Oakleigh Lodge provides residential and respite care and support for up to 15 people who have a learning disability, mental health condition or brain injury. Ten people were using the service at the time of our inspection. One of the ten people was staying at Oakleigh Lodge for a short period of respite care. There was a registered manager in post at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

We found that improvements were needed to ensure people received their care safely. Risks to people’s health and wellbeing were not always adequately assessed, recorded or reviewed. Accurate and up to date information about people’s risks was not always available for the staff to follow. The staff could not consistently evidence that incidents involving safety were analysed and managed effectively to prevent further incidents from occurring. Care was not always planned for or delivered in a manner that met people’s individual and complex care needs, and professional advice was not always followed. This meant that people were at risk of receiving care in an unsafe and inconsistent manner. You can see what action we told the provider to take at the back of this report.

Some people who used the service did not have the ability to make decisions about some parts of their care and support. The Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) set out the requirements that ensure where appropriate decisions are made in people’s best interests when they are unable to do this for themselves. Staff told us they had received training in the Act but most of the staff we spoke with were unable to demonstrate their understanding of the DoLS. This meant that staff could not always be responsive to the needs of people who were unable to make decisions for themselves and there was a risk that people could be deprived of their liberty without the appropriate safeguards being in place. You can see what action we told the provider to take at the back of this report.

People could access support from GPs and nurses if they became unwell. However the staff could not always demonstrate that concerns about people’s health and wellbeing had been identified and handed over to the relevant health care professionals in a timely manner. This meant that improvements were needed to ensure people received the right care and support at the right time.

Peoples care preferences were sought and the staff understood and met these preferences. Staff received regular training about how to provide care and support. However the provider needs to review the training needs of the staff to ensure they have the knowledge and skills to meet people’s individual and complex needs.

People who used the service and their relatives’ views and opinions of the care were sought. Appropriate action was taken by the registered manager in response to any concerns raised through feedback. The registered manager was beginning to make some improvements in the way information was presented to people who used the service. However, we found that further improvements were required to ensure information about how to complain or escalate concerns about the care was accessible in formats that met people’s individual communication styles.

The registered manager had systems in place that ensured there were enough staff on duty to meet people’s individual preferences. Staff told us they were well supported by the registered manager.

Effective systems were not in place to enable the registered manager or provider to assess and monitor the safety and effectiveness of the care. The concerns with the care we identified at this inspection had not been identified by the registered manager or provider.

We spoke with four of the nine people living there on the day of our inspection. We also spoke with the manger, a senior staff member and a support worker.

One person told us, "It's a brilliant place, the staff are really good and help me loads". We saw people were asked for their consent about the care they received. People were consulted about their care choices and how they preferred their care to be delivered.

People were supported to pursue their interests and risks to people's health were identified and planned for. We saw people were supported to eat and drink enough, and arrangements were in place to identify where people needed specialist support to do so.

Systems were in place so that people had their medicine when they needed it.

Staff had the support they needed to carry out their care tasks to an appropriate standard.

People had access to a complaints procedure and were confident their concerns would be addressed.

We visited Oakleigh Lodge on 25 May 2012 as part of our schedule of planned visits. We had also been informed of concerns about the care people received. As Oakleigh Lodge has only been registered for less than a year this was its first inspection by us.

There were seven people living at the home when we visited. The visit was unannounced which meant the provider and the staff did not know we were visiting.

Before our visit, we contacted other people who may have had an interest in the service such as the local commissioners who purchase a service from Oakleigh Lodge. We had very positive feedback about Oakleigh Lodge from visiting social workers, which told us they had no concerns about standards within the service.

We also contacted local involvement networks (LINks). LINKS are groups of individual members of the public and local voluntary and community groups who work together to improve health and social care services. To do this they gather the views of local people. As Oakleigh Lodge has only been registered for less than a year they had no information to share with us.

During our visit to Oakleigh Lodge we saw that relatives and visiting professionals had written very positive comments about their contacts and experiences, these included:

“We are extremely relieved that X is being cared for so well”.

“Staff are so welcoming and X has come on brilliantly since being here”.

“We are pleased to see that X is so happy and obviously enjoying the excellent standard of care”.

This told us that people who visited Oakleigh Lodge regularly were very happy with the standards of care.

We spoke with four people during our visit and observed the delivery of care for three people. People were positive about their experiences. Their comments included: "“I love it here the staff are brilliant, they look after me, they know when I’m worried about stuff and when I panic they will talk to me, help me to see things calmly”.

Another person we spoke with told us they were “Alright” and when asked if they were happy responded “yes”.

We looked at the plans of care for three people and found that these were detailed and provided guidance to staff on how people needed and wished to be cared for. There was evidence that people had been involved in the development of care plans and decisions about their care and treatment, and that where people needed they had an advocate to represent their views. We saw lots of examples where people had been supported to understand information written about them, or information that affected them.

We saw that the provider had actively recruited experienced and trained staff to meet the diverse needs of the people living at Oakleigh Lodge. We observed staff to be caring, professional and responsive to people’s specialist needs.

We saw that the systems to monitor and audit the quality of the service and delivery of care were well established with further plans to develop a ‘family forum’ demonstrating that the provider is committed to continually improve the standard of service provided.

People had access to facilities with a range of aids and adaptations ensuring their physical needs could be met. The furnishings and equipment included a cinema room, a sensory room and a computer area. The building is furnished to a high standard, spacious, and bright and provides an excellent environment for younger adults. One person told us “I’ve never lived in a lovely place like this, everything is so lovely, and the staff are great, really really great”.

This inspection took place on 5 and 8 January 2016 and was unannounced. The provider of Oakleigh Lodge is registered to provide accommodation with personal care for up to 19 people. Oakleigh Lodge provides residential and respite care to people who have a learning disability, autism, and mental health condition or brain injury. Thirteen people were using the service at the time of our inspection, ten people lived in the main house and three people were accommodated in three of the four adjoining flats.

A registered manager was in post at the time of our inspection. 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 our last inspection of February 2015 the provider was not meeting one regulation that we assessed relating to people’s care records. Improvements were also required regarding managing people’s medicines and providing additional staff training to ensure the care needs of people were met effectively. Further  consideration of people’s capacity was needed to ensure their safety. The monitoring of the quality of the service needed strengthening to ensure any risks to people’s health and safety were managed. Following our inspection the provider sent us an action plan which highlighted the action they would take to improve. During this inspection we looked to see if improvements had been made and found that they had.

We saw that improvements had been made so that staff had the training they needed to administer people’s medicines safely.

People told us that they felt safe and we saw staff knew how to identify and report any concerns they had about harm or abuse.

People’s care needs were met by sufficient numbers of staff. Staff had access to a range of training which included additional specialist training to care for people who had complex needs. Staff felt their training and support helped them to develop the skills to meet people’s needs safely

We saw staff understood people's care and support needs and how to enable people to achieve their goals. People were satisfied staff cared for and supported them in the way they wanted. We saw staff were attentive and caring towards people. Staff used people's preferred communication to ensure their individual choices were fully respected. They promoted people's dignity and privacy and supported people to follow their own interests.

Staff supported people to remain healthy and well. Staff monitored people's health and shared information effectively to make sure people received the right care and treatment. Staff followed the advice of health professionals so that any risks to their health could be reduced. People liked the meals provided and had been involved in planning and choosing what they ate.

People’s consent was sought before staff provided care or support to them. Where people were unable to consent to their care because they did not have the mental capacity to do so decisions were made in their best interests. Staff practices meant that people received care and support in the least restrictive way. The registered manager understood when people’s liberty may need to be restricted to ensure their safety so that any restrictions to people's liberty were lawfully applied.

We saw the provider had made a number of improvements since our last inspection. They had restructured the management team and improved their systems to monitor and review people's care. The provider had visited the home and carried out checks on all aspects of the service. He had provided opportunities for people, their relatives and the staff to share their experiences. He had made improvements so that people received a good quality service at all times.