring the quality and safety of people's care. Notifications were not always submitted as required. People did not feel the management team were visible or responsive to them.

People were able to access healthcare professionals as needed and staff knew people’s support needs well. Staff were seen to be caring and attentive in their approach and had formed positive, friendly relationships with people. Staff felt they worked well as a team and felt supported by the management team. The registered manager was open to feedback and eager to make improvements through the inspection.

Rating at last inspection and update

The last rating for this service was requires improvement [published 11 April 2019] and there were breaches of regulation. 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 the provider remained in breach of regulations.

The last rating for this service was requires improvement (published 11 April 2019). This service has been rated requires improvement on 4 out of 5 previous inspections since 04 February 2015.

Why we inspected

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, effective and well-led which contained those requirements.

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 has remained 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 Cottage on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to staffing, consent, safe care and treatment, staff support and governance arrangements at this inspection.

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.

People’s experience of using this service:

• People were not always protected from the risk of harm, because appropriate window restrictors were not in place on the first floor of the building, to ensure people’s safety.

• Staff had not always received the required training. Many staff had received an induction to the service, but no formal training had taken place.

• Audits were not always effective. There were no effective audits on staff training. Training records kept were out of date, and there was no oversight on staff training.

• This was the second time we had found a lack of training within the service. At a previous inspection in July 2014, staff were not sufficiently trained.

• Timely action was not always taken to respond to known areas of required improvement.

• People told us they felt safe. Staff understood safeguarding procedures.

• Risk assessments were in place to manage risks within people’s lives.

• Staff recruitment procedures ensured that appropriate pre-employment checks were carried out.

• Staffing support matched the level of assessed needs within the service during our inspection.

• Staff were supervised well and felt confident in their roles.

• People were supported to have a varied diet.

• Healthcare needs were met, and people had access to health professionals as required.

• People's consent was gained before any care was provided, and they were supported to have maximum choice and control of their lives.

• Staff treated people with kindness, dignity and respect and spent time getting to know them.

• People were supported in the least restrictive way possible.

• Care plans reflected people’s likes, dislikes and preferences.

• People were able to take part in a wide range of activities and outings.

• People and their family were involved in their own care planning as much as was possible.

• A complaints system was in place and was used effectively.

• The registered manager worked in partnership with outside agencies to improve people’s support when required

• The service had a registered manager in place, and staff felt well supported by them.

Rating at last inspection: Good (report published 23/08/2016)

Why we inspected:

• This was a planned inspection based on the rating at the last inspection.

Enforcement

• Please see ‘the action we have told the provider to take’ section towards the end of the report.

Follow up:

• We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Oak Cottage provides care and support for up to 21 older people. At the time of the inspection, there were 18 people being supported by the service.

The service has 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.

There were risk assessments in place that gave guidance to staff on how risks to people could be minimised and how to safeguard people from the risk of possible harm.

The provider had effective recruitment processes in place and there were sufficient staff to support people safely. Staff understood their roles and responsibilities and would seek people’s consent before they provided any care or support. Staff received supervision and support, and had been trained to meet people’s individual needs.

People were supported by caring and respectful staff who they felt knew them well. Relatives we spoke with described the staff as kind and caring. People were supported to be part of the community and visit the local area.

People had been assessed, and care plans took account of their individual needs, preferences, and choices. Staff supported people to be as independent as possible.

The provider had a formal process for handling complaints and concerns. They encouraged feedback from people and acted on the comments received to continually improve the quality of the service. The provider also had effective quality monitoring processes in place to ensure that they were meeting the required standards of care.

When we inspected the home we found that it had completed all actions required and was now compliant with the regulations.

While at the service we did find that the provider was not meeting the requirement under cleanliness and infection control within the laundry area of the home.