This was an unannounced inspection which took place over two days on 15 and 17 October 2014. Oakhurst Lodge provides accommodation and care for up to eight young people of both sexes from 16 – 35 years of age with autistic spectrum disorder, associated learning disabilities and who might display behaviours which challenge.
Oakhurst Lodge has not had a registered manager since November 2013, although an application to appoint a registered manager has been submitted. 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 and associated Regulations about how the service is run.
The premises were of suitable design and layout to meet the needs of people using the service and keep them safe. However, we found that some internal areas required maintenance or repair to ensure they were places that could be enjoyed by each person using the service. This is a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.
Staff had not completed all of the training relevant to their role. For example, only two out of 30 staff listed had completed first aid training. No staff had completed training in nutrition. Despite being a specialist autism home, none of the staff we spoke with said they had any recent or detailed training in autism. This is a breach of the regulation 23 Health and Social Care Act 2008 (Regulated Activities) Regulations.
We were told that the home was supported by a multi- disciplinary team (MDT) which included a psychologist, dietician, an occupational therapist and behavioural specialists. We found that the MDT was not often involved in people’s care and we did not get a strong sense that the support of the young people was adequately underpinned by the skills and knowledge of the organisation’s specialist practitioners. We felt therefore that this aspect of the support was not being fully effective.
Systems were in place to monitor the quality and safety of the service, but accidents and incidents were not always being monitored by the manager to ensure that any trends were identified.
People told us they felt safe and we saw that there were systems and processes in place to protect them from harm. Staff were trained in how to recognise and respond to abuse and understood their responsibility to report any concerns to their management team.
People were protected against the risk of unlawful or excessive control or restraint because the provider had made suitable arrangements to ensure staff were competent and confident in the use of suitable and acceptable physical interventions to reduce or manage behaviour that challenges and put people at risk.
Risks to people’s safety were identified and managed effectively. Risk assessments were detailed and covered activities and health and safety issues both within the home and out in the community.
Safe recruitment practices were followed and appropriate checks had been undertaken which made sure that only suitable staff were employed to care for people in the home.
There were sufficient numbers of experienced staff to meet people’s needs. We saw that staffing levels were adjusted to enable people to undertake activities of their choice or to attend college. Staffing levels were being reviewed to ensure that evening shifts had sufficient staff to respond to any incidents and to support the young people going out to a range of activities.
Medication was administered safely by staff who had been trained to do so. There were procedures in place to ensure the safe handling and storage of medicines.
People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. The support plans contained personalised information about how each person liked to be supported. Staff knew people well and appeared to have good relationships with people. The atmosphere was happy and relaxed.
The manager and staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made where this was in their best interests.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the manager understood when an application should be made and how to submit one and was aware of a recent Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty.
People were provided with a choice of healthy food and drink which ensured that their nutritional needs were met.
People’s physical health was monitored as required and people were supported to see healthcare professionals such as GP’s, chiropodists, dentists and opticians.
People’s preferences, likes and dislikes had been recorded and we saw that support was provided in accordance with people’s wishes. People were supported via a range of communication techniques to be involved in decisions about their care which helped them to retain choice and control over how their care and support was delivered.
Staff were kind and respectful and were aware of how they should respect people’s dignity and privacy when providing care.
People were involved in a range of activities both within the home and out in the community, although this was often not in a structured or planned way. People told us they enjoyed the activities, but would like the opportunity to do more.
The complaints procedure was on display in the home in a format that was accessible to people who used the service. Feedback from people was encouraged and acted upon wherever possible. We saw that complaints were investigated and responded to by the management team or the provider.
Staff told us that the home was well led and that the management team were supportive and approachable and that there was a culture of openness within the home which allowed them to suggest new ideas which were mostly acted upon. Staff were now receiving supervision and they told us they were satisfied with the support they received from the manager.