We completed an inspection of Oakfield Lodge on 15 and 16 August and 4 October 2018. The inspection was announced. We had previously inspected the service on 24 February 2016 and rated the service as Good.

Oakfield Lodge is registered to provide care and support to people living in specialist ‘extra care’ housing in London Borough of Redbridge. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is bought or rented, and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service. This type of housing allows people who need the reassurance of 24-hour care and support to continue to live independently in their own home for as long as possible. The Oakfield Lodge scheme has self-contained flats with access to communal areas and social activities. Some tenants of the scheme were independent and did not receive personal care or support from the service. There were 30 people within the Oakfield Lodge scheme who received personal care from the service.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Risk assessments were in place however, they lacked detail regarding plans to mitigate risk. This did not adhere to the provider’s policy on risk management. There were also no records of lessons being learned when things went wrong as the registered manager did not complete any analysis of incidents or accidents.

Staff did not receive training that was planned to take place and had not received refresher training in certain topics for over 3 years. There was a lack of robust governance procedures in place, including a lack of audits or quality assurance checks. The registered manager told us they completed no audits and were unaware of audits taken by the local authority which they should have known about.

People’s privacy and dignity was only respected sometimes. Staff did not always knock before entering their properties and people’s personal information was not always kept securely.

Peoples concerns and complaints were not always listened to. People told us they felt nothing happened following their complaints and we found the registered manager was not maintaining a log of complaints.

People were safeguarded from abuse through robust policies and procedures and staff’s knowledge of what to do if they suspected abuse. There were enough staff working at the service to meet people’s needs and there were responsible recruitment procedures were in place.

People’s needs were assessed appropriately before they started using the service by social workers with whom the service had close links with. Staff received supervision and appraisals to support them in their roles. People were supported to have a balanced diet and to eat healthily. Staff had systems in place to communicate effectively.

People were supported to access relevant health care services and the provider was compliant with their duties under the Mental Capacity Act 2005. People received personalised care that was responsive to their need and they told us they were treated with respect and that staff were caring. People and staff told us they were able to express their views through meetings and surveys.

Staff spoke positively about the management. The service had good links with the local community.

We identified breaches of three regulations relating to safe care and treatment, good governance and staffing. You can see what action we told the provider to take at the back of the full vers

This inspection took place on 24 February 2016 and was announced. The registered manager was given 48 hours’ notice because the location provides a domiciliary care service. This was to ensure that members of the management team and staff were available to talk to. At our last inspection in November 2013 we found the provider was meeting the regulations we inspected. The inspection was carried out by two inspectors.

Oakfield Lodge is registered to provide personal care and is part of community services provided by the London Borough of Redbridge. They provide an extra care service to 32 people who are tenants at Oakfield Lodge, which is one of the borough's sheltered housing units. The service offers individuals personal care, support and 'extra care' they require to continue to live independently.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People and their relatives told us they felt their relatives were safe. We saw staff had received training to enable them to recognise signs of abuse and how to report them. There were processes to minimise risks associated with people’s care to keep them safe and to enable them to be as independent as they could be.

There were sufficient staff to support people with their needs and received consistent support from staff who knew them very well. Recruitment checks were carried out on staff to ensure their suitability to work with people who used the service.

Staff had attended a variety of training to ensure they were able to provide care based on current practice when supporting people. They were supported by the registered manager and had regular one to one time meetings.

People told us the support provided met their needs and the staff were kind, caring and polite. They felt able to make requests and express their opinions and views.

People and their relatives said they could speak with staff or the registered manager if they had any worries or concerns and they would be listened to. People had good relationships with staff that had a good understanding of people’s care.

The registered manager understood the principles of the Mental Capacity Act (MCA), and staff told us how they respected people’s decisions and gained people’s consent before they provided personal care.

We found systems were in place to make sure people received their medicines safely. People were assisted to arrange health appointments if required.

People felt they were treated with kindness and had their privacy and dignity respected. Staff provided care and support in a caring and meaningful way. They knew the people using the service well.

People had a support plan that reflected their individual needs and wishes and these were reviewed to ensure they remained up to date.

There was an effective quality monitoring systems in place. The registered manager was open to improvement and welcomed feedback from people or their relatives, staff or other professionals.

People told us they were treated with dignity and respect by staff. One person told us "staff are okay, they are kind." We found that staff undertook training in basic care principles, including dignity, independence and choice. Risk assessments and care plans were in place in most cases which set out how to meet individual people’s needs.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and reduce the risk of abuse from happening. They or their relatives said they felt safe using the service and if they had any concerns they would speak to their carer or the manager.

We found that staff received appropriate professional development. People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on in most cases. The service had a system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service. A relative said “if we have anything we need to raise, we raise it and feel they’ve (management) responded to it."

A review of this service was carried out on 4 April 2012, when we inspected four outcomes relating to the care and welfare of people who use services, safeguarding people who use services from abuse, management of medicines and supporting workers. We found that the service was meeting the essential standards of quality and safety relating to these outcomes. In order to complete a full review of the service, on 27 February 2013 we assessed how the service handled complaints received by them.

People said they would raise any concerns with the manager, careworker, relative or friend. One person told us "I would go to the office and they would look in to it." They were confident that their complaints would be listened to and resolved by the manager to the best of her ability.

During this visit we did not speak to people using the service because we were following up concerns identified during our inspection visit on 28 August 2011. We gathered evidence by checking the care plans, risk assessments and other systems the service had implemented to meet the essential standards of quality and safety, following our previous inspection.

One person using the service told us, “yes I like it here” and when talking about the carers, said that “staff are good, they do everything I need.”

Another person said “yes they help me but I need more help now.”

Most people using the service told us that carers listened to what they wanted and did as they were asked. They told us "we get the service we want."

Most people told us that they felt safe and comfortable with the people supporting

them.

When we asked people about the competence of the carers providing a service they

told us that "most of them are very good, caring, but there are others that are not so good".

"The carers know what needs to be done".

“I am happy with the carers, they are always helpful.”