The inspection took place on 18 December 2018 and 3 January 2019. The first day of the inspection was unannounced.

We last inspected the service in February 2018 and found the provider had breached two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. This related to the systems and processes used to assess, monitor and improve the safety of the service, which had not identified the concerns we found. The provider had failed to submit statutory notifications. We asked the provider to complete an action plan to show what they would do to improve the service.

Oak lodge is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Oak lodge can accommodate up to 28 people. At the time of our inspection 13 people were using the service.

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 requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At this inspection medicine administration records did not always appropriately record the effectiveness of ‘as and when’ medicine. The provider's quality assurance process had failed to identify these shortfalls.

The provider’s quality assurance system had not identified the shortfalls. This was a breach of Regulation 17 (Good governance) 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 the report.

No new staff had been recruited since our last inspection. The provider did have a policy and procedure in place for safe recruitment.

The provider ensured staffing levels met the needs of the people living in Oak Lodge.

Staff were aware of safeguarding and knew how to raise concerns if they felt people were at risk of abuse or poor practice. Where lessons could be learnt from safeguarding concerns these were used to improve the service.

Accidents and incidents were recorded and monitored as part of the provider’s audit process.

Health and safety checks had been completed such as gas and electrical safety checks.

Systems and processes were in place to ensure medicines were available for people. Medicines were managed by trained staff whose competency to administer medicines was checked regularly.

Staff received regular supervision and an annual appraisal. Staff mandatory training was up to date.

People’s nutritional needs were assessed on a regular basis. People enjoyed a varied diet, with choices offered and alternatives available. Staff supported people with eating and drinking in a safe, dignified and respectful manner. People were supported with their health needs and had access to healthcare professionals when necessary.

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.

People and relatives felt the service was caring. Staff provided support in a respectful manner ensuring people’s privacy and dignity was promoted. Where possible people were supported to be as independent as possible.

People enjoyed a range of activities, including trips into the community and in house entertainment.

The provider had a complaints process in place which was accessible to people and relatives.

People, relatives and staff felt the registered manager and deputy manager were approachable. We observed the registered manager was visible in the service and found people interacted with them in an open and friendly manner.

The premises were su

This inspection took place on 15 and 23 February 2018. The inspection was unannounced. This meant the provider and staff did not know we were coming.

Oak Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service accommodated up to 28 people. At the time of the inspection 12 people were using the service. 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 requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We visited the home in January 2017 and found the risks we had identified at the previous inspection in August 2016 had been addressed. We found the provider had taken action in relation to the electrical and fire safety in the home. We also found the registered manager was undertaking recruitment checks to ensure the safe employment of staff and was carrying out a range of regular audits to check the health and safety of the service. People had risk assessments in place to keep them safe.

At this inspection we found that there was a breach of one of the Fundamental Standards of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to the governance in the home and the lack of oversight of the provider’s regulatory requirements.

A fire detector check was carried out in November 2017. The report highlighted six fire detectors in the home that were out of date and reported as obsolete. The contractor had advised the detectors may not work in the event of a fire. We checked to see if these works had been carried out and found no remedial work had been completed and the obsolete fire detectors remained in situ.

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.

People who were being deprived of their liberty did not always have decision specific best interests recorded in their care records regarding the use of bed rails. Despite assessments identifying these were required for personal safety. Where the provider had received authorisation to deprive people of their liberty, notifications had not been submitted to CQC as part of the provider’s regulatory requirements. We will deal with this outside of the inspection process.

The provider’s business continuity plan did not meet the needs of the service in the event of an emergency.

The provider’s quality assurance system had not identified the concerns found at the inspection.

People and relatives felt the service was safe. Policies and procedures were in place to keep people safe such as safeguarding, accident and incident policies. Staff had received training in safeguarding and knew how to report concerns.

Staff recruitment procedures were robust and included Disclosure and Barring Service checks and references. Staffing levels were appropriate to the needs of the people using the service.

Risk assessments were detailed, person-centred, and gave staff clear guidance about how to support people. People had personal emergency evacuation plans in place in case of an emergency.

People received their medicines safely and medicines were stored correctly.

Staff were trained in a range of subjects such as health and safety, first aid and fire safety. Staff also completed training in specific subjects such as dementia and end of life to meet the needs of the people using the service.

Staff received regular supervisions and an annual appraisal which covered their personal development. Staff felt they were well supporte

We had carried out an inspection on August 25, 30, 31 2016 following anonymous concerns raised about fire safety at the home. We carried out the visit with a Fire Officer from the local Fire Service. We found concerns in relation to fire doors, checks on fire safety equipment, five year fixed wiring and an ineffective fire risk assessment. We also found concerns in relation to safe recruitment and quality audits. These were subject to a warning notice that was required to be met by 31 Dec 2016.

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. We met with the registered manager during this inspection and they showed us remedial action the service had taken.

At this visit, we were checking whether the service had met the requirements of the warning notice. At the time of our visit there were 13 people using the service at Oak Lodge.

We saw all fire doors were fitted with intumescent strips as per guidance from the Fire Officer and there were regular checks in place on fire equipment as well as regular fire drills to ensure staff were familiar with evacuation procedures. Records to support the safe evacuation of people in event of a fire were in place and up-to-date. People had risk assessments that included any health and safety risks being identified and measures taken to reduce any risk of harm.

Works in relation to fixed five year electrical wiring had been addressed.

We saw the registered manager was undertaking recruitment checks to ensure the safe employment of staff and was also carrying out a range of regular audits to check the health and safety of the service.

The inspection visit took place on the 25 August 2016. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting. We visited the service in response to concerns about fire doors raised with CQC and the local authority. We visited with the Senior Fire Officer from County Durham and Darlington Fire and Rescue Service. Following our joint visit on 25 August, the CQC inspector returned to the service on 30 and 31 August to continue with a comprehensive inspection.

We last inspected the service in January 2016 and it was compliant at that time and rated as 'Good'.

Oak Lodge is situated in a residential area of Darlington close to all amenities. It provides accommodation for up to 28 people who require personal care. The service previously provided nursing care but ceased to provide this in December 2015.

There was not 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. The previous registered manager had left the service in February 2016. The manager currently working at the home commenced in March 2016 and had an application to be registered accepted by CQC.

All people we spoke with told us they felt safe at the service. Staff were aware of procedures to follow if they observed any concerns and staff also told us they would raise issues with the manager.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS).

We checked whether the service was working within the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. The provider did not have best interests decisions in place for people who required bed rails.

Established staff at the service were all given workbooks to undertake mandatory training refreshers and we saw some of these were outstanding although we saw the manager was prompting staff to complete these. The service did not provide an appropriate induction using the Care Certificate for staff new to the care sector. Some recruitment checks had not been carried out for staff recruited recently, this may mean that the service did not recruit appropriate personnel. We saw that staff had received supervision.

There were sufficient staff on duty to meet the needs of the people and the staff team were supportive of the management and of each other.

Medicines were not stored in a safe manner, although administration records showed staff were administering medicines safely.

We saw people’s care plans had been assessed and people's care needs were reviewed. We saw people were being given choices and encouraged to take part in all aspects of day to day life at the home.

Staff had a good awareness of people’s dietary needs and staff also knew people’s food preferences well. We saw everyone’s nutritional needs were monitored and mealtimes were well supported.

We observed that all staff were very caring in their interactions with people at the service. People clearly felt very comfortable with all staff members. There was a warm and caring atmos

The inspection visit took place on the 12 January 2016. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

We last inspected the service on the 8 February 2015 which was a follow up inspection from September 2014. In April 2014 we found that the service needed to improve its systems and training in relation to the Deprivation of Liberty Safeguards. In February 2015 we saw this had been completed and the service was not in breach of any regulations at that time.

Oak Lodge is situated in a residential area of Darlington close to all amenities. It provides accommodation for up to 28 people who personal care. The service previously provided nursing care but ceased to provide this in December 2015.

There is 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.

All people we spoke with told us they felt safe at the service. Staff were aware of procedures to follow if they observed any concerns.

There were policies and procedures in place in relation to the Mental Capacity Act and Deprivations of Liberty Safeguards (DoLS). The registered manager and staff had the appropriate knowledge to know how to apply the MCA and when an application should be made and how to submit one. This meant people were safeguarded.

We saw that staff were recruited safely and were given appropriate training before they commenced employment. Staff had also received more specific training in managing the needs of people who used the service such as medicines training as this was previously carried out by nursing staff at the home. There were sufficient staff on duty to meet the needs of the people and the staff team were supportive of the management and of each other.

Medicines were stored and administered in a safe manner.

There was a regular programme of staff supervision in place and records of these were detailed and showed the home worked with staff to identify their personal and professional development.

We saw people’s care plans had been well assessed. The home had developed care plans to help people be involved in how they wanted their care and support to be delivered. We saw people were being given choices and encouraged to take part in all aspects of day to day life at the home, from planning entertainment to deciding on décor colour schemes .

Staff had a good awareness of people’s dietary needs and staff also knew people’s food preferences well. We saw everyone’s nutritional needs were monitored and mealtimes were well supported.

We observed that all staff were very caring in their interactions with people at the service, this did not just include care staff but also the administrator, maintenance person and domestic. People clearly felt very comfortable with all staff members. There was a warm and caring atmosphere in the service and people were very relaxed. We saw people were treated with dignity and respect. People told us that staff were kind and professional.

We also saw a regular programme of staff meetings where issues where shared and raised. The service had a complaints procedure and staff told us how they could recognise if someone was unhappy and how to report it.

Any accidents and incidents were monitored by the registered manager to ensure any trends were identified. This system helped to ensure that any patterns of accidents and incidents could be identified and action taken to reduce any identified risks.

The service had a comprehensive range of audits in place to check the quality and safety of the service and equipment at Oak Lodge. Action plans and lessons learnt were part of their ongoing quality review of the service

One inspector carried out this follow-up inspection. At the time of our inspection there were 15 people living at Oak Lodge.

We carried out this inspection to check that improvements had been made in respect of shortfalls in the consent to care and treatment identified on our previous visit on 2 September 2014.

During our inspection on 9 February 2015, we spent time speaking with the new manager, the senior nurse in charge and three care staff. We reviewed records and quality documentation that was appropriate to the focus of this inspection, including seven care plans. We spent time observing and speaking with people who lived there.

At our inspection we found that the home had recruited a new permanent manager. This individual had just received their criminal background check to be able to register with CQC.

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

The inspection team consisted of one inspector and during the inspection; we spoke with five out of 18 people who lived at the home, the lead nurse and three staff. We looked at four sets of care records. We also observed care practices within the home.

The management of the home had recently changed and provider was actively recruiting for a new manager. The nurse in charge said herself and another nurse at the service were managing as an interim measure but it “was challenging”.

We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Everyone we spoke with told us they felt safe and secure living at the home. Staff we spoke with understood the procedures which they needed to follow to ensure that people were safe. We saw that staff had not followed recent legislation changes regarding the Deprivation of Liberty Safeguards and no appropriate applications had been made to the supervisory body. People also did not have current capacity assessments in their plans of care. The nurse in charge stated she would seek advice from the supervisory body and work on assessments immediately after our visit.

Care plans and risk assessments were in place and updated on a regular basis and were based on people’s individual needs and preferences.

Systems were in place to make sure that staff learnt from events such as accidents and incidents, concerns, complaints, whistleblowing and investigations. This helped to reduce the risk of harm and ensured that lessons were learnt from mistakes.

Is the service effective?

Everyone had their needs assessed and had individual care records which set out their care needs.

It was clear from our observations and from speaking with staff that they had a good understanding of the care and support needs of people living at the home and that they knew people well. Assessments included dietary, social and leisure and emotional needs.

People spoke highly of the staff and said that they were happy with the care that had been delivered and their needs had been met. On the day of our visit an entertainer dressed in war-time clothing was visiting the home and people joined in the songs and appeared to enjoy the show very much.

People had access to a range of health care professionals some of which visited the home and all was documented in the care files.

Is the service caring?

People were supported by kind and attentive staff who showed patience and gave encouragement when supporting people, whilst helping them to remain independent.

People who used the service, their relatives and friends were asked for their views on the care and service provided. Where shortfalls or concerns were raised, these were addressed.

People told us that they were happy with the care and support provided to them.

Is the service responsive?

There was clear evidence contained within people's care plans to show how they worked with other health and social care professionals.

People told us that they knew how to make a complaint if they needed to.

Is the service well-led?

There were systems in place to assure the quality of the service provided. The way the service was run was regularly reviewed. The manager had recently left the home and we saw that the home was actively recruiting for a manager and following the inspection the regional manager stated she was offering further support to the home in the interim. The nursing staff were also having to undertake administrative responsibilities and we asked the provider to ensure they had enough time away from their nursing duties to make sure these tasks this took place.

Staff were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and were knowledgeable about people's needs. This helped to ensure that people received a good quality service at all times.

What people said:

People who were able to express their views told us they were happy with the care and support they received. People said of the staff; “The staff are all nice” and “The staff are lovely”. One person said; “I play dominoes and watch tv”. Comments about food were very positive by everyone we spoke with, people told us; “They feed us too much and there is plenty of choice”

Staff told us “It’s a nice home here, the care is good” and “We are a good staff team”. The laundry staff told us; I get what I need, I’ve got some new towels on order”.

We saw that care staff were friendly, polite and caring in their communication with people who used the service. People told us; “It’s smashing, they can’t do enough for you” and “It’s a home from home”.

We saw from the activities file, that activities were planned in throughout the year including trips, walks, going to the pub, music and a variety of entertainers who were scheduled to visit the home.

The home was clean although fixtures and fittings were looking dated. We saw that staff had information about infection control and we observed people using personal protective equipment appropriately. The home was working on an action plan from an infection control audit carried out by the Primary Care Trust in 2012.

We saw records of regular staff and resident meetings and a monthly newsletter where issues relating to the day to day running of the home were talked about. This showed that people were kept informed about issues regarding the home.

We spoke with six people. They said:

“I’ve been here six years and I’ve been fine”,

“There are good staff here”,

“They come and ask me what food I want”,

“The food is good, her cakes are lovely”,

“I go across to the pub once a fortnight”,

“It’s just like home”,

“You don’t have to worry about anything, its all done for you”,

“I can do anything I want” and

“We are one big happy family”.

Some people were not able to tell us directly what they thought about the service. However, during our visit we spent time observing how care staff supported people and this was positive and respectful.

Staff told us:

“Its nice working here”,

“Its like a big a family, we all work together” and

“It’s a shame people are put off by looking at the outside and front of the building”.