About the service:

Oak View Residential Care Home 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 View Residential Care Home is registered to provide care for up to 42 people, including people living with dementia. At the time of the inspection, there were 42 people living at the service some of whom had a diagnosis of dementia.

People’s experience of using this service:

• People were happy with the care they received from the staff at Oak View Residential Care Home.

• People and family members told us that safe care was provided.

• Staff were well trained and received support and supervision.

• People received support to take their medicines safely and as prescribed.

• Risks to people's well-being and environmental safety were recorded and updated when the circumstances changed.

• People's rights to make their own decisions were respected. Staff supported people to make choices in line with legislation.

• People were supported to access health and social care professionals if needed.

• People's dietary needs were assessed and where required, people were supported with

their meals.

• People were supported to participate in a range of activities of their choice.

• Staff were kind, patient and responsive to people's needs. People were treated with dignity and staff respected their privacy.

• People knew how to complain and were confident that if they raised concerns, the management would act promptly to address these.

• People and staff were fully engaged in the running of the service.

• The management team were open and transparent. They understood their regulatory responsibilities.

• The management team had effective quality assurance systems in place.

The service met the characteristics of Good in all areas. More information is in the full report.

Rating at last inspection:

The service was rated as Good at the last full comprehensive inspection, the report for which was published in September 2016.

Why we inspected:

This was a planned inspection based on the previous inspection rating.

We carried out an inspection of this service in April 2015 and found the provider was not meeting the legal requirements in relation to standards of care and welfare for people who use the service. Care and treatment had not been designed to meet people’s needs or preferences. There was a failure to ensure systems and processes were in place to assess, monitor and mitigate the risks relating to the health, safety and welfare of people, or to record and investigate incidents and accidents at the home. We carried out an unannounced inspection of this home on 10 August 2016 and found the provider had made improvements in these areas and was now meeting the requirements of these regulations.

The home provides accommodation and personal care for up to 34 older people, some of whom live with dementia and mental health conditions. Accommodation is arranged over two floors with stair lift access to the second floor. At the time of our inspection 34 people lived at the home.

A registered manager was 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 were supported by staff who had a good understanding of how to keep them safe, identify signs of abuse and report these appropriately. Robust processes to check the suitability of staff to work with people were in place. There were sufficient staff available to meet the needs of people and they received appropriate training and support to ensure people were cared for in line with their needs and preferences.

Medicines were administered, stored and ordered in a safe and effective way.

Risk assessments in place informed plans of care for people to ensure their safety and welfare, and staff had a good awareness of these. External health and social care professionals were involved in the care of people and care plans reflected this.

People were encouraged and supported to make decisions about their care and welfare. Where people were unable to consent to their care the provider was guided by the Mental Capacity Act 2005. Where people were legally deprived of their liberty to ensure their safety, appropriate guidance had been followed.

People received nutritious meals in line with their needs and preferences. Those who required specific dietary requirements for a health need were supported to manage these.

People’s privacy and dignity was maintained and staff were caring and considerate as they supported people. Staff involved people and their relatives in the planning of their care. The home used closed circuit television and locks on bedroom doors to promote the privacy, dignity and safety of people.

Care plans in place for people reflected their identified needs and the associated risks. Staff were caring and compassionate and knew people in the home very well.

Effective systems were in place to monitor and evaluate any concerns or complaints received and to ensure learning outcomes or improvements were identified from these. Staff encouraged people and their relatives to share their concerns and experiences with them.

The service had effective leadership which provided good support, guidance and stability for people, staff and their relatives. Relatives and staff spoke highly of the registered manager and their team of staff.

We carried out an unannounced inspection of this home on 20 April 2015. Oak View Residential Care Home provides accommodation and care for up to 34 people who are over the age of 65, and may have mental health conditions or live with dementia. The home provides accomodation over two floors and stair lifts are in place to assist people to move between the floors. At the time of our inspection 32 people lived at the home.

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.

People felt safe at the home. Staff knew them well and they felt confident any concerns they might have would be addressed. The registered provider and staff had a good awareness of how to safeguard people from abuse. Policies and procedures were in place to support staff in the management of safeguarding issues. Staff were confident to raise any issues with the management team and confident these would be addressed promptly and efficiently. Safe recruitment practices in place meant staff were suitable to work with people in a care setting.

Risk assessments in place did not inform care plans and records, to ensure people received individualised, safe and specific care based on their needs . Incidents and accidents were not recorded, monitored and reported in a way which ensured the safety and welfare of people.

Medicines were stored securely and people received their medicines in a safe and effective way. We have made a recommendation for the provider on the management of “as required” medicines.

Staff at the home were guided by the principles of the Mental Capacity Act 2005 (MCA) when working with people who lacked capacity to make decisions. The Care Quality Commission monitors the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These had been implemented appropriately to ensure the safety and welfare of people. Care records reflected support people received in decision making and who should be involved with this.

Staff knew people very well and interacted with them in a calm, encouraging and positive manner at all times. They ensured people were offered choice at every opportunity and demonstrated good communication skills. Staff received training to support them in their role. However, not all staff had received training in MCA and Dols.

Nutritious and well-presented food was provided for people. Dietary requirements were recognised and recorded. People had access to external health and social care professionals for support and treatment as was required.

People felt valued, happy and content in their home. They enjoyed living at the home and found staff very caring and compassionate. Their privacy and dignity was respected at all times and they felt able to express their views and have them respected and acted upon.

Whilst assessments of people’s needs had been completed on and since admission to the home, care plans did not always reflect person centred and individualised plans of care for people.

Relatives and health and social care professionals found staff and the registered manager responsive to and effective in meeting the needs of people.

An activities coordinator was available to support people on five afternoons per week. Whilst some activities had been planned the home lacked the provision of stimulating activities which encouraged people’s independence and reflected their choices. We have made a recommendation abut the activities avaialable for people who live with dementia.

People and their relatives spoke highly of the registered manager and their staff. They said the manager and senior staff were easy to talk to, open to suggestions for improvements or new ways of supporting people, and always responded to them positively and with encouragement.

The registered provider did not have an effective system of audit in place to ensure incidents and accidents were reported, recorded and followed up in a way which ensured the safety and welfare of people. Audits of care plans were not sufficiently robust to ensure they were individualised and consistently updated.

We found a number of breaches 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.

This visit took place in response to concerns raised with us. We were told that the home's management had instructed staff to get people up from 4am as there were insufficient numbers of day staff coming on duty in the morning to assist people to get up.

We visited the home at 5am and found that people living at this home were asleep in bed.

We spoke with staff and the manager. We were unable to speak to any people living at the home as we were told they were asleep. The home was quiet and we did not see any people who were living at this home.

We looked at five people's care records. These were personalised and showed that people were offered choices as to when they got out of bed.

We saw that staff checked people at the home hourly through the night. Records showed any support people required at these times and clearly identified when people had chosen to get up.

We carried out an inspection on 30 May 2013. At our last inspection we found that the provider was non-compliant in a number of outcome areas. During this inspection we found that the provider had made the improvements to ensure that they were compliant in all of these areas.

On the day we visited there were 32 people living at the home, some of whom had memory impairment and or a physical health problem. During our inspection we spoke with the manager, four staff members, one relative and four people who use the service.

We saw that the home was clean and well maintained. We observed people doing activities in their rooms, for example one person was listening to their favourite music. People were able to participate in activities in the communal areas of the home including quiz games and singing. People were able to personalise their rooms with their own possessions.

We saw that the home had in place risk assessments for the use of equipment to support people in living independently. We saw that people had their care discussed and agreed with them.

During the lunchtime we used our SOFI (Short Observational Framework for Inspection) tool to help us see what people's experiences at mealtimes were. Staff were observed assisting people in a calm, friendly and polite manner. People were given choices about the food they would like to eat and were given reassurance and support as needed.

Oak View is a home for older people and they are registered for up to 34 people. On the day we inspected there were 34 people living at the home the majority of whom had memory impairment. During our inspection we spoke with four staff, the manager, the provider, a relative and three people who use the service.

As not everyone who lived at Oak View was able to tell us what they thought about the care and support provided, we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We spent time in their company in the lounge and dining area observing the support people received before and during their lunch?. We saw that the staff were friendly and respectful and that they were quick to respond if anyone appeared unhappy or distressed.

A relative told us, “I can not find fault” and “If I did not trust the staff then I would not leave my mother here”. People told us that “ Staff are nice and very hardworking”.

Staff we met on the day told us about the training they had attended recently and that they were able to speak openly with the manager and provider about any concerns.

Whilst our observations, people using the service, relatives and staff were positive about the care provided at the home, we found that the care plans and other records did not reflect the needs of people and the support they needed.

People we spoke with told us they were getting the care and support they needed. They said that they were treated well by the staff and that they had no concerns about the way that the service was organised and run.

We observed that staff responded promptly when people pressed the call button or requested assistance. Staff supported people in ways that upheld their dignity and promoted their independence as much as possible. Staff we spoke with demonstrated their understanding of the needs of people who use the service and interacted positively with them. We saw that people could move freely between the communal areas and their own rooms and personalise their rooms with their own belongings.

As part of our review we visited Oak View and spoke with two of the people who use the service, four relatives, two members of staff and the manager. We also observed interactions between staff and people who use the service.

A person who lives at Oak View told us that staff respect their privacy and dignity and consult them about how their care is delivered. Visitors we spoke with also said the services consults with them about their relatives care and keeps them informed about important health matters. We observed that staff asked if people required support and respected their choices. People who use the service told us that staff were good at dealing with their health issues and that there are opportunities to access the community. They gave positive comments about the choice of meals and said that staff were always available to support people at mealtimes if required. People who live in the home and relatives also commented positively about the staff and manager, describing them as “calm, professional and understanding”. They told us that the service listen to them, act on what they say and deal with any concerns or issues promptly and appropriately.