Background to this inspection
Updated
10 January 2020
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 Care Act 2014.
Inspection team
The inspection was carried out by one inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Oak Trees (Respite) is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service also provides care and support to people living in 10 ‘supported living’ settings, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; where people were being supported by the supported living service we looked at people’s personal care and support.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave a short period notice of the inspection because we needed to make arrangements to speak with people using the service.
Inspection activity started on 2 December 2019 and ended on 3 December 2019. We visited the care home and the office for the supported living service on 3 December 2019.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.
During the inspection
We spoke with nine people who used the service and 13 relatives about their experience of the care provided. We spoke with six members of staff including the managing director, the registered manager, a house leader and three support workers. We also spoke with two visiting social care professionals who were working with the service. Following an invitation from one person using the supported living service we visited their home to talk to them about their experience of the care provided.
We reviewed a range of records. This included three people’s care records and five people’s medication records. We looked at one staff file in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at additional training material and other records related to the running of the service.
We spoke with an additional social care professional, another person who used the service, and a support worker. The training manager and a house leader also contacted us to tell us about their experience of working for the service and we spoke with them.
Updated
10 January 2020
About the service
Oak Trees (Respite) is a residential care home which provides accommodation and personal care via a short break (respite) service to people with a learning disability. The service is registered to provide this regulated activity to up to four people at a time. At the time of the inspection three people were staying at the service and 33 people were using the service on a regular basis.
Oak Trees (Respite) is also registered to provide personal care to people living in their own homes. At the time of the inspection the service was providing support to 21 people with a learning disability across ten supported living locations. 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.
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.
There were deliberately no identifying signs, intercom, cameras, or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.
People’s experience of using this service and what we found
Everyone we spoke with praised the high quality of the service provided. People, relatives, and professionals were keen to tell us about the support provided and the positive difference it made. There was a deeply embedded person centred, open, and inclusive ethos. People were fully consulted about their care arrangements and involved in the operation of the service.
People, relatives, and staff worked together to support and develop the service. There was a strong sense of ownership and investment amongst everyone involved with the service. There were strong links to the local community which were utilised to benefit people using the service and this enhanced their daily lives and provided them with equal opportunities. Everyone we spoke with praised the dynamic leadership in the service, notably the registered manager’s passion and dedication. The provider was committed to developing and improving their service. They looked across the social care sector at best practice and considered how this could be implemented within their own service. Robust quality assurance systems underpinned the continual development and improvement in the service leading to positive outcomes for people. Throughout the service we found creative ideas and actions that had helped put people at the heart of their care and decision making.
People were exceptionally safe using the service. There were established relationships of trust and support between staff which enabled people to stay safe. People were empowered to make decisions about their safety, which helped avoid unnecessary restrictions being placed on people and maximised their control over their lives. Staff were very sensitive to the vulnerabilities of people living in the community. They acted proactively when concerns were identified and supported people to protect themselves. A strong sense of security and safety had been created for people by the use of the respite service location as a flexible and accessible space. One relative likened the service location to ‘a crisis centre’ offering a safe space and support for people to stay safe whenever they needed it. People were supported by a creative and inclusive approach which helped them understand potential risks and make decisions in respect to this. Best practice guidance was utilised and adapted to support people’s individual needs and circumstances.
People were supported by a stable and consistent staff team. People were allocated core groups of staff to aid continuity of care and ensure people felt comfortable and safe. If particular sensitive tasks or events took place, then people were supported to express which staff they might like to support them, which was accommodated. Each staff group’s training and skills reviewed in relation to the people they supported. The service understood the importance of empowering people so that they could understood how to live safely. Safety training, such as first aid and infection control, was offered to people alongside staff. People were supported by staff who understood the importance of safe medicine administration. This included ensuring people had regular reviews of their medicines and staff supported people to reduce their use of medicines when appropriate.
People were supported by very compassionate and dedicated staff who genuinely cared for them. Staff took great care and effort to ensure people were supported and their needs met, particularly during distressing or difficult times. Understanding and respecting equality and diversity were at the heart of the service. People’s rights were respected and encouraged. People were supported to lead fulfilling and rich lives by staff who had high expectations of their abilities and needs. This meant staff worked hard to support and increase people’s independence. The service was very inclusive, everybody we spoke with told us that the service felt like a big extended family. The service understood the importance of advocacy and worked hard to ensure people were provided with independent advocacy where necessary. In addition, staff spoke up for people and advocated for them to ensure they had the support and services they needed.
Peoples needs were assessed holistically across a wide range of areas. This included needs in relation to people’s protected characteristics such as gender and sexuality. People were supported by staff who had training and support to understand their needs. Staff were supported to professionally grow and develop, which included gaining nationally recognised qualifications.
People were supported to plan and cook their meals, information was given to people on healthy eating. The service took a proactive and creative approach to helping people understand their health care needs. People were supported to make decisions and feel in control of their own lives. Staff worked with specialist professionals to help support people’s decision making. Where staff had identified concerns around people’s ability to make particular more complex decisions they had requested specialist support, such as a psychologist, to support people’s understanding and decision making. 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 provided with flexible, responsive, person centred care. Staff knew people well. This helped them deliver care that met people’s individual needs and preferences. People’s needs, interests, and backgrounds were taken in to account when supporting people to access the community and take part in social activities. The service thought creatively about how people could be supported to understand information. The service provided face to face information and training sessions to people using the service. A wide range of information, including the service’s policies and procedures, were provided to people in an easy read format.
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.
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 this service was good (published 07 June 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.