Oaklands

The service was not always effective and has been rated requires improvement. We found a breach of Regulation 17 relating to the safe management of medicines.

Medicines were not always managed safely. Whilst Medicine records assured us people were receiving their oral medicines as prescribed, records did not always support the safe administration of medicines. For example, there was not a robust process in place to manage the application of topical medicines. Records for all topical medicines completed by care staff, including those that were medicated, were not robust and we found significant gaps in recording. For example, for one person who received cream for their PEG (Percutaneous endoscopic gastrostomy) site, for recurrent infections, records showed this was not consistently applied as per prescribed instructions placing this service user at unnecessary risk. Records reviewed demonstrated that medicated creams were being applied by care staff without the appropriate training and management staff confirmed this. Care plans were in place and the content in these care plans was person specific. However, further detail was required for some people using the service with complex conditions such as diabetes. We found no evidence that people had been harmed. However, systems were either not in place or robust enough to demonstrate medicines were always effectively managed. This was of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People received a safe service. The provider had systems in place to investigate accidents and incidents to ensure there were lessons learned to embed good practices. Safeguarding incidents were appropriately reported to the relevant agencies and investigations undertaken. Staff and the manager worked with other agencies to help keep people safe. There were effective systems in place to safely recruit staff. There were enough staff to care for people.

People and their representatives were involved in the assessing and planning of the person’s needs. Assessments of people’s care considered their emotional and physical wellbeing, communication and communication needs.

The service worked with other health and social care professionals to support people and provide consistency in care. Staff worked together to share information about the people they were supporting to ensure people received consistent care. Information was shared via staff meetings and daily handovers.

We found the service was working within the principles of the Mental Capacity Act 2005 and if needed, appropriate legal authorisations were in place to deprive a person of their liberty. Any conditions related to DoLS authorisations were being met.

Staff had developed positive and caring relationships with people which helped them to deliver person centred care to meet people’s individual needs and preferences. Care plans included detailed information on people’s cultural needs, abilities and aspirations.

People were able to receive visitors without restrictions in line with best practice guidance. Family members said they could visit their loved one at any time. People were supported to maintain contact with those important to them.

Staff we spoke with spoke positively about the support they received from management. Staff had access to regular team meetings and one to one supervision which enabled them to provide feedback about the service and seek any necessary support or guidance.

People’s care plans holistically reflected their care and support needs. This included physical, mental, emotional wellbeing, social and cultural needs. Where people required specific support to meet their cultural needs this was reflected in their care plan. People who use the service and their representatives were regularly involved in planning and making shared decisions about their care and treatment, so it is centred around the person and their needs.

People were supported to live healthier lives and had choice and control over the activities they participated in. Adjustments were made to ensure people were able to attend their appointments. For example, social stories were used to support people with what to expect before their appointment.

The management were knowledgeable about the needs of the people using the service. There were regular team meetings where the values and the direction of the service were discussed.

There were systems in place to monitor the quality of service provided and identify improvements. However, whilst the registered manager carried out audits and checks; these had not identified the shortfalls we had found with safe medicines management. Where audits had identified improvements, these were recorded in the home action plan. There were processes to ensure that learning took place when accidents or incidents occurred to minimise the risk of them reoccurring.

Staff felt confident in raising concerns with management, who they described as open and approachable. Comments from staff included, “Feel like I can approach management team here” and “There is a really good management team. They are approachable easy to talk to and there is an open door policy. The managers will help you with looking for ways to improve things for people.” Where staff had made suggestions there was a ‘you said, we did’ information board which informed staff of any actions taken by management to implement their suggestions. People and staff were encouraged to give feedback about the service, which was being used to drive improvements.