The Oaks

We found the following examples of good practice.

The provider had clear records of cleaning including four hourly sanitising of all frequent touch areas.

Staff absence was covered by either colleagues or bank staff who had limited where they would work to minimise working across different services. Should there be a need for staff to work in more than one of the providers services a risk assessment was completed to minimise potential concerns.

Staff had been trained in infection prevention and control, IPC, and understood why they were taking the actions required to protect people.

There were clear entry procedures for visitors and staff told us they had refused admission to people who had not provided a clear lateral flow device test, LFD, and who had subsequently refused to take one. We saw records of temperatures taken and were asked about vaccines and our current health.

Emergency access to the service by people who had no LFD test or who were unvaccinated was permitted depending on completion of a risk assessment however this process had not been used. For example, a paramedic attending an emergency could access the service without having received a vaccination as the benefit to a person in a health emergency outweighed the risk of the access.

The provider had risk assessed as aspects of COVID-19 including specific risk assessments for people and staff from a clack and minority ethnic background, BAME. The BAME risk assessments identified some tasks, such as aerosol generating tasks in infected people that people of BAME origin should avoid.

People were supported to access the community and day service. Staff supported them to complete an LFD test before leaving the service and after their trip.

The premises were cleaned as well as was possible however there was a need for some areas such as carpets and hard floors to be deep cleaned. There were also maintenance concerns such as damaged wood finishes and unsealed flooring that made maintaining a very hygienic environment difficult, however we saw no impact as people had not ever tested positive for COVID-19 at the Oaks.

We were assured that this service met good infection prevention and control guidelines as a designated care setting

People’s experience of using this service:

A registered manager was not in post. However, the manager had submitted an application to the Care Quality Commission and this was in progress.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice 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. The outcomes for people using the service reflected the principles and values and people were encouraged to be independent within their home. Staff understood people's individual communication needs and worked in proactive ways to provide person-centred support.

People were supported to have choice and control over their lives and staff demonstrated an understanding and awareness of mental capacity and best interests’ decisions. However, the records did not fully support this and the manager had plans in place to address this.

The environment although accessible did not always meet the needs of people living at The Oaks. There were delays to the completion of required maintenance and there were outstanding actions that when completed would enhance the environment.

Staff were caring. Everyone we spoke with was very complimentary about the service and said they would recommend the home. There was a strongly embedded culture within the service of treating people with dignity, respect, compassion, warmth and kindness.

Accidents and incidents analysis was not always shared. We have made a recommendation that the provider improve the recording of shared learning of accidents and incidents.

Most of the care plans were up-to-date, person centred and goal orientated with a focus on achieving outcomes. However, care plans and risk assessments relating specifically to manual handling on the electronic system did not contain sufficient detail to enable staff to carry out the support safely.

Activities were available to keep people occupied both on a group and individual basis. Activities were organised in line with people's preferences.

A system was in place to ensure medicines were managed in a safe way for people. Staff were trained and supported to ensure they were competent to administer medicines.

People received support with meals and drinks.

Staff knew how to access relevant healthcare professionals if their input was required. The service worked in partnership with other organisations and healthcare professionals to improve people's outcomes.

Staff were recruited safely and there were sufficient numbers of staff deployed to keep people safe and to meet their care needs. Staff were received appropriate training which was relevant to their role. Staff were supported by the manager and were receiving formal supervision where they could discuss their on-going development needs.

Individual needs were assessed and met through the development of detailed personalised care plans, which considered people's equality and diversity needs and preferences. Care plans were up to date and most detailed the care and support people wanted and needed. Risk assessments were in place and showed what action had been taken to mitigate any risks which had been identified. Appropriate referrals were being made to healthcare professionals when necessary.

There was a complaints procedure available which enabled people to raise any concerns or complaints about the care or support they received. Systems were in place to ensure complaints were encouraged, explored and responded to.

Staff meetings were held regularly and covered relevant topics. However, there was no evidence that actions from meetings were reviewed and actioned.

The manager provided staff with leadership and was very approachable. Audits and checks were carried out and used to drive continuous improvements to the service people received.

Rating at last inspection: Good (report published 9 December 2016).

Why we inspected: This was a scheduled inspection and was planned based on the previous rating.

Follow up: We will continue to monitor the service and plan to inspect it in line with our re-inspection schedule. If we receive any information of concern we may bring out inspection forward.

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

The Oaks provides care and accommodation for up to eight people. On the day of the inspection eight people were living in the home. The service provides care for people with learning and or a physical disability.

At the time of our inspection there was 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 were able to do things they enjoyed and keep in touch with those people who were important to them. Risks to people's safety were understood by staff and people benefited from receiving care which took into account their safety needs.

Staff understood what actions to take if they had any concerns for people's wellbeing or safety. People were supported to take their medicines so they would remain well and there were enough staff to meet people's care and safety needs.

The provider acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

Staff worked with other organisations and relatives so that people's right to make decisions and their freedom was protected. Some people enjoyed making their own meals and drinks, other people received help from staff to enjoy a range of food and drinks.

Staff assisted people to attend specialist health appointments and followed the advice given by specialist health services so people would receive the care they needed as their health needs changed.

People enjoyed spending time with the registered manager and staff and people were given encouragement and reassurance when they needed it. People's need for independence and privacy was understood and acted upon by staff. People were encouraged by staff to make their own choices about what daily care they wanted.

Where concerns had been raised these were dealt with in a timely manner.

Regular checks were undertaken on the quality of the care provided by the provider and the registered manager.

We used this inspection to answer our five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service and the staff told us.

Is the service safe?

None of the people we spoke with had any concerns about the support they received.

We saw care and treatment was planned and delivered in a way that ensured people's safety and welfare. All of the care plans we looked at had risk assessments in place to help minimise any risk that had been identified.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Care plan files contained information regarding to consent to care and treatment. We saw information was in place regarding people's capacity to consent and the needs for capacity assessments and best interest meetings to be carried out where necessary.

There were arrangements in place to deal with foreseeable emergencies. We saw the service had an agreement with another home operated by Dolphin Homes Limited which was nearby. This would provide initial temporary accommodation if people could not return to the home after an evacuation

Is the service effective?

Each person had a plan of care and support. We saw support plans explained what the person could do for themselves and what support they needed from staff. Staff told us the care and support plans gave them the information they needed to provide the level of support people required.

We observed staff supporting people. Care staff we spoke with were aware of people's needs and preferences. They knew how people wanted their care to be delivered. We saw they offered advice and support but they enabled people to make their own choices and decisions.

Is the service caring?

We observed staff speaking to people appropriately and they used people's preferred form of address. We saw people and staff got on well together.

We observed staff consulted people as much as possible when supporting them. Staff spoke to people clearly and explained to people what they were doing. We saw people were happy with the support they received and people we spoke with confirmed this.

Is the service responsive?

We saw people had regular reviews of the care and support they received. We saw review notes showed alterations had been made to people's plans of care as people's needs had changed.

We saw people were able to participate in a range of activities both in the home and in the local community. Staff told us they encouraged and supported people to participate in activities to promote and maintain their well-being.

People who used the service were asked for their views about how the home was meeting people's needs and any concerns or ways to improve the service were acted on. .

Is the service well led?

The Oaks had a policy and procedure for quality assurance. The provider organisation employed a Quality Manager who ensured annual audits on the quality of the service provided was carried out. The provider organisation also employed an area manager who carried out regular visits to the service.

Regular staff meetings took place and minutes of these meetings were kept. Staff we spoke with confirmed this and said the staff meetings enabled them to discuss issues openly with the manager and the rest of the staff team.

Meetings with people who used the service also took place weekly and these were used to discuss any issues in the home and also to plan activities and menu's for the following week.

The manager told us that all staff received supervision every six to eight weeks where staff performance issues were discussed and additional staff training was identified as necessary. The manager also told us staff received annual appraisals. Staff we spoke with confirmed this.

We found that all people had a plan of care that gave staff the information they needed to support people effectively. Care plans we saw contained information regarding people's preferences for the care and support they received.

People were able to show us how they made choices and we saw that people had a care plan regarding choice and consent. The plans contained information on how people made choices and gave their consent to the care and treatment they received.

We observed and people told us they were well cared for and that they got on well with all the staff. There was a friendly atmosphere in the home throughout our visit.

We spoke with the registered manager, a senior support worker and three members of staff. They said that they enjoyed working at the home and that everyone worked well as a team.

Staff said they were well supported and that they were provided with the training and information they needed to support people effectively. They told us that management were supportive and approachable.

We saw that The Oaks had an effective system to regularly assess and monitor the quality of service that people receive.

During our visit we spoke with the four members of staff on duty and the registered manager.

We looked at four care plans and medical files.

People using the service were protected from abuse as they were supported by a staff team who had received appropriate training on safeguarding adults. People told us if they had any concerns they would report them to the manager.

On the day of our visit we saw that there were enough staff working in the home to support people when they needed it.

Records showed that staff received ongoing training and supervision which provided them with the skills and knowledge to meet the needs of the people they were supporting.