Archived: Oak Tree Care Services

Oak Tree Care Services is a supported living service, providing personal care and accommodation to six people with a learning disability or a mental health need. The home is on a residential street in a community setting and designed to promote people's inclusion and independence.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. On the day of our inspection there were six people living in the supported living services but only three required support with personal care. At the time of this inspection the people living at the service were aged 18-35.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service :

People told us they enjoyed living at the supported living service. They felt safe with the staff and the other people who lived at the service. Staff were kind to them and treated them with respect.

There was a person-centred culture at the service. 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 supported this practice.

People were involved in a wide range of activities including education and volunteering. Care records outlined people’s needs but also their abilities and the registered manager and staff team promoted independence for everyone living at the service.

People were supported, where needed, to access external health professionals to help promote good health and wellbeing. Family members praised the service provided and the ability of staff and the senior management team that worked in partnership with them.

People were safeguarded against the risks of abuse and harm by the systems and by the staff. Risks to people were assessed and mitigated. There were enough staff to meet people’s needs and provide flexible, responsive care.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the nominated individual at this inspection. The nominated individual is responsible for supervising the management of the service on behalf of the provider. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.

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 the service was good (published 5 May 2017).

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection on 26 April 2016, the service was found to be in breach of Regulations 11 and 12 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. These breaches related to risk management and consent for care and treatment.

The service did not have a registered manager. 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 legal requirements in the Health and Social Care Act 2008 and the associated regulations on how the service is run. A manager was in place and we were informed they were in the process of applying for registration with CQC.

During this inspection records showed that a risk assessments had not been updated to reflect the person’s current circumstances. The director told us that the risk assessment had been updated before the inspection and may have been misplaced. We were sent evidence to support this after the inspection.

Medicines were being managed safely for the person.

There were systems in place for quality assurance and quality monitoring.

There was appropriate staffing at the service.

Staff had the knowledge, training and skills to care for people effectively. Staff received regular supervision and support to carry out their roles.

Staff sought people's consent to the care and support they provided. The person’s rights were protected under the Mental Capacity Act 2005. The service was in the process of applying for Deprivation of Liberty Safeguard for the person.

The person was able to attend routine medical and health monitoring appointments with staff support.

The person was treated in a respectful and dignified manner by staff who understood the need to protect people's human rights.

There was a programme of activities. These activities took place regularly.

Staff found the manager approachable and had confidence in their ability to act on queries.

Oak Tree Care Service supports people at supported living services. At the time of our inspection there were four people who received personal care from the service. At our last inspection the service was in breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which was related to staffing. We found appraisals and an induction programme had not been undertaken for two staff members. We also found a person was not receiving one to one care as planned in their care arrangements and comprehensive audits were not being carried out.

The service did not have a registered manager. The provider told us a manager had been recruited and was due to start their employment. Once in post the manager would submit their application to register 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.

Some risk assessments were not updated to reflect people's current needs and did not take into consideration people's health needs. When a risk was identified, assessments did not provide clear guidance to staff on the actions they needed to take to mitigate risks in protecting people, such as weight loss.

Medicines were administered on time and were stored safely. A person was allergic to a particular medicine and this was not recorded on the medicines record. We fed this back to the provider and the person's allergy was recorded. The provider told us that the GP and dispensing pharmacist were aware of the person's allergy.

People’s capacity was being assessed. However, the assessments did not specify what area’s people had or lacked capacity using the Mental Capacity Act 2005 principles. Due to risks to their safety, two people living at the supported living service we visited were not allowed to go outside without staff or a relative accompanying them. Appropriate Deprivation of Liberty safeguards had not been applied for.

Quality assurance and quality monitoring systems had been implemented to allow the service to demonstrate effectively the safety and quality of the service.

People had choices during mealtimes and staff assisted with meals in accordance to people's preferences.

People were protected from abuse and avoidable harm. Staff knew how to report alleged abuse and were able to describe the different types of abuse. Staff knew how to 'whistleblow'. Whistleblowing is when someone who works for an employer raises a concern about a potential risk of harm to people who use the service.

People were supported by suitably qualified and experienced staff. Recruitment and selection procedures were in place and being followed. Checks had been undertaken to ensure staff were suitable for the role. Staff members were suitably trained to carry out their duties and knew their responsibilities to keep people safe and meet people's needs.

People were supported to plan their support and received a service that was based on their personal needs and wishes. People were involved in the planning of their care and the care plan was then signed by people to ensure they were happy with the care and support listed on the care plan.

There was a formal complaints procedure with response times. People were aware of how to make complaints and staff knew how to respond to complaints in accordance with the service's complaint policy.

People and relatives told us that staff communicated well with them. People’s ability and preference on communication was recorded on their care plan.

People were supported to maintain good health and appropriate referrals to other healthcare professionals were made.

People were encouraged to be independent and their privacy and dignity was maintained.

Staff and resident meetings were held regularly.

We identified breaches of regulations relating to consent and risk management. You can see what action we have asked the provider to take at the back of the full version of this report.

We spoke with two people who use the service at one of the service's two supported living schemes. They raised no concerns about the support provided to them. 'They meet my needs well,' one person told us, adding that there was a lot of support from staff who were always available.

We found that there were enough qualified, skilled and experienced staff to meet people's needs overall. Records and feedback indicated that although staffing levels had been temporarily reduced pending recruitment of new staff, staffing was flexibly provided when needed. Most staff had the skills to meet people's needs, and the manager provided us a training plan to address a few shortfalls.

We found some occasions when the staff member working the waking night shift also worked the eight-hour day shift immediately before or after the night shift. The provider may find it useful to note that this could impact on that staff member's ability to effectively meet people's needs.

People we spoke with raised no concerns about how they were supported with any medicines prescribed to them. We found that people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People told us that staff understood their needs and knew their preferences. Staff demonstrated good awareness of people's individual needs and circumstances. They knew how to provide appropriate support to people.

People told us they felt safe using the service, and that they could speak with staff or the manager if they had concerns. They told us of monthly meetings at each scheme, at which they could raise concerns if needed. People said they found the meetings useful. We found that these meetings contributed to the provider ensuring that there were systems in place to monitor and improve the quality of services.

We found that staff training and supervision arrangements helped to enable people to be supported by staff who delivered care safely and to an appropriate standard. Recruitment processes, which included applicants meeting people who use the service, ensured that people were supported by suitably qualified, skilled and experienced staff.