We expect health and social care providers to guarantee people with a learning disability, and autistic people, respect, equality, dignity, choices and independence, and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability, and autistic people, and providers must have regard to it.About the service
Oakleigh Lodge is a residential care home which can provide personal and nursing care for up to three people. Oakleigh Lodge is a care home which does not provide nursing care. Three people were living at the care home at the time of the inspection.
People’s experience of using this service and what we found
People were not always supported by enough suitable staff to meet their individually assessed needs in a person-centred manner. This impacted some aspects of the care people received and their ability to engage in community-based activities which were meaningful to them.
People were supported by staff who had not all received specialist training in how to support people who had complex care needs.
Parts of the care home required refurbishment to enable effective cleaning and infection prevention and control.
People ate a varied diet, and mealtimes were relaxed and flexible. People’s weight had not been regularly monitored and action had not always been taken when a person lost weight unexpectedly.
People were not always supported to follow and achieve their goals and aspirations. Community based activities had reduced during the COVID-19 pandemic and were still limited due to staff shortages.
Relatives were not always involved in the development of people’s individual care plans and were not always informed about people’s activities.
The provider had quality monitoring processes in place but had not identified all the issues which we found during the inspection. The communication of important information, from the previous registered manager to the provider, was not always effective. The provider’s quality monitoring processes were not always effective, and this hampered the provider’s ability to understand what was happening in the care home.
The care home layout met people’s mobility support needs and people’s bedrooms were generally personalised. However, some areas of the care home needed redecoration.
People were supported by staff who knew how to protect them from potential abuse or neglect and the provider had procedures in place to support that. People had access to sensory activities in the care home and in the garden area, which they enjoyed.
People’s prescribed medicines were stored, administered, and recorded appropriately. People had health action plans in place and were supported to access specialist medical support services when needed.
Staff followed appropriate guidance in respect of the use of personal protective equipment and the care home had safe visiting arrangements in place.
People’s communication needs were met by staff who understood how each person communicated. People’s privacy and dignity was maintained. Staff were kind and compassionate when supporting people.
Right Support
People did not always receive person-centred care due to the provider not having enough staff. People had limited opportunities to engage in community-based activities which were meaningful to them. The service enabled people to access specialist health care support from the community health care teams when required. The service gave people care and support in an environment which met their sensory and physical needs. Staff communicated with people in ways that met their needs.
Right Care
Staff promoted equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care. People received kind and compassionate care. Staff protected and respected people’s privacy and dignity; and understood how to protect people from poor care and abuse.
Right culture
Staffing levels affected how the service could meet people’s needs and wishes. Not all staff had received the specialist training necessary to understand best practice; in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. However, staff knew people well and placed people’s wishes, needs and rights at the heart of everything they did.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was Good (published 20 August 2019).
Why we inspected
We undertook this inspection to assess that the service is applying the principles of Right support right care right culture. The inspection was also prompted, in part, by our receipt of concerns relating to staffing levels and personalised care. This inspection examined those risks.
We also looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Responsive and Well-led 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 are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches of regulations 9, 15, 17 and 18 in relation to staffing levels, person centred care, hygiene, and governance processes, at this inspection. We have issued the provider with a Warning Notice.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.