This inspection took place on 5 and 16 January 2018. The first day of our visit was unannounced and the second day was planned and agreed with the management team.

Oak House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The home is a grade two listed building situated in the town of Axminster. The service is registered to provide care and accommodation for up to 17 people. They provide care and support for frail older people and some living with dementia. There were 17 people living at the service when we visited.

At the last inspection in November 2016, we found a breach of regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had not ensured that people were always treated with dignity and respect and their privacy was not always maintained. The service had been rated as requiring improvement overall. Following the inspection the provider sent us an action plan telling us the improvements they would make. This included staff receiving supervision to discuss concerns and putting in place curtain screens in shared bedrooms. At this inspection we checked to see whether the requirement had been met and found it had been addressed.

The registered provider is also the registered manager of the service. A registered manager is a person who has registered with CQC 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. The registered manager had delegated the day to day running of the service to a new acting manager who had started working at the service in November 2017. The provider’s area manager worked at the home at least one day a week to provide support for the management team.

People, visitors and staff gave positive feedback about the management team. They were happy to approach them if they had a concern and were confident that actions would be taken if required. The management team and staff promoted person-centred care and a family-like atmosphere at the service. People were treated equally with any diverse requirements accepted and met.

There were sufficient numbers of suitable staff to keep people safe and meet their needs. People were supported by staff who had the required recruitment checks in place and were trained and had the skills and knowledge to meet their needs. Staff had received a full induction and were knowledgeable about the signs of abuse and how to report concerns.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (2005) (MCA). Where people lacked capacity, mental capacity assessments were completed and best interest decisions made in line with the MCA.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS provide legal protection for those vulnerable people who are, or may become, deprived of their liberty. The service had made appropriate applications to the local authority DoLS team for people they had assessed as needing to be deprived of their liberty.

Staff were friendly in their approach and maintained people’s privacy and dignity while undertaking tasks. They supported people to maintain a balanced diet and knew people’s likes and dislikes and ensured people had their preferred meal choice. We observed two lunchtime meals where people were seen being supported discreetly and enjoying their

This inspection took place on 17, 23 and 29 November 2016. The first visit was unannounced and the second visits were planned with the management team. Oak House is registered to provide care and accommodation for up to 17 people, some living with dementia. The home is grade two listed building situated in the town of Axminster. They provide care and support for frail older people and those people living with dementia. On the first day of our visit there were 16 people living at the service which included one person receiving respite support. On the second day of our visit another person had come to the home making 17 people at the service.

We carried out an unannounced comprehensive inspection of this service on 26 February 2015. Two breaches of legal requirements were found. These were regarding the safe management of people’s medicines, accurate records and effectiveness of the quality monitoring of the service. At this inspection we checked to see whether the requirements had been met and found they had been addressed.

The registered provider is also the registered manager of the service. A registered manager is a person who has registered with Care Quality Commission (CQC) 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. The registered person had delegated the day to day running of the service to an acting manager. They had recognised that even with their regular visits to the home the acting manager who also undertook care shifts required additional support. The area manager worked at the home two days a week to provide support for the acting manager. Further changes are planned for the management of the home in the near future.

Staff did not always treated with dignity and respect and ensure their privacy was maintained. People were supported to eat and drink enough and maintained a balanced diet. Staff relationships with people were strong and supportive.

The acting manager was very visible at the service and undertook an active role. They were very committed to providing a good service for people in their care and demonstrated a supportive approach to staff. They were supported by a deputy manager and senior care staff. The management team were open, friendly and welcoming. The area manager and acting manager had recognised there were areas which required improvement. They were developing their roles and responsibilities and were delegating staff roles and responsibilities. The provider had purchased a new quality monitoring system. This had been put into place to continually review and improve the service. Where there were concerns or complaints, these were investigated and positive action taken.

People were supported by staff who had the required recruitment checks in place. However improvements were needed regarding ensuring employment gaps had been checked for staff employed using the new employment application forms used by the provider. Staff received an induction and were knowledgeable about the signs of abuse and how to report concerns. All care staff with the exception of one had undertaken or were enrolled on recognised national qualifications in health and social care. However not all staff had undertaken refresher training of the provider’s mandatory training. This had been recognised and training was being scheduled. The area manager had taken on responsibility to ensure there were adequate staffing levels at all times to meet people’s needs.

Staff had a good understanding of what constituted abuse and how to report if concerns were raised. Measures to manage risk were as least restrictive as possible to protect people’s freedom. Medicines were safely managed on people’s behalf, with the exception of people’s prescribed topical creams. However action was taken during the inspection to put

At the time of the inspection there were seven people living at the service; we met with or saw the majority of people. We spoke in depth with five people to hear about their experiences. People told us they were happy with the level of care and attention they received and that they felt safe at Oak House. Comments included, "We have a lot of fun here, staff are lovely” and “There are always people around and I can potter around as I like”. We found people’s care and welfare needs were met by staff that were familiar with people’s individual needs and preferences. We observed that staff interacted well with people, and were caring and compassionate.

We found that people who use the service understood the care and treatment choices available to them and that they were involved in their care planning. People received regular stimulation and were able to choose to participate in appropriate activities or one to one time with staff and/or the activities co-ordinator.

The home had recently been refurbished and 13 rooms had been re-decorated, the dining and lounge refurbishment was on-going. The home was clean and tidy in all areas and there were effective systems in place to reduce the risk and spread of infection. There was a robust recruitment procedure which ensured that vulnerable people were kept safe from unsuitable staff. There was a clear complaints procedure and people were aware of how to complain or information had been given to their relatives.

We found that Oak House was meeting all of the outcomes we inspected.

There were 15 people living at the home at the time of the inspection and two vacancies.

People who use the service understood the care and treatment choices available to them and were treated in a respectful way.

People expressed their views and were involved in making decisions about their care and treatment.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People who use the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

There were effective systems in place to reduce the risk and spread of infection.

There were enough qualified, skilled and experienced staff to meet people’s needs.

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on.

Oak house care home was last inspected on 23 October 2013. The home was found to be meeting all requirements in the areas inspected.

When we visited there a registered manager in post. 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.

Oak house care home provides care and support for up to 17 older people. At the time of the inspection there were 16 people living at the home.

Staff lacked the guidance and support to be able to give on a required needs basis. This put people at risk of receiving medicines inappropriately or when other actions may have been just as effective..

The provider had systems in place to ensure the quality of the service was regularly reviewed and improvements were made but this was not being fully used. This meant that some areas of the care and support people received were not regularly audited and areas for improvement not recognised. Whilst the staff knew people’s needs well, the records relating to people’s care and support were not always up to date.

People told us that the staff met their care needs well. One person told us “I would rather be at my own home but I can’t. The staff look after me well and I have plenty of friends here. They know what I like and treat me with a great deal of kindness”. We observed this to be the case.

Staff knew people’s routines and respected them. One person told us “I like to spend time on my own after dinner and lie on my bed, the staff know this and only come to make sure I am alright if I use my call bell”. Staff knew how to support people when they became anxious and had effective ways of addressing presenting issues.

The provider was meeting the requirements of the Mental Capacity Act 2005 and assessments of people’s capacity had consistently been made. The staff at the home understood some of the concepts of the Act, such as allowing people to make decisions for themselves.

The staff demonstrated a caring and compassionate approach to people living at the home. People were offered choices at mealtimes such as where to sit and what to eat. The provider had a system to offer choice during mealtimes that was effective.

People told us there were enough staff to meet their needs. People told us they often went to the local shops with staff support although sometimes they had to wait for a short period of time for this support. The provider was able to demonstrate that extra staff were available to support people should their needs change or if extra support was required.

The staff told us they worked well as a team and enjoyed working at the home. They told us there was enough flexibility within their working hours to sit and talk with people and to do things with them that they knew interested them.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which correspond to regulations of the Health and Social

Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the report.