We carried out an unannounced inspection of Oak House on 9 February 2017. Oak House provides care and accommodation for up to 11 people who require accommodation and personal care. Nursing care can be provided through the local community nursing services if appropriate. At the time of the inspection 11 people were living at Oak House.

There was a registered manager who was also the provider. They were supported by an assistant 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection in October 2015 we found improvements should be made to ensure processes followed legislation to ensure people’s legal rights were protected. This had meant that some people at that time may have been deprived of their liberty without the correct authorisation. Since the last inspection, we found that the provider had followed the requirements in deprivation of liberty (DoLS) authorisations and related assessments and decisions had been appropriately taken. All staff and the registered manager/provider demonstrated a good knowledge and understanding of the (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff clearly understood the importance of seeking people's consent and offering them choice about the care they received. Therefore, at this inspection we found the service was meeting all regulatory requirements and we did not identify any concerns with the care provided to people living at the home. One relative said, "It’s lovely here. They really understand [person’s name]. They can do what they want and be themselves.”

On the day of the inspection there was a calm and relaxed atmosphere in the home and we saw staff interacted with people in a friendly and respectful way. People were able to choose what they wanted to do and enjoyed spending time with the staff who were visible and attentive. People were encouraged and supported to maintain their independence. There was a sense of purpose as people engaged with staff, watched what was going on, read newspapers, played games and

pottered around the home or went out. The majority of people were living with dementia and were independently mobile or required some assistance from one care worker. Staff engaged with them in ways which reflected people's individual needs and understanding.

People were provided with an excellent variety of opportunities for activities, engagement and trips out. These were well thought out in an individual way, with opportunity for spontaneous outings to buy a magazine for example or go for a drive. People could choose to take part if they wished. Activities were not only organised events such as trips out and external entertainers but on-going day to day activities. For example, there was always something for people to do for stimulation such as chatting with staff, playing games, looking at books, household chores or arts and crafts sessions.

People and relatives said the home was a safe place for them to live. Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns. Staff were confident that any allegations made would be fully investigated to ensure people were protected. There had not been any safeguarding concerns in the last 12 months. People said they would speak with staff if they had any concerns and seemed happy to go over to staff and indicate if they needed any assistance. Staff were vigilant about protecting each person from possible negative interactions with other people living at the home, recognising frustrations and misunderstandings between people due to them living with dementia. People and relatives knew how to make a formal complaint if they needed to but felt that issues wo

This inspection took place on 1 October 2015 and was unannounced.

The service provides accommodation and support for up to 11 adults who have care needs due to dementia, old age or mental health problems. The home cannot provide nursing care except through the local community nursing service. At the time of the inspection there were ten people living in the home, some with complex care and communication needs. The provider who is also the registered manager was on annual leave, but spoke with us by telephone. Most of the people were living with dementia, and had varying degrees of communication and mobility needs. We were able to engage in short conversations with three of the people. As we were unable to communicate verbally with everybody we also relied on our observations of care and our conversations with people’s relatives and staff to help us understand their experiences.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. At this service the registered manager is also the registered provider. 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. Everyone was positive about them, and felt they were approachable, caring, and committed to the service and the well-being of people there.

The provider had not followed legislation designed to protect people’s human rights. This meant that some people may have been deprived of their liberty without the correct authorisation.

On the day of our inspection there was a calm and relaxed atmosphere. People appeared happy, engaging with activities or ‘doing their own thing’, with staff support if they needed it. People, their relatives and health care professionals all spoke highly about the care and support the home provided. One person told us,” I’m better cared for than I’ve ever been”.

There were enough staff deployed to meet people’s complex needs and to care for them safely. They knew people living at the service extremely well, and had the training, experience and knowledge to support people’s mental and physical health needs. Care and support was provided in line with individual care plans, which were regularly updated to reflect people’s changing needs. Effective risk assessments promoted people’s independence while keeping them safe. A new computer system being installed would allow staff to access and maintain information about people’s care needs and risks more even effectively.

People appeared very comfortable with the staff who were supporting them, and we observed staff treated them with kindness, dignity and respect. We saw they always checked with people before providing care or support and then acted on people’s choices.

People’s relatives said they were made very welcome and were able to visit the home as often and whenever they wished. They valued the support that staff had given them when it had been difficult for them to deal with their family member’s illness, and said the service was good at keeping them informed and involving them in decisions about their relatives care.

The service recognised the importance of activities in boosting people’s self-esteem and maintaining their skills and independence. Staff therefore encouraged involvement in everyday activities, as well as supporting people to engage in a lively activities programme, which had strong links with the local community.

People received their medicines safely and were supported by a range of external health and social care professionals.

The service’s quality monitoring systems enabled the service to maintain high standards of care and to promote continuing service improvements.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

At the time of the visit there were 10 people living at Oak House. We reviewed four care records, three staff personnel files and other records relating to the management and administration of the service.

We spoke with four people who used the service; the registered manager; five other staff on duty; one visiting Community Nurse and one visitor/ relative. We observed how care and support was provided to people. We looked at the homes environment and whether it met the needs of the people who lived there.

People told us they were very happy about how care and support was provided to them, and with the staff who provided that care. We were told that they had the help and assistance they needed. We observed that people had good relationships with the staff. People told us that they liked living in the home. One said “I couldn’t imagine it better. The staff are extremely good. They don’t restrict us at all”.

We saw that the home involved a variety of other professionals in a timely way. However care records lacked detail and did not reflect how best interest decisions took account of people’s mental capacity and deprivation of liberties. Care plans were not dated individually or signed.The care records relating to each individual were held in a variety of places and meant staff did not always have readily available up to date information about the people they cared for.

People’s privacy and dignity were respected, with their various needs met through the individualised care planned for them. They and their property were protected by various measures the provider had in place to safeguard them. Staff were supported to deliver care safely and appropriately. However, the provider had not informed us about some events that had affected some people’s welfare, thus we could not be confident that any such occurrences had been responded to appropriately.

Individuals and their representatives were involved in making decisions about their care. A visitor confirmed that the home kept them informed about their relative. People at the home were able to be part of a wider community through support for contact with family, friends and local groups as well as local outings.

One person told us the staff listened and were “always open to changes,” supporting them to have choice and variety in their daily life. We saw staff noted people’s body language to enable those who were less able to communicate verbally to achieve or have what they wanted. Where people did not have the mental ability to consent to care or treatment, the provider had not always acted in line with legal requirements to ensure their rights were still upheld.

The provider had systems to monitor the quality of service and manage risks to those living at the home, the staff and visitors. This included taking into account the views or experiences of people who used the service.

Summary

We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found.

On the day of our inspection there were 10 people living at Oak House with an additional person receiving respite support at the home.

The summary is based on our observations during the inspection. We spoke with three people living at the home, the registered manager who is also the provider, deputy manager and five workers. The inspection was undertaken by one inspector over two days.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People who used the service told us they felt safe with the staff that provided care and support for them. Comments included, “I am very happy here; they (staff) are all so lovely”.

The registered manager understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty safeguards (DoLS). Although no DoLS applications had been made, the registered manager was able to describe the circumstances when an application should be made and knew how to submit one.

The home had suitable arrangements in place to reduce the risks of people receiving inadequate nutrition or becoming dehydrated. We saw there was a choice of suitable and nutritious food and drink available in sufficient quantities.

The home was clean and had processes in place to maintain a hygienic environment. We found the home to be free from offensive odours.

The home had robust recruitment processes in place ensuring new staff had full employment checks. This meant people were protected from risk of harm by staff being employed who were appropriately qualified and physically and mentally able to meet people’s health and welfare needs.

Is the service effective?

This service was found to be effective because we saw people were supported in a way that suited their personal needs and maintained their quality of life.

It was clear from our observations and from speaking with people and staff they had a good understanding of people’s care and support needs and they knew them well.

People’s health and care needs were assessed and their care plans and assessments were reviewed monthly so changes to people's needs could be identified. Specialist dietary, mobility and night time needs had been identified in care plans where required. This showed people were having care delivered effectively and in accordance with their assessed needs.

Is the service caring?

We found the service was caring. People were supported by care workers who were understanding and sensitive to their needs. We saw care workers tended to the care needs of each individual person in a way that was appropriate for them. For example we saw care workers supporting people, they demonstrated a good understanding of the people’s individual needs. We saw they engaged in cheerful conversations with the person they were supporting and were kind and discreet in their approach.

We saw people’s social needs were met as there were opportunities for people to be engaged in activities.

Is the service responsive?

We found the service was responsive because the service had appropriate systems in place for gathering, recording and evaluating information about the quality and safety of the overall service. Systems were in place to make sure the registered manager who is also the provider learnt from events such as accidents and incidents for individuals. However the analysis of patterns of incidents at the home were not recorded. This meant people were at risk of a potential accident because systems were not in place to protect them from repetitive incidents at the home.

The home took account of complaints and comments to improve the service. We saw a complaints procedure displayed in the main entrance guiding people who to contact if they had a complaint. We were told by the registered manager and deputy manager because the unit is small and they are in day to day control at the home any concerns which are raised are dealt with at the time. People can therefore be assured the home acted upon complaints, which were investigated and action was taken as necessary.

We found the home had made improvements to people’s personal care records they were accurate and fit for purpose so care workers could respond to people's needs in a timely manner.

Is the service well-led?

We found the service was well led. The registered manager was supported by a team of committed care workers at the home with a low staff turnover, which meant people had continuity at the home. Staff told us they had confidence in the registered manager and were able to approach her if they had any concerns. Comments included “It is a lovely place to work” and “I can always go to X if I have a problem and it will be sorted out”.

Care workers told us they were clear about their roles and responsibilities. They demonstrated a good understanding of the ethos of the home. This helped to ensure people received a good quality service at all times.