Oakfield Lodge

About the service

Oakfield Lodge is registered to provide care and support to people living in specialist ‘extra care’ housing in London Borough of Redbridge. Not everyone who lived in the housing received personal care from the service. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service. People using the service lived in their own flats or bungalows within a gated community where there were 73 properties. The service was providing personal care to 19 people at the time of the inspection.

People’s experience of using this service and what we found

Right Support

Staff were recruited with people’s safety in mind. There were enough staff to support people safely. Staff received an induction when they began employment to ensure they could support people correctly. People were supported to access health care services and the service understood risks and needs of their various health conditions. People were supported to eat and drink healthily.

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 told us their consent was sought before care was provided.

People and relatives were able to be involved with decisions about care. However, care plan reviews with social workers were not always as regular as they should be. The registered manager implemented a new way of ensuring care was reviewed following the inspection. Care plans were person centred and captured people’s needs. People’s communication needs were met. People were able to take part in activities and supported to avoid social isolation. The service was able to support people who were at the end of their lives.

Right Care

Risks to people were recorded, monitored and managed. Medicines were managed safely. The service sought to keep people safe from infection through good infection prevention and control. People’s needs were assessed before they began using the service to ensure their needs would be met adequately. Staff received regular training to ensure they could continue to care for people in the right way. People were well treated and supported; people and relatives told us staff were caring. People’s privacy, dignity was respected, and their independence promoted. People were cared for by staff who knew them. Managers and staff were clear about their roles and knew their responsibilities towards the safety of people. The registered manager understood duty of candour and the regulatory requirements placed on them.

Right culture

The service had systems and process in place to protect people from abuse. Lessons were learned when things went wrong. Incidents and accidents were recorded, and actions take to lessen further risks to people. Staff had supervision to provide them with the support they needed to do their jobs properly. People’s equality and diversity was respected. People and relatives were able to complain and if they did the service responded appropriately. The service promoted a positive culture which was person centred. People and relatives were complimentary about staff and management. People and staff were able to engage with the service. The service worked with others to the benefit of people it cared for.

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 14 January 2020) and there were multiple breaches of regulation. The provider completed an action plan after that inspection to show what they would do and by when to improve. We completed a further inspection (published 16 March 2020) to check they had complied with their action plan and that they were no longer in breach of regulations. At this inspection we found improvements had been maintained.

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture. This inspection was prompted by a review of the information we held about this service.

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.

We found the following examples of good practice.

There were safety measures in place for visitors to the housing complex. People entering the service were required to provide evidence of a recent negative COVID-19 Lateral Flow Test (LFT) result. Where visitors had not completed tests before visiting, the service offered these. There was Personal Protective Equipment (PPE) available for visitors to wear, such as a face masks, to limit potential infection transmission.

Relatives of people using the service, and all those living at the complex, were kept up to date on changing visiting restrictions either by phone or email. Similarly, there was signs at the entrance reminding visitors about the importance of hand hygiene, PPE and not to visit if they had COVID-19 symptoms. People were supported to maintain contact with relatives if required. For example, the service assisted with phone calls and window visits when restrictions were in place. As people lived in their own fats and properties they were free to come and go as they pleased. However, the provider supported those who had tested positive for COVID-19 by asking them to isolate where possible and supporting them with food and domestic chores whether they were a service user or not.

Staff were tested regularly. Until recently staff members took Polymerase Chain Reaction (PCR) tests weekly and LFT daily before attending shifts on site. Now in line with updated government guidance the provider only sought LFT results. Only staff providing negative test result were permitted to work.

The service had enough staff. Staff absences were covered by existing staff. The registered manager showed us their contingency planning for the service which explained how the service would be supported should extraordinary circumstances arise, such as further outbreaks of COVID-19.

Infection control policies, procedures and risk assessments were up to date. These supported staff to keep people safe. The provider kept up to date with government guidance with regard to COVID-19 to ensure they were following it correctly, cascading relevant information to staff.

All staff had been trained in infection control and the use of PPE, including agency staff. We saw staff using PPE correctly. Handwashing guidance and infection control signage was displayed in prominent places. The communal areas of the complex was kept clean at all times to maintain hygiene and help prevent the spread of infections.

Oakfield Lodge is registered to provide care and support to people living in specialist ‘extra care’ housing in London Borough of Redbridge. Not everyone who lived in the housing received personal care from the service. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service. People using the service lived in their own flats or bungalows within a gated community where there were 73 properties. The service was providing personal care to 29 people at the time of the inspection.

People’s experience of using this service and what we found

At our previous inspection of this service on 15 November 2019 we found risk assessments were not robust and did not identify risks to people around their health conditions. At this inspection we found improvements had been made and people’s risks were assessed and monitored. There was information for staff to mitigate risks.

At the previous inspection we found staff had not completed their mandatory training as the registered manager lacked oversight of the training staff had completed and what they were required to do by the provider. At this inspection the provider had reduced their mandatory training required by staff, so it was more specific to their care setting and staff had completed it. The registered manager had improved oversight of training and ensured future training had been booked for staff to ensure their compliance with training outcomes. Staff received supervision and the provider had systems in place to ensure staff received supervisions regularly.

The service had completed an action plan in response to CQC enforcement since our last inspection and had complied with this action plan. The service quality assurance measures were robust, and the registered manager and senior staff had completed spot checks on all people using the service. There were systems in place to ensure ongoing spot checks would be completed regularly.

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

Rating at last inspection

The previous rating for this service was requires improvement (published 15 November 2019) and there were multiple breaches of regulation. CQC had issued warning notices for Regulation 17 (Good Governance) and Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There was also a requirement notice issued for Regulation 12 (Safe care and treatment) of the same Act. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had been made and the service was compliant with the warning notices issued.

Why we inspected

We undertook this targeted inspection to check whether the warning notices we previously served in relation to Regulations 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC are currently trialling targeted inspections, to measure their effectiveness in following up on a Warning Notice or other specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

Oakfield Lodge is registered to provide care and support to people living in specialist ‘extra care’ housing in London Borough of Redbridge. Not everyone who lived in the housing received personal care from the service. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service. People using the service lived in their own flats or bungalows within a gated community where there were 73 properties. The service was providing personal care to 29 people at the time of the inspection.

People’s experience of using this service and what we found

At our last inspection in 2018 we found breaches of regulations on safe care and treatment, good governance and staffing. At this inspection we found little improvement had been made and therefore further improvement was required; specifically, risk assessments were not personalised and did not always address people’s medical conditions, staff had not completed their mandatory training, and quality assurance systems were not up to date or effective in monitoring or improving care.

Some staff had not received regular supervision. New staff received inductions, though their training was incomplete. This meant that people being care for may be receiving care from people who had not been trained in all aspects of their role.

People were supported to have maximum choice and control of their lives and staff did support them in the least restrictive way possible and in their best interests; however the policies and systems in the service did not support this practice because staff had not received training on the Mental Capacity Act since 2012.

There were safeguarding systems and processes in place that helped protect people from the risk of abuse. There were robust recruitment procedures in place. Staff used infection control practices. Incidents and accidents were recorded, and actions completed to mitigate their risk of reoccurrence.

People were supported with their health care needs and the service worked with other agencies to ensure people received good care. Food and fluid preferences were recorded for people. People’s needs were assessed before they used the service, so they service knew whether they could support people or not.

People and relatives told us staff were caring. Policies and procedures at the service supported equality and human rights. People expressed their views and had input into their care. People's privacy and dignity were respected.

The service was able to work with people who were at the end of their life. We have made a recommendation about recording end of life wishes as this was not systematically completed as best practice guidance recommends. People knew how to make complaints and the service responded appropriately when complaints were made. Care plans recorded people’s needs and preferences. The service supported people with communication needs and sought to ensure people were not isolated in their homes.

People thought highly of the management. The management acted responsively to concerns. People and staff were able to feedback about the service which was then acted upon by management. The service had links to the local community and with other health and social care providers.

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

Rating at last inspection

The previous rating for this service was requires improvement (published 26 November 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified continued breaches in relation to safe care and treatment, good governance and staffing.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Oakfield Lodge is registered to provide care and support to people living in specialist ‘extra care’ housing in London Borough of Redbridge. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is bought or rented, and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service. This type of housing allows people who need the reassurance of 24-hour care and support to continue to live independently in their own home for as long as possible. The Oakfield Lodge scheme has self-contained flats with access to communal areas and social activities. Some tenants of the scheme were independent and did not receive personal care or support from the service. There were 30 people within the Oakfield Lodge scheme who received personal care from the service.

There was a registered manager in place. 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.

Risk assessments were in place however, they lacked detail regarding plans to mitigate risk. This did not adhere to the provider’s policy on risk management. There were also no records of lessons being learned when things went wrong as the registered manager did not complete any analysis of incidents or accidents.

Staff did not receive training that was planned to take place and had not received refresher training in certain topics for over 3 years. There was a lack of robust governance procedures in place, including a lack of audits or quality assurance checks. The registered manager told us they completed no audits and were unaware of audits taken by the local authority which they should have known about.

People’s privacy and dignity was only respected sometimes. Staff did not always knock before entering their properties and people’s personal information was not always kept securely.

Peoples concerns and complaints were not always listened to. People told us they felt nothing happened following their complaints and we found the registered manager was not maintaining a log of complaints.

People were safeguarded from abuse through robust policies and procedures and staff’s knowledge of what to do if they suspected abuse. There were enough staff working at the service to meet people’s needs and there were responsible recruitment procedures were in place.

People’s needs were assessed appropriately before they started using the service by social workers with whom the service had close links with. Staff received supervision and appraisals to support them in their roles. People were supported to have a balanced diet and to eat healthily. Staff had systems in place to communicate effectively.

People were supported to access relevant health care services and the provider was compliant with their duties under the Mental Capacity Act 2005. People received personalised care that was responsive to their need and they told us they were treated with respect and that staff were caring. People and staff told us they were able to express their views through meetings and surveys.

Staff spoke positively about the management. The service had good links with the local community.

We identified breaches of three regulations relating to safe care and treatment, good governance and staffing. You can see what action we told the provider to take at the back of the full version of the report.

This is the first time the service has been rated Requires Improvement.

Oakfield Lodge is registered to provide personal care and is part of community services provided by the London Borough of Redbridge. They provide an extra care service to 32 people who are tenants at Oakfield Lodge, which is one of the borough's sheltered housing units. The service offers individuals personal care, support and 'extra care' they require to continue to live independently.

There was a registered manager in place. 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.

People and their relatives told us they felt their relatives were safe. We saw staff had received training to enable them to recognise signs of abuse and how to report them. There were processes to minimise risks associated with people’s care to keep them safe and to enable them to be as independent as they could be.

There were sufficient staff to support people with their needs and received consistent support from staff who knew them very well. Recruitment checks were carried out on staff to ensure their suitability to work with people who used the service.

Staff had attended a variety of training to ensure they were able to provide care based on current practice when supporting people. They were supported by the registered manager and had regular one to one time meetings.

People told us the support provided met their needs and the staff were kind, caring and polite. They felt able to make requests and express their opinions and views.

People and their relatives said they could speak with staff or the registered manager if they had any worries or concerns and they would be listened to. People had good relationships with staff that had a good understanding of people’s care.

The registered manager understood the principles of the Mental Capacity Act (MCA), and staff told us how they respected people’s decisions and gained people’s consent before they provided personal care.

We found systems were in place to make sure people received their medicines safely. People were assisted to arrange health appointments if required.

People felt they were treated with kindness and had their privacy and dignity respected. Staff provided care and support in a caring and meaningful way. They knew the people using the service well.

People had a support plan that reflected their individual needs and wishes and these were reviewed to ensure they remained up to date.

There was an effective quality monitoring systems in place. The registered manager was open to improvement and welcomed feedback from people or their relatives, staff or other professionals.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and reduce the risk of abuse from happening. They or their relatives said they felt safe using the service and if they had any concerns they would speak to their carer or the manager.

We found that staff received appropriate professional development. People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on in most cases. The service had a system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service. A relative said 'if we have anything we need to raise, we raise it and feel they've (management) responded to it."

People said they would raise any concerns with the manager, careworker, relative or friend. One person told us "I would go to the office and they would look in to it." They were confident that their complaints would be listened to and resolved by the manager to the best of her ability.