This inspection took place on 2 and 3 August 2016 and was unannounced. The Oak Lodge Nursing Home provides accommodation, personal care and nursing care for up to 60 people. At the time of our inspection, 58 people were living at the home. Most were older adults with needs associated with physical disability, dementia or long-term health conditions.

The service had a registered manager, who was referred to as the matron by people and staff. 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. The matron was supported by a deputy manager, who was referred to as the head of care.

Staff knew how to keep people safe and understood their responsibilities to protect people from the risk of harm and abuse. The home had identified risks to people and assessed, reviewed, recorded and managed them appropriately to minimise the risk of harm or abuse. Health professionals told us they had observed staff supporting people safely in accordance with their risk assessments and recognised best practice in relation to dementia awareness, moving and positioning, pressure area management, wound dressing, infection control and management of pain relief. Staff knew and understood the provider’s incident and accident reporting process to ensure all risks were identified and managed safely.

The matron completed a daily staffing analysis to ensure that sufficient suitable staff were available to meet people’s needs. People benefited from excellent continuity of care from ‘familiar friendly faces’, which particularly provided reassurance for older people who were confused or anxious. The home followed robust recruitment procedures to ensure that people were protected from the employment of staff unsuitable to support vulnerable older people.

The provider operated health and safety systems effectively to protect all people from harm in the home. The home had contingency plans to ensure the safe delivery of people’s care in the event of emergencies such as fire, flood or utilities failure. People were kept safe by staff who understood the provider’s procedures and their individual role and responsibility in such circumstances.

The home managed people’s medicines safely in accordance with best practice and national guidance. Staff who had completed safe management of medicines training had their competency to administer medicines assessed annually by the matron and head of care.

People consistently told us that the professional knowledge and skill of well-trained, professional staff had a positive impact on their quality of life, health and wellbeing, which was echoed by relatives. All health professionals told us they were impressed with the excellent standard of nursing care at Oak Lodge. The matron was committed to and passionate about staff training and continued professional development to improve the quality of care. People were supported by staff who had completed a thorough and effective induction into their role at Oak Lodge. The provider promoted best clinical practice through the use of lead roles, called Champions, who had completed further training in specific areas of nursing care, which they shared with colleagues.

People were protected from the risks of malnutrition and dehydration. People and relatives told us the quality and choice of food were exceptional and that their individual nutritional needs were well met, which our observations confirmed.

People were supported to maintain good health and had regular access to healthcare professionals. People requiring specialist advice or specific care to meet their changing needs were referred promptly to relevant healthcare professionals. Health professionals observed that staff implemented their guidance

On the day of our inspection there were 45 people living at Oak Lodge. Two adult social care inspectors carried out this inspection. During the inspection we spoke with 15 people who use the service and the relatives of four people who were visiting. We also spoke with the registered manager, the head of care, the administrator, the area manager, two nurses, eight care staff, the cook, the maintenance officer and two activities coordinators.

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;

Is the service safe?

We found that people were cared for safely. People's needs had been assessed and reflected in their care plans. Where necessary, assessments had been completed which identified and reduced risks to people, whilst supporting them to remain independent.

Where people needed support with more complex health needs we saw there were specific plans which detailed the care needed and how staff should provide this. We found that staff had received appropriate training in relation to meeting people's complex needs from health professionals, which had ensured that people’s needs were met safely.

People who use the service said they felt safe with staff, who treated them with dignity and respect. One person said, “I couldn’t wish for better care. The staff treat me like a human being. They always listen to me and have time for a chat.” Another said, “I feel safe and trust the staff who are so kind and friendly.”

The service had ensured that people were protected from the risk of inappropriate or unsafe care. This was because the provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others in relation to incidents.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which apply to this service. The registered manager told us they had not needed to apply for DoLS authorisation for any of the people who use the service since the last CQC inspection, but they were aware of the process to follow.

Staff told us that they had received training about the Mental Capacity Act 2005 (MCA). One care worker told us, “We care for some people with dementia and know what decisions they can make and others where they need support.” A relative told us, “The staff always contact me before any action is taken if the GP wants to change their medication.”

Is the service effective?

We found that the service placed people at the centre of all decisions regarding their care and support. Where the service identified a person lacked capacity to make a decision, a best interest meeting had been held with people who knew and understood them, which ensured their human rights were protected. We noted that advance decisions had been appropriately recorded and had been respected by staff.

People we spoke with were complimentary about the care they received. One relative told us, “The staff provide excellent care, with compassion and patience. Famiies and friends are encouraged to visit at any time and are made to feel welcome by the staff.” The relative of a person with complex needs told us, “I don’t think they would have made such a good recovery if they weren’t at Oak Lodge. The staff are out of this world.”

People had been protected from the risks of malnutrition and dehydration.The provider had identified where people were at risk of poor nutrition and hydration or had swallowing difficulties. We observed that people had a choice of suitable and nutritious food and hydration in sufficient quantities to meet their needs.

Staff had received an induction recognised by the care sector, covering core subjects that included safeguarding, dementia awareness, the MCA 2005 (MCA),infection control, management of medicines, food hygiene and moving and positioning.

We found that staff were knowledgeable about people's specific health and personal care needs and had received training to update their skills and knowledge. Staff had also received training to meet the specific needs of people. The provider had ensured that people received appropriate care from competent staff who had been supported in their personal development by an effective system of supervision and appraisal.

Is the service caring?

People were supported by kind and compassionate staff, who spoke to people in a friendly, caring manner. We saw that care workers gave encouragement to people who were able to do things at their own pace. One person told us “They always take their time and never rush me.” Another person said, “It’s the way that staff make you feel special that makes this home better than others.” A relative told us, “They have definitely got it right here. It’s not like other places where staff are rushing about. There is a calmness and tranquility and staff have time to deal with people as individuals.”

People were supported by kind and compassionate staff, who spoke to people in a friendly, caring manner. We saw that activity coordinators and care workers gave encouragement to people who were able to do things at their own pace. One person told us "The staff are wonderful. They keep us on our toes and help us to do things you wouldn’t think were possible. I really like the “chairobics.”

We observed that staff supported people to make their own daily living choices and to be as independent as they were able to be. This promoted people's self-esteem and gave them a sense of achievement. The care staff we spoke with enjoyed working with people they supported. One care worker told us, "I like to hear about people’s life stories because it helps me to understand them and provide better care.”

Is the service responsive?

The service was organised to respond to the diverse requirements of different people. People's needs had been assessed and their care was planned and delivered in accordance with their personal preferences. Staff had a clear understanding of each person’s needs and how they should be met. For example, the service had responded well to incidents where a person displayed behaviours which may challenge. The person’s behavioural support plan had been updated to ensure staff knew how to respond appropriately to such behaviour in the future.

We found that the service was responsive to the changing needs of people and these had been continually reviewed. Where staff required further training this had been planned in advance or where anticipated had been arranged immediately.

Is the service well-led?

We found that the management team provided clear and direct leadership, which was recognised and appreciated by the staff. Care workers spoke positively and with pride about the service they provided for people. The registered manager or deputy manager worked every week end and the administrator worked on Saturday. The registered manager told us that they wished to show their commitment to the people they cared for and their staff. Staff told us that the manager's spoke with them about any changes planned and they felt part of a team where their contribution was valued. One care worker told us, ''If there are any problems the manager is always on call and lives nearby.” A nurse told us, “If we need her she will always come in and is always happy for you to call her at home.” This meant that care workers felt confident to raise concerns and seek advice.

The registered manager operated systems to deal with comments and complaints which were clearly understood by people, well-publicised and reflected established principles of good complaint handling.