Oakwood Court

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last inspection we rated this key question requires improvement. At this inspection the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Staff documented accidents and incidents involving people and escalated concerns to the management team. Accidents, incidents and near misses were investigated and route causes were identified to minimise the chance of reoccurrence. Actions were taken and lessons learnt were cascaded to staff through meetings and emails.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. Assessments were undertaken prior to people moving into Oakwood Court. Where applicable, information from the hospital, other care services, medical histories and support plans from the local authority were considered during the assessment process. A summary of a person’s care record was available should they require admitting into hospital or another service; this promoted a continuity of care.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately. People told us they felt safe, a person said, “I feel really safe here, staff know me well.” Safeguarding concerns were escalated appropriately to the local authority and a log was kept to identify themes and trends not only within Oakwood Court, but also the provider’s other locations. A lessons learned statement was shared amongst staff to avoid concerns reoccurring. Staff and management worked within the principles of the Mental Capacity Act 2005 (MCA). Where people had a Deprivation of Liberty Safeguards (DoLS) in place, conditions to their authorisations were being met. The registered manager held a tracker to ensure DoLS authorisations were in date, remained relevant and where conditions were imposed.

The service worked with people to understand and manage risks by thinking holistically. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Risk assessments and associated care plans included how people wanted to be supported. People who were at risk of choking received diets appropriate to their needs. Speech and language therapists (SaLT) advice was clear in people’s care plans. Staff were knowledgeable of who received modified diets. People had personal emergency evacuation plans (PEEPs) which were regularly reviewed and highlighted what assistance people required in an emergency.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Management and maintenance staff completed regular checks around the building, these included checks on fire safety, legionnaires and electrical safety. Where the Food Standards Agency had made some minor recommendations, these were completed in a timely way. Equipment was stored and serviced appropriately. Risk assessments were in place for people who required equipment to safely move and position.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. People and their relatives commented positively about staffing levels. One staff member told us, “I did some training with [nominated individual] the other day, we have reminders of what training is on offer locally or interactive training or online. NVQs and everything we have loads of opportunities.” Staff who were new to the service were supported in their roles, for example, a newly appointed deputy manager spent time at another of the provider’s services for experience and training to enable understanding of their responsibilities.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. Staff were trained in infection prevention and control (IPC) and some and were IPC champions. Champions undertook regular audits to ensure that people were protected from risk of infection. This included access to personal protective wear and its use. Staff handed out hot cloths for people to freshen up at meal times. People and their relatives told us the service was kept, “beautifully clean.”

The service made sure that medicines and treatments were administered and stored safely. People were involved in planning, including when changes happened. However, records in relation to medicines were not always completed consistently. Staff recorded when people’s ‘as required’ (PRN) medicines had been administered, such as, to manage pain, but were not consistently documenting when it had been offered and declined. PRN protocols were in place, however, they did not contain sufficient information about when the medicine may be needed. This might make it difficult for staff administering PRN medication to have timely access to guidance whilst dispensing medication. Medicines audits had not identified these issues, but the management team updated the protocols on the day of our visit to signpost staff to relevant care plans which provided more detail.