Oaks Care Holdings LTD

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. This is the first assessment for this newly registered service. This key question has been rated Good. This meant people were safe and protected from avoidable harm. People were safe with staff and staff were made aware of any individual risks to people, following guidance to help mitigate the risk of harm. Staff arrived on time and carried out care calls in an unrushed way, ensuring all tasks were completed prior to leaving the person.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had a proactive and positive culture of safety. The registered manager made records in relation to accidents and incidents and these were analysed monthly. Lessons learnt were shared with staff. The registered manager said, “We have very few incidents and I know the clients really well. We had an incident of a poor discharge (from hospital) and I rang the emergency services (for them to take her back to hospital). We have monthly meetings where I share information with staff and we hold a debrief if it is something significant.” A staff member told us, “We have staff meetings. These are an opportunity to discuss things and share information. I suggested [person’s name] needed their time adjusted and it was.”

Staff planned and organised care and support with people, working with external professionals. The registered manager worked with people and their families to develop an assessment of the person’s needs prior to a care package commencing. The registered manager said, “I will go to the person’s property and if possible, take a carer with me as they will be looking after the person most of the time.”

The registered manager and staff understood their responsibility to notify the local authority safeguarding team should they have any concerns or suspect abuse; this knowledge was gained through training and supervision. A staff member said, “It can be neglect, physical or emotional abuse. I would be calm and take my time and report it to 111 (for advice) and the manager (to report to safeguarding).” However, the registered manager was unaware that they3 should also report all incidents of suspected abuse to CQC whether or not it met the safeguarding authority’s threshold. They agreed to review the requirements of registration to remind themselves of when notifications needed to be submitted to the Commission. This would help prevent anyone being harmed intentionally.

Staff worked with people to understand and manage risks, and they provided care to meet people’s needs that was safe and reflected their individual needs. A relative said, “It’s the way they adapt themselves which assures you he is safe.” The registered manager told us, “Risk assessments are written when assessing a person. We give any updates to the carer and take a copy of the new risk assessment to the person’s house.” Risks to people had been identified and there was guidance in care plans to direct staff in ways to help ensure these risks were mitigated. For example, people at risk of their skin breaking down were supported with suitable equipment for transferring them. Where one person was in a specialised bed, staff were instructed to make sure this was at its lowest level. However, we also found that one person who preferred soft food had no choking risk assessment in place and another person who has Parkinson’s had no falls risk assessment. The risk of harm to people was reduced as both lived with family and staff did not prepare or supervise meals for the first person. Although we did raise these with the registered manager to address.

The registered manager told us each person had an environment risk assessment contained within their care plan holding information relevant to people’s homes to help ensure that any risks were identified and made known to staff.

Prospective staff were recruited through good recruitment processes which included providing references, an employment history and undergoing a Disclosure and Barring Service (DBS) check to help ensure they were suitable to work in this type of service. They also received appropriate induction and training. A staff member said, “I did all of the training before I started and did shadowing. That’s the most important.” Relative’s told us staff arrived on time and stayed the full time expected of them. They said if staff were going to be late, they would always receive a phone call. A relative told us, “[Registered manager] will ring if the carer is going to be late, but otherwise they are always on time and stay the full time.” The registered manager monitored staff to help ensure they were following their roster and were not leaving calls early or forgetting to log in. They said, “If I notice anything this forms part of a 1:1 conversation with the carer.” We saw evidence of this. Staff told us they had plenty of time at care calls as well as travelling time in between to ensure they were not rushed. One said, “I have enough space between calls, so I can take time with people. I am never running late. I like to spend time with people.”

Relative’s told us they had no concerns about staff’s infection prevention and control (IPC) practices and staff said they had stocks of personal protective equipment made available for them. Staff undertook IPC training and they put this training into practice when providing care to people. A relative said, “I have no concerns with infection control.” A staff member told us, “I use gloves and I have a face mask and apron available too (for personal care).” The registered manager said, “I encourage staff to think about washing their hands, rather than always wearing gloves when they are not providing personal care. Staff wear uniforms and I carry out spot checks. If I use an agency staff member, I will provide them with one of our uniforms.”

Although no one required staff to dispense tablets to them as family members were responsible for this part of a person’s care, staff followed good medicines practices in their application of medicated creams to people. Each person had a medicine administration record which recorded what, when and where the cream was applied. A relative told us, “I have no concerns about how the creams are done.” The registered manager told us, “Staff complete medication Level 2 training and I am trained to complete competency checks.”