Archived: Oak Cottage

Oak Cottage is a care home that provides personal care and accommodation for up to five children between the age of 13 to 17 or younger adults who may have a learning disability, autistic spectrum disorder or mental health needs. There were three children living at the home at the time of our inspection.

The service was a large domestic size home. There was little in the way of identifying the home was anything other than a domestic property. Staff did not wear anything that suggested they were care staff when coming and going with children. Children shared communal areas, but all had separate bedrooms, some with ensuite facilities.

The provider is also registered to provide personal care to people that use supported living. None of the people using the supported living were receiving personal care at the time of our inspection. CQC only inspects these services where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

The provider’s management of the service was reactive, and although there was evidence of some positive changes recently, these were mostly driven by the findings from another regulator that had inspected the service prior to our inspection. The provider needed to improve their systems of governance and self-audit so changes to the service are proactive and planned.

There were occasions where some staff had not adhered to boundaries identified to keep children safe.

Young people’s medicines were not always recorded accurately meaning it was not always possible to confirm if a young person had taken their medicines and the reasons for this.

Staffing levels reflected those needed to provide for young people’s safety although there had been a period where numerous agency staff were employed to maintain staff numbers. The provider was recruiting staff, in a safe way, to ensure their reliance on agency staff was reduced and better consistency of care maintained.

The provider’s process for admitting people to the service did need review and care did need to be taken to ensure a person’s admission was safe. In addition, the impact on other people who lived at the home and the anxiety moving to the home would present to a person needed consideration.

The home's environment did not present as that within a family home, as many items had been removed due to the risk of damage, although work was been taken to repair areas of damage as quickly as possible.

Staff understood safeguarding processes related to children and adults and knew how to raise concerns and who to. The provider had kept CQC informed of any allegations of abuse or incidents where younger people may be at risk.

Staff were knowledgeable about children and what may make them anxious, and how they should respond to reduce this anxiety.

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 (last report published 19/03/2019)

Why we inspected

The inspection was prompted in part due to concerns received about the safety and management of the service following inspection by another regulator.

We received concerns in relation to the safety of young people using the service. This had triggered an inspection by OFSTED, as the care home is also registered as a children’s home.

We reviewed the information we held about the service. Areas of concern identified related to safety and management. We therefore inspected to look at the domains safe and well led. 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 changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well led sections of this report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We have identified breaches in relation to some elements of the management of the service.

Please see the action we have told the provider to take at the end of this 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.

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Oak Cottage provides accommodation and personal care for up to five people with a learning disability or mental health needs. At the time of our inspection there were three young people (14-18 years) living there. People in care homes receive accommodation and nursing or personal care

as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service also supports an active transition plan from children's services to adult's services working closely with partners from Children and Families Services.

Oak Cottage also provides care and support to people living in ‘supported living’ settings (Rose House and Harmony House), so that young people can live as independently as possible. This support is provided from Oak Cottage staff. One of the supported living settings was attached to Oak Cottage and one of the settings in Wolverhampton. Oak Cottage is also registered to provide domiciliary care. It provides personal care to young people living in their own houses and flats in the community. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living. At the time of the inspection, no young person was receiving personal care in the supported living settings and no one was receiving the domicillary care service.

The service had a registered manager. 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’s experience of using this service:

¿ Young people were supported to develop and maintain their independence and have choice and control over their daily lives. Staff supported young people according to their individual preferences and needs. There was a drive to deliver person centred care which focused on getting the best outcomes possible for young people for example by supporting their recovery, building relationships and considering future plans such as college and activities.

¿ The outcomes for young people using the service reflected the provider’s values and included; promoting independence, choice and control over day to day routines where possible, inclusion, and involvement in the local community. People's support focused on them having as many opportunities as possible to gain new skills, develop skills for independent living, for example budgeting, and develop their independence.

¿ People were supported in the least restrictive way possible; the policies and systems in the service supported this practice.

¿ Staff told us they were well supported by management and their colleagues through supervision, appraisals and staff meetings. They commented on the availability of registered manager and other senior staff at Oak Cottage for support, advice and guidance at all times. Training covered a wide range of areas and was regularly refreshed. Staff were able to request additional training to meet people’s specific needs and many commented on how their development and career was supported through external courses.

¿ Where restrictions had been put in place to keep young people safe this had been done in line with the requirements of the legislation as laid out in the Mental Capacity Act (2005) and associated Deprivation of Liberty Safeguards. Any restrictive practices were related to the safety of the young person, discussed with health and social care professionals involved, clearly recorded and regularly reviewed to check they were still necessary and proportionate.

¿ Young people were at the centre of care planning and the decisions about how care was delivered. Although there were “house” rules and boundaries, we observed people were in charge of their own routines as far as possible and were able to request support when they needed it.

¿ Staff were thoughtful, kind and passionate about ensuring young people were well cared for and supported to reach their unique goals.

¿ The service was well-led. Staff told us they enjoyed working at the service. They were encouraged to develop their skills and contribute to the running of the service, many having additional responsibilities, for example training, care planning or safety checks. The staff team and management team were enthusiastic, passionate about the support they gave young people and keen to share their experiences with us. They had high expectations for young people and this was a shared vision.

At the last inspection the service was rated as Good (Report published October 2016)

Why we inspected: This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned based on the rating. If we receive any concerns we may bring our inspection forward.

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

Oak Cottage provides accommodation and personal care for up to five people with a learning disability or mental health needs. At the time of our inspection there were three people living there. The home had a registered manager. 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 who lived at the home told us they felt safe. People told us and we saw there were sufficient numbers of staff to meet people’s needs. Risks to people’s health and safety were well managed by staff. There was a system in place which ensured staff were recruited safely. People received their medicines on time.

People were supported by staff who had appropriate training to meet their needs. The registered manager had considered people’s capacity to make decisions for themselves. Staff understood the principles of the Mental Capacity Act. People told us they enjoyed the food at Oak Cottage and they got a choice of what they wanted to eat. People had access to outside health professionals when their health needs changed.

People told us they were supported by kind and considerate staff. Staff knew the care needs of people who lived at the home. People were involved in their care. Staff respected people’s privacy and dignity.

Staff understood people’s individual care needs. People’s likes, dislikes and preferences were taken into account by staff when they supported them with care. People had access to leisure activities of their choice. People told us they knew how to make a complaint. Systems were in place to monitor complaints.

There was a system in place to monitor the quality of care people received. People were involved in the development of the service. People told us they were happy living in the home. Staff felt supported by the registered manager.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who use the service, the staff supporting them and from looking at records. We spoke with two people, four members of staff and the deputy manager. We looked at two people's care records. There were four people staying at the service at the time of our inspection.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People we spoke with told us they felt safe staying at the service. Staff demonstrated that they knew how to safeguard people. However, we found that some risk assessments were missing for some activities.

No applications for the Deprivation of Liberty Safeguards (DoLS) had been submitted by the service, but staff showed good knowledge about how they should protect people's rights. Staff gave examples of the sorts of restrictions which may require a DoLS.

We found that the provider had adequate processes and systems in place to meet the requirements of the law in relation to keeping people safe.

Is the service effective?

We saw that people were involved in the review of their care plan. Staff listened to people and reacted to matters raised within reviews to support people's interests. However, we found that one person's review was out of date. Staff ensured people were consenting to the care they received.

Staff accurately reflected the needs of people and how they supported them to pursue interests in a safe way. We saw that staff considered the best way to support people through challenges they might face, while supporting people's rights.

Staff were supported by senior staff to ensure they remained effective in their role. Staff told us they could approach the management team with any issues they had. We found that some staff training was out of date, but the provider was addressing this.

Is the service caring?

We observed staff interacting with people and saw that these interactions were positive and caring. Staff demonstrated good rapport with people and people responded well to staff.

People were positive about staff members. One person told us staff were, 'OK' and 'Nice'.

We saw that staff supported people to access the community so that they could be involved in activities they enjoyed, such as watching football matches and day trips.

Is the service responsive?

We found that staff responded to people's choices and respected these. We saw that staff used communication in the way people preferred so that they could understand their choices.

We saw that the provider sought to manage risks to people's safety and wellbeing. People were referred to outside agencies as appropriate to assist with their health as required.

Is the service well-led?

The service was led by a registered manager. They were not present during our inspection and we were assisted by the deputy manager. We were told an additional deputy manager was being recruited to assist with the running of the home and with quality assurance processes.

We saw that a number of audits were carried out in order to assess the quality of the care provided, although there were sometimes gaps in these audits. Some audit sheets had not been correctly dated. This made it difficult to determine when some audits were carried out or that they had been fully carried out.

We found that systems were in place to ensure the safe handling of medicines for the people using the service.

We found that people's independence was promoted and people's cultural choices were respected. People received care which met their needs and promoted their wellbeing. One person told us, 'I'd give it 9 out of 10'.

We found that procedures and policy around medication were not always followed. We found discrepancies between what records told us and what medication people had received.

Staff were subject to robust checks and recruitment processes to ensure they were of suitable character to care for people. One person told us, 'They're great. They help me achieve success'.

The service had a clear complaints procedure which was accessible to people. People said they felt confident in reporting issues to staff and that they would be listened to.

We found that people were supported in making day to day decisions about the care they received. People's values and diversity were respected and promoted. A relative said staff, 'Welcome all people who come here'.

The care people received was reflected in their care plans. People experienced care which met their needs.

Incidents of potential harm were correctly reported. One person told us, 'Yes, I'm safe'.

We found that staff employment risk assessments and checks had not always been carried out. People told us they liked the staff and staff supported them.

The service had a number of audits to ensure the quality of the service. People's opinions on their care had been sought and actions taken to address issues.