Oak House

We found the following examples of good practice.

• Clear signage was on display within the service, highlighting to visitors the risks that COVID-19 presented and how to keep themselves and others safe during their visit.

• Personal Protective Equipment (PPE) was accessible throughout the building. This ensured staff wore the appropriate PPE in line with current government guidelines.

• Personalised care plans were in place for people. These documents identified the persons preferences around wearing PPE and how to safely support the person when seeing their friends and family.

• People’s vaccination status was recorded within their care plans. This ensured the dates of these vaccinations were clear as well as the types of vaccination they had received being detailed.

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.

Oak house is a residential home providing personal and nursing care to seven people living with autism, learning disability or other sensory impairment. At the time of our inspection there were three people using the service all under 65.

Oak house is an adapted building providing single bedrooms on ground and first floor, some include a kitchen and lounge. There is also a shared lounge/dining room and kitchen. There was an enclosed garden and easy access to town.

The service had not been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This would have ensured 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 did not receive a sufficiently planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The building design was appropriate. There were deliberately no identifying signs, intercom, cameras, industrial bins 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

The three people using the service at the time of our inspection had very different needs which required one to one staff support. We had concerns that people's care records were not sufficiently robust or for one person make it clear how their needs were clearly being met. Their care plan did not include a clear transitional plan when transferring from hospital to care home and there was poor evidence of how they were being supported to develop their skills and confidence.

People’s needs were not sufficiently well managed. Records did not show how changes in need were quickly identified and there was insufficient action to mitigate risk. People were at risk from self -inflicted behaviours or challenging behaviours from others and staff were not sufficiently equipped to deal with people’s behaviour. This resulted in incidents which could have been avoidable and self -neglect which went unchallenged.

People had been assessed as needing a minimum of one to one staffing and in certain situation two to one staffing. Staffing levels were being maintained but records did not provide evidence that people had lots of opportunity to engage in activity in and out of the service. We did not see regular, planned activity for people to develop their confidence, self-esteem and independence.

Team work was not good with some staff having a poor attitude to their job. The service objective talked of creating a calm, therapeutic atmosphere for people. This is not what we observed. Some staff did not demonstrate the right attitude or demonstrate how they could adapt their practice to working in a community care setting. Not all staff were following procedures or reporting incidents in line with operating procedures. This in effect meant incidents were not appropriately managed. The new manager of the service was aware of issues amongst the staff team and was addressing these with support from operational staff and human resources. We had concerns that their records did not show how these performance issues were being addressed but were reassured that the provider was taking action through their human resources department.

Since registration there had been three changes in manager, including a peripatetic manager which had impacted on the stability of the service and had meant that staff had not had clear leadership and direction. The new manager had been in post a month, the deputy manager a week. They were making some inroads in terms of service improvements and there was a clear action plan in place. Despite these improvements there had been a number of significant incidents in the week leading up to the inspection where people had suffered harm which could have been avoided if staff worked consistently and in line with best practice.

Rating at last inspection

This service was registered with us on 25 May 2018 and this is the first inspection.

Why we inspected

This was a planned inspection carried out according to our methodology. We have found evidence that the provider needs to make improvements. Please see the relevant key question sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified five breaches in relation to the safety of people using the service as a direct result of poor management and oversight and staff not having the necessary skills and competences. People were not receiving a service around their assessed needs and preferences in the least restrictive way.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

In response to this inspection CQC took some actions against the provider to help ensure the service continued to make the improvements necessary.

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