Oak Farm

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Systems and processes designed to oversee the safety and quality of the service needed some review to address the concerns we identified. Leaders were present at the service and acted as role models. The Registered Manager was held in high regard by people who used the service, relatives, staff and most healthcare professionals. The registered manager told us they are committed to working on relationships where needed, in order to ensure the best outcomes for people who use the service.

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Staff gave very positive feedback about the registered manager and considered them a role model. There was also positive support for the deputy manager. Care staff were positive about the nurses and felt able to rely on them for advice and guidance. One staff member explained, '[The registered manager] goes on the floor and helps if ever we need it -without asking.'

Although staff gave positive feedback about the leadership of the service and of the registered manager in particular, we found processes that had been put in place were not always robust. Induction and ongoing training did not ensure staff were fully clear on all aspects of their role, such as Deprivation of Liberty Safeguards, safeguarding and safe medicines management. Oversight had not identified the issues we found during our assessment.

Staff told us they felt comfortable raising issues and had the forum to do so. Staff surveys were circulated for feedback and comment. Staff had regular supervision and stated the registered manager had an 'open door' policy' and would always be happy to make time for them to raise an issue. Staff knew there were external agencies such as the local authority and CQC who could be contacted if they had any concerns about the service.

There were policies and procedures in place to assist staff to speak up should they need to. Information about how to raise concerns (whistleblow) externally was available to staff. We received some mixed feedback from relatives. Some said they had not been given a formal opportunity to give feedback on the service but nobody had felt the need to make any formal complaint. Where people had raised issues with the registered manager, they were satisfied with the response they had received and positive about the experience.

Staff told us the service was inclusive and treated them equally and fairly. Staff recruited from overseas were well integrated into the staff team and told us the team worked well together. Some staff had left to join other providers but returned as they viewed this provider as fair and felt staff all focused on the needs of the people who used the service.

Staff received equality and diversity training, although 7 staff's training had expired.

Staff were able to tell us about how they hand over and manage information to ensure people received the care and support they required. They said they had confidence in the management team and told us they understood their roles and responsibilities well. However, some staff were not clear on some fundamental issues such as fire safety, Deprivation of Liberty Safeguards and safe management of medicines.

Systems and processes to monitor and ensure the safety and quality of the service were not always fully established and effective. The registered manager completed a weekly care audit but other staff, including regional staff had not signed it and it was not clear who had viewed the document. Whilst the audit was wide ranging and identified areas which needed improving, it was not always clear what actions had taken place and who had oversight of this. The issues we identified relating to safe medicines management had not been picked up in these weekly audits, although they were followed up in the next weekly audit to take place following our onsite visit. The issues we identified during this assessment, including staff confusion over people's DoLS status and fire procedures had also not been identified by the provider using their own quality assurance processes. The registered manager said the weekly audits and monthly overview of accidents, incidents and near misses were shared with the provider but there was no evidence of this and it was unclear how this oversight worked in practice, although staff told us regional leaders were regularly at the service.

Staff told us they felt confident to share any ideas to improve the service and did this in staff meetings and had been asked to do this via an annual staff feedback survey, which the provider carried out. Nurses completed their revalidation programmes and told us they shared knowledge and information with care staff. The registered manager carried out a mentoring role with another of the provider’s services on the same site. They told us they used this to share good practice and innovation.

Staff told us they worked well with other health and social care providers. The local GP service had a regular visit set up with the service to monitor people's health and feedback about this was positive on both sides. We observed staff discussing a person's care with staff from the hospital they had recently been discharged from. Communication was clear and staff recorded new information on the person's care plan.

Partners gave mixed feedback with some praising the partnership working highly and others raising significant concerns. Relationships with some healthcare professionals were not positive and the registered manager accepted work was needed to improve this. One professional commented, '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.' Other professionals made similar comments. However, some healthcare professionals found the service did not work easily with them and did not follow guidance and care plans always, which had been put in place by other healthcare professionals involved in people's care. One professional commented, ‘The culture is controlling of those with capacity who have spinal injury.' We saw that the registered manager and these professionals had a poor working relationship and the registered manager acknowledged that they needed to address this with the professionals concerned in order to ensure people had the seamless care they required.

The provider worked closely with a variety of health and social care professionals and most relationships appeared to be very positive. Where they were less positive limited action had been taken to examine this and review ways of working. The provider did not proactively seek out feedback from other professionals and, where relationships were not working well, there was an adversarial culture at times. The registered manager acknowledge the issue and noting concerns on both sides, gave us assurances they would address this with the partners concerned.

Staff told us they felt confident to share any ideas to improve the service and did this in staff meetings and had been asked to do this via an annual staff feedback survey, which the provider carried out. Nurses completed their revalidation programmes and told us they shared knowledge and information with care staff. The registered manager carried out a mentoring role with another of the provider’s services on the same site. They told us they used this to share good practice and innovation.

Nursing and care staff worked in partnership with the service’s complementary professionals such as occupational therapists and physiotherapists and aimed to put their programmes in place. Information sharing and analysis was in place. However, sometimes people had refused an aspect of their care and been repeatedly documented as being ‘non compliant’ rather than a more detailed account of how this was being managed.