Archived: Oak View

People’s experience of using this service:

The outcomes for people using the service reflected the principles and values of Registering the Right Support. People were supported to make choices in all areas of daily living from choosing clothes to wear to what they ate on a daily basis. Opportunities to use local facilities and amenities had increased and people had equipment that enabled them gain new skills to increase their independence in whatever way they could.

There were enough staff who had been appropriately recruited, to meet people’s needs. Staff had a good understanding of the risks associated with supporting people. They knew what actions to take to mitigate these risks and provide a safe environment for people to live. Staff understood what they needed to do to protect people from the risk of abuse. Incidents and accidents were well managed. People’s medicines were managed safely.

People’s needs were effectively met because staff attended regular training to update their knowledge and skills. Care staff attended regular supervision meetings and told us they were very well supported by the management of the home. People were encouraged to make decisions and choices. They were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were treated with dignity and respect by kind and caring staff. Staff had a good understanding of the care and support needs of people and had developed positive relationships with them. People were supported to attend health appointments, such as the GP or dentist and attended appointments for specialist advice and support when needed. People had enough to eat and drink and menus were varied and well balanced.

Relatives commented on the improvements in the service over the past year. This was attributed to the reduction in the staff turnover and the manager growing in experience in the role. Professionals spoke positively of the staff and how they interacted with people and how they always acted on specialist advice and guidance.

Staff had a very good understanding of people as individuals, their needs and interests. Everyone needed support with communication and were not able to tell us their experiences; we observed that they were happy and relaxed with staff. People were supported to take part in activities to meet their individual needs and wishes. This included trips to the local parks, theatres, cafes and restaurants. Emphasis had also been placed on increasing opportunities for activities, so people had attended football matches, had enjoyed trips to London and arrangements were being made for one person to go to Disneyland Paris.

The environment was clean and well maintained. The provider had ensured safety checks had been carried out and all equipment had been serviced. Fire safety checks were all up to date.

Rating at last inspection: At the last inspection the service was rated requires improvement. (The last inspection was published 1/05/2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will review the service in line with our methodology for 'Good' services.

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.

This is the second time the home has been rated requires improvement. At the last inspection there was a breach of regulation and a requirement notice was issued. The breach was in relation to safety of administration of some medicines and because not all risks to people’s safety had been assessed to reduce the risk of harm. We asked the provider to complete an action plan to show improvements they would make, what they would do, and by when, to improve the key questions in safe to at least good.

This comprehensive inspection took place on 18 and 23 January 2017 to check the provider had made suitable improvements to ensure they had met regulatory requirements. We found that although the matters raised at the last inspection had mostly been addressed there were other areas of safety identified so there was a continuing breach of Regulation 12. This was because we could not be sure people were receiving enough to drink and risk assessment documentation was not always up to date or accurate.

At the last inspection of the service we rated the well led domain requires improvement. This was because the provider was not always effective in identifying shortfalls in the service. At this inspection we found the home was in breach as there were a number of areas where record keeping was not accurate or up to date. In particular this included monitoring in relation to daily records, minutes of meetings, records of staff induction and systems for assessing people’s views of the care they received. A number of these areas had been identified and repeated through regular auditing. However, it was noted that additional measures had been taken to address these matters shortly before our inspection but there had not been enough time for these to be effective.

There were good recruitment procedures and enough staff to meet people’s individual needs. Staff knew how to safeguard people from abuse and what they should do if they thought someone was at risk. Incidents and accidents were well managed. People’s medicines were managed safely.

People’s needs were effectively met because staff had the training and skills they needed to do so. Staff were supported well with training, supervision and appraisal. Staff supported people in the least restrictive way possible. People were encouraged to be involved in decisions and choices when it was appropriate. Mental Capacity Act 2005 (MCA) assessments were completed as required and in line with legal requirements. Staff had attended MCA and Deprivation of Liberty Safeguards (DoLS) training.

People were treated with dignity and respect by kind and caring staff. Staff had a good understanding of the care and support needs of people and had developed positive relationships with people. People were supported to attend health appointments, such as the GP or dentist.

Most people attended day centres at least one day a week and people were also supported with daily activities both within and outside of the home.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

This inspection was unannounced and took place on 13 and 14 December 2016.

There was a registered manager responsible for the service. 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 leaving the service in December 2016. The deputy manager had been appointed as the new manager.

People had communication difficulties associated with their learning disabilities. We met all four people who lived ¿at the home. We had very limited communication with people. We also used our discussions ¿with people’s relatives and staff to help form our judgements.

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People received their medicines when they needed them. Where people took their medicines with food and drink their GPs had agreed medicines were safe to take this way, however the service had not checked this method was safe with a pharmacist. The registered manager arranged for this to be completed during our inspection and the pharmacies confirmed these methods were safe. Medicines were stored securely and staff received training before being able to administer them.

Risk assessments had been carried out and they contained guidance for staff on reducing the risk. However, some of the assessments did not fully consider all the risks relating to people and following a choking incident staff did not follow the provider’s policy in relation to reporting incidents.

People appeared happy with the care they received and interacted well with staff. Staff did not always inform people of how they were supporting them. Staff supported people’s independence and ¿involvement in the community.

There were systems in place to monitor and improve the quality of the service provided. The systems did not identify the shortfalls we identified during our inspection.

Relatives and staff told us there had been a high turn over of staff working at Oak View. There were sufficient staff available to enable people to take part in a range of activities according to their interests and preferences.

A safe recruitment procedure was in place and staff received pre-employment checks before starting work with the service.

Staff knew how to recognise and report abuse. They had received training in safeguarding adults from abuse and they knew the procedures to follow if they had concerns.

People’s health care needs were monitored and met. The home made sure people saw the health and social care professionals they needed and they implemented any recommendations made.

Staff received a range of training to meet people’s needs and keep them safe. Where staff required training, the registered manager had arrangements in place for staff to attend a future date.

Routines in the home were flexible and were based around the needs and preferences of the people who lived there. Relatives felt involved and were kept up to date with any changes to their family members care.

Relatives were aware of the complaints policy and felt confident to raise any concerns with the registered manager.

Staff felt supported by their managers. The provider had notified us of all significant incidents in line with their legal responsibility.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations (2014). You can see what action we told the provider to take at the back of the full version of this report.

Below is a summary of what we found. This is a summary of what we observed, were told, and the records we looked at. People using the service had complex needs, which meant that they were not able to tell us their experiences.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

There were robust systems in place for the management of medicines. All staff with responsibility for administering medicines received appropriate training. There was thorough monitoring of the systems in place to ensure that medicines were managed appropriately.

There were thorough staff recruitment procedures in place. Systems ensured that staff employed to work in the home were of good character and received appropriate training to fulfil the duties of their role.

Below is a summary of what we found. This summary describes what people and staff told us, what we observed and the records we looked at. We used a number of different methods to help us understand the experiences of people using the service. People using the service had complex needs, which meant that some were not able to tell us their experiences.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw that staff had completed training on the subject. Mental capacity assessments had been carried out and best interest decisions documented. In addition, further advice had been sought in relation to the recent changes in DoLS.

The staff recruitment procedures were not thorough. For example although checks were carried out for new staff we saw gaps in one staff member's employment history and there was no evidence that this had been explored with them.

We saw that some of the systems in place for the management of medicines were not safe. For example, although staff monitored the temperature at which medicines were stored they did not take action when the temperatures were above accepted safe guidelines.

We have asked the provider to tell us how they will make improvements in relation to staff recruitment and the management of medicines.

Is the service effective?

Care plans provided clear information about how people's needs should be met and they were reviewed at regular intervals. Staff spoken with had a good understanding of people's support needs. This demonstrated that staff had been given clear advice to meet people's needs.

We saw that when people needed specialist advice and support, arrangements were made for this to happen. For example, there was evidence in care plans that specialist advice had been sought in relation to people's mobility.

Is the service caring?

People were treated with respect and dignity. They explained to people what they were doing and offered them a choice of activities. We saw that when people refused care or support staff respected their decisions.

Is the service responsive?

We saw that people's needs were regularly reviewed. Records confirmed that people's preferences, interests and diverse needs had been recorded.

People had access to activities that were important to them. Activities included swimming, music and exercise, computer time, bowling, sensory cooking and aromatherapy.

Is the service well led?

We saw that the organisation had a range of measures to monitor the quality of the service provided at Oak View and that when shortfalls were identified actions were taken to address them.

The home had systems in place to seek the views of people, relatives, staff and visiting professionals. We saw that a relative had requested a 'veggie/herb garden' and that raised vegetable and herb beds had been created.