Oaklands

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

The service was not always effective and has been rated requires improvement. We found a breach of Regulation 17 relating to the safe management of medicines. Medicines were not always managed safely. Whilst Medicine records assured us people were receiving their oral medicines as prescribed, records did not always support the safe administration of medicines. For example, there was not a robust process in place to manage the application of topical medicines. Records for all topical medicines completed by care staff, including those that were medicated, were not robust and we found significant gaps in recording. For example, for one person who received cream for their PEG (Percutaneous endoscopic gastrostomy) site, for recurrent infections, records showed this was not consistently applied as per prescribed instructions placing this service user at unnecessary risk. Records reviewed demonstrated that medicated creams were being applied by care staff without the appropriate training and management staff confirmed this. Care plans were in place and the content in these care plans was person specific. However, further detail was required for some people using the service with complex conditions such as diabetes. We found no evidence that people had been harmed. However, systems were either not in place or robust enough to demonstrate medicines were always effectively managed. This was of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People received a safe service. The provider had systems in place to investigate accidents and incidents to ensure there were lessons learned to embed good practices. Safeguarding incidents were appropriately reported to the relevant agencies and investigations undertaken. Staff and the manager worked with other agencies to help keep people safe. There were effective systems in place to safely recruit staff. There were enough staff to care for people.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s care and support was planned, and assessments completed which considered the person’s physical and emotional wellbeing, communication and risks to their safety. People were supported by staff who understood their care and support needs. Risks in relation to people’s care and support were assessed. There was evidence of people and their representatives being involved in planning and reviewing care requirements.

Staff had a good understanding of incident and accident reporting and provided examples of the different types of incidents they would report on the Datix system (the provider’s electronic system for monitoring accidents and incidents). Staff knew how to access policies and procedures including the whistleblowing procedure and told us they had completed training on how to report serious concerns. The provider had appointed a freedom to speak up ambassador who took on the responsibility to support staff to raise concerns if necessary. The management team was open and honest throughout the inspection and showed a commitment in wanting to further improve the service.

The provider had processes for staff to report incidents and accidents which were then reviewed by management in a timely manner. There were systems in place to record and investigate complaints and duty of candour incidents. Lessons learned were shared with staff through monthly bulletins, at handover and staff meetings and through the governance process.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People were protected against the risks of potential abuse. Staff had the knowledge and confidence to identify safeguarding concerns and acted on these to keep people safe. Risks to people's safety had been assessed and plans were in place to minimise these risks. Relatives we spoke with felt their loved one received a safe service.

Staff knew where to access safeguarding policies and demonstrated good knowledge of how to report concerns. The home had a safeguarding display board which contained information on how to report safeguarding concerns as well as whistleblowing guidance for staff to access easily. This included contact information for the relevant local authority. Staff have access to an external whistleblowing phone line which can be used to report concerns. Staff we spoke with were aware of this service and knew how to use it.

The atmosphere at the service was welcoming, relaxed and friendly. People looked comfortable and at ease with the staff team. People engaged freely in conversations with the staff supporting them sharing jokes and laughing. The interactions from staff were respectful and considerate of people and their needs. We observed people asked for help and support from staff when they needed.

Staff had a good understanding of safeguarding and told us they received training in this area. Provider training compliance showed that over 90% of staff had completed safeguarding individuals at risk training. The provider confirmed that there had been no notifiable safety incidents that fell under the Duty of Candour regulation however management were able to explain how they would act in this situation if needed. The provider ensured appropriate decision specific mental capacity assessments were carried out in line with the Mental Capacity Act 2005 (MCA) and where best interest decision making was required, the relevant people were involved, and the least restrictive practices were considered. Applications were being submitted appropriately when DoLS authorisations were needed.

Relatives we spoke with felt their loved ones received a safe service. They said they were involved in making decisions about their relative’s care. This was done through meetings, phone calls and sometimes emails.

When people communicated their needs, feelings and sometimes distress staff managed this in a positive way. Person centred plans were in place to support staff with understanding people’s distress and how to support this. Where people may require restraint guidance was in place to ensure staff were only using this as a last resort and in a way that was safe and proportionate. The registered manager explained that every incident of restraint was reviewed and discussed during the multi-disciplinary meeting to ensure it was being used appropriately in line with guidance.

We observed the home was clean, tidy and kept free of clutter. This meant that people could move safely around the home. People’s rooms were personalised and organised to ensure a safe environment. We observed staff supporting people appropriately to take individual risks. For example, where people were at risk of choking we observed staff offering support during meal times in line with their care plan.

Risks to people’s personal safety had been assessed and plans were in place to minimise these risks. For example, where people were at risk of choking, care plans contained detailed information on how staff needed to support the person safely during mealtimes. There were plans in place to support people to safely leave the building in the event of a fire. Risk assessments were in place to support people with retaining their independence whilst staying safe. Care plans and handovers helped ensure risks were managed safely and staff were aware of any changes to care.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

There were enough staff to meet people’s needs and ensure they were supported safely and appropriately. One person told us staff were “kind” with their support during a recent incident.

Staff received regular training and supervision to support them in their roles. Staff told us they received training in core areas such as learning disability, autism, dealing with distressed behaviour, safeguarding, Mental Capacity Act, and food hygiene. One staff member said, “Yes, I have had specific training in LD and autism for my role.” There was a comprehensive induction programme in place for both new staff and agency staff. There were systems in place to monitor staff’s compliance with training and to identify when refresher training needed to be completed.

Staff were present and available during the inspection, and we observed people being provided with the right level of staffing which meant they did not have to wait for their care and support needs to be met.

Safe recruitment practices were followed to ensure people were supported by staff with the appropriate experience and character. Records showed appropriate checks had been completed prior to them commencing employment with the service. This included checks with the Disclosure and Barring Service (DBS). DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers ensure staff are suitable to care for people.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We were not able to speak with people about their experience of being involved with their medicines administration. Care plans were in place and the content in these care plans was person specific, however further detail was required for some residents. For example, we found for one person with diabetes, there was no signs/symptoms to look out for in relation to a diabetic episode or any guidance around blood glucose parameters and when to take action. This meant the person was at risk of not receiving the appropriate care and support relating to their diabetes.

Staff told us that they received training in how to safely administer medication. However, we found that staff were not always supporting people with their medicines in a safe way.

Medicines were not always managed safely. Whilst Medicine records assured us people were receiving their oral medicines as prescribed, records did not always support the safe administration of medicines. For example, there was not a robust process in place to manage the application of topical medicines. Records for all topical medicines completed by care staff, including those that were medicated, were not robust and we found significant gaps in recording. For example, for one person who received cream for their PEG (Percutaneous endoscopic gastrostomy) site, for recurrent infections, records showed this was not consistently applied as per prescribed instructions placing this service user at unnecessary risk. Records reviewed demonstrated that medicated creams were being applied by care staff without the appropriate training and management staff confirmed this. Care plans were in place and the content in these care plans was person specific. However, further detail was required for some people using the service with complex conditions such as diabetes. We found no evidence that people had been harmed. However, systems were either not in place or robust enough to demonstrate medicines were always effectively managed. This was of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014