This inspection was unannounced and took place on 1November 2016. At the last inspection in September 2015, we found the provider was not meeting all of the requirements of the regulations we reviewed. We asked them to make improvements to maintaining the dignity of people living at the home and notifying CQC of incidents that occurred within the home. The provider had submitted an action plan detailing the improvements they planned to make and at this inspection we found improvements had been made and the provider was now meeting the regulations.

Oaks Court House is registered to provide accommodation and personal care for up to 41 older people, some of whom have dementia. On the day of the inspection there were 23 people living at the home. There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Relatives told us their family members were safe. People appeared comfortable in the presence of staff and staff knew how to protect people from the risk of harm. Staff supported people to manage their risks. There were staff available throughout the home to respond to people when needed. The provider had safe recruitment systems in place which ensured appropriate staff were employed to support people. People received their medicines as prescribed and had access to pain relieving medicines when required.

People were supported by staff who had the skills and knowledge required to meet their needs. Staff received training relevant to their role and were supported by the senior staff and registered manager. People were asked for their consent before care was provided and the registered manager had assessed people’s capacity to make decisions as required by law. People were happy with the food and drink provided and people were supported to access healthcare professionals when required.

People had developed positive relationships with staff and told us staff were friendly and kind. People were involved in making decisions about their care and support. We observed some occasions where staff missed opportunities to engage more with people and encourage or promote their independence. People were supported in a way that upheld their dignity.

People had not always been involved in the planning of their care due to their capacity to make decisions. However, we saw relatives and other professionals had been involved and had been asked to contribute to support and care planning. A programme of activities was available that was relevant to some people’s interests and pastimes, although some people told us they felt the activities offered were not of interest to them.

People and staff told us they felt the home was well managed. The registered manager and staff sought people’s views on the service they received. Staff felt supported by the management of the home and told us they felt their contribution was welcomed, and shared examples of where they ideas had been adopted and improvements made. The registered manager had notified us of events as required by law and felt supported by the provider. There were systems in place to review the quality of care people received and where improvements were identified action was taken to improve the quality of care people received.

In this report the name Margaret Sims appears, who was not in post and not managing the regulatory activities at this location at the time of this inspection. Their name appears because they were still identified as the registered manager on our register at the time.

At our previous inspection on 12 and 15 November 2013, we found that the management of people's prescribed medicines was unsafe. This inspection was carried out to see what action had been taken to ensure that people were appropriately supported to take their prescribed medicines.

During this inspection we looked at records and audits in relation to medicine management. We spoke with one care staff who was responsible for the management of medicines. The people who used the service were unable to tell us about the support provided to them due to their health condition.

We found that systems in place were more effective to protect people against the risks associated with the unsafe use and management of medicines. The care staff in charge said, “We have worked hard to put systems in place and the manager carries out regular audits."

This inspection was carried out because of concerns we had received from an anonymous source about the service provided to people. During this inspection we spoke with three people who used the service, six staff members, the general manager and the provider. The registered manager was not present.

We found that care plans provided staff with relevant information about people’s care needs but people could not always be assured that their needs would be met.

There were insufficient food provisions in place to ensure people's nutritional needs were met. One care staff said, “We occasionally have a gateaux for Sunday tea but that’s no good if we haven’t got the main food.”

Appropriate arrangements were not place to ensure that people were protected from abuse.

People lived in a clean and tidy environment but the absence of cleaning staff could compromise the daily hygiene standard. One care staff said, "Not having any cleaning staff has had a massive impact on the service."

People had access to appropriate items of equipment to promote their independence but the absence of frequent servicing of that equipment did not ensure that they would be safe to use.

There were insufficient staffing levels provided and this meant that people could not be confident that their needs would be met.

People had access to a complaints procedure that was also available in different formats to promote their understanding.

The home provided a residential care service for older people. During the inspection visit we spoke with two people who used the service, a visiting relative, registered manager, operation manager and four staff members.

We found that some improvements had been made to the management of people’s prescribed medicines but the provider was not entirely compliant in this area and further work was required to ensure practices were safe.

Some improvements had been made to the management of complaints but the provider was not entirely compliant in this area and further improvements were required. The home had a complaints procedure in place but not everyone who used the service was aware of this. One person who used the service said, “I’m not aware of the home’s complaint procedure but I don’t have many problems but if I did the staff would sort things out for me.” The home had received one complaint since the last inspection visit and we found that this had been responded to in a timely manner.

The home provided a service for people who were elderly frail and for those who had a diagnosis of dementia. The majority of people who used the service were unable to tell us about their experiences of living there. We observed staff interacting with people and talked to staff about how they cared for the individual.

We found that people were provided with information about their care and treatment choices but these were not provided in a format that everyone could understand. We observed that people's right to privacy and dignity was respected.

We found that care plans were in place and provided information about people’s care needs but these were not always followed and could compromise the care and support people received.

We found that the management of people’s prescribed medicines was inadequate and staff responsible for managing medicines had not received up to date training and this placed people at risk of not receiving the appropriate treatment.

The manager was confident that there were sufficient staffing levels to meet people’s needs but confirmed that there had been a shortage. A visiting relative raised concern about the deployment of care staff and felt this compromised the supervision of vulnerable people.

The complaints policy was not in a format that everyone could understand. We found that not all complaints were recorded or responded to. This meant people’s comments and complaints may not be listened to or acted on.

Staff had access to care plans and risk assessments to support their understanding of people’s needs. We observed staff assisting people in a caring manner.

One person who uses the service said, “I’m happy living here.”

Another person told us, “The staff do ask me how I would like to be cared for and they do listen to me.”

One visiting relative said, “The care provided here is good.”

Staff had received dementia awareness training to ensure they have the skills to assist people with this health condition.

A visiting general practitioner said, “Staff are aware of people’s care needs and care records are well maintained.”

Care plans provided staff with information about people’s cultural and religious needs.

The home had a number of quality assurance programmes in place to monitor the effectiveness of the service delivery.

This inspection was unannounced and took place on 1November 2016. At the last inspection in September 2015, we found the provider was not meeting all of the requirements of the regulations we reviewed. We asked them to make improvements to maintaining the dignity of people living at the home and notifying CQC of incidents that occurred within the home. The provider had submitted an action plan detailing the improvements they planned to make and at this inspection we found improvements had been made and the provider was now meeting the regulations.

Oaks Court House is registered to provide accommodation and personal care for up to 41 older people, some of whom have dementia. On the day of the inspection there were 23 people living at the home. There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Relatives told us their family members were safe. People appeared comfortable in the presence of staff and staff knew how to protect people from the risk of harm. Staff supported people to manage their risks. There were staff available throughout the home to respond to people when needed. The provider had safe recruitment systems in place which ensured appropriate staff were employed to support people. People received their medicines as prescribed and had access to pain relieving medicines when required.

People were supported by staff who had the skills and knowledge required to meet their needs. Staff received training relevant to their role and were supported by the senior staff and registered manager. People were asked for their consent before care was provided and the registered manager had assessed people’s capacity to make decisions as required by law. People were happy with the food and drink provided and people were supported to access healthcare professionals when required.

People had developed positive relationships with staff and told us staff were friendly and kind. People were involved in making decisions about their care and support. We observed some occasions where staff missed opportunities to engage more with people and encourage or promote their independence. People were supported in a way that upheld their dignity.

People had not always been involved in the planning of their care due to their capacity to make decisions. However, we saw relatives and other professionals had been involved and had been asked to contribute to support and care planning. A programme of activities was available that was relevant to some people’s interests and pastimes, although some people told us they felt the activities offered were not of interest to them.

People and staff told us they felt the home was well managed. The registered manager and staff sought people’s views on the service they received. Staff felt supported by the management of the home and told us they felt their contribution was welcomed, and shared examples of where they ideas had been adopted and improvements made. The registered manager had notified us of events as required by law and felt supported by the provider. There were systems in place to review the quality of care people received and where improvements were identified action was taken to improve the quality of care people received.