We undertook an unannounced inspection on 6 and 7 June 2017 of Five Oaks. Five Oaks is registered to provide nursing care and accommodation for a maximum of 45 older people. At this inspection there were 44 people living in the home.

At the last inspection on 27 and 28 November 2014 the home was rated ‘Good’. At this inspection we found the service remained ‘Good’.

The service had a registered manager. 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 legal requirements in the Health and Social Care Act 2008 and the associated regulations on how the service is run.

Risks had been identified and assessed that provided information on how to mitigate risks to keep people safe.

Medicines were being managed safely.

Staff had the knowledge, training and skills to care for people effectively. Staff received regular supervision and support to carry out their roles.

Staff sought people's consent to the care and support they provided. People's rights were protected under the Mental Capacity Act 2005. Deprivation of Liberty safeguarding (DoLS) applications had been made to deprive people of their liberties lawfully.

People had choices during meal times. Specific diets were catered for. People and relatives told us they generally enjoyed the food. People’s weight was regularly monitored and appropriate action taken if people lost weight.

People had access to healthcare services.

People told us that staff were friendly and caring. Our observations confirmed this.

People were treated in a respectful and dignified manner by staff who understood the need to protect people's human rights.

There was a programme of activities. These activities took place regularly.

People received care that was shaped around their individual needs, interests and preferences. Care plans were person centred.

Staff felt well supported by the management team and people and relatives were complimentary about the management of the home.

Quality assurance and monitoring systems were in place to make continuous improvements.

At the last inspections on 17 July 2013, we identified that staff were not receiving regular and appropriate supervision. The provider sent us an action plan to address this.

At this inspection, we returned to review the provider's actions to address the lack of staff supervision. The provider had attempted to ensure staff were supported, and over half of the care staff had received a supervision or an appraisal since the last inspection. Despite this, supervisions were still not being delivered in line with the home's supervision policy. Since the inspection, the registered manager had carried out supervisions for all care staff and arranged supervision and appraisal dates for 2014 for all employed staff.

On balance we found that the provider had taken steps to ensure staff were appropriately supported.

We observed that staff were kind and promoted people’s mobility. The format of the care plan had been changed and we saw they were person-centred and included people’s individual preferences, such as for two pillows or a scotch or gin before dinner. The care plan records were mostly complete although we did find that some additional records were kept in different places. The provider was continuing to improve record-keeping.

Systems were in place to protect people at risk of poor nutrition or hydration. Their food and fluid intake was monitored and we observed that people were helped to eat and drink at lunchtime.

Staff received appropriate professional development. A comprehensive training matrix was in place and we saw induction checklists were completed. The frequency of supervision meetings did not meet the provider’s own policy however.

The provider had systems in place to improve the quality of the service delivered and we saw that learning from incidents / investigations took place and changes had been implemented.

We used a number of different methods to help us understand the experiences of people using the service, because some of the people using the service had complex needs which meant they were not always able to tell us their experiences.

We observed staff supporting people in a friendly and professional way and saw that people were being offered choice with regard to menus, activities and care preferences. We observed that the way staff were supporting people in the home had a positive effect on their well being. People who use the service told us that staff were kind and respected their privacy. One person commented, “they are very, very kind.”

People were able to express their views and were involved in making decisions about their care and treatment. They told us they had good access to health care professionals such as doctors, district nurses, dentists and chiropodists. People felt safe with the staff who supported them. They said they had no concerns or complaints about their care but knew how to raise a concern if the needed to. We saw that the complaints procedure was clearly displayed in the reception area .One person told us, “I cannot fault the staff.”

People told us that they thought there were enough staff on duty to support them properly. We saw that medication records were being regularly audited so that any issues or problems could be identified in a timely manner.

On the day of our inspection we were informed that the registered manager had very recently resigned from her post and that the service manager would be providing full time management of the home.

People who use the service were generally very positive about the care and treatment they receive at the home. People told us the staff were kind and professional. One person who had recently moved into the home told us, “It’s a good home, it’s clean and the carers are very good”.

We observed staff supporting people in a friendly and respectful manner.

People told us that the quality of food provided by the home had improved since our last inspection. Comments included, “The variety of food is better”, “It’s improved a lot”, “It’s OK” and “It’s really nice”.

People confirmed that there was a choice of menu and that they always had enough to eat.

We observed that lunch time was relaxed and sociable and staff were providing discreet support when needed.

We observed medicines given to three people and saw that they were given professionally, with patience and explanation.

Other people we spoke with said they were happy with the arrangements that the home makes for their medicines.

People who use the service were positive about the staff team at Five Oaks. Comments made by them included, “They are all hard working” and “I’ve no complaints about the staff”.

Staff we spoke to told us they enjoyed working at the home and understood the need to improve service delivery.

People who use the service were generally positive about the staffing levels at Five Oaks. Some people told us that, as there were only three staff on duty during the night, the night staff were very busy during this time. One person commented, “They are so busy”.

Staff we spoke to told us that there were sometimes problems with managing people with dementia who may not sleep throughout the night.

People told us that they had no complaints about the service. However some people told us they were unclear about how and who to make a complaint to if they did have concerns. One person told us, “I like to make suggestions rather than complaints”.

We saw from our inspection of records of administration and stocks of medicines that some people were not receiving their prescribed medicines. The medicines concerned were prescribed for heart disease, bone disease, gastro-intestinal disorders and dementia. Not having these medicines could have a detrimental impact on peoples’ health and well being.

People who use the service told us that staff were kind and respectful and made sure their privacy was respected. One person commented, “They are so kind and lovely”. People told us that the service kept them informed about their care and that they had opportunities to be involved in planning their care needs. People said that the staff talk to them and let them know about the care and support they are receiving. One person commented, “They are very good”. People who use the service were positive about the care and support they receive at the home. Visitors to the home told us that they could visit at any reasonable time and that the management and staff always made them feel welcome. People said they were happy with the activities provided and that they could choose to join in if they wished.

People who use the service told us that the quality of the food was generally poor.

People confirmed that they were satisfied with how the home communicates with the doctor and other health care professionals.

People told us they felt safe at the home and that they knew who to talk to if they had any concerns. One person commented, “I feel safe”.

People told us they were happy with the cleanliness of the home. Comments included, “It’s very good”, “You can’t fault it” and “There are no offensive smells”. A visitor told us the care was, “Amazing”. We asked people what they thought about the quality of care they received and people said it was very good. People said they had a good relationship with the manager and they felt the manager listened to their comments and concerns.

We undertook this unannounced inspection on 29th & 30th November 2015 of Five Oaks to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008. The last inspection was carried out on 19th December 2013 and the home was found to be compliant.

The home has a registered manager. 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 of the Health and Social Care Act and associated Regulations about how the service is run.

Five Oaks provides care and accommodation for a maximum of 45 older people, some of whom may have dementia. At this inspection there were 43 people living in the home. On both days of the inspection staff were welcoming and people in the home looked relaxed and well cared for. We saw staff talking with people in a friendly and respectful manner. One person said, “I have been treated with respect and my privacy have been respected.” Another person commented, “I am happy here. The food is good, the staff are pleasant.”

Three professionals who provided us with feedback stated that their clients were well cared for and the home was well managed.

Throughout the inspection we saw that staff were responsive towards people and constantly checking that people were safe and their needs met. Staff respected people’s privacy and knocked on bedroom doors to ask for permission before they went in.

People’s needs had been assessed and appropriate care plans were prepared with the involvement of people and their representatives. Their physical and mental health needs were closely monitored. There were regular reviews of people’s health and the home responded appropriately to changes in people’s needs. People were assisted to attend appointments with health and social care professionals to ensure they received treatment and support for their specific needs.

Staff had been carefully recruited and provided with the training they needed to enable them to care effectively for people. Staff we spoke with had a good understanding of the needs of people. People, their relatives and three professionals informed us that staff were caring and provided people with the care they needed.

There was a safeguarding adults policy. Staff had received training and knew how to recognise and report any concerns or allegation of abuse. Staff were aware of the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). The DoLS are part of the Mental Capacity Act 2005. They exist to protect the rights of people who lack the mental capacity to make certain decisions about their own wellbeing. Staff knew they had to obtain appropriate authorisations when it was necessary to deprive a person of their liberty for their own safety. We however, noted that applications had not been made for people living in the home who needed continuous supervision and due to risks to their safety were therefore not free to leave without staff or relatives accompanying them. The registered manager agreed to consult with the local authority officer responsible for DoLS regarding this. Following this inspection, she confirmed that she had made the necessary applications.

The registered manager and the staff team worked with other social and healthcare professionals to ensure people received appropriate care and support. The feedback received from the three professionals we contacted, was overwhelmingly positive. Meetings and one to one sessions had been held to ensure that people could express their views and their suggestions were addressed. The last satisfaction survey indicated that people were satisfied with the quality of care provided.

The home had a complaints procedure and people were aware of who to talk to if they had concerns. Relatives informed us that when concerns were expressed, staff responded promptly and appropriately.

We found the premises were clean and furnished to a high standard. Infection control measures were in place although the policy needed to be updated. There was a record of essential inspections and maintenance carried out. Window restrictors had been fitted to bedrooms we visited. Fire safety arrangements were in place.

People informed us that staff listened and responded to suggestions made by them. The results of the last survey indicated that people who used the service and their representatives were satisfied with the services provided. The quality of the service was carefully monitored. Regular audits and checks had been carried out by the manager and area manager of the company to ensure that people were well cared for.