Archived: Oaklands - Care Home with Nursing Physical Disabilities

Oaklands is a Leonard Cheshire Foundation home providing care and support for adults with physical disabilities. The home is an adapted property situated in extensive grounds on the outskirts of Garstang. It is registered to accommodate a maximum of 30 persons needing nursing or personal care. The home provides short to long term care. At the last comprehensive inspection on 22 April 2015 the service was rated overall as good.

At this inspection we found the service had improved and was outstanding overall.

At this inspection visit there 30 people lived at Oaklands.

There was a registered manager registered with CQC. However the registered manager had been promoted with the company and was cancelling their registration. The deputy manager had become the new manager of Oaklands and was applying to become registered with CQC. 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 2008 and associated Regulations about how the service is run.

People we spoke with said staff were kind and caring and they felt safe and well supported. One person said, “The staff are marvellous.” Another person told us, “The care is very good in fact just fantastic. The staff are all extremely kind.”

Staff were exceptional in the way they respected people’s family and personal relationships and encouraged and supported contact with families and friends. We saw people were supported to attend important events in their lives.

The manager told us, “The staff care not because they are paid to care but because they really do care.” They told us staff visited people in hospital, particularly those with limited family contact. They made sure the person was clean and comfortable made sure they had drinks, snacks and toiletries and things to do and knew they were not forgotten.

Staffing was sufficient to meet people’s care needs and provide activities. Staff were recruited safely and had the skills, knowledge and experience to provide safe and effective support. We saw staff interacted with people in ways that showed their well-being and happiness mattered to them. They helped them to live meaningful lives and be as independent and active as was possible for them.

There were frequent and varied social and leisure activities and opportunities for socialising. Staff made huge efforts to meet people's wishes and aspirations. Staff supported people's individual interests and were innovative in how they helped them meet these. They supported people on more unusual activities such as a sky diving experience, co-piloting a small plane and going to the Northern Lights. These improved the well-being of the individuals and gave other people ideas of what they could do. One person said, "I like fishing and I go out fishing with staff who also like fishing. We sit and chat while we fish or just relax.” Another person said, “I play wheelchair tennis, I go to the gym, trampolining and bowling. I enjoy sport and it keeps me fit and active.”

We found examples of exceptional end of life care. Staff were exceptionally compassionate and proactive in meeting people’s wishes. People’s end of life wishes were recorded so staff were aware of and went out of their way to meet and exceed these. Staff supported people to spend time with loved ones and spend special moments with them.

There were procedures in place to protect people from abuse and unsafe care. Staff were familiar with these and had received training in safeguarding adults. We saw risk assessments were in place which provided guidance for staff. These measures minimised risks to people. Care plans were personalised detailing how people wished to be supported. They were fully involved in planning their care and their consent and agreement were sought before providing care.

People who received support or where appropriate their representatives were involved in planning and making decisions about their care. Their consent and agreement to provide care were sought. Where people were unable to make their own decisions independent advocates were available. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

Staff managed medicines safely. Medicines were stored securely, administered as prescribed and disposed of appropriately.

Oaklands was clean and hygienic and met the needs of people who lived there. Staff used protective clothing such as disposable aprons and gloves. They also washed their hands before caring for each person to reduce the risk of passing germs from one person to another. Equipment was maintained and the environment regularly checked for safety.

People told us they were pleased with the variety and choice of meals available to them. Staff knew people’s food likes, dislikes and any allergies people had. The food was well presented and people said they enjoyed it. One person told us, “Most of the time the food is very good but occasionally it is just good.” Staff assisted people chatting with them as they helped them with their meal, making meals a pleasant and social experience.

The training staff received assisted them in providing effective, caring support to people. They received regular support and supervision from senior staff to help them develop additional skills. Staff were pleased to work for the service and felt they worked well as a team. They felt listened to and well supported through supervision and training.

People knew how to raise a concern or to make a complaint and were encouraged to raise any concerns they had. They said any concerns were listened to and acted on. People told us they were encouraged to voice their views and opinions about the service provided. They told us the manager and staff team were approachable and supportive and listened to their views.

Systems were in place to effectively govern, assess and monitor the quality of the service and the staff.

We considered our inspection findings to answer questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found -

Is the service safe?

People we spoke with told us they felt safe living at Oaklands and felt able to raise any concerns with staff or the manager. Nobody we spoke to who lived at Oaklands told us they had ever witnessed a potential safeguarding incident or ever felt uncomfortable with the actions or attitude of the staff that provided support for them.

There had been recent safeguarding issues at Oaklands that had been reported to the Care Quality Commission by the home in line with their own safeguarding policy. However due to staffing issues, particularly with regard to nursing staff, the home were unable to follow their own suspension policy due to not being able to staff the service safely. A risk assessment had been carried out by senior management within the organisation before this decision was made and steps had been taken to ensure that people who lived at the service were safe. However the fact that the suspension policy could not be followed highlighted that suitable arrangements were not in place to ensure there was sufficient numbers of suitably qualified staff.

Is the service effective?

The staff we spoke with all felt they were well supported in their role. One member of staff we spoke with told us, 'Support is very good from both the management team and peers'. Another staff member told us, 'If you are unsure about anything you can ask one of the nurses or Linda (Manager)'. The manager for the service told us they were well supported by the area manager for Leonard Cheshire.

Is the service caring?

We spoke with five people who lived at the home during our inspection. Not all the people we spoke with were able to communicate using words but they were able to tell us they were content with the support they received by using gestures to indicate they were happy. One person who lived at the home told us, "I like it here, it's always been alright. There have been ups and downs now and again but what household doesn't have them. Management and staff come and go, I come and go as I please. I don't impinge on the other people in the house and they don't with me. One thing I can say is that you always have a choice here".

Is the service responsive?

Care plans were easy to follow and it was evident that regular reviews of people's needs were carried out. Risk assessments were in place covering areas such as manual handling, falls and nutrition. Evidence was in place showing that regular reviews of all risk assessments were carried out. At the time of our last inspection the home had begun to introduce a new person centred planning format. This exercise was now complete and it was evident from looking at care and support plans and speaking to staff that the 'new' care plans were a big improvement from the previous ones in place.

Is the service well-led?

A 'service managers monthly report' was returned to Leonard Cheshire head office. This covered issues such as occupancy, accounts issues, staff vacancies, sickness, safeguarding issues, complaints and fundraising.

One person we spoke with had chosen to self-administer their own medicines. They confirmed that they had everything they needed and that they had good support from the nurses.

Medicines were regularly audited. We saw that should any errors occur, these were promptly and appropriately addressed by the manager.

People we spoke with confirmed that creams were applied as needed but records confirming the application of creams were not consistently completed.

Not all the people we spoke to living at Oaklands were able to use words to tell us if they were happy with the way the service was run, but they were able to indicate through smiles and gestures that they were content with the service they received and the way they were supported..

People told us that they thought that their care and support was safe and that at times they perceived that staffing was poor but this had not had an impact upon the care and support they received

We saw that people's health care needs were supported by staff who were caring. However some people told us they were disappointed that their names had been used in an anonymous letter sent to theCommission without their permission. They said their confidentiality and rights had been breached and the letter was inaccurate. The people we spoke to did not have concerns about their care.

We found non-compliance in the outcomes for management of medicines, supporting staff and record keeping.

One person living at Oaklands told us the importance of maintaining their independence was essential to them. They told us they were able to choose their own routines and lifestyles and these decisions were respected by staff. They said that staff supported them were quick to respond to their requests for assistance. They said, 'All I need to do is press the call and they are here within one to five minutes'.

We saw that people's health care needs were supported by staff who they said 'friendly', 'lovable like a great big family', 'know their limitations' and 'great fun to have around'. Staff told us they were well trained and supported. We saw they were respectful of the needs of people living at the home.

People told us that the environment was comfortable and going through a major refurbishment. They said they were able to choose the d'cor of their bedrooms. One person told us,' The thing I like about Leonard Cheshire is that you are involved in everything. They are doing all this work and I as well as other residents have been asked what we want. They don't do things on the cheap either'.