Oaklands Care Home

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We did not look at all quality statements for Effective at this assessment. The service was not always effective. This rating uses some scores from the previous inspection. Assessments completed by the service were insufficiently detailed to enable effective, good quality care planning. This included failure to carry out a pre assessment for one person, who as a result had no care plan or risk assessments in place. There was a lack of understanding by staff and leaders about capacity and consent. There were no mental capacity assessments for people living with dementia who might not be able to consent to all aspects of their own care and treatment. Where people made decisions which could be considered unwise, there was no evidence of support or further information provided by staff. During our assessment of this key question, we found concerns about consent and capacity, which resulted in a breach of Regulation Need for consent. You can find more details of our concerns in the evidence category findings below.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider acknowledged their failure to appropriately assess individuals before admission to the service and said they would put systems in place to improve this. The manager did not have a good understanding of people's assessed needs, as during our first day of our site visit, the manager told us no one was at risk of choking. We subsequently found 3 people had care plans in place with identified risks of choking.

The provider acknowledged their failure to appropriately assess individuals before admission to the service and had put systems in place to improve this. The manager did not have a good understanding of people's assessed needs, as during our first day of our site visit, the manager told us no one was at risk of choking. We subsequently found 3 people had care plans in place with identified risks of choking.

The provider failed to have robust preadmission processes in place, this had meant they did not consider if they could meet the needs of people or assess the impact of people’s needs on others already receiving a service. People’s assessments were insufficiently detailed to enable effective, safe, good quality care planning. This put people at risk of their needs not being met. For example, we found a number of people who were at risk of choking. In one person’s care plan it identified the person needed a pureed diet. It also stated the person could manage independently with a normal diet. This had not been identified by the provider’s own audits.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

There were ineffective systems to ensure that capacity was assessed. Care plans for some people were inconsistent regarding capacity and consent. For example, one person’s care plan said they had capacity however we found consent had been signed on their behalf. There was no consent obtained from people or their representatives for the CCTV in the service. The provider failed to ensure consent was always sought from people. Deprivation of Liberty Safeguards (DoLS) had not always been obtained or reviewed to restrict people of their liberty and freedom.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. People with capacity to be involved in their care planning and decisions around their care and treatment had not been consulted with regarding changes to the service or reviewing of their care plans. Where people lacked capacity to make decisions, their families have not been given the opportunity to inform the care and treatment in the best interests of their relative. We found the service was not always working within the principles of the MCA as some people's capacity had not been assessed or their ability to make decisions reviewed or recorded in their care plans. We found that practices were not always the least restrictive and the impact of decisions made had not been assessed. For example, one person had their cigarettes and lighter removed from them. There was no assessment to support this was proportionate and in their best interests.

The manager acknowledged the lack of capacity assessments and inconsistencies and said this was something they had been addressing. However, we did not see any evidence to support this. Staff were aware of people’s rights to refuse care and treatment and said they would respect the persons wishes.