Oakmeadow Community Support Centre

Oakmeadow community support centre is a residential care home providing personal care for up to 32 people. The home is divided into Oakmeadow on the lower floor providing intermediate care, and Hawthornes on the upper floor offering care an a period of rehabilitation. The aim of the home is to prepare and enable people to go home following discharge from hospital or to prevent people being admitted to hospital following a specific event.

Oakmeadow community support centre also is registered for personal care and this service supports people with personal care in their own homes following discharge from either hospital or from Oakmeadow.

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

At the last inspection we found that significant improvement was needed in monitoring risk, the appearance of the environment, care records, activities, staff supervision and management oversight. At this inspection we found that some improvements had been made, whilst others needed to be revisited.

On this inspection we identified breaches in regulation relating to staff training, supervision and appraisal both in the care home and the domiciliary service. Training and staff supervision were not consistent across the service. Staff told us that they had not always received appropriate training to ensure that they were equipped to fulfil their role.

People’s care and support needs were mostly reflected in their plans, however not all support plans were complete and accurate. Details about health and care plans relating to End of Life care for those people receiving support in the community and health led therapies for those people living in the care home were not always available. This was a further breach of regulation.

We also identified a breach in regulation relating to governance. Systems in place were not effective in identifying the shortfalls in the service.

People in the care home were offered a good selection of food and drink. Records relating to weight and food/fluid intake were inconsistent and did not always reflect the reason as to why they were recording the information. We have made a recommendation about this.

People supported by both services had good access to health professionals to support them with their recovery and rehabilitation.

At the last inspection the home was described as industrial and in need of decoration. The home has since been decorated, the community team offices moved from the home to more suitable locations. The home was bright, fresh and clean. The walls still lack any art work and this was discussed with the registered manager.

The registered manager has employed an activities coordinator and we saw that activities were taking place although this is in the early stages of development. we made a recommendation that the timetable for activities be re-visited to best utilise the times when people are available to participate.

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 overall supported this practice.

We observed positive warm interactions between people living at the service and staff. It was clear that staff knew people well.

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 19 December 2018). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Oakmeadow Community Support Centre is a ‘care home’. 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 centre is a two-storey community residential support centre based near Widnes town centre. It offers a range of services for adults requiring rehabilitation after illness or injury and assessment for people who may require permanent residential care. The service can accommodate up to 19 people. The centre also provides day care services and carers break services, along with physiotherapy, occupational therapy, community nursing and social work intervention. For the purposes of regulation the day care facilities are not regulated or inspected by CQC.

The service offers short term care, people stay for approximately four to six weeks while they are assessed for further care or assisted with rehabilitation to go home and live independently. The service was last inspected in December 2015 and rated ‘good’.

At this inspection there was a manager who had been in post for four weeks. They had applied to register with CQC; their application had been accepted and was awaiting further checks. Prior to this, the service had been managed by a deputy and principal manager, though neither had applied to register with CQC. 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 manager had identified that there were areas of the service that required improvement. They had devised an action plan that detailed the improvements, when they would be completed and by whom. The dates for completion of the action plan were no later than January 2019, with most being November and December 2018. All of the areas identified as requiring improvement in this report had already been identified by the manager on the action plan.

Staff told us they had confidence in the manager. They told us they were proud to work there and were excited about the improvements the manager was implementing. People who use the service and staff told us they liked the deputy manager and they were supportive and approachable.

People using the service and their relatives told us they felt safe living there. Medications were well managed and people who were able to manage their own medications were encouraged to do so. This promoted their independence.

Risk assessments were in place in respect of people’s care and rehabilitation. The risk assessments highlighted risks to people and provided staff with some guidance on how to mitigate risk and keep people safe. However, the documentation lacked clarity and detail. When we looked at how people were cared for, we found that risks were well managed and people were kept safe. The lack of clarity was a documentation issue and did not affect the level of care people received. The manager had already highlighted this and developed plans to improve the documentation.

There were enough staff to keep people safe and the provider operated safe recruitment practices.

We observed good practice around the prevention and control of infection.

The environment, although safe and exceptionally clean, was tired and required improvement. Communal areas were not used and the corridors felt industrial rather than homely.

Staff were task orientated and told us that they did not have time within their working day to sit and chat to people. There was a general lack of stimulation and people spent most of their time in their bedrooms.

People using the service were supported to eat and drink enough to maintain a balanced diet. They told us they enjoyed the food but the meal time experience lacked atmosphere and there was a lack of interaction between people and staff.

People received a multi-disciplinary approach to care. They were reviewed by the GP who visited every day and there was access to the community nursing team. As people were assessed by different health care professionals, documentation was stored on three separate systems which made it difficult for the manager to maintain complete oversight. The manager had a plan to improve this which was due to be implemented by December 2018.

Oakmeadow is a two storey community Support Centre located close to Widnes Town Centre. It offers a range of services for adults of all ages requiring accommodation in the reablement Intermediate Care Unit. It also provides Intermediate Care, Day Care and carers break day care. The residential intermediate care unit is equipped to accommodate up to 19 people and provides short term rehabilitation to maximise the independence of people and enable them to return to living in their own home in the community. The service comprises care, therapy (occupational therapy and physiotherapy) and nursing and social work intervention that all are based in the same building. For the purpose of regulation the day care facilities are not regulated or inspected by the Care Quality Commission. This inspection focused on the reablement services provided at Oakmeadow.

The service has a new manager who is awaiting registration with the Care Quality Commission (CQC). 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.

Although only recently in post for this role the manager has been a principal manager within Halton reablement services for a number of years and demonstrated clear understanding of the staff and service provision. They were knowledgeable and inspired confidence in the staff team. They had a proactive approach to developing a positive culture in the service.

Staff were recruited in safe way and full employment checks were completed before they started work in the service. There were sufficient staff on duty to meet the range of care, support and treatment needs of people who used the service. Staff were well trained. They also had supervision and support systems in place to ensure their practice was monitored and they were able to develop skills and knowledge. We saw that staff had competed safeguarding training and wherever possible knew what to do to keep people safe from abuse or harm. There were policies and procedures available for additional information and guidance.

People praised the staff for their kindness and were happy with the care and support they received. We saw staff engaged positively with people, encouraging and supporting their independence. Staff had a good knowledge and understanding of people’s needs and worked well together as a team.

The environment was safe, equipment was checked and maintained and risk assessments were carried out to ensure all equipment was safe to use. There was evidence throughout the inspection that all efforts were made to support people’s safe mobility and wherever possible prevent falls.

People were supported to maintain links with the community and participate in meaningful activities that interested them and met their individual needs.

Staff had a good knowledge of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) legislation, and whether these needed to be considered for people who lived at the service. Documentation on people’s care plans showed that when decisions had been made about a person’s care, where they lacked capacity, these had been made in the person’s best interests. Changes to the law regarding the DoLS were understood and appropriate referrals had been made to the relevant local authority department to make sure people’s legal rights were protected.

We found that people’s health care and nutritional needs were met. There were choices for meals and fluids and dietetic advice was obtained when required. We saw the lunchtime experience was relaxed with people joining each other in the dining room for a social chat whilst others choose to eat their meal in their room.

We observed the culture of the service was one of openness and sound values based on putting the people who used the service at the centre of the services they provided. There was a quality monitoring system to enable checks of the services provided to people and to ensure people were able to express their views so that any improvements identified could be addressed.

We spoke with the principal manager, registered manager, four staff, a health care professional, fourteen people who used the service and two of their relatives. We encouraged the people using the service to communicate their thoughts about the service using their preferred methods of communication.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

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

Is the service safe?

Policies and procedures had been developed by the registered provider (Halton Borough Council)) to provide guidance for staff on how to safeguard the care and welfare of the people using the service. This included guidance on the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS).

We were informed that none of the people using the service had been referred for a mental capacity assessment and no applications had therefore been submitted to deprive a person of their liberty.

Training records highlighted that all staff had completed Mental Capacity Act or Deprivation of Liberty Safeguards training.

The provider had developed clear policies and procedures to provide staff with supervision and support. We looked at a sample of personal records for four staff. Examination of records and / or discussion with staff confirmed staff had been provided with training, guidance and support to enable them to carry out safe care practices.

Is the service effective?

We spoke with 14 people who used the service and two of their relatives. They all made positive comments about the care and support provided. Comments included; "I couldn't do without them really. They are brilliant" and "The staff are very kind and helpful and I feel at home with them" and "I have needed quite a lot of care recently and know what is good and what is bad. I can say that this service is wonderful, and has done me the world of good".

Records highlighted that people were encouraged to give feedback about the service and any complaints had been listened to and acted upon. No complaints or allegations were received from people using the service or their representatives during our inspection.

No concerns were raised by the people using the service or their representatives about the meal options, standard of catering or quantity of food provided during our visit. People spoken with informed us that were offered a choice of menu and records of individual choices were available for reference.

The manager told us that menus had recently been updated and we noted that menus were in place on all the tables. People told us that the food was "excellent, plentiful and lots of choice."

Information held in the home quality assurance records identified that the people who use the service feel that the services provided are pre planned and are effective in achieving future goals.

Is the service caring?

The fourteen people spoken with who were supported by the service told us they were more than happy with the way they were looked after. All feedback received was positive and confirmed the service was responsive and caring to the needs of the people using the service.

We received comments such as: "This is home from home" and "We really do get wonderful service from people who know what they are doing".People also told us that staff were caring. Comments included " Staff are kind and helpful people", "The staff here are my friends" and "Staff do their very best to make our lives good." A relative of a person who used the service told us that staff were "Kind supportive people who really did care about the people they supported." This showed us that Oakmeadow provided a caring and responsive personal care service which was valued by the people using it.

Is the service responsive?

Records viewed highlighted that the provider is committed to the inclusion of people in the development and operation of the service. For example, since our last inspection the provider had responded to peoples changing needs and had updated care plans and daily recording systems to ensure that all care and support provided was centred around the needs and wishes of the person who used the service.

Is the service well- led?

The provider has worked well with the Care Quality Commission and was aware of the need to keep us updated on any significant events via statutory notifications.

The service continued to utilise a comprehensive internal quality assurance system and had developed systems to involve and obtain feedback from people using the service and / or their representatives.

Feedback from staff identified that they felt supported and empowered within their various roles and they told us that the management of the service was excellent.

During this visit we saw that people were being supported by staff at mealtimes, the food appeared appetising and was plentiful and several people told us that they liked it. However drinks were being served in cups without saucers and food was being delivered to people choosing to eat in their own rooms without a tray and uncovered. Although there was a written menu plan for several weeks the staff on duty were unsure about what week was current. There was no menu displayed for the day and several people using the service did not know what was being served.

One person using the service told us '' All of the carers are fantastic'' and another '' The service is absolutely brilliant''.