We undertook an announced inspection on 11 April 2017 of Oak Tree Care Services. Oak Tree Care Services is a supported living service, which has been registered to provide support to people in their own homes. At the time of the inspection there was one person living at the service receiving personal care.

At the last inspection on 26 April 2016, the service was found to be in breach of Regulations 11 and 12 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. These breaches related to risk management and consent for care and treatment.

The service did not have 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. A manager was in place and we were informed they were in the process of applying for registration with CQC.

During this inspection records showed that a risk assessments had not been updated to reflect the person’s current circumstances. The director told us that the risk assessment had been updated before the inspection and may have been misplaced. We were sent evidence to support this after the inspection.

Medicines were being managed safely for the person.

There were systems in place for quality assurance and quality monitoring.

There was appropriate staffing at the service.

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. The person’s rights were protected under the Mental Capacity Act 2005. The service was in the process of applying for Deprivation of Liberty Safeguard for the person.

The person was able to attend routine medical and health monitoring appointments with staff support.

The person was 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.

Staff found the manager approachable and had confidence in their ability to act on queries.

We carried out an inspection of Oak Tree Care Service on 26 April 2016. This was an announced inspection where we gave the provider 48 hours' notice because we needed to ensure someone would be available to speak with us.

Oak Tree Care Service supports people at supported living services. At the time of our inspection there were four people who received personal care from the service. At our last inspection the service was in breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which was related to staffing. We found appraisals and an induction programme had not been undertaken for two staff members. We also found a person was not receiving one to one care as planned in their care arrangements and comprehensive audits were not being carried out.

The service did not have a registered manager. The provider told us a manager had been recruited and was due to start their employment. Once in post the manager would submit their application to register with the Care Quality Commission (CQC). 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.

Some risk assessments were not updated to reflect people's current needs and did not take into consideration people's health needs. When a risk was identified, assessments did not provide clear guidance to staff on the actions they needed to take to mitigate risks in protecting people, such as weight loss.

Medicines were administered on time and were stored safely. A person was allergic to a particular medicine and this was not recorded on the medicines record. We fed this back to the provider and the person's allergy was recorded. The provider told us that the GP and dispensing pharmacist were aware of the person's allergy.

People’s capacity was being assessed. However, the assessments did not specify what area’s people had or lacked capacity using the Mental Capacity Act 2005 principles. Due to risks to their safety, two people living at the supported living service we visited were not allowed to go outside without staff or a relative accompanying them. Appropriate Deprivation of Liberty safeguards had not been applied for.

Quality assurance and quality monitoring systems had been implemented to allow the service to demonstrate effectively the safety and quality of the service.

People had choices during mealtimes and staff assisted with meals in accordance to people's preferences.

People were protected from abuse and avoidable harm. Staff knew how to report alleged abuse and were able to describe the different types of abuse. Staff knew how to 'whistleblow'. Whistleblowing is when someone who works for an employer raises a concern about a potential risk of harm to people who use the service.

People were supported by suitably qualified and experienced staff. Recruitment and selection procedures were in place and being followed. Checks had been undertaken to ensure staff were suitable for the role. Staff members were suitably trained to carry out their duties and knew their responsibilities to keep people safe and meet people's needs.

People were supported to plan their support and received a service that was based on their personal needs and wishes. People were involved in the planning of their care and the care plan was then signed by people to ensure they were happy with the care and support listed on the care plan.

There was a formal complaints procedure with response times. People were aware of how to make complaints and staff knew how to respond to complaints in accordance with the service's complaint policy.

People and relatives told us that staff communicated well with them. People’s ability and preference on communication was recorded on their c

We undertook this unannounced inspection because we received some information about the service’s management of people’s medicines and staffing levels that suggested possible risks to the health, safety and welfare of people using it.

We spoke with two people who use the service at one of the service’s two supported living schemes. They raised no concerns about the support provided to them. “They meet my needs well,” one person told us, adding that there was a lot of support from staff who were always available.

We found that there were enough qualified, skilled and experienced staff to meet people’s needs overall. Records and feedback indicated that although staffing levels had been temporarily reduced pending recruitment of new staff, staffing was flexibly provided when needed. Most staff had the skills to meet people’s needs, and the manager provided us a training plan to address a few shortfalls.

We found some occasions when the staff member working the waking night shift also worked the eight-hour day shift immediately before or after the night shift. The provider may find it useful to note that this could impact on that staff member’s ability to effectively meet people’s needs.

People we spoke with raised no concerns about how they were supported with any medicines prescribed to them. We found that people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We spoke with five people who use the service. People praised the service and the support provided. Comments included, “the staff are lovely” and “I’ve grown as a person, and built confidence.” We also spoke with a health and social care professional, whose overall comments included, “I can’t praise them highly enough.”

People told us that staff understood their needs and knew their preferences. Staff demonstrated good awareness of people’s individual needs and circumstances. They knew how to provide appropriate support to people.

People told us they felt safe using the service, and that they could speak with staff or the manager if they had concerns. They told us of monthly meetings at each scheme, at which they could raise concerns if needed. People said they found the meetings useful. We found that these meetings contributed to the provider ensuring that there were systems in place to monitor and improve the quality of services.

We found that staff training and supervision arrangements helped to enable people to be supported by staff who delivered care safely and to an appropriate standard. Recruitment processes, which included applicants meeting people who use the service, ensured that people were supported by suitably qualified, skilled and experienced staff.

This inspection took place on 25 and 26 March 2015 and was announced. We gave the provider two days notice of our inspection as we needed to make sure that someone was at the office.

Oak Tree Care Services is a supported living service which has been registered to provide personal care to people in their own homes. At this inspection the service supported eleven people living in supported living schemes in Enfield and Haringey. The provider met all the standards we inspected against at our last inspection on 13 December 2013.

The service did not have a registered manager. However, the director of the company informed us that he had appointed a new 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.

People told us that they had been treated with respect and dignity and they felt safe with staff who cared for them. Arrangements were in place to ensure people’s safety. The service had a safeguarding policy. Staff had received training and knew how to recognise and report any concerns or allegation of abuse. We noted that recommendations following safeguarding meetings had been implemented. This included new policies and procedures to provide guidance for staff. This is to ensure the safety of people.

People had been given their medicines and the medicines administration records were well maintained. There was an updated medicines policy and procedure to provide guidance for staff. There were measures were in place for infection control and staff were aware of procedures to prevent infection. However, the policy was not sufficiently comprehensive. This is needed to ensure that staff were fully informed of their responsibilities

We saw that there were sufficient staff and they interacted well with people. Staff were knowledgeable regarding people’s needs and preferences. Staff had received appropriate training to ensure that they had the skills and knowledge to care for people. Staff supervision had been provided. However, we did not see evidence of staff induction in two staff records or annual appraisals in the staff records examined. These are needed to ensure that staff are supported.

People’s needs had been assessed and detailed care plans were prepared with the involvement of people and their representatives. Their physical and mental health needs were monitored and they had access to health and social care professionals to ensure they received treatment and support for their specific needs. We however, noted that one person had not received their planned one to one sessions for a period of two months. This meant that this person did not receive all the support planned for them. We recommend that support arrangements to meet individual needs be implemented as planned.

The CQC monitors the operation of the DoLS (Deprivation of Liberty Safeguards) which applies to care homes. The nominated individual and senior staff were knowledgeable regarding the Mental Capacity Act 2005 (MCA) and the DoLS. The service had policies and guidance on MCA and DoLS.

Staff were aware of the aims of the organisation which were to ensure that people were well cared for and encouraged to be as independent as possible. The quality of the care provided was monitored by the nominated individual. However, there was no documented evidence of regular checks and audits of various aspects of the service carried out by the nominated individual or senior staff. This is needed to ensure that the service provided is of a high quality.

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