The Oaks & Woodcroft

Updated 17 August 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 2 inspectors.

Service and service type

The Oaks & Woodcroft is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Oaks & Woodcroft is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced on the 13 June 2023 and announced on the 2nd visit 19 June 2023.

What we did before the inspection

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We spoke with the local authority and reviewed information about the service including enquiries and share your experiences. We used all this information to plan our inspection.

During the inspection

We spoke with 2 people using the service but used observation as our main frame of reference. We had discussions with 3 care staff plus the team leader, the deputy manager, the registered manager, and the regional manager.

We reviewed 3 people’s care records, risk assessments and medication record and continued to request specific documentation. We looked at the environment and reviewed 2 staff recruitment records, training records and other records relating to the management and safety of the service.

We completed a second half day inspection and observed activities taking place. We continued to review information and received feedback following the inspection from 6 health care professionals and 4 relatives.

Updated 17 August 2023

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

The Oaks & Woodcroft are two residential bungalows registered as one location and provide personal care for up to 12 people with a learning disability, mental health need, physical disability and/or autistic people. The service had 6 people living at The Oaks and 6 people living at Woodcroft at the time of our inspection.

People's experience of using this service and what we found.

Right Support: Some facilities were shared which did not maximize people’s choices and independence. For example, both bungalows had their own kitchen but the fridge in Woodcroft was almost empty, and inspectors were told staff could take food from The Oaks fridge which did not enhance choice for people, as they were reliant on staff to anticipate their needs and needed support to access the kitchens. We observed people and staff walking through each other’s bungalows without using the front door and waiting to be invited in. At least 1 person living at Woodcroft was using the bathroom at the other bungalow. This should be considered in terms of the rights and privacy of everyone using the service. One bungalow was for men and the other for women and there had been sexual safety concerns in the past which needed careful consideration.

Staff did not support people in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People’s access to parts of their home were restricted and we found other restrictive practice and limited choices for people around their daily routines and activities.

Some key aspects of people’s lives had not been reviewed for a long time, for example: control and support people needed to manage their finances and medicines and support with day-to-day tasks which would maximize people’s independence. People were supported to discuss their wishes and have goals and objectives in place to show how they would like to spend their time and what they would like to do. For example, go on holiday.

Right Care: Staffing was not consistently safe to ensure people’s needs were met. A high number of incidents had resulted in more staff being employed across the day shift. We had concerns about shift patterns as there was a reduction of staff from 7pm which could impact on people’s choices of activities and routines.

Staff needed additional training to help ensure they understood how to support people safely and in the least restrictive way. People’s records required improvement to help guide staff as to the actions they should take to reduce incidents and know how and what to record. Staff showed a limited understanding of the function of behaviour, possible triggers, and consequences.

Right Culture: We found cultural changes were necessary to ensure people had their rights upheld and people were treated with dignity and respect. We found some of the terminology used in people’s records, such as ‘challenging behaviour’ was not person centred and staff did not address people in a dignified or person-centred way.

Audits and surveys were used to identify areas for service improvement and development, but these were not yet fully effective as we identified areas of concern which could compromise people’s care and treatment. Staff worked in conjunction with other professionals and families to ensure the care was as holistic as possible, but health care professionals and family members stated the service could be slow to act on their concerns.

Several incidents had not been reported to CQC to ensure we could assess if appropriate actions had been taken. During our inspection we found information governance was poor but accepted that the provider was migrating records from paper to electronic systems which should improve accessibility. However, we found information was not always up to date, accessible or known by all staff. This could compromise people’s care.

The registered manager, the regional manager and the senior team were working hard to improve the culture of the service and ensure staff through training, supervision and induction had the right skills and attitude.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection and update –

The last rating for this service was Requires improvement (published 22 December 2020.)

Why we inspected.

We undertook this focused inspection to follow up on concerns raised by the Local Authority and in response to a recent coroner’s inquest which required the provider to take certain actions.

The provider submitted us their report. We initially looked at Safe and Well-led but opened the inspection up to look at Effective as well due to some concerns about the performance of the local medical practice and the potential impact this might have on people using the service. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains Requires improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and recommendations.

We have identified breaches of regulation 11 consent, regulation 12 safe care and treatment, regulation 17, good governance regulation 18 staffing.

For more serious breaches of regulation 12 Safe care and treatment and regulation 17 we have served Warning notices.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Oaks & Woodcroft on our website at www.cqc.org.uk.