The Oaks

We found the following examples of good practice.

People were well supported by staff to have telephone and video call contact with their family and friends. The registered manager ensured that in person visits were in a manner which minimised the risk of infection spread, including visits in the gardens.

The provider considered people’s anxieties and how their behaviours would be challenged through isolation and lockdown. Staff used lessons learnt and reflection to consider how to support people more effectively when health issues like Covid-19 affected their emotional wellbeing. People had up to date and individual Covid-19 behavioural support guidance on how staff could reduce triggers and pressures associated with social distancing and lock down.

The registered manager had created two Infection Prevention and Control (IPC) Champions to ensure staff were upskilled in IPC measures and to bring best practice to the home. The registered manager and deputy manager undertook clinical infection control training though the World Health Organisation to improve practices relating to outbreak management and how to further improve PC measures to reduce the risk of further transmission.

Accommodation was provided over two floors and communal areas included a lounge and dining room, an additional dining room and kitchen and a sensory room. People had their own rooms with access to gardens at the rear of the home.

People’s experience of using this service: We observed people and we saw they were comfortable in the presence of staff and in their home. Throughout the inspection, we observed positive interactions between people and staff. Staff spent time with people as and when they wanted. Staff respected people and enabled people to be independent. People were treated with dignity, patience and kindness.

People were safe and were supported by staff who were trained to recognise the signs of any potential abuse. Staff had been trained in safeguarding and knew what action to take if they had any concerns about people’s safety or welfare. People’s risks were identified and assessed appropriately. Staff knew how to keep people safe in an emergency such as a fire.

The provider’s internal quality assurance team carried out audits which the registered manager used to improve the service. A range of quality assurance systems measured and monitored the quality of care and the service overall. The registered manager worked with a maintenance plan to identify issues and to ensure planned improvement works were carried out.

There were sufficient staff to meet people’s needs, to enable them to engage with activities, access the community and to live their lives as independently as possible. People were supported by staff whose suitability was checked through a robust recruitment process. People’s medicines were managed safely.

Before they came to live at the home, people’s needs were fully assessed to ensure that staff could meet their needs appropriately. Staff completed training that was driven by the needs of the people and were experienced in their roles to provide effective care to people. Staff received regular supervisions and an annual appraisal.

Staff used people’s feedback, likes and dislikes to plan menus and staff knew people’s dietary and eating requirements. People had access to a range of healthcare professionals and services. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were comfortable and relaxed in the company of the managers and support staff. Staff were asked for their feedback about the home and staff meetings were held regularly. Relatives were asked for their feedback about the home through surveys and by talking to the registered manager.

People received personalised care that was tailored to meet their individual needs, preferences and choices. Care plans were detailed and guided staff about people’s needs and how to meet them. Staff supported people to make choices and to live as independently as possible. Complaints were recorded and resolved. No-one living at the home required end of life care at the time of the inspection.

This service met the characteristics of Good. More information is in the ‘Detailed Findings’ below.

Rating at the last inspection: Good. The last inspection report was published on 29 June 2016.

Why we inspected: This was a planned comprehensive inspection that was scheduled to take place in line with Care Quality Commission (CQC) scheduling guidelines for adult social care services.

Follow up: We will review the service in line with our methodology for 'Good' services.

The property is a modern detached house located in a residential area on the out skirts of Crawley. Of the six bedrooms, five are on the first floor, one of which is en-suite and one bedroom is on the ground floor. The property has level access to a rear garden and there is a stair case to the first floor.

This inspection took place on 4 May 2016 and the provider was given one days’ notice. This was to enable the provider to arrange for sufficient numbers of staff to be available to facilitate the inspection without disrupting the daily routines of the people who lived there.

At the time of the inspection there was no registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. The day-to-day management of the service was being overseen by a manager who is referred to as ‘the manager’ throughout this report.

People were supported by kind, caring staff that knew them well and understood the importance of supporting people to follow their daily routines.

People’s independence was promoted and they participated in a range of activities of their choice such as going to the pub or a café for lunch, trampolining, using a local hydrotherapy pool, carriage driving, attending sessions at a local sensory room and going to a local day centre.

People were supported to have a nutritious diet that met their individual preferences and needs such as a vegetarian diet and thickened drinks.

People were supported to maintain relationships with people that mattered to them. Relatives were kept informed of their loved one’s wellbeing and any changes in their needs.

People’s needs had been assessed and planned for. Plans took into account people’s preferences, likes and dislikes and were reviewed on a regular basis. Staff worked in accordance with the Mental Capacity Act (MCA) and associated legislation ensuring consent to care and treatment was obtained. People were supported to make their own decisions and where people lacked the capacity to do so, their relatives and relevant professionals were involved in making decisions in their best interest.

Medicines were ordered, administered, stored and disposed of safely by staff who were trained to do so. Referrals were made to relevant health care professionals when needed and each person had a health action plan in place.

Staff received the training and support they needed to undertake their role and were skilled in supporting people with learning disabilities and autism. One staff member told us “The training is excellent. They identify the gaps in your knowledge and provide the training”. Staff had a good understanding of each person’s communication needs and of how some people communicated their feelings through their actions. They were able to recognise when people were feeling anxious and took appropriate action to minimise or where possible remove the source of these anxieties.

Staff knew what action to take if they suspected abuse had taken place and felt confident in raising concerns. Risks to people were identified and managed appropriately and people had personal emergency evacuation plans in place in the event of an emergency.

The service followed safe recruitment practices and staffing levels were sufficient to meet people’s assessed needs, including spending one to one time with people.

The management of the service were open and transparent and a culture of continuous learning and improvement was promoted. The provider had ensured there were robust processes in place for auditing and monitoring the quality of the service and complaints were responded to appropriately.

People who used the service were supported to make choices about what they want to do, for example, whether they want to go out or not. We found that there were mental capacity assessments in place which showed that people were unable to make decisions without support. Staff had received training in relation to autism awareness and mental capacity training. We spoke to one relative who told us that communication with the staff at the home was good and that they were 'Happy to communicate with everyone.'

We were shown round the home and we found that the environment was clean and tidy and free from unpleasant odours

All staff received appropriate professional development. We were told by staff that everyone was required to attend mandatory training updates and on-going professional development to ensure the care they gave was safe. We found there were regular team meetings and each member of staff signed to confirm that they agreed with what had been discussed. Staff told us that they had a 'Good team here'.

There were effective systems in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others. One relative told us, 'They keep the place lovely. The food is nice. They do a very good job.'

There were sufficient staff to meet the needs of the people who use the service and staff had an induction and mandatory training. All staff had achieved NVQs or were working towards them. Staff understood that the people who use the service were vulnerable to abuse and they understood what to do if they saw anything untoward. There was a safeguarding policy and staff had attended safeguarding training.

There was a quality audit system which recorded complaints, accidents and incidents, safeguarding alerts and CQC notifications. The service was audited by the provider's Quality Assurance Manager and an annual survey of the people who used the service was carried out.