Oaklands - Care Home with Nursing Physical Disabilities

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

People told us they were very happy with the care they received. We found improvements had been made since our last inspection to the assessing and monitoring of risks and to the oversight of the quality and safety of the service.

Some staff employed had not had all the required checks completed for working with vulnerable people before they began their employment. There were enough staff available to provide care and support to people as they needed it and in the event of an emergency.

We have made a recommendation that the recruitment processes used include all of the required checks of suitability to work with vulnerable people.

Risk assessments were in place to monitor and minimise the potential risk of avoidable harm to people. Systems were in place to record accidents and incidents. These were consistently monitored to identify any lessons learned, themes or trends. Safeguarding incidents were identified and shared with relevant authorities.

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's care and support had been planned in partnership with them and their relatives where possible.

People told us they felt the staff were well trained to meet their needs. Records demonstrated appropriate and relevant training was completed. Referrals were made to other healthcare services where necessary.

People told us the staff treated them with respect and dignity and were kind and caring towards them. Care plans demonstrated a person-centred approach. People’s individual needs were responded to well and people were extremely satisfied with the service. Concerns and complaints were promptly responded to.

There was a positive culture in the home, people spoke very highly about the staff who cared for them and all the staff we spoke to told us they really enjoyed their jobs. There were improved, communications, systems and processes used to ensure regular oversight of the safety and quality of the service. The registered manager and staff had worked hard to improve people's experiences and to address shortfalls found at the last inspection driving improvements at the home.

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

The last rating for this service was requires improvement (published 03 December 2021).

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.

At our last inspection we recommended that the provider ensured a good level of cleanliness throughout the home and improved storage space for large pieces of unused equipment. Care files needed more detailed to show the support people preferred. The recording of staff supervision and training needed to be more accurately recorded and people's privacy and dignity to be promoted at all times

At this inspection we found the provider had acted on all of the recommendations and we saw where improvements had been made.

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, caring and well-led which contain those requirements.

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.

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 changed from requires improvement to good. 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 Oaklands – Care Home with Nursing Physical Disabilities on our website at www.cqc.org.uk.

Recommendations

We have made a recommendation that the recruitment processes used include all of the required checks of suitability to work with vulnerable people.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Oaklands - Care Home with Nursing Physical Disabilities (Oaklands) is a residential care home providing personal and nursing care for up to 30 adults. At the time of the inspection there were 29 people living at the home.

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

People were at risk of avoidable harm because the provider did not have systems in place to ensure risks were always assessed and managed well.

The environment was not of a reasonable standard in relation to cleanliness, infection control and accessibility. The provider had already identified this area needed to be improved and had appointed a cleaning contractor to deep clean the entire premises. We noted improvements had been made during the second day of our inspection.

We have made a recommendation about ensuring a good level of cleanliness throughout the home and improved storage space for large pieces of unused equipment.

People did not always receive person-centred care in a respectful way. We observed staff providing support which did not promote a dignified approach. However, some people were supported to maintain their independence by accessing the community and partaking in activities, such as attendance at college and meeting up with friends. This helped to empower the individual and to enable reasonable risk taking. Staff did not always ensure people’s care records were updated as their needs changed. For example, the current moving and handling equipment used for one person was not accurately reflected in the care records.

Staff told us staffing levels were low and records showed a high percentage of agency staff were being used. Staff recruitment was safe. The management team confirmed a recruitment drive had recently been conducted, which had filled the staff vacancies.

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 told us they felt supported and listened to. People had access to a wide range of external health care professionals. There were procedures in place to promote equality, diversity and human rights.

Some care records were detailed and well written. However, others were less informative and provided basic information only.

We have made a recommendation about care files being more detailed to show the support people prefer.

Training for staff and supervision had fallen behind during the pandemic. However, the registered manager assured us this had been scheduled to take place and any overdue training would be brought up to date.

We have made a recommendation about recording staff supervision and training more accurately.

We received positive feedback from visiting professionals who told us staff were responsive to people’s changing needs and good at asking for support. Some care plans contained good detail about people’s needs and preferences. Staff supported people to maintain a healthy balanced diet. People had a choice of meals. However, on the first day of our inspection the dining experience was not a positive one. The registered manager felt this was due to the staff team being nervous about the inspector observing.

We have made a recommendation about people’s privacy and dignity being promoted at all times.

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

This service was registered with us on 06/08/2019 and this is the first inspection.

The last rating for the service under the previous provider was outstanding, published on 08/11/2017.

Why we inspected

The inspection was conducted so that we could give a rating under the new provider. It was also prompted in part due to concerns received about a closed culture in the home, safeguarding incidents and complaints. A decision was made for us to inspect and examine those risks.

The provider did not always ensure good governance of the service. However, the provider made some improvements straight away to mitigate the immediate risks identified. We found evidence that the provider needs to make further improvements. Please see the key question sections of this full report.

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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.