The Oaks

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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

We assessed a limited number of quality statements in the safe key question and found areas of concern. The scores for these areas have been combined with scores based on the rating from the last inspection, which was good. Though the assessment of these areas indicated areas of concern since the last inspection, our rating for the key question remains good. Staff supervision and training was completed in line with the provider’s policies. People were supported by staff who had the understanding and knowledge of how to keep them safe. However, people were not always protected from risk due to the lack of detailed information and guidance available to staff. People told us there was not always staff available. The principles of the MCA had not been fully embedded.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Most people felt safe at the service. We received mixed feedback regarding access around the service. The provider had recently taken away access fobs from service users with capacity. These fobs enabled people to move freely around the service and to exit the service at their wish. However following an incident, the provider had made the decision to remove free access for people with capacity to avoid reoccurrence and to ensure that people without capacity remained safe. One person told us, "Now I have to walk around the home looking for staff to let me out as can't access anywhere independently."

Mental capacity documentation demonstrated staff and management lacked understanding of the principles of the MCA. Training had been arranged for staff on this topic. Staff spoken with as part of the assessment showed a good understanding of their individual role to ensure people were safeguarded from abuse. The manager was open and honest regarding incidents and safeguarding concerns at the service and followed internal and external procedures to keep people safe. The provider worked with external agencies to ensure people were safeguarded from abuse.

We observed people been supported by staff to move around the service. We also observed people waiting for staff to support them. In communal areas people were sat for up to 10 mins waiting for staff to assist them.

MCA documentation was not always in place or completed in line with the principles of the MCA. An external company had completed a provider wide audit of MCA's which highlighted to the provider a number of improvements needed to ensure their services understood the MCA. The provider had processes to safeguard people. Clear records of all incidents ,safeguarding referrals and near misses were recorded with action taken and lessons learnt. Policies and procedures were in place to ensure people remained safe. Risk assessments were completed where the provider had identified risks to people and control measures were followed by staff.

People did not always feel safe at the service. Some people raised concerns about the call bell system not working correctly which made them feel unsafe. One person told us, "I never know if the staff are coming or not as my call bell doesn’t always work. People told us they were involved in reviews of their care plans and risk assessments. However, updates were not always shared with people following changes been made. One person told us, "Had a meeting recently in which they reviewed my care plan and these are now up to date but I have not received a copy of this, I would like one."

Appropriate documentation was not always in place to guide staff. Staff were trained in the use of equipment and understood their roles in relation to managing risks posed to people. Staff told us they had access to people's risk assessments via the online system.

We observed people did not always have appropriate care plans or risk assessment in place to inform staff on how to manage specific health conditions.

We could not be assured the processes in place always managed people's risks and provided staff with up to date guidance. Whilst people's risks were assessed, we found conflicting information in care plan records relating to people's health needs. Care plans did not always provide information for staff to manage associated risks with people's health conditions. This was found to be a recording concern and is covered in the well led section of this report.

People did not always feel safe within the environment. One person told us, "Most of the time I feel safe, but sometimes have to wait for staff to come and this worries me." People's rooms were person centred and the registered manager supported people to plan and design their own room as they wished and to mirror their own bedroom on their previous bedroom to support them to move around safely.

The provider was in the process of changing health and safety audits as they had identified that the current system did not support the care home environment. The provider told us that on occasions where agency staff were deployed, they needed to work with regular staff to ensure they learnt the routine. This could impact on people waiting for assistance.

The service and equipment were clean and well maintained. During the assessment we observed that the storage of PPE did not support good infection prevention and control practice and the service was experiencing a COVID-19 outbreak.

The processes in place had not addressed some of the issues noted during this assessment, including people not always feeling safe. The provider had appropriate checks in place to ensure the environment and equipment used were checked on a regular basis. Regular health and safety audits were completed and any identified actions were recorded and reviewed on an ongoing action plan.

Some people, relatives, and partner agencies told us more staff were needed. One person said "I waited 4 hours to be assisted to get up and dressed at the weekend. I used my call bell to ask for support and one staff member told me to stop using it, I didn’t feel safe then." People told us that there was not always staff around when they needed them. For example, when they wish to leave the floor that they are on sometimes they have to walk around 3 times before they can find a staff member to access the lift for them.

Staff did not always feel there was enough staff to meet people's needs. Staff told us that people often had to wait for assistance as they were busy supporting others. One staff member told us that staffing levels were not always considered when people needs changed. The manager stated the dependency tool used showed that the service was over staffing. The provider stated that an extra member of staff has been added to the rota to support the care staff on a morning. This member of staff will be preparing breakfast so staff can concentrate on assisting people with personal care.

We observed people waiting around and looking for staff at times. Inspectors had to support people to find staff to support them during the inspection.

Improvements were required to ensure staff were deployed effectively to meet people's needs in a timely way. The management team were not included within the rotas or dependency assessment however they were available on site to support if needed. Staff were recruited safely with all appropriate checks in place.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.