The Oaklea Trust (Durham & Northumberland)

During our assessment of this key question, we found concerns around safeguarding and mental capacity. This resulted in breaches of regulation 11 and 13 of the Health and Social Care Act 2008 (Regulated Activities). Safeguarding concerns had not always been responded to fully to keep people as safe as possible. Staff had safeguarding training and knew how to recognise abuse. Staff had not always followed the requirements of the Mental Capacity Act 2005 (MCA). There was not always guidance for staff when people were being deprived of their liberty, for example if they needed constant supervision. Staff could not confidently tell us who had Deprivation of Liberty Safeguards in place (DoLS is the legal authorisation to deprive someone of their freedom) or if these had been applied for. You can find more details of our concerns in the evidence category findings below. Recruitment records needed to improve to ensure risk assessments were completed for staff who required these. Staff knew people well and supported them with risk management, however, because of the lack of clarity around MCA we could not be sure people always understood and agreed to how risks were managed. There were processes to respond to risk and learn from incidents. People and relatives told us that people felt safe at the service, they were happy and that they knew who to speak to if they had concerns.

The provider had not always considered or documented people’s capacity to consent in line with the Mental Capacity Act 2005. Where people lacked capacity to make their own decisions there was not always documentation to show decisions had been made in-line with MCA requirements and in their best interest. Staff had received training around the Mental Capacity Act 2005 and associated Code of Practice. Staff told us they felt they supported people to make informed decisions when care was delivered. People and relatives confirmed people were consulted in decision making, advocates and professionals were also involved for bigger decisions.

Staff were kind and caring. People and relatives told us they were happy with the choices on offer and were involved in decisions about their care. They told us they were supported to live as independently as possible. While we observed some positive practices, we could not be assured processes supported people to make choices that they had the capacity to consent to. Staff did not have documented guidance about MCA and best interest decisions to support people with choices made on their behalf.

People had good experiences and outcomes. People and relatives told us people achieved good care outcomes and accessed health and social care services when they needed them. People accessed the community and took part in activities of their choice. Staff assisted people to set and work towards goals and evidenced when these were achieved. Staff also told us they worked with people and their families to achieve the best outcomes for people.

The service was not consistently well-led. Governance processes were in place, but these failed to identify and remedy the issues found at this assessment, around safeguarding, MCA, recruitment, medicines and people’s personal finances. Improvements to MCA had been recommended by a partner agency in May 2024 but limited action had been taken to address this. This resulted in a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities). The service is supported by 2 registered managers, although each was knowledgeable about their area of the service neither had full oversight of the service. The management team were open and approachable and acted on feedback given at this assessment around standardising MCA and finance practices. All people, relatives and staff gave positive feedback about the management of the service and the support they received. They told us there was a positive culture and they felt confident to raise any concerns. People, relatives and staff were asked for their feedback, and this was used to develop the service. The provider invested in a range of initiatives to support staff wellbeing and worked hard to promote the values of the service at every level in the organisation. Staff attended forums to share best practice, and people were active members of their local communities.