Oaklands

Oaklands is a care home providing residential and nursing care for up to 15 adults with learning disabilities or other complex needs. At the time of the inspection there were 14 people living at the home.

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

The model of care and setting maximised people's choice, control and independence 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. Staff supported people to take part in activities and pursue their interests in their local area. People were supported to take their medicines safely and in line with best practice.

Staff supported people to access specialist health and social care in the community when required. The home was clean and tidy and infection control procedures were monitored. Risk assessments were in place which provided guidance and direction to staff. These were reviewed regularly and updated to ensure they accurately reflected people's needs.

Right care:

People received care which was person centred and were treated with dignity and respect. One healthcare professional said, “This is a very person-centred needs led service.” Staff were trained to protect people from abuse or poor care and would have no hesitation to report any concerns.

There were enough safely recruited and skilled staff to meet people’s needs and keep them safe. Staff were well supported. Staff received training to support them to care for people in the way they wished.

Right culture:

The provider was constantly improving the service to ensure staff had the values and attitudes to maximise people's lives. People and those important to them, including advocates, were involved in planning their care.

The service worked hard to instil a culture of care in which staff truly valued and promoted people’s individuality and protected their rights. We received a few negative comments regarding a senior staff member which the registered manager was made aware of to address. Communication had been identified as an area to continue to work on improving but the registered manager was aware of this.

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 requires improvement (published 13 January 2020).

Why we inspected

This inspection was prompted by a review of the information we held about this service and to ensure improvements had been made since our last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

The last inspection was prompted in part by notification of a specific incident involving the death of a person using the service. Following a review of the information submitted, no further regulatory activity was required by the CQC.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Oaklands on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The service is a large home, much bigger than most domestic style properties. It is registered to provide nursing care and support for up to 15 people with learning disabilities, mental health conditions or autism. There were 14 people living at the home at the time of the inspection.

The home continued to work towards 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 should 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

A number of recent adverse events had impacted upon the safety and smooth running of the home. Action was being taken to help ensure people were safe. Checks and systems were still being implemented, reviewed and monitored at the time of the inspection.

There had been changes in staffing which had affected the skill mix of the team. The provider increased staffing levels at the time of our inspection.

The design, signage and decoration did not always promote a homely environment. The home had previously been a hospital and maintained some hospital characteristics. Management staff were aware of this issue and plans were in place to address it.

Work was being undertaken to ensure 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.

People received a suitable diet which met their needs. Staff were knowledgeable about people’s preferences and risks relating to eating and drinking.

There were positive interactions between staff and people. Some staff were more confident than others when communicating with people.

People were supported to maintain their hobbies and interests both within and outside the home. Further work was being carried out to ensure that people were involved in meaningful activities and occupation to enable them to progress and achieve their full potential.

There had been a number of changes in management. Staff recognised the instability which management changes had upon the smooth running of the home. Staff spoke positively, however, about working at the home and the importance of remaining cheerful for the people who lived there.

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 requires improvement (published 4 July 2019). We identified two breaches of the regulations relating to safeguarding people from abuse and improper treatment and good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection action had been taken to improve and the provider was no longer in breach of regulations. However, further improvements were required in the safe, effective and well-led key questions.

Why we inspected

The inspection was prompted in part by notification of a specific incident. Following which a person using the service died. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of choking. This inspection examined those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and effective key questions of this full report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service is a large home, much bigger than most domestic style properties. It is registered for the accommodation and support of up to 15 people with learning disabilities, mental health conditions or autism. 15 people were using the service at the time of the inspection. This is larger than current best practice guidance.

The service continued to work towards 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 should 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

The service did not consistently apply 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 did not fully reflect the principles and values of Registering the Right Support.

People were not always protected from potential harm and care was not always person-centred, although people told us they felt safe. We were told of some potential inappropriate staff practice that needed to be investigated further. The local authority safeguarding team and the provider were looking into the issues raised.

People received their medicines as prescribed, but record keeping needed to be improved and monitored better. Quality assurance systems needed to be reviewed as they had not always found the issues we had.

The service was clean and tidy. There were enough staff on duty during the inspection, but we have made a recommendation to review staff rota systems to ensure the skills mix and allocation of staff to support people is always suitable.

The service was working in partnership with other organisations. People and staff spoke well of the registered manager. Meetings took place for people to express their views and actions were taken from comments made.

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 requires improvement (published on 4 October 2018). The service remains rated requires improvement.

Why we inspected

We received concerns in relation to the safety of people. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only.

We reviewed the information we held about the service. At the time, no other areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

We found evidence that the provider needs to make further improvements. Please see the safe and well-led sections of this full report.

Enforcement

We have identified two breaches in relation to safeguarding people from abuse and good governance. You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will continue to closely monitor information we receive about the service until we return to visit as per our re-inspection programme. We will work with the local authority to monitor progress. If we receive any concerning information we may inspect sooner.

Oaklands is a 'care home'. People in care homes receive accommodation and nursing or personal care as single packages under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

In 2016 the provider had applied to the Care Quality Commission (CQC) to register a further five beds at the service, making the total 20. This had not been agreed by the CQC as it was not in line with values that underpin the Registering the Right Support guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. Although the service had not been originally set up and designed under the Registering the Right Support guidance, they were continuing to develop their practice to meet this and used other best practice to support them.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good in the caring and effective domains, but the overall rating had deteriorated to Requires Improvement as there were some areas for further development.

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 2008 and associated Regulations about how the service is run. We were informed during the inspection that the registered manager was working their notice and due to leave in October 2018.

People received their medicines safely, although we have made a recommendation regarding the administration of medicines as we found some people routinely brought to the medicines room to be given their medicines to take with no record of this being agreed. This was not person centred. The registered manager was in the process of addressing this.

There were sufficient staff working at the service, although a number were agency staff and not permanent, which relatives had recognised and commented on as not being ideal. The registered manager was working hard to address this, but recruitment uptake had been slow due to the rural location of the service.

Risk assessments were carried out and promoted positive risk taking which enabled people to live their lives as they chose. We noted that records were not kept of checks made to ensure that staff were shown how to use the mini buses at the service and we have made a recommendation about this. We also asked the registered manager to consider risks in relation to a lift at the service and its isolated location which accessed unstaffed parts of the building.

People told us they felt safe living at the service and relatives confirmed their feelings were the same.

Bedrooms had been individualised in most cases, although we found not all. One bedroom was very sparse in items and in decoration due to the person's needs. However, when questioned, full consideration had not been given as to how this could still be individualised. This was being reviewed by the management team.

People were not always supported to have full choice and control of their lives although staff supported them in the least restrictive way possible; and the procedures in the service supported this practice; the renewal of people’s Deprivation of Liberty Safeguarding authorisations had been applied for but delayed due to external factors and was not due to any oversight by the provider.

Although people received choice in things they wanted to do, we found people who could not communicate verbally may not have always been given choice, for example, in the meals they wanted. We also found that a small number of bedrooms may not have been considered in the way they were decorated. In response to our concerns, this was being looked into by the registered manager.

A range of activities were in place for people to participate in within the service and outside in the local community. However, outcomes and aspirations for people were not consistently monitored, encouraged or met. Commissioners for the service confirmed this and we found examples ourselves, including self-medication or holidays wished for.

Staff had received suitable induction and ongoing training. The provider had also recently started to use reflective practice meetings with staff to support this. Staff supervisions were now recorded formally and yearly appraisals had been undertaken. The service conducted sufficient checks to ensure prospective staff were safe to work with vulnerable people. The service had recruitment procedures in place and conducted background checks of all potential staff. References were obtained and criminal background checks were recorded ensuring staff were suitable for their roles.

Where required, people were supported to access health professionals and staff ensured their health and well-being was monitored. People’s care needs were effectively communicated through a system of team meetings and handover meetings. Information was communicated in different formats to enable people to understand, including easy read.

People's nutritional needs were met and a variety of food and meals were available.

Staff were supportive in a kind and caring manner. Staff provided people with emotional support. Staff respected people and treated them with dignity, although we found an issue in the garden area which had been addressed by additional fencing being installed. People were encouraged to share their views both inside and outside of the organisation.

There was a complaints policy in place and we saw information displayed on how to make a complaint.

People or other relevant persons were involved in decisions about their care needs and the support they required to meet those needs. People had access to information about their care. Staff supported people to use various communication systems including FaceTime and Skype.

The service had links with the local community and these were being built upon.

During the inspection, we found several shortfalls in relation to person centred medicines administration, care records, the use of mini buses, the analysis of accidents and incidents, the suitability of the environment and supporting choice and involvement for people who were unable to communicate verbally. We were assured that the registered manager would address these issues.

We have made two recommendations in the report in connection with person centred administration of medicines and mini buses used by staff.