This inspection took place on 24 and 25 January 2018.

Oakmount House is a care home which is registered to provide care and accommodation for up to 10 adults with mental ill health. The service does not provide nursing care. People in care homes receive accommodation and 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. It is an older type adapted property situated on a main road on the outskirts of Burnley town centre. At the time of the inspection there were nine people accommodated at the service.

The service was managed by 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. Although at the time of this inspection there were two managers registered with the Commission, one was no longer working at the service.

At our last inspection on the 7 and 8 January 2016 the overall rating of the service was ‘requires Improvement’. There was a breach of the regulations; this related to the provider not having proper oversight of Oakmont House, including a lack of effective systems for checking, improving and developing the service. We therefore asked the provider to make improvements. We received an action plan from the provider indicating how and when they would meet the relevant legal requirements. At this inspection we found sufficient improvements had been made. At our last inspection, we also made recommendations relating to the assessment and management of risks, infection prevention and control, medicines management and working within the principles of the Mental Capacity Act 2005. We found improvements had also been made on these matters.

During this inspection we found there were no breaches of the regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. However we found some further progress was needed with medicines management and therefore made a recommendation.

We found there were management and leadership arrangements in place to support the effective day to day running of the service. The new registered manager had made a number of improvements and the provider was monitoring the service to ensure they had proper oversight.

Systems were in place to maintain a safe environment for people who used the service and others. We found some matters were in need of attention and the registered manager took action to make improvements.

Recruitment practices were in place to make sure appropriate checks were carried out before staff started working at the service. There were enough staff available to provide care and support and we were told staffing arrangements were kept under review.

Staff were aware of the signs and indicators of abuse and they knew what to if they had any concerns. Staff had received training on safeguarding and protection matters.

Arrangements were in place to gather information on people’s backgrounds, their needs, abilities and preferences before they used the service. The registered manager had introduced a way of promoting a smooth admission to the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Policies and processes at the service supported this practice.

We found people were effectively supported with their healthcare needs and medical appointments. Changes in people’s health and well-being were monitored and responded to.

People were satisfied with the meals provided at Oakmount House. Arrangements were in place to offer a balanced diet. People were actively involved with devising menus, which meant they could make choices on the meals

We carried out an unannounced inspection of Oakmount House on 8 and 9 December 2016. The first day was unannounced. Before the inspection we received information of concern relating to a safeguarding alert. This had been raised with the local authority and was subject to a multi-agency investigation. The concerns raised prompted us to carry out the inspection.

Oakmount House is registered to provide accommodation and personal care for up to nine people. The home supports people with mental ill health. It is an older type large terraced property, situated on a main road on the outskirts of Burnley centre and close to the town’s amenities. Communal areas consist of a lounge, dining room, kitchen, quiet area and bathrooms. There is a separate laundry in the basement. Accommodation is provided in single bedrooms some having en-suite facilities. At the time of our visit there were nine people living in the home.

At the time of the inspection the registered manager was absent from the service. 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 the previous inspection on 19 and 23 February 2015, we asked the provider to make improvements in relation to the safety and suitability of the premises. We did not receive an action plan from the provider indicating how and when they would meet the relevant legal requirements. At this inspection we found sufficient improvements had been made, however further action was required to minimise risks to the health safety and welfare of people using the service. We have therefore made a recommendation in respect of this matter.

During this inspection we found the provider was in breach of one regulation of the Health and Social Care Act (Regulated Activities) Regulations 2014. This related to the provider not having proper oversight of Oakmont House, including a lack of effective systems for checking, improving and developing the service. You can see what action we told the provider to take at the back of the full version of this report.

We have also made recommendations for improved practice in relation to the assessment and management of risks, infection prevention and control, medicines management and working within the principles of the Mental Capacity Act 2005. Following the inspection we received information from the provider that told us action was being taken in respect of these matters. We will check for improvements at our next inspection.

The people we spoke with indicated satisfaction with the care and support they experienced at the Oakmount House. Their comments included, “Things are alright” and “Everything is fine.” Some people did express dissatisfaction with the new lounge chairs, the acting manager was to purse this matter at the next residents meeting.

We found there were interim management and leadership arrangements in place to support the day to day running of the service. Staff indicated the acting manager was supportive and approachable.

Staff were aware of the signs and indicators of abuse and they knew what to if they had any concerns. Proper character checks had been carried out before new staff started working at the service. There were enough staff available to provide care and support and we were told staffing arrangements were kept under review.

We found people were supported to make their own decisions and choices. They were effectively supported with their healthcare needs and medical appointments. Changes in people’s health and well-being were monitored and responded to.

People were satisfied with the meals provided at Oakmount House. Arrangements were in place to offer a balanced diet. People were actively involved in devising menus, which meant they could m

We visited the home to check the action taken since the last inspection in July 2013, with regard to regulation 12, outcome 8, cleanliness and infection control, and regulation 15, outcome 10, safety and suitability of the premises. At our inspection in July the home was found to be non compliant with these regulations and was required to take action. The provider submitted an action plan which told us how they would become compliant.

At our recent visit in November we did not speak directly to people living in the home about these matters but spoke to the manager and looked round the premises. We found all the areas we looked at, and accessible to residents, were clean and free from unpleasant odours. We also found that some of the property restoration and maintenance work had been completed, and other major work was in progress.

We discussed all matters with the manager. She told us there had been changes to the cleaning routines in the home and that another member of staff had been made responsible for ensuring the home was kept clean. She also explained the progress of the major restoration work being completed in one half of the building. There had been problems with builders not meeting deadlines and their verbal commitments to undertake the work. This meant some work had been delayed. At the time of our visit this work had commenced. The registered manager agreed to send us an updated timescale for completion.

The purpose of this inspection was to check on the progress made with improvements that were needed at the inspection in October 2012 at which Oakmount was found to be non compliant with Regulations,11 Safeguarding and 15 Safety and Suitability of Premises. We were concerned that residents' finances were not being properly safeguarded and the local authority and police were undertaking investigations into this matter at the time of this inspection. The poor state of the premises that had been of concern over a number of years had still not been sufficiently improved. We made compliance actions for the regulations relating to both these matters, and asked the provider to submit an action plan to tell us how and when the home would be compliant.

At this inspection in February 2013 we found the provider, with the support of the local authority, had taken sufficient action to safeguard residents' finances. A major area of the home had been considerably renovated and the appearance was much improved. We were told there were plans to complete similar renovations in another part of the home within a reasonable timescale.

The residents we spoke with were aware of the changes to the arrangements for their finances and spoke positively of these changes. They also appreciated the improvements that had been made to the premises. The members of staff spoken with also regarded all the changes as positive, and felt they enhanced residents' independence, morale and well being.

We carried out this inspection as part of our annual inspection schedule, and also to follow up some on going issues of concern from previous inspections. At our last inspection in March 2012 the registered person was non-compliant with four Regulations under the Health and Social Care Act 2008. At this inspection we checked on the improvements we had asked them to make. We did this through talking to service users and staff, talking to the manager and looking at records. We also liaised with people in the mental health services who were supporting people at Oakmount.

We saw staff treating people with respect, understanding and patience. People living in the home were happy with the care and support given to them and with the choices they had in their daily routines and daily lives. One person told us about the day trips they had been on this year and told us they had decided where they wanted to go. People also told us they were pleased with some of the changes in the home - the new kitchen, new furniture and more single bedrooms being created. Two people were pleased with their relatively new en suite bedrooms.

We found on this visit some matters had improved, for example, some parts of the premises, cleanliness and the home's own quality monitoring checks. However there were still matters of concern. The premises/environment was still unpleasant and poorly maintained in places, and we had concerns that service users finances were not being managed properly.

At this visit we did not talk to the people living at Oakmount as the purpose of this particular inspection was to check on the progress made with the improvements that were needed at the inspection in December 2011. However it was clear that people still felt settled living in the home, as they had done at previous inspections. We saw one person had acquired some new furnishings for their new bedroom and was pleased with the result. We also saw people coming in and out of the home in accordance with their choice of daily activities. One person told us they had had the operation they were waiting for when we last visited and was feeling better.

Since the last visit the kitchen had been refitted to a good standard, and therefore was considerably improved. However there were no other improvements to the general maintenance and fabric of the premises/environment. Although people were settled living in Oakmount, overall we felt that allowing the poor standard of the environment to continue could mean that people's right to pleasant and comfortable accommodation was not respected.

Most of the people living in Oakmount House had lived there for a considerable period of

time and would not want to live anywhere else. One person had a downstairs room recently converted to a bedroom to cater for some mobility problems so that they did not have to move to another home.

At this visit we did not talk to the people living at Oakmount as much as we would normally do about their views of the home, as the purpose of this particular inspection was to check up on the progress made with the improvements that were needed at the inspection in July. However it was clear that people felt settled living in the home, and the person referred to above was pleased with their new room. However we were also told that this person, and the other resident who also had a new (downstairs) bedroom, had not had any choice in the decorating or furnishing of these rooms.

Another person had acquired some new furnishings for their bedroom and was pleased with the result. This person told us that they were "not bothered" by the conversion of a lounge to a bed room (see above), but another person said they ddin't like the changes.

Apart from the bed room conversions we found no improvement to the general maintenance and fabric of the premises/environment. Although people felt settled living in Oakmount, overall we felt that allowing the poor standard of the environment to continue could mean that people's right to pleasant and comfortable accommodation was not repected.

Most of the people living in Oakmount House had lived there for a considerable period of time and would not want to live anywhere else. One person had been in hospital earlier in the year and had been given the opportunity to move to another home as their needs had changed. This person told us that they wanted to return to Oakmount House and this choice had been accommodated. People told us that they had choices in what to do each day and in their daily routines. It was also clear that people living in the home could make choices and were informed about their support and health care

We carried out an inspection of Oakmount House on the 19 and 23 of February 2015. The first day of our visit was unannounced. We last inspected Oakmount House on 4 November 2013 to check whether improvements we required to be made had been completed. We found the issues raised had been dealt with satisfactorily.

Oakmount House is registered to provide accommodation and personal care for up to nine people. The home supports people with mental ill health. It is an older type property situated on a main road on the outskirts of Burnley town centre and close to the town’s amenities. Communal areas consist of lounge and dining room and kitchen. There is a separate laundry. Accommodation is provided in single bedrooms and one shared bedroom. At the time of our visit there were eight people living in the home.

The service was managed by 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 using the service were involved in decisions about how their care and support would be provided. The registered manager and staff understood their responsibilities in promoting people’s choice and decision making under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). CQC is required by law to monitor the operation of the DoLS. We found the location to be meeting the requirements of DoLS.

People told us they were cared for very well and they felt safe. Staff treated them well and gave them all the support they needed. One person said, “I love living here, it’s my home. We all get on well together. Nobody tells us what we can or cannot do.” Another person told us, “I’ve been here a long time and I wouldn’t like to go anywhere else. I feel perfectly safe here.”

People told us they determined their lifestyle and did not have to conform to any institutional practices. Routines were flexible and people had their preferred daily living plan recorded in their care records. This supported people’s varying needs being met at times that suited them and prevented institutional routines and practices occurring.

Staff gave a good account of and showed understanding of the varying needs of different people we had discussed with them. Staff said they enjoyed their work and worked well together for the benefit of people living in the home. Staff were clear about their responsibilities and duty of care.

People were cared for by staff who had been recruited safely and were both trained and receiving training to support them in their duties. Staff were kept up to date with changes in people’s needs and circumstances on a daily basis. We found there were sufficient numbers of suitably qualified staff to attend to people’s needs and keep them safe.

Contractual arrangements were in place to make sure staff did not gain financially from people they cared for at the home. For example, staff were not allowed to accept gifts, be involved in wills or bequests. This meant people could be confident they had some protection against financial abuse and this was closely monitored.

Individual risk assessments had been completed for all activities and were centred on the needs of the person. People’s rights to take risks were acknowledged and management strategies had been drawn up to guide staff and people using the service on how to manage identified risks. People were supported to use community facilities.

People had their medicines when they needed them. Medicines were managed safely. We found accurate records and appropriate processes were in place for the ordering, receipt, storage, administration and disposal of medicines.

The home was warm, clean and hygienic. There were infection control policies and procedures in place and the service held a maximum five star rating for food hygiene from Environmental Health following a self-assessment.

People told us they were satisfied with their bedrooms and living arrangements. Required maintenance work was being identified and monitored for completion by the registered manager. However we found radiators to be very hot and water temperatures exceeded a safe bathing temperature. This meant people were at risk of accidental scalding and burns. The registered manager said this would be raised as a safety issue with the registered provider. This was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we have asked the registered provider to take at the back of the full version of this report.

Each person had an individual care plan. These were sufficiently detailed to ensure people’s care was personalised and they were kept under review. People were given additional support when they required this. Referrals had been made to the relevant health and social care professionals for advice and support when people’s needs had changed. This meant people received prompt, co-ordinated and effective care.

Health and social care professionals commented “They definitely want the best for people with quality lifestyles and giving them a feeling of self-worth.” And “They make sure people are not marginalised and will try to give people the same opportunities as everyone else. Very professional.”

People said the food served was very good and they had everything they wanted. They could have hot and cold drinks when they wanted. One person told us, “I go shopping every week with the staff for the food. We choose what we want on the menus at our meetings. The food is good and I can have what I want. The staff are good cooks.”

People told us they were confident to raise any issue of concern with the registered manager, staff and with the registered provider and that it would be taken seriously. They also told us they were encouraged to express their views and were kept up to date with any planned changes.

Confidence was expressed in the management of the home by people using the service, staff and health and social care professionals who visited the home on a regular basis. They described the management team and staff as ‘being professional’ and ‘doing a ‘sterling job’.