The inspection of Oaktree Lodge Residential Home took place on 15 and 19 February and was unannounced. This was a comprehensive inspection. The previous comprehensive inspection of the home was carried out in July 2016 and the service was rated as requires improvement. Four breaches of regulations 12, 17, 18 and 19 of the Health and Social Care Act 2008 were identified. These were because people were not receiving their medicines safely, care plans did not always guide staff how to support people safely, there were no audits in place to identify shortfalls, recruitment checks were not always carried out and staff did not always have sufficient training. We served a requirement notice for these breaches of regulations. At this inspection we found the provider had made improvements and there were no breaches of regulation.

Oaktree Lodge Residential Home also provides a domiciliary care service to people in their own homes, we therefore gave 48 hours notice to the provider. This was because we wanted to speak with people in their own homes and wanted their permission to do this. However the provider had given notice that they would cease delivering this service on 7 March 2018. During our inspection, we therefore only focused on the leadership, management and forward planning towards closing this part of the service.

During this inspection we checked that the provider was meeting the legal requirements of the regulations they had breached. You can read the report from our last comprehensive inspection, by selecting the 'All reports' link for Oaktree Lodge, on our website at www.cqc.org.uk.

Oaktree Lodge Residential 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.

Oaktree Lodge residential home provides care and accommodation for up to 34 people older people and people living with dementia. On the days of the inspection 30 people were living at the home. The home was over four floors, with access to all floors either via stairs or the lift.

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 and their relatives were complimentary about the registered manager, the staff and the care they received. Staff knew people well and delivered care in the way they preferred. The service had a relaxed homely atmosphere and was clean throughout.

People’s care needs any risks to their health and wellbeing were comprehensively assessed and clear plans were in place to guide staff on how best to support people. There were good systems in place to identify any changes in people’s health and well-being and staff took swift action when they identified any health needs.

Staff were competent, knowledgeable and caring and recruited safely. They received appropriate training and supervision. The registered manager monitored staff performance and addressed any issues promptly.

People had plenty to eat and drink and had a choice of food and drink. Staff ensured people received support if needed but promoted independence as much as possible.

Staff respected people’s decisions and understood how to support people to make their own choices. Regular activities were available for people should they wish to take part, however, if people wished to spend the majority of time in their room this was respected.

The provider had an effective governance system in place to manage the quality of the service. There was a system of daily checks by senior staff and deputy managers overseen by the registered manager. These checks

The inspection took place on the 18, 19 and 21 of July 2016 and was unannounced to the care home and announced to the domiciliary care part of the service. At the last inspection in April 2014 the provider was found to be meeting all of the standards inspected.

Oaktree Lodge residential home provides care and accommodation for up to 34 people. On the days of the inspection 30 people were living at the home. The home was over four floors, with access to all floors either via stairs or the lift. One set of stairs had a stair lift in situ. Some bedrooms have en-suite facilities. There are shared bathrooms, shower facilities and toilets. Communal areas included two lounges, one conservatory, one dining area and back garden with decking and patio area.

The service also provides domiciliary care services to adults within the Portishead, Clevedon and Nailsea area. On the day of our inspection 37 people were using the service. The domiciliary care service provides support to older people living at home.

The service did not have a registered manager at the time of the 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. There was a manager in post however they had not applied to be registered with us. We raised this with the provider who told us they would ensure an application would be completed.

People did not always have adequate risk assessments and guidelines in place relating to their care needs. The provider had no care plan and support plans in place for people who were at risk of developing pressure sores. Those people at risk did not have records completed that confirmed support provided by staff.

People felt safe although not all notifications were being made when required to the Care Quality Commission. A notification is information about important events which the service is required to send us by law. People could be at risk due to the department of health’s code of practice not being followed. This was due to poor use of personal protective equipment such as gloves and aprons. Clinical waste and dirty laundry was being left in communal hallways which placed people at risk of cross infection.

People had personal evacuation plans in place although these did not always include a photograph of the person so they could be identified by someone who did not know them. People were at risk of receiving unsafe medicines and some records were poor and not all staff being trained. People were not always being supported by staff who received regular supervision and training. Staff did not always have adequate checks completed prior to working with vulnerable people.

Staff felt well supported and demonstrated a kind and caring approach to people they cared for.

Staff who worked for the residential home had staff meetings and these were used for learning opportunities to prevent issues from reoccurring. However staff who worked in the domiciliary care service did not. People were supported to maintain relationships with people who were important to them.

People’s consent to care and treatment was obtained, and staff asked people for their consent prior to supporting them. Care plans reflected if people had capacity to make their own decisions. People were involved in their care planning and referrals were made to health care professionals when required.

The environment had risk assessments in place and people and staff felt the home was welcoming and friendly. People had access to activities and people enjoyed participating in these. People told us they enjoyed the meals and care plans reflected people’s individual dietary needs. Although this information was not always available to kitchen staff.

People and relative’s views w

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

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.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People were treated with respect and dignity by the staff and they told us that they felt safe. One person told us "They really look after you here". The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one. This meant that reasonable steps had been taken to protect people from abuse.

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns and investigations. This reduced risk to people who used the service and helped the service to continually improve.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly.

The needs of residents were taken into account when making decisions about the qualifications, skills and experience required when appointing new staff. Recruitment practice was safe and thorough. Policies and procedures were in place to make sure that unsafe practice was identified and people were protected. Disciplinary procedures were applied fairly and resulted in positive outcomes. This helped to ensure that people’s needs were always met.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people’s care and support needs and that they knew them well. Staff had received training to meet the needs of the people living at the home.

People’s health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People said that they had been involved in writing them and they reflected their current needs.

Although Oakwood Lodge had not been originally built as a care home, people’s needs had been taken into account when it had been converted. The layout of the accommodation enabled people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people with physical impairments.

Relatives and friends confirmed that they were a made welcome when they visited, could share meals with residents and could stay overnight if necessary.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were patient and gave encouragement when supporting people. People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this. A visitor said "Everyone is very friendly and caring here".

As well as addressing physical needs, care plans also described specific ways of comforting individuals if they became distressed. Individual preferences were always respected and people who lived at the home were encouraged to arrange their rooms to reflect their own taste and wishes.

The manager had developed a good relationship with a local GP surgery. Regular weekly visits ensured that any long-term medical issues were addressed in a timely manner. We were told that GPs responded quickly if there were more urgent medical problems that needed to be resolved.

Is the service responsive?

People’s needs had been assessed before they moved into the home. Records confirmed that people’s preferences, interests, aspirations and diverse needs had been recorded. Care and support had been provided that met their wishes. Special attention was paid to nutritional needs and people told us that they enjoyed the home-made food.

People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives. People took part in a range of activities both in and outside the home on a regular basis.

People knew how to make a complaint if they were unhappy. No-one that we spoke with had had cause to complain but they were confident that any problems would be dealt with effectively.

Is the service well-led?

The service worked well with other agencies and services to make sure people received continuity of care. People who lived at the home confirmed that staff listened to their views, both individually and during the monthly residents meeting. Changes that they had suggested had been acted on whenever possible.

The service has a quality assurance system. Records seen by us showed that identified shortfalls were addressed promptly. The registered manager of the home was actively involved in the day-to-day care of residents and was able to train and supervise less experienced staff. This meant that any weaknesses in the care provided were rapidly addressed. As a result of these measures the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. They had a good understanding of the ethos of the home and told us that they enjoyed helping the people who lived at Oaktree Lodge. This helped to ensure that people received a good quality service at all times.

People we spoke with said they were happy with the care and support provided by the home. People told us that they were assessed before they came to live at Oaktree Lodge Residential Home .They said they were involved in developing their care and support plans and staff treated them kindly and politely. We observed staff interacting with people who used services in a respectful and dignified manner.

We saw that the provider had a policy on safeguarding people from abuse. Staff had attended training to ensure that people who lived in home were protected from the risk of abuse. People said they felt safe with staff who supported them.

We saw the provider had an effective system in place to regularly monitor the quality of service that people received. People told us they were able to discuss issues openly at the residents' monthly meetings. People said they were aware of the complaint procedure. One person said “I am quite content, I have no complaints”.

People told us that the home was clean and the food was good. One person said: "this is an excellent home. I love it here, the food is good, it's very clean. The staff are very polite and always cheerful. I have been here a long time".

We found that there were sufficient numbers of suitably qualified, skilled and experienced staff at all times.

Three relatives we spoke with told us that their family members were in a good place. They said their relatives were happy and settled as staff were kind.

During our visit 31 May 2012 we found that the home was not compliant with the regulations in the outcome areas of both care and welfare and safety and suitability of premises. The provider wrote to us following our visit and told us what they were going to do to make sure that they were compliant with the regulations in these areas.

Prior to our visit we had also received some concerns from a member of the public about cleanliness and infection control.

We visited the home on 26 September 2012 to check that the provider had made the improvements which they told us they would.

We did not speak to people in depth during this inspection, but three people we spoke with told us that they liked living at the home and they liked the staff. One person told us that “they had no complaints and most people are quite happy living here”. We observed the interaction between staff and people. We saw that members of staff respected people’s privacy and dignity and helped people to be as independent as they wanted to be without compromising their safety and health.

We visited Oaktree Lodge Residential Home on 31 May 2012 and during our visit we spent time reviewing the personal care provided to people accommodated in the home. We also reviewed the personal care provided to people in their own homes, but organised by the manager from an office within the home. We were told by the provider and manager that the service provided to people in their own homes which commenced in January 2012 had started small, but it was expanding slowly as people heard about the service through “word of mouth”.

During our visit we spent time talking with people who lived in the home and people who lived in their own homes in the local community. We also spoke with relatives and care staff as part of this inspection. All the people we spoke with confirmed that the staff were respectful towards them and that they felt consulted and involved in their individual care packages. People told us that they felt safe living in the home and with the support provided to them in their own homes.

Four out of the six outcomes inspected were met, but we had concerns in two areas. One concern was in respect of some poor care practices in the home and risk assessments not being maintained. We felt that this had a minor impact on people who used the service. We also had concerns about the maintenance of the premises and environmental risks not being well managed, and we felt that this had a moderate impact on people who used the service.