Oakwood

Updated 29 July 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 2 inspectors, 1 medicines inspector and an Expert by Experience who spoke with relatives via telephone. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Oakwood is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Oakwood is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post although they were not present during our inspection.

Notice of inspection

The first day of our inspection was unannounced. We gave the service a short notice period of our subsequent days of inspection to enable people living at Oakwood to be made aware of our visit. We visited Oakwood on 24 and 27 March and 4 April 2023. We visited the providers head office on 24 April 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We observed people and their interaction with staff and each other throughout the inspection visits. We spoke with 5 relatives and 3 health and social care professionals to gain their views. We also spoke with 14 members of staff including 10 care staff, deputy manager, interim manager, head of specialist care and the director and associate director of services for people with learning disabilities. We viewed a range of records held within the service, this included 5 care plans and multiple medicines records. We looked at 4 staff files in relation to recruitment. A variety of records relating to the management and oversight of the service, including staff training records, risk assessments, policies and procedures were reviewed. After the inspection we continued to receive information relating to quality assurance audits, policies and procedures. We sought clarification on staffing, staff training and competencies.

Updated 29 July 2023

About the service

Oakwood is a residential care home providing personal and nursing care to up to 7 people. The service provides support to people with a learning disability and autism in a one-story purpose built home. At the time of our inspection there were 7 people using 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 Support:

People were not always supported to identify and work towards achieving their goals and aspirations. Staff did not always support people in a person-centred way and people were not always offered the opportunity to go out or to do the things they enjoyed. The service had a clinical rather than a homely atmosphere. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Consistent guidance in how to support people during times of distress was not always available to staff. This meant there were occasions where staff used restraint techniques which had not been recommended. Post-incident reviews were not routinely held where people had experienced being restrained. Medicines were not always managed safely and people’s health in relation to their medicines was not routinely monitored as required.

Staff were receiving additional safeguarding training to ensure they were aware of their responsibilities to people. There was good standard of hygiene and staff were seen to be following infection prevention and control guidance.

Right Care:

Robust assessments were not always completed prior to people moving into Oakwood to ensure their needs could be met and were compatible with others. People’s health needs were not always monitored which had led to delays in health referrals being made for some people. People were not supported to develop their independence and were not routinely involved in care planning and decisions such as planning what they wished to do and what/where they would like to eat.

In some areas we found people had been supported well with their healthcare needs and professionals told us this had led to an improvement in their health.

Right Culture:

Staff did not see people as their equal and outdated language such as referring to people as ‘patients’ was frequently used. Not all staff knew people well which meant they were unable to respond to people’s needs and communication appropriately. Staff training was not effectively monitored and not all staff were able to demonstrate training and understanding of supporting people with a learning disability and autism. Managers and staff were not aware of the ‘Right support, right care, right culture’ guidance and how this should influence the support people received.

There was a lack of management oversight which had led to concerns not being identified and acted upon. Some staff told us there had been a negative culture at the service for some time, with the service being run to meet the needs of some staff members rather than the needs of the people living at Oakwood. Audits and reviews were not effective in identifying shortfalls in the care and support people received. There was a lack of forward planning and the management team had not demonstrated a drive to meet high standards and ensure continuous development.

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

Rating at last inspection

The last rating for this service was good (published 10 January 2020).

Why we inspected

The inspection was prompted in part due to concerns received from the provider, relatives and professionals about people being at risk of abuse. A decision was made for us to inspect and examine those risks. The provider informed us they had informed relevant authorities about the concerns. A number of regular staff were not working at the service at the time of our inspection to ensure investigations could be fully and fairly completed.

We found no evidence that people were at risk of abuse at the time of our inspection. However, breaches of regulations in other areas were identified.

The overall rating for the service has changed from good to inadequate based on the findings of this inspection. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to the way risks to people’s safety were managed, medicines management, person-centred care, consent to care, management oversight and governance at this inspection. We issued warning notices against the provider in relation to these concerns.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.