Oakwood

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.

Oakwood is a small residential care home providing accommodation and personal care to a maximum of seven adults with a learning disability and autism. Oakwood is a purpose-built building with three flats and four bedrooms. At the time of our inspection there were five people living in the home.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

Staff supported people to manage their medicines safely. There were enough staff available to support people safely. Staff were recruited safely. Risks to people were identified and guidance was in place for staff to reduce the level of risk to people.

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.

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.

Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their needs. Staff received one to one supervision and told us they felt supported.

Support plans were detailed and reviewed regularly. People’s healthcare needs were identified and met. Staff worked with a range of healthcare professionals and followed professional advice and guidance when needed.

People were supported by caring staff who worked towards promoting their dignity, privacy and independence.

There were systems to ensure care was responsive. Relatives felt their concerns and complaints would be listened to and responded to. People had plans relating to end of life care decisions.

The feedback on the leadership of the service and the registered manager from relatives and staff was positive.

There were effective governance systems in place to monitor the quality of service and the health, safety of welfare of people.

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 May 2017).

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 re-inspection programme. If any concerning information is received, we may inspect sooner.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission 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 and associated Regulations about how the service is run. The registered manager assisted us during our inspection.

At our last inspection in February 2016 we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take action in relation to ensure they followed the requirements in relation to consent and good governance. Following the inspection the provider submitted an action plan to us to tell us how they planned to address these concerns. We carried out this inspection to check if the provider had made the changes required. We found that improvements had been made in all areas and the regulations were now being met.

People lived in an environment that had been personalised for them and they were cared for by staff who knew them well. People were provided with respect, dignity and person-centred care. Staff supported people to eat a good range of foods and those with a specific dietary requirement had their needs met.

Staff ensured when people required it external health care professional involvement was sought. People received the medicines they required and staff followed good medicine management processes. There was a sufficient number of staff present to help ensure people received the care and support they required, both within the home and when going out to activities.

Activities for people were personalised and individualised and staff encouraged people to be independent and make decisions for themselves whenever possible. People’s care plans were person-centred and people were encouraged in developing them.

Staff were following the legal requirements to make sure that any decisions made or restrictions to people were taken in the person’s best interests. People were supported to give their views in relation to the care they received.

Staff received a range of training and told us they had regular supervision with their line manager. Staff met regularly to discuss all aspects of the home and they told us they felt listened to by the registered manager. There was guidance in place for staff on how to evacuate people in the event of an emergency.

Accidents/incidents were recorded and reviewed by the registered manager and the provider’s services manager. Actions were taken when appropriate to help ensure that accidents/incidents did not reoccur. Where people were at risk of harm, risk assessments had been drawn up to help ensure people were protected from these risks. Staff knew what action to take in respond to any suspected safeguarding concerns and the provider had carried out appropriate checks to help ensure only suitable staff worked in the home.

Quality assurance audits were carried out to help ensure the care provided was of a standard people should expect. A complaints procedure was available for any concerns.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission 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 and associated Regulations about how the service is run. The registered manager was not present during our inspection and we were assisted by the Trust service manager and other staff.

Quality assurance procedures were in place and audits were undertaken by both the staff and the provider. However, not all feedback received by staff was acted on promptly. For example, the personalisation of people’s rooms.

Staff understood the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) to ensure decisions were made for people in the least restrictive way. However where there were restrictions in place staff had not always followed legal requirements to make sure this was done in the person’s best interests. We found that mental capacity assessments had not always been carried out for people for specific decisions.

Although staff worked in a confident and independent way they were not always provided with training specific to the needs of people. For example, training in autism.

We saw staff had good relationships with people. It was evident staff knew people well and were knowledgeable in relation to their individual likes and dislikes. When people wished time on their own staff respected this. For example, when someone spent time in the sensory room.

People were safe living at Oakwood as staff carried out appropriate checks to make sure that any risks of harm were identified and managed. For example, when someone needed equipment to assist them with walking.

Staff knew how to safeguard people from abuse. They were able to tell us what they would do in such an event. We saw information for people around safeguarding displayed in a way they could access. In the event of an emergency and people needed to be evacuated from the home staff had guidance to follow. People would be moved to another of the Trust homes should the home need to be evacuated. Staff were up to date with fire training and carried out fire drills.

There were enough staff deployed in the home. Where people required two to one, or one to one care we saw this happen. We did not see anyone having to wait to be assisted by staff and there were always enough staff on hand to support people when they needed it.

People received their medicines in a safe way. People were involved in choosing the food they ate and some were encouraged to be independent by doing their own cooking. People had access to information on how to make a complaint should they wish to.

Appropriate checks were carried out to help ensure only suitable staff worked in the home. Staff were involved in running the home as they had the opportunity to meet together to discuss all aspects of the home. Staff met regularly with their line manager to discuss their individual work.

Professional involvement was sought by staff when appropriate in order to maintain good health for people. Activities were planned in an individualised, meaningful way for people. Activities took place both inside and outside of the home.

During the inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.