The Oaklea Trust (Durham & Northumberland)

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

During our assessment of this key question, we found concerns around safeguarding and mental capacity. This resulted in breaches of regulation 11 and 13 of the Health and Social Care Act 2008 (Regulated Activities). Safeguarding concerns had not always been responded to fully to keep people as safe as possible. Staff had safeguarding training and knew how to recognise abuse. Staff had not always followed the requirements of the Mental Capacity Act 2005 (MCA). There was not always guidance for staff when people were being deprived of their liberty, for example if they needed constant supervision. Staff could not confidently tell us who had Deprivation of Liberty Safeguards in place (DoLS is the legal authorisation to deprive someone of their freedom) or if these had been applied for. You can find more details of our concerns in the evidence category findings below. Recruitment records needed to improve to ensure risk assessments were completed for staff who required these. Staff knew people well and supported them with risk management, however, because of the lack of clarity around MCA we could not be sure people always understood and agreed to how risks were managed. There were processes to respond to risk and learn from incidents. People and relatives told us that people felt safe at the service, they were happy and that they knew who to speak to if they had concerns.

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 and relatives felt that care packages met people’s needs. They told us they were involved in planning care and how care was delivered. Relatives told us when there had been accidents and incidents, they were informed and knew the actions being taken to learn from these and reduce future risks.

Staff told us they knew how to report incidents. Staff told us their suggestions about people’s care were listened to and acted on by management.

Staff worked with partners to learn from incidents and accidents.

There were processes to support a learning culture. Processes were in place to learn from accidents and incidents. The provider had completed surveys, held meetings to gather staff, partner and people’s views and acted on any suggestions made through these processes.

People and their relatives told us they felt care was safe and staff worked with other agencies, such as: GPs and specialist health services. However, systems to support people’s safety were not always effective.

The management team and staff told us they had good working relationships with other agencies which supported smooth transition and care pathways.

Partner agencies told us generally pathways and transitions worked well. We saw examples of positive joint working, proactive referrals and successful transitions. However, one partner raised with us that the providers systems had failed to alert them to safeguarding concerns. The provider had an action plan from a partner agency to improve MCA records.

Processes were in place to support safe systems and transitions, but they were not always effective. Systems did not fully explore people’s capacity and consent to ensure they were as independent as possible while protecting them from risk. Quality assurance systems to ensure safe care and smooth transition had not identified all the issues found at this assessment. We could not be assured that systems to identify and respond to safeguarding concerns were robust.

People and relatives told us they felt people were safe, and they knew who to speak to if they had concerns. A relative told us, “[Person] is definitely safe here, and I know he's happy.” However, we found that in some circumstances people had not been fully protected from the risk of harm when safety concerns had been raised.

The management team told us systems supported them to recognise and act on safeguarding allegations, however we found examples where allegations had not been acted on in-line with good practice and provider policy. On other occasions appropriate action had been taken. Staff had safeguarding and MCA training. One staff member told us, “We do MCA training, DoLS and safeguarding and we do them every year.” However, we found that staff did not always follow MCA principles and could not consistently tell us who needed support with which specific decisions. Staff supporting people did not know who in the service had or required DoLS, and what this meant in terms of supporting people. Staff told us they understood how to identify abuse and how to report safeguarding concerns. Staff told us they had confidence in the way safeguarding concerns were handled. One said, “If the situation arose the management team and my colleagues would act appropriately and always put the care and concerns of the customers as a priority.” Staff also accessed safeguarding training through the Local Authority, giving them knowledge of the Local Authorities expectations in terms of reporting safeguarding concerns.

We observed positive interactions between staff and people in all the houses we visited. Some improvement was needed in 2 of the houses because there were restrictions in place which had not been fully explored and reduced. For example, in one service people did not have free access to the washing machine even though they could do their laundry independently. We raised this with the registered manager, and it was immediately addressed. In another service people did not have access to the kettle. Risk assessments were in place, and this decision had been made to promote safety, but had not been made with consideration to people’s level of capacity in relation to this decision.

Safeguarding processes were in place, but we found these were not always effective. We found 2 examples where insufficient action had been taken to assure us that people had been kept safe from the risk of harm. Where people lack capacity to make decisions for themselves these need to be made in-line with the Mental Capacity Act 2005. Documentation relating to MCA was either not in place or not accessible to staff when delivering support. Staff had consulted others such as families and/or advocates to aid decision making, although we saw some examples of this, recording around decision making was not consistent. We found examples of possible restrictions that had not been agreed in-line with good practice. Processes did not ensure staff had relevant information about DoLS or DoLS applications.

People and relatives were involved in the design of the care package, how it was delivered and felt their suggestions were acted upon. However, because decisions about people capacity were not recorded, we could not always be assured that risk assessment explored all risks. Relatives told us they were involved in discussion about how risks were managed.

Staff and the registered managers told us they felt people were supported to manage risks. However, we could not be assured this was a consistent approach as we found some issues around MCA and safeguarding. Managers and staff told us they supported people to take positive risks. A registered manager told us, “We have a policy on positive risk taking for staff to refer to for help and guidance as we recognise that sometimes people may want to do something we feel is unwise, but they still have the right to do this.” Staff confirmed this is the approach they took. One staff member told us, “With positive risk taking, I try to use a positive approach, minimise the risks as best possible and try to help my service users make informed choices as well as they can.” Another staff member gave us examples of this, for example, “Supporting a customer to get a volunteering job and gradually lessened our support, supporting a customer to use public transport independently, supporting a customer to travel independently in a taxi to day service, supporting customer to use sharp utensils in the kitchen and supporting customers with their voting rights.”

We observed staff supporting people to understand and manage risks. We observed people being supported to take positive risks such as around cooking, looking after their homes and taking part in community activities. However, we also observed some risks had been reduced for people’s safety without full exploration whether this still allowed them to be as independent as possible.

Processes did not consistently support people and staff to manage risk. For example, where people were in relationships it was not documented how capacity had been explored to ensure they understood any risks involved. Policies supported positive risk taking and, in some cases, these were followed successfully to allow people new experiences and to live full lives.

People told us they liked their homes, and we observed they met their current needs. People and relatives did not express any concerns about the environment.

Staff told us they made checks on the environment to help keep people safe.

We observed environments were safe and well maintained.

Processes were in place to check the safety of the environment. Any concerns were reported to landlords. People were supported with this if they needed help. Processes were in place to reduce risk, for example in the event of a fire.

People and relatives told us they had confidence in staff and that there were enough trained, skilled staff. However, improvement was needed to recruitment practices to ensure any potential risks to people were considered. One relative told us, “I’m assured staff have the correct training, they definitely seem valued, and they appear to be supported well in their roles. They also seem really happy in their roles, which we like to see, which has really impressed us.” Relatives told us staffing hours had been reduced due to reassessment by funding agencies. Registered managers were working with all parties to ensure hours continued to meet people’s needs.

Staff told us they felt there were enough skilled and qualified staff to deliver safe care. One staff member told us, “Staffing is right and its safe and we can help people to have a quality of life doing what they want.” There was an established staff team who knew people well. Staff told us they had the support and training to do their jobs safely. One staff member told us, “Staff have been put through training needed to support our customers. Oaklea are very good at keeping up with training, when training is due to expire and offering extra training that they think may be beneficial.” Another staff member told us, “We don't have to wait for a supervision we can raise concerns with [team leader] at any time. We're well supported and have a good team here.”

We observed there were enough skilled and trained care staff. Staff knew people well and had a good rapport with them. People were assisted to go out into the community and take part in activities of their choosing.

Processes were in place around safe staffing and recruitment, but these were not always effectively followed. Some staff required risk assessments to be completed when they were appointed, we found these did not follow good practice or fully explore risks and how these would be reduced. Processes were in place to support staff and ensure they had the correct training. There were high levels of training compliance overall. However, training records did not reflect all clinical training and updates, such as for catheter training. Staff confirmed they had this training, but this was not monitored on central training records. Improvement was required to evidence staff remained competent with clinical tasks.

People were supported to keep their homes clean and tidy. One person told us, “They [staff] help me to clean my room.” No one expressed any concern about infection prevention and control.

Staff told us they enabled people to keep their own homes clean and tidy.

We observed that people could keep their homes as they wanted but were encouraged to follow good infection prevention and control practices.

Processes supported good infection prevention and control.

People and relatives told us they felt people received their medicines safely.

Staff told us they had completed medicines training and had been recently assessed to ensure they remained competent.

We observed medicines being given safely. However, we also observed some medicines practices that could be improved or could be more person centred.

Medicines were managed safely. We previously made a recommendation about medicines, and this had been met. Improvement had been made to the way medicines were signed for and stock monitored. However, some further improvements were needed in the records for medicines. For some people guidance to support staff to safely give ‘when required’ medicines were not available. Handwritten entries on Medicines Administration Records were not always double signed, it is good practice to ensure 2 staff check medicines are written down correctly. We found medicines practices were not always person centred. Everyone’s medicines were stored centrally rather than in their own rooms. Comprehensive policies and procedures were in place to support the administration of medicines. Medicines were stored securely.