Oakdene

Oakdene is residential care home providing personal care for up to 40 adults living with enduring mental health needs. This may include people who are subject to specified provisions of the Mental Health Act in order to live at the service; and people who may abuse drugs and alcohol. At this inspection, there were 39 adults receiving care at the service. This included 3 female adults.

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

People’s individual choice and control was not fully promoted in relation to communal living arrangements, or to maximise opportunities for people’s mental health support and life goal planning.

Improvements were made and ongoing to ensure people’s care plans were individualised; to inform their care needs, preferred daily routines and lifestyle interests. People were mostly happy with their care and daily living arrangements and knew how to make a complaint or raise a concern if they needed to.

The provider was meeting the accessible information standard for people. The service is not a primary care provider for end of life care. Systems were in place to enable people’s related support, wishes and decision making.

Arrangements for the prevention and control of infection helped to protect people from the risk of an acquired health infection. Safeguarding, staffing, medicines and risk management arrangements helped to protect them from the risk of harm or abuse. The provider acted to ensure people’s safety when things went wrong at the service and to prevent any reoccurrence.

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 effective care from staff who were trained and supported to ensure this. Staff supported people to maintain and improve their health and nutrition through timely consultation and information sharing with relevant external health and social care professionals, when needed.

People were happy with their environment, which was kept clean, generally well maintained and equipped. Improvements were assured from people’s expressed views in relation to lighting levels and wifi access.

People received care from staff who treated them with respect and ensured their dignity and rights. People were supported to express their views and involved in making decisions about their care.

Improvement was made to ensure effective monitoring of the quality and safety of people’s care. Management and staff understood their role and responsibilities for people’s care. Operational management arrangements were sufficient to ensure effective communication, partnership working and information handling for people’s care.

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

Rating at last inspection and update

The last rating for this service was Requires Improvement (published September 2018) with one breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made. The provider was therefore no longer in breach of regulation.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Oakdene provides personal care and accommodation for up to 40 people living with mental health needs. At the time of our inspection 38 people were using the service.

At the last inspection in September 2016, the service was rated ‘Good’ in all the key questions. At this inspection, we found the fundamental care standards were not being fully met, resulting in the rating for the service changing to ‘Requires Improvement.’

At the time of our inspection there was a registered manager in place but they were unavailable on the day of the inspection due to being on leave. A registered manager is a person who has been registered with the Care Quality Commission (CQC) to manage the service. Like registered providers they are “registered persons”. Registered persons have the legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated regulations about how the service is run.

Risks associated with people’s needs had not always been effectively assessed, planned for or monitored. Information to guide staff of how to manage risks lacked detail or was not consistently followed.

Some shortfalls were identified in the management of medicines, this was in relation to medicines prescribed to be used ‘as and when required’. Staff were not consistently provided with guidance of the administration of these medicines. Body maps were not routinely used to instruct staff where prescribed creams should be applied and two staff signatures were not used for transcribing hand written entries.

Infection control and cleanliness of the service had been improved. This included new systems for monitoring how infection control measures were met. However, further time was required for these to be fully imbedded and improvements to be sustained.

People were protected from the risk of abuse as far as possible because staff had received safeguarding training and followed the provider’s safeguarding policies and procedures to safeguard people. Staffing levels and skill mix were sufficient at the time of this inspection. The provider had a dependency tool used to review staffing level requirements, staff covered any shortfalls and new staff were being appointed to fill vacancies.

Staff received an induction and ongoing training opportunities to formally review their work, training and development needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the provider’s policies and systems in the service supported this practice. Where people lacked mental capacity to consent to their care and treatment, assessments to ensure decisions were made in their best interest had been completed. The provider was making further improvements to support staff by implementing new documentation to support the assessment of people’s capacity.

People received a choice of meals and their nutritional care needs were known, understood and followed by staff. The staff team worked well with external healthcare professionals when required in meeting people’s health needs. The internal and external environment met people’s individual needs. There was a well maintained and secure garden with a smoking shelter.

Staff were aware of people’s needs, routines and what was important to them. Staff were kind, caring, and they supported people ensuring their privacy, dignity and respect was met. Independence was encouraged and supported. Information about independent advocacy services was available.

People’s care plans were not consistently detailed. Staff were aware of people’s needs but there was a risk new staff, would not have sufficient written information to provide responsive and effective care and support. People’s diverse needs had been assessed and were met, this ensured people did not experience any discrimination.

People received opportunities if they chose to participate in social and recreational activities. The provider’s complaint policy and procedure had been made available to people who used the service. People’s end of life wishes in relation to their care and support had been discussed with them and staff worked well with external professionals to support people’s end of life care.

People received opportunities to share their views about the service they received. The systems and processes in place to check on quality and safety were found to be ineffective because not all the shortfalls identified in this inspection had been identified by the provider.

During this inspection we found one breach of the of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Oakdene provides accommodation and personal care for up to 40 people living with mental health needs. At the time of our inspection there were 38 people living at the service.

Oakdene is required to have 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. At the time of the inspection a registered manager was in post.

People received a safe service. Staff were aware of the safeguarding adult procedures to protect people from abuse and avoidable harm and had received appropriate training. Risks were known by staff and managed appropriately. Accidents and incidents were recorded and appropriate action had been taken to reduce further risks. People received their medicines as prescribed and these were managed correctly.

Staff were recruited through safe recruitment practices. Staff received an induction, training and appropriate support. There were sufficient experienced, skilled and trained staff available to meet people’s needs. People’s dependency needs had been reviewed and were monitored for any changes.

People received sufficient to eat and drink and their nutritional needs had been assessed and planned for. People received appropriate support with their eating and drinking needs and choices were offered and respected. People’s healthcare needs had been assessed and were regularly monitored. The service worked well with visiting healthcare professionals to ensure they provided effective care and support. When concerns were identified about people’s healthcare needs swift action was taken.

The manager applied the principles of the Mental Capacity Act 2005 (MCA) and Deprivations of Liberty Safeguards (DoLS), so that people’s rights were protected. People were asked for their consent before care and support was provided and this was respected.

Staff were kind, caring and respectful towards the people they supported. They had a clear understanding of people’s individual needs, preferences and routines. The provider asked people, relatives and representatives, including visiting professionals to share their experience about the service provided. Feedback given on ways to improve the service was acted upon.

People were involved as fully as possible in their care and support. There was a complaint policy and procedure available and confidentiality was maintained. People had access to independent advocacy services should they have required this support. There were no restrictions on people visiting the service.

People were supported to participate in activities, interests and hobbies of their choice and had no restrictions placed upon them. People accessed the community independently and some people were supported to develop their independence and life skills with the goal to live more independently in the future.

There were systems in place for the registered manager to ensure all areas of the service were regularly checked and the overall quality of care was monitored by the director of operations on behalf of the provider.

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

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

Is the service safe?

People told us they felt safe.

We saw that the home was clean and well maintained and there were systems in place to monitor the cleanliness and infection control in the home.

People were effectively assessed to identify the risks associated with nutrition and hydration. A person who used the service told us, 'The food here is brilliant.'

There were systems in place to protect the rights of people who used the service that were unable to give consent to care and treatment or they refused.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Staff were able to describe the circumstances when an application should be made and knew how to submit one. This meant that people were only deprived of their liberty when it was in their best interests and there were no other less restrictive ways to keep them safe and well.

Is the service effective?

We looked at four care plans which showed people who used the service received personalised care and treatment that was centred on their needs. The care plans were written in a way that reflected their preferences, interests, aspirations and diverse needs.

There were arrangements in place to speak to people about what was important to them. People who used the service told us they were safe and being cared for. Comments included, 'They know me here.' And, 'It's brilliant here, best place I have been. I love the atmosphere, we can do the activities we like and choose. I have a problem with my knee and this is sorted. I see the chiropodist; they come here to treat me. I am very satisfied.'

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, 'I am always asked what I want, I have choices, nobody makes me do anything I don't want to do.'

Our observations of the care provided, discussions with people and records we looked at told us that individual wishes for care and support were taken into account and respected.

Is the service responsive?

Care records we looked at showed that people using the service had access to independent advocates. This meant that people who used the service could be assured that the staff were respecting their right to have an advocate to assist them in understanding their options and help them to make an informed decision.

People told us and we observed, that they were able to participate in a range of activities both in the home and in the local community.

People told us they were involved in reviewing their plans of care when their needs changed. Records we saw showed that when people had an accident their care plan was reviewed to ensure that any risk to their health and safety was minimised.

Is the service well-led?

The provider had systems in place to make sure people who used the service were not harmed as a result of the care they received. Care plans and risk assessments were reviewed regularly. The manager regularly audited a number of care plans to ensure staff kept them up to date. Infection control practices and environmental risk assessments ensured the safety of the premises.

Information from the analysis of accidents and incidents had been used to identify changes and improvements to minimise the risk of them happening again.

People's personal care records, and other records kept in the home, were accurate and complete.

We toured the premises and saw all shared areas and a sample of bedrooms. We found that appropriate standards of cleanliness and hygiene were not maintained in all areas. Two people shared their concerns with us about the lack of cleanliness in a shower room and we found other areas where adequate cleanliness was not maintained.

We found the premises were not adequately maintained. There were some long term problem areas that had not been rectified and no maintenance had been carried out at all for the last five weeks. We were particularly concerned about people who had no heating in their bedrooms, but action was taken the following day to provide some heating for them.

The people we spoke with told us the staff were very kind and knew how to help them. We saw there were effective recruitment and selection processes in place, so that people were cared by suitable staff.

In this report the name of a registered manager appears who was not in post and not managing regulatory activities at this location at the time of the inspection. Their name appears because they were still on our register at the time.

People who used the service told us they received the support they needed. One person told us, "They come and talk to me when I need support." We saw staff talking individually with people in private. Other people were engaged in activities in the home or out in the community.

All the people we spoke with told us that they liked staff to look after there medicines to keep them safe. One person said, "They always give me my tablets when I need them."

Staff we spoke with told us they felt supported by the provider company and by the manager. We saw that regular training was provided for all staff.

People were consulted about the service in regular group meetings and individually. The registered manager maintained files of information that showed that he was continually monitoring the service.