This was an unannounced inspection carried out on 21 and 22 June 2017. At the last inspection we found that there was a lack of management oversight at the service and that there was not a robust programme of activities. Furthermore we found that the building was not properly maintained and that staff did not receive appropriate support and supervision. At this inspection we found improvements had been made in all these areas.

Oak Tree Lodge is situated in the Harehills area of Leeds. It is a purpose built home with 60 beds, providing care for older people and people living with a dementia related condition. There were 59 people living at the service at the time of inspection. The building was split into three floors, with the ground and first floor catered towards people living with a dementia related condition, and the top floor was for people requiring personal care and accommodation. The building was wheelchair accessible with lift access to all floors, and the building was secured with keypad entry.

There was 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.

People told us they felt safe in the home. There were enough staff to deliver care safely, and staff had appropriate training. Staff had a good understanding of safeguarding vulnerable adults. People had plans in place to manage risks, which were understood by staff.

People received their medicines safely and as prescribed. Medication Administration Records (MAR charts) accurately recorded prescribed medications delivered and medicines were stored safely. People had regular and appropriate access to health professionals to meet their needs. Staff worked in partnership with health professionals who had no concerns with care provided at the service.

There were adequate recruitment processes in place to ensure staff were recruited safely and that they were suitable to meet people’s needs. Staff had sufficient training to ensure they could carry out their roles effectively. Staff were supported with regular appraisals, and the service was starting a new appraisals process to enhance existing mechanisms.

There were policies and procedures in place in relation to the Mental Capacity Act (MCA) 2005. Staff were trained in the principles of the MCA and could describe how people were supported to make decisions; and where people did not have the capacity; decisions were made in their best interests.

People received support from kind and compassionate staff who understood their individual needs. Care plans were person centred and evidenced input from people and their relatives.

People were supported to eat and drink safely and there was evidence people were able to choose what they wanted. If people did not like the options, kitchen staff were able to prepare alternatives from a well-stocked pantry containing fresh produce. People’s weight was monitored and nutritional risk assessed appropriately.

There were systems in place for people to raise any concerns, and we saw evidence that complaints were responded to, in line with the provider’s policy in a timely and appropriate way.

There was an appropriate programme of meaningful activities for people delivered by staff, and people’s participation was recorded. People were able to access the community and people’s ideas and suggestions were listened to and acted upon. We saw that the service asked people what they thought of their care and that their views generated actions taken by the service to address them.

There was a clear leadership structure with the registered manager holding oversight of governance arrangements. The registered manager provided clear leadership, and staff understood their roles and w

This was an unannounced inspection carried out on 05 April 2016. Our last inspection took place on 26 October 2014 when we gave an overall rating of the service as ‘Requires Improvement’. We found a single breach of the legal requirements in relation to consent to care and treatment. At this inspection we found improvements had been made.

Oak Tree Lodge is registered to provide accommodation and personal care for up to 60 people. The service had recently transferred from Ideal Carehomes to Anchor Carehomes. At the time of the inspection, the service had a manager registered 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.

People told us staff responded to their needs promptly, although we saw occasions where communal lounges were not staffed. The service was in the process of recruiting to some vacant posts. Medicines were generally well managed. However we saw some examples where medicines had been signed for as given before they were administered.

Recruitment practices were mostly found to be safe. People told us they felt safe living in the home and staff who had received safeguarding training were able to describe the action they would take to report abuse. Risks were being managed effectively in the service.

Staff were satisfied with the induction they received and records we looked at showed most staff were up-to-date with their training. The registered manager acknowledged there were gaps in staff supervisions and appraisals. Staff told us they were happy with the support they received from the registered manager.

This service was meeting the legal requirements of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). Staff supported people to access healthcare services and people were found to have been supported with their nutritional needs. People and staff provided mixed feedback about the quality of food.

People and relatives spoke positively about the support they received from staff who had good working relationships with them. Staff were able to describe how they protected people’s privacy and dignity, although we found one example when this did not happen.

People expressed frustration at the lack of activities taking place. On the day of our inspection there were no activities happening. The activities planner included ‘hairdresser’ and ‘family day’ as activities.

People’s care plans generally contained sufficient detail for staff to be able to provide effective care. We saw some examples of care plans which had not been fully completed.

People and relatives knew how to complain if they were unhappy with the service they received. We saw complaints were recorded and responded to appropriately. The registered manager had started a weekly ‘clinic’ to meet with people and relatives.

The home was generally clean and tidy, although we found concerns with the storage of clinical waste. Some maintenance checks had not been completed as scheduled and we found this had not been monitored appropriately.

We found a notification had not been sent to the CQC as required under the terms of the provider’s registration, although this had been submitted to the local authority. There was limited evidence of the registered manager’s involvement in audits carried out in the home, although the area manager carried out their own checks. Confidentiality was not always been maintained as sensitive records were being stored in an unsecured area.

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

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014.

Oak Tree Lodge is registered to provide accommodation and personal care for up to 60 people. The home 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 saw people looked well cared for. Staff spoke in a caring and respectful manner to people who lived in the home. Staff demonstrated that they knew people’s individual characters, likes and dislikes.

The service was not always following the Mental Capacity Act 2005 for people who lacked capacity to make certain decisions, however since our inspection we have been told this has been resolved.

People were protected from the risk of abuse. For example, one person had been kicked by another person living at the home. The manager showed us their response to this which included a referral to the local safeguarding team.

We looked at the home’s medication policy and found it was robust and gave staff good guidance on how to administer people’s medication safely and appropriately. Records we looked at were accurate, medication rooms were clean and tidy and temperatures of both the room and the medication fridges were monitored and recorded.

People enjoyed the food on offer at the home. One person told us “The food is lovely. I can have whatever I want.” We observed people being given choice and independence in accessing food and drink. People’s nutrition and hydration needs were being met. However, staff told us they thought the main meals served at lunch time were repetitive and they thought there should be more variation of meals on the menu.

The home displayed entertainment on offer to people although we saw there were no planned activities being facilitated on the day of our visit. We saw staff were engaging with people in a positive way however, they were busy providing care to people. Staff we spoke with told us they were often told by people they were bored.

Staff we spoke with gave us mixed feedback regarding the leadership and management of the home. They told us they received supervision however, this was often used as a ‘telling off’ for something they had not done. They did not see supervision as supportive. We were also told staff meetings were not taking place and they felt as though there were limited opportunities for them to have their opinions taken into consideration regarding the running of the service. However, we did see minutes from a staff meeting which had taken place in October 2014.