Oakfield (Easton Maudit) Limited is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered to accommodate 18 adults with autism and/or learning disabilities, dementia, mental health and physical and sensory difficulties; at the time of our inspection, there were 15 people living in there. The service provided was not initially developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. However, people were given choices and their independence and participation within the local community encouraged.
At our last inspection in May 2017, this service was rated overall as requires improvement. At this inspection, the service remains rated as requires improvement.
The inspection took place on the 8 and 9 May 2018; the first day was unannounced and we carried out an announced visit on the second day.
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.
The systems in place to monitor the quality of care and effectiveness of the service had not been sufficiently embedded for us to fully assess their effectiveness. Although the provider had identified shortfalls in their monitoring processes, there had been a delay in establishing effective processes.
People could not be assured that they were always cared for safely as there were not always risk assessments in place to mitigate any identified risk. Infection control processes needed to be strengthened.
There was not always sufficient staff with the right skills deployed to meet everyone’s needs. People’s access to activities outside of the home could be limited at times.
Staff understood the need to undertake specific assessments where people lacked capacity to consent to their care and/or their day-to-day routines. However, there had been a failure to recognise that applications for authorisation under the Deprivation of Liberty Safeguards needed to be made to ensure that people were being supported in line with the principles of the Mental Capacity Act.
People received care from staff that knew them and were kind, compassionate and respectful. The staff were friendly, caring and passionate about the care and support they delivered. People had formed positive therapeutic relationships with staff and were treated as individuals.
Care plans were in place, which enabled staff to provide consistent care and support in line with people’s personal preferences and choices, however these needed improving to ensure all the information about people’s life history was included. End of life wishes were discussed and plans put in place.
People were cared for by staff who were respectful of their dignity and who demonstrated an understanding of each person’s needs. This was evident in the way staff spoke to people and the activities they engaged in with individuals. Relatives spoke positively about the care their relative received and felt that they could approach management and staff to discuss any issues or concerns they had.
Staff were appropriately recruited. People received their prescribed medicines safely. Staff understood their responsibilities to keep people safe from any risk or harm and knew how to respond if they had any concerns.
People’s health care and nutritional needs were carefully considered and relevant health care professionals were appropriately involved in people’s care. There was a variety of activities available for people to participate in if they wished to and family and friends were welcomed to take part in events at the home.
Staff had access to the support, supervision and training that they required to work effectively in their roles. Development of staff knowledge and skills was encouraged.
The service had a positive ethos and an open culture. People knew how to raise a concern or make a complaint and the provider had implemented effective systems to manage any complaints that they may receive.
At this inspection, we found the service to be in breach of two regulations of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. The actions we have taken are detailed at the end of this report.