Oak House

Updated 29 March 2022

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

As part of CQC’s response to the COVID-19 pandemic we are looking at how services manage infection control and visiting arrangements. This was a targeted inspection looking at the infection prevention and control measures the provider had in place. We also asked the provider about any staffing pressures the service was experiencing and whether this was having an impact on the service.

This inspection took place on 24 February 2022 and was announced. We gave the service 24hours notice of the inspection.

Updated 29 March 2022

About the service

Oak House is a residential care home providing personal and nursing care to one person aged 18 and over at the time of the inspection. The service can support up to seven people. The service provides self-contained accommodation which includes a bedroom, lounge, bathroom and kitchenette. Accommodation is provided on both ground and first floor level and there is a shared garden, communal kitchen, laundry and shared areas. The service is situated in the heart of Diss.

Services for people with learning disabilities and or autism are supported

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 and what we found

At the last inspection which was the first inspection for this service we found wide spread failings and rated the service inadequate and placed it in special measures. We put a restriction on new admissions until the service made the improvements required. At our latest inspection the service was supporting one person. The previously registered manager had left the service and a temporary experienced manager had been registered to help ensure the service had some continuity. The deputy manager told us they were applying to be the registered manager and a new deputy manager would be appointed.

We were encouraged by the progress made by the management team since our last inspection. Staff told us they felt well supported. There was regular input by the senior management team. The provider had sent us a monthly action plan to show us month on month improvements being made. This included information about the management of risks, incidents and staff competency and training. However, these improvements need to be sustained, maintained and fully embedded in the service.

Although this was an improved service, we found some gaps in records and recording particularly in relation to staff recruitment and staff induction. We were however satisfied that recruitment was adequate.

The culture of the service had been a concern at the last inspection, and we found at this inspection some staff had left voluntarily, other staff had faced disciplinary actions. The current staff team had been supported to ensure they worked in a way which was appropriate to the setting and had the necessary training required. This included value-based training which centred on the needs of people using the service.

Staffing was appropriate and overstaffing gave the service flexibility to undertake staff training and other core activities associated with the regulated activity. Regular agency staff were being used to cover nights and sleep ins. The service was actively recruiting staff and assured us they would not admit any further people unless they had the staffing in place.

Risks were appropriately documented showing what actions were being taken to reduce and mitigate risk. The environment was fit for purpose and regular auditing and checks on equipment helped ensure it was safe. Any incident was logged and showed actions taken by staff and whether it was appropriate or what if any lessons could be learnt.

Staff told us there was space to reflect on their practices and all staff had received training to help them deescalate any situations where people using the service where anxious or their behaviour challenged others. Staff told us training had provided them with more confidence and skills to manage these moments effectively and keep people safe. Incidents had significantly reduced and we discussed what additional training staff could receive to help them understand people’s needs further.

Medicines were appropriately managed, and auditing was effective. Staff supported people to stay healthy and access the services they needed. People were supported with their meal preparation and diet.

Recruitment records on site were not fully complete but recruitment processes were robust and held centrally. We advised the service that they needed a full employment history on site and to ensure agency profiles were regularly updated to show agency workers had up to date training in line with the needs of the service.

Staff training had improved but we found induction records were not robust and records did not show that all staff had completed a sufficiently detailed induction covering all the key areas of practice. The provider assured us the care certificate, a nationally recognised induction course would be rolled out to all staff. All staff had received some observations of practice to assess if they had key competencies necessary for their role. They also had regular supervisions so gaps in their knowledge could be quickly identified.

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 had autonomy to make their own decisions. The service ensured mental capacity assessments were completed and decisions were taken in people’s best interest. However, we found these had been signed off by staff without showing the involvement and consultation of other relevant persons.

People’s needs were met holistically. Care plans were robust and clearly showed people’s preferences and routines. They set objectives to be achieved and progress towards these. We found for the existing person using the service their anxiety was lower and they were managing better within their environment.

There were mechanisms in place to gain feedback about the service from people using it, staff and relatives, but this could be extended to health care professionals to ensure a more balanced view of the service. The service had clear action plans and oversight to ensure the service was progressive, forward planned and met people’s needs safely.

We asked for assurances of how any new admission to the service would be planned and saw the admission policy. We were told there was no urgency and new admissions would be carefully spaced out and due consideration given to staffing and compatibility with the existing service user.

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 Inadequate (published 14 August 2019)

The provider completed an action plan after the last inspection to show what they would do and by when to improve. This service has been in Special Measures since 7 June 2019. During our recent inspection of 12 March 2020, the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

We always ask the following five questions of services.