We undertook an unannounced inspection of Oaken Holt Nursing and Residential Home on 1 November 2018. People in nursing 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 is registered to provide nursing care for up to 59 older people, some of whom have dementia. On the day of our inspection 48 people were living at the home.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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 were safe. There were sufficient staff to meet people's needs and staff had time to spend with people. People’s nutritional needs were met and staff supported people to maintain a healthy diet. Where people had specific dietary needs, these were met.

Risk assessments were carried out and promoted positive risk taking, which enabled people to live their lives as they chose. People received their medicines safely. Records relating to risks and medicines were accurate and up to date.

The service provided support in a caring way. Staff supported people with kindness and compassion and went the extra mile to provide support at a personal level. Staff knew people extremely well, respected them as individuals and treated them with dignity whilst providing emotional support. People and their relatives, were fully involved in decisions about their care needs and the support they required to meet those individual needs.

There was a positive culture at the service that valued people, relatives and staff and promoted a caring ethos that put people at the forefront of everything they did.

People received effective care from staff who had the skills and knowledge to support them and meet their needs. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the procedures in the service supported this practice. People were supported to access health professionals when needed and staff worked closely with people's GPs to ensure their health and well-being was monitored.

People had access to information about their care and staff supported people in their preferred method of communication.

The service continued to be responsive to people's needs and ensured people were supported in a personalised way. People's changing needs were responded to promptly. People had access to a variety of activities that met their individual needs.

The registered manager monitored the quality of the service and looked for continuous improvement. There was a clear vision to deliver high-quality care and support and promote a positive culture that was person-centred, open, inclusive and empowering which achieved good outcomes for people.

This inspection took place on the 28 July 2016. It was an unannounced inspection.

Oaken Holt House Nursing & Residential Home provides accommodation and nursing care for up to 59 older people. On the day of our inspection 46 people were living at the home. Most people were living with dementia. The home was undergoing extensive refurbishment and some areas of the home were closed.

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 benefitted from caring relationships with staff. People were treated with dignity and respect and they were involved in their care. Staff promoted people’s independence. On the day of our inspection there were sufficient staff to meet people’s needs. The service had safe, robust recruitment processes.

Most staff understood their responsibilities in relation to safeguarding. Staff had received regular training to make sure they stayed up to date with recognising and reporting safety concerns. However, some staff we spoke with were unsure who they could contact outside of their organisation. The service had systems in place to notify the appropriate authorities where concerns were identified.

People received their medicine as prescribed. However, medicines were not always stored safely and medicine records were not always accurate. The registered manager took immediate action to rectify our concerns.

Where risks to people had been identified, risk assessments were in place and action had been taken to manage the risks. Staff were aware of people’s needs and followed guidance to keep them safe.

Staff had a good understanding of the Mental Capacity Act (MCA) and applied its principles in their work. The MCA protects the rights of people who may not be able to make particular decisions themselves. The registered manager was knowledgeable about the MCA and how to ensure the rights of people who lacked capacity were protected.

People had enough to eat and drink. People could choose what to eat and drink and their preferences were respected. Where people had specific nutritional needs, staff were aware of, and ensured these needs were met.

People told us they were confident they would be listened to and action would be taken if they raised a concern. We saw complaints were dealt with in a compassionate and timely fashion. The service had systems to assess the quality of the service provided. However, these systems had not identified our concerns.

Staff spoke positively about the support they received from the registered manager. Staff supervision and meetings were scheduled as were annual appraisals. Staff told us the registered manager was approachable and there was a good level of communication within the service.

The registered manager told us their vision was to provide people with the best care possible.

People told us the service was friendly, responsive and well managed. People knew the managers and staff and spoke positively about them. The service sought people’s views and opinions and acted upon them.

The inspection was carried out by an adult social care inspector. An Expert by Experience was part of the inspection team. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. During the inspection evidence was gathered to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with nine people who use the service, one relative, one health professional, the registered manager, and seven care staff. We looked at records relating to the management of the home and five people’s care records.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

We found the service was safe. People told us they felt safe. One person said, “I feel I am in safe and kind hands.” Staff had a clear understanding of their responsibilities to report abuse and all staff we spoke with had received safeguarding vulnerable adults training.

People’s needs were assessed and care plans reflected their identified needs. We saw that where risks were identified these had been assessed and appropriate action taken. For example, where people were at risk of pressure damage, pressure relieving equipment was in place in line with their care plan.

There were sufficient staff on duty to meet people’s needs. We observed staff responding in a timely manner to any requests for support. People told us their call bells were answered promptly. Staff showed a good knowledge of the needs of the people they were supporting.

The provider understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The manager was aware of the recent Supreme Court judgement in relation to the Deprivation of Liberty Safeguards and would take appropriate action if a person required a DoLS.

Is the service effective?

We found the service was effective. People were supported in a dignified and respectful manner. We saw that care records were person centred and written with the involvement of the person and their families.

People’s cultural and spiritual needs were identified. We saw people being supported to attend Holy Communion in the home. Two people told us their faith was important to them and were grateful to have the opportunity to take Holy Communion and go to church.

People were supported to maintain and improve their independence. We observed people being encouraged to carry out activities. For example, during the book club meeting the activity coordinator supported people to read passages of the book in a reassuring manner. One person’s care record identified they were now able to feed themselves with support having previously been dependent on care staff. We observed this person being encouraged to feed themselves.

Is the service caring?

People told us they felt well cared for. One person told us, “Staff are absolutely marvellous, very caring.” Another said, “I feel that all the staff are caring.”

People were supported by caring and attentive staff. We saw care workers encouraging people with patience and understanding. People were not rushed and were able to do things at their own pace.

People were supported in a timely manner, with dignity and respect. For example, one person was being transferred from their wheelchair to an arm chair using a hoist. This was done with care and reassurance.

Is the service responsive?

The service was responsive to people’s needs. Where changes in people’s needs were identified appropriate support from health professionals was sought and changes to care needs met. For example, where care records showed people had been assessed as at risk of choking they had been referred to the speech and language therapist (SALT). The recommendations made had been implemented and we saw people receiving the correct consistency of fluids.

The home took account of complaints in order to improve outcomes for people. One person's relative had complained about the lack of physiotherapy support for their relative. This was reviewed by the home manager and additional support provided.

Is the service well-led?

The service was well-led. The provider had systems in place to monitor the quality of the service. Annual surveys were conducted to gain the views of people using the service and their relatives. We saw that comments from the survey had resulted in actions being taken to improve the service. For example the survey showed that relatives felt communication between relatives and the home manager could be improved. This resulted in the manager relocating their office to the main building, nearer to the entrance.

There was a clear procedure for recording incidents and accidents. Any incidents and accidents relating to people who used the service were recorded centrally by the manager and then filed in peoples care records. The manager checked all incident forms to identify any risks or trends and what changes might be required to make improvements for people who used the service.