Oak Farm

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Most people told us they were routinely asked for their consent before care and support was provided. However, some records did not evidence the correct processes had always been followed in relation to establishing people’s capacity to consent and ensuring their rights. The provider has assured us they will review people’s Mental Capacity Act 2005 assessments in the light of our findings. People’s needs were assessed before they were placed at the service to ensure the service could meet them. Where other healthcare providers, such as spinal injury units, had put care plans in place for people’s recovery and ongoing rehabilitation, the service aimed to follow these. Feedback about this was mostly very positive, although we did also receive some negative feedback. Care was regularly reviewed, and most people were involved in care planning and review. There was good oversight of people’s complex healthcare needs.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People who used the service told us staff knew how to support them with their health and care needs. They said they valued the physiotherapy support. One person felt the service could be more proactive in supporting them to increase their independence and had discussed this with staff. Relatives gave positive feedback and said the staff knew people's needs very well. One relative commented, 'The staff understand my relative's needs. I see them talking to my relative to explain what is happening....The staff value [my relative]. ...I have seen and signed the care plan and am happy with it.' Another commented, 'The staff know my relative so well. About a month ago my relative was not feeling well. They flew into action and called the GP and an ambulance. They were given antibiotics. It was all so fast.'

Staff knew people's individual and complex needs well and provided good support. Staff knew how to access care records and ensured they referred to specialist professionals when needed. Feedback from some of these professionals was broadly very positive with one consultant commenting, 'I have always seen the team to be motivated to make a change and to listen to patients' needs while planning the rehabilitation programme. Those clients who have been admitted for the rehabilitation programme have done well and the feedback from clients have been positive on the approach the team takes.' The provision of a dedicated therapy team meant people needing specialist intervention were well monitored.

Detailed care plans documented people's health and care needs and associated risks. Staff knew where to find key information about people and care plans were regularly reviewed. We received contradictory feedback about how well the service follows plans set out by other healthcare settings, such as spinal units, where people have transferred from. However, most feedback was positive and other professionals felt the service's processes supported people well, although there were areas for further improvement. One healthcare professional commented, 'The physio aspect to the service I believe has been very positive and, for most patients, this is the focus of their stay, and positive outcomes have meant patients have managed to walk long distances when they have been told walking following a spinal injury is unlikely. I think the negatives for me have been around nursing staff not being more proactive in teaching individuals to manage certain aspects of their care interventions and encouraging patients to be more functionally independent in their activities.' The service used national assessment tools to assess and monitor people's pressure care and nutritional needs and risks. People had oral healthcare assessments in place to ensure they maintained their oral health and relatives confirmed this aspect of care was well managed. People’s communication needs were recorded and understood by staff.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

Whilst people felt their physical health needs were very well managed, there was mixed feedback about maximising people's independence. One person commented, 'If I want to do something, like go to [the supermarket] a carer will usually comply.' Some people told us they were not given enough opportunities to develop their independent living skills and set and achieve their own goals. Another told us they were unhappy as they had to go to bed at a time which was not their choice. They explained that staff supported them into bed by 7pm, straight after their dinner and they were bored as there was nothing else to do. They were unhappy with the amount of time they had to spend in their room.

Staff showed an understanding of people's health and wellbeing needs. Staff told us how they supported people to stay hydrated and fluids were promoted during the hot weather. Staff understood people's complex needs relating to their physical health and acquired brain or spinal injury.

We received some mixed feedback from healthcare professionals. Although staff provided excellent support for people's complex physical healthcare needs, staff could be more proactive in supporting people to make healthier choices. Some people had made poor choices with regard to their health and in response to their acquired injuries. One person was making a determined effort to reverse this and become healthier but felt staff were not actively supporting them. We saw that, although processes were in place to support people with their healthy choices, this could be more robust for some people.

People told us staff routinely monitored their healthcare needs. People were involved in reviews of their health and wellbeing needs. Some people stated they wished for more positive outcomes with relation to their social independence.

Staff were aware of their duties to monitor and record aspects of people's care and support and to share significant information with clinicians and other healthcare professionals working with the service.

The service worked in line with care plans set up by other healthcare professionals, such as rehabilitation units. Sometimes these plans had been challenged but a consensus reached ultimately. People's health needs were well managed and feedback from clinicians was mostly very positive. One healthcare professional commented, 'Generally, all advice is acted on, and they are very good at identifying residents whose MUST scores [which relate to people's eating and drinking] are high.'

People who used the service and their relatives stated staff asked for consent before providing care and treatment and most felt their wishes were always respected.

Staff had received training in the Mental Capacity Act 2005 but its principles were not well understood by staff and we received conflicting information about people's rights. For example we received several different lists of names when we asked who was subject to a DoLS (Deprivation of Liberty Safeguards). The registered manager was clear about who had an authorised DoLS in place but staff, including senior staff were not all clear. This meant there was a risk people could be deprived of their liberty without authorisation or insufficiently monitored if a decision had been made to deprive them of their liberty for their own safety. We asked one senior member of staff why one person had a DoLS in place. They responded, '[They are] making unwise decisions'. This is not, on its own, a reason to deprive someone of their liberty and staff training and records needed to reflect this more clearly.

We noted although staff were offering choice and gaining consent for routine care and treatment, when people refused treatment there was sometimes a lack of a proactive approach to try to ensure people received the care they required. Where people refused an element of care it was sometimes recorded that they were 'not compliant' and steps to try and gain their consent were not always documented. We also found some language in records was not inclusive. Some records included people having 'permission to do' things and 'allowing' others. Where people's capacity to consent to care and treatment had been assessed, relevant people had been involved, including the person themselves and representatives. However, some assessments were generic and covered a range of topics rather than one specific topic. This is not the purpose of this type of assessment. We asked the provider to review this and they have given us assurances they will do this as a priority.