Oakley House Ltd

Oakley House Ltd is a residential care home providing personal care for up to 11 people with a mental health diagnosis and a learning disability. At the time of the inspection there were nine people living at the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Care:

The model of support did not always promote maximum choice and independence. The ethos, attitudes and behaviours of managers and staff did not always ensure that people lead confident inclusive and empowered lives.

Right Support:

The provider could not show how they met some of the principles of Right support, right care, right culture. This meant we could not be assured that people who used the service were able to live as full a life as possible and achieve the best possible outcomes.

Right culture:

Although people told us they felt safe and were happy living at Oakley House, the provider did not focus on people's quality of life, and care delivery was not person centred. Staff did not always recognise how to promote people's rights, choice or independence.

People received their medicines as prescribed and staff supported them to manage their treatment by arranging blood tests and healthcare appointments. However, improvements were required around the guidance for staff for when some medicines were required. The provider was also not following the guidance required when visitors were attending the service.

Risk associated with people’s care was managed well by staff. People told us they felt safe at the service and staff ensured they were protected from the risk of abuse and neglect. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff received appropriate training in relation to their role and were encouraged to progress.

People enjoyed the meals at the service and where they were at risk nutritionally staff supported them with this. Staff ensured that people were supported with their ongoing health.

Rating at last inspection

The last rating for this service was Good (published 11 March 2020).

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support, right care, right culture. We had also received concerns that related to whether people were protected from the risk of abuse.

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 COVID-19 and other infection outbreaks effectively.

This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

The ratings from the previous 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 Good 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 Oakley House Ltd on our website at www.cqc.org.uk.

Follow up

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

Oakley House Limited is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the

care provided, and both were looked at during this inspection. Oakley House is registered to provide personal care for up to 11 people with a physical or learning disability. There were seven people living at the service at the time of our inspection.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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

People told us they felt safe living at Oakley House and that they trusted staff to keep them safe. People said they were happy in their home.

Potential risks to people had been assessed and measures put in place to mitigate these. If accidents or incidents occurred, staff acted to reduce the risk of similar incidents happening again. Medicines were managed safely, and staff maintained appropriate standards of hygiene and infection control.

People were supported by consistent staff who knew them and their needs well. Staff communicated effectively with one another about people's needs daily. A person told us, “They always seem to know what is going on and I think they make sure all staff are aware if anyone is in a particularly bad mood.”

People told us they enjoyed the food and that they had a choice and input into planning meals in addition to being supported to go out and buy ingredients.

Staff treated people with respect and maintained their dignity when supporting them. Staff encouraged people to make choices about their care and respected their decisions.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported to take part in activities personal to them. People were able to access the community as and when they wanted to.

People and relatives told us they were aware of the complaints procedure and how to make a complaint. Complaints had been responded to in a timely manner. There was an easy read complaints document displayed within the home which people had access to and the support of their key worker.

The provider had developed audit processes following the last inspection. The audits had been used to identify additional areas for improvement which had been actioned the provider and management team. Staff and people gave positive feedback about the provider and the manager. Staff felt supported and had supervisions with the manager which had been another improvement since the last inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update (and update)

The last rating for this service was requires improvement (published 14 February 2019) and there were multiple 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

This inspection site visit took place on 14 November 2018 and was unannounced.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. On the day of the inspection the registered manager was on leave so instead we were supported by the provider.

There were aspects to care delivery that were not safe. Where a risk had been identified there was no assessment of this risk with measures in place. Accidents and incidents were not always recorded onto incident forms. Staff were not always following best practice in relation to infection control. There were aspects to the environment that required improvements. We have recommended that they are always the appropriate numbers of staff available as at times they were lacking.

Staff did not always have the competencies they needed to meet people's needs and ensure their safety. Although training was being provided staff were not always providing the most effective care. People’s rights were not always protected because the staff did not always act in accordance with the Mental Capacity Act (2005) MCA or Deprivation of Liberty safeguards DoLs. Mental capacity assessments were not always taking place particularly when specific decisions needed to be made. Where people had capacity, their rights were at times were being restricted.

There were times where people were not always treated with dignity. People were not always involved in the planning of their care and were not always supported with their independence. Care plans lacked detailed around the specific needs of people particularly where they had a mental health diagnosis. Improvements were needed around the activities and access to the community.

Audits and surveys were not being used as an opportunity to make improvements.There were insufficient processes in place to ensure that people were aware of how to complain. The provider was not delivering on their statement of purpose.

We saw that medicines were being managed in a safe way and there were systems in place to ensure that people were safe in the event of an emergency. There were aspects of risk assessments that were appropriate to ensure that risks to people were reduced. Robust recruitment checks were in place that ensured that only suitable staff worked at the service.

Pre- admission assessments took place before people moved in to the service. People at risk of malnutrition and dehydration had systems in place to monitor their health. People were protected from the risk of abuse as staff understood what they needed to do should they suspected abuse was taking place.

People enjoyed the food at the service and were offered choices of meals. Referrals to healthcare professionals were being completed where required and people received healthcare support when needed.

There were times where staff at the service were observed to be kind, caring and respectful towards people. People that were able could access all areas of the service when they wanted.

People had the opportunity to attend meetings to feedback on aspects of care. Staff said they felt supported and valued. We saw that the registered manager worked with organisations outside of the service in relation to people’s care. Notifications that are required to be sent to the CQC were being sent.

This was the first inspection at the service. We identified seven breaches of the Health and Social Care Act 2008. You can see what action we have taken at the end of this report.