People's experience of using this service:

The service had deteriorated in some areas since our last inspection.

People’s medicines were managed safely and properly. However, where people chose to look after and administer their own medicines, the provider had not carried out any risk assessment. The service had a system to record and analyse any accidents or incidents. However, we saw some recorded accidents and incidents lacked detail around the incident and what action had been taken. The provider had robust recruitment procedures, however, we saw full employment histories had not always been obtained and gaps in employment had not always been explored with candidates. The home was generally clean and tidy; however, the service did not always follow good infection prevention and control practices. The registered manager had not reviewed accidents and incidents to look for any emerging themes or trends, which could help to identify measures to be put into place to help lessen the risk of recurrence. People received personalised care that was responsive to their needs and preferences. However, we found care plans were not always accurate and up to date. The provider had auditing systems to ensure they met legal requirements. However, these had not identified the shortfalls we identified during our inspection

We received consistently positive feedback from people about Red Oak Care Home. People told us it was homely, safe and that staff were kind and treated people well. Staff understood the importance of providing person-centred care and treated everyone as individuals, respecting their abilities and promoting independence. There were enough staff on duty at the right time to enable people to receive care in a timely way. People had opportunity to access a range of activities including access to the local community. Staff had built positive caring relationships with people they supported and their families. Staff liaised with other health care professionals to ensure people's safety and meet their health needs. We received consistently positive feedback about how the service was managed.

More information is in the full report.

Rating at last inspection: Good (Report published 27 May 2017).

About the service: Red Oak Care Home is registered to provide care for up to 17 older people. It is situated in the south of Blackpool. The home is a large detached building with a large garden and decking areas at the rear, with ramps for people to use if required. The home has two lounges and a separate dining area. All bedrooms are en-suite with communal bathroom and toilet facilities also available each floor.

Why we inspected: This inspection was brought forward due to concerns raised by the police and local authority safeguarding team during investigation of an incident. This incident is subject to a criminal investigation and, as a result, this inspection did not examine the circumstances of the incident.

However, the information shared with the Care Quality Commission about the incident indicated potential concerns about the management of risk of falls and seeking medical treatment. This inspection examined those risks.

Follow up: The next scheduled inspection will be in keeping with the overall rating. We will continue to monitor information we receive from and about the service. We may inspect sooner if we receive concerning information about the service.

This inspection visit took place on 11 and 13 April 2017 and was unannounced on day one and announced on day two.

Red Oak care home provides care and residential accommodation for up to17 older people who do not require nursing care. The home is situated in a residential area of Blackpool and is in close proximity to the shops, local amenities and public transport. There is a communal lounge and a dining room on the ground floor. Bedrooms are on the ground and first floor. A passenger lift provides access between floors. The rear garden provides a safe, secure outdoor area for people’s use. Parking is available on the forecourt of the home.

At the last comprehensive inspection on 07 January 2015 the service was rated overall as good.

At this inspection we found the service remained good.

There were procedures in place to protect people from abuse and unsafe care. We saw risk assessments were in place which provided guidance for staff. This minimised risks to people.

Staff supported people with medicines safely. Medicines were stored securely, administered as prescribed and disposed of appropriately.

Infection control practice was good and staff had received training in this area.

There were sufficient staff available to provide people with personal care and social and leisure activities. Staff received training to carry out their role and knew how to support and care for people. They had the skills, knowledge and experience to provide safe and effective support.

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

People told us they were happy with the variety and choice of meals available to them. Staff knew people’s food likes, dislikes and any allergies people had.

Care plans were personalised detailing how people wished to be supported. People who received support or where appropriate their relatives were involved in making decisions about their care. Their consent and agreement were sought before providing care.

People knew how to raise a concern or to make a complaint. The complaints procedure was available and people said they were encouraged to raise any concerns.

Senior staff monitored the support staff provided to people. Audits of care and support records and risk assessments were carried out regularly. People and their relatives were encouraged to complete surveys about the quality of their care.

The inspection at Red Oak was undertaken on 07 January 2015 and was unannounced.

Red Oak provides care and support for a maximum of 17 older people. At the time of our inspection there were 16 people who lived at the home. Red Oak is situated in a residential area of Blackpool. All bedrooms are en-suite with communal bathroom and toilet facilities available on each floor. In addition there is a dining room and two communal lounges. Outdoor decking areas to the rear are accessible for wheelchair users via a ramp.

There was a registered manager in place. 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.

At the last inspection on 12 November 2013, we asked the provider to take action to make improvements to how people’s care and welfare were maintained and how people were safeguarded from abuse. We also asked the provider to take action to improve quality assurance monitoring systems, the management of complaints, record-keeping and requirements related to the reporting of incidents to CQC. At the follow-up inspection on 24 January 2014 we observed improvements had been completed and the service was meeting the requirements of the regulations.

During this inspection we noted systems were in place to protect people against abuse. Individuals who lived at the home and their representatives told us they felt safe. We observed people were comfortable and relaxed and staff engaged with them in a caring and supportive manner. We observed people received their medication safely and in a timely manner.

The staff worked with individuals to ensure they received appropriate support. People told us they were involved in their care and assisted to make day-to-day decisions. We observed staff did not excessively limit people’s freedom and were about to receive training to underpin their understanding of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Systems were in place to protect people’s human rights. We observed staff maintained individuals’ privacy and dignity throughout our inspection. For example, people’s confidentiality was protected because their care records were securely stored.

Not all care records were detailed and risk assessments had limited information about managing potential risks to people who lived at the home. People’s preferences were not always recorded and care plans were more task orientated rather than personalised to the individual’s needs. However, we observed the registered manager had introduced a new care planning system and were reassured the management team would continue to develop this.

People and their representatives told us they were fully involved in their care planning. This included frequent review of the support they received. Staff effectively monitored people’s health and worked with other providers to ensure their continuity of care.

People and their representatives confirmed staffing levels were sufficient for their needs. The registered manager told us these were being reviewed to assure adequate staff numbers and skill mixes were maintained. Staff told us they were effectively trained and supported to carry out their work. Records confirmed staff were experienced and enabled to properly support people in their care. We saw evidence that the registered manager was planning further staff training, such as managing people’s nutritional needs.

Staff and people who lived at the home told us the registered manager was visible and promoted an open working culture. People and their representatives’ views were regularly sought and acted upon as a way of checking the quality of the service. The management team carried out frequent audits to protect the health and safety of staff, visitors and people who lived there.

During our inspection in November 2013 we found people’s safety was at risk. This was because suitable arrangements were not in place to safeguard people against the risk of abuse. We found there was no evidence to demonstrate comments or complaints had been taken into account and dealt with through the home’s complaints procedure. We also found the manager had not notified the Care Quality Commission of a serious injury to a service user or of an allegation of abuse in relation to a service user. We used this inspection to see what actions had been taken to meet the essential standards of quality and safety.

We spoke with a range of people about the home. They included the manager, staff members, residents and visitors to the home. We also asked for the views of external agencies in order to gain a balanced overview of what people experienced living at Red Oak.

We spent much of the time in the communal areas making observations of how people were being cared for. This helped us to observe the daily routines and gain an insight into how people's care and support was being managed. We observed staff assisting people who required care and support. Staff treated people with respect and ensured their dignity when supporting them. They provided support or attention as people requested it.

The people we spoke with told us they had no concerns about the care being provided. They told us they felt safe and well cared for. One person told us, "I feel at home. The staff are excellent and I am very happy."

We found new procedures and paperwork had been introduced. This was to ensure there was an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service.

We spoke with a range of people about the home. They included the provider, staff members, residents and visitors to the home. We also asked for the views of external agencies in order to gain a balanced overview of what people experienced living at Red Oak.

We spoke with people who lived at the home. They told us they could express their views and were involved in making decisions about their care. They told us they felt listened to when discussing their care needs. Staff confirmed to us they also involved people to ensure they received the right care and support.

We spent time in areas of the home, including the lounge and the dining areas. This helped us to observe the daily routines and gain an insight into how people's care and support was being managed. Staff treated people with respect and provided support or attention as people requested it.

We looked at how the service was being staffed and reviewed staff training and supervision. We saw there was sufficient staff on each shift with a range of skills and experience. Staff told us they felt supported, had regular meetings with the provider and their training was kept up to date.

There were a range of audits and systems in place to monitor the quality of the service being provided.

People told us they could express their views and were involved in decision making about their care. They said they attended meetings with the provider where they were encouraged to express their views about the service provided. They told us the staff team provided sensitive and flexible personal care support and they felt well cared for. They told us they felt safe and protected from potential harm.

“I attend the meetings with the owner and other residents. She always wants

to know if we are happy or have any concerns about anything. She is very approachable and I feel I can talk to her about anything. She always listens to what we have to say”.

“This is a very well run home in my opinion. I came to look around with my son before moving in and liked what I saw. The staff are excellent and the owner is very supportive. I have been very happy with my choice”.

“This is a wonderful place to live. The staff are kind, friendly and always helpful. We have lots of activities to keep us occupied and the food is very good. Plenty of variety and choices available. The portions are so good I am having to watch I don’t put weight on”.

“Very friendly, helpful and polite staff. I am very happy with my care”.

“The care here is excellent. The owner and her staff are very attentive”.

“I chose this home because it was local to where I had always lived. When I came to look around I was made welcome and felt comfortable. It was clean, smelt fresh and the atmosphere was very relaxed. I have a lovely room and have made some good friends. I am very happy”.

“I am happy with my care and feel safe. I have never witnessed anything that caused me any concern”.

This inspection was carried out to assess the safety of people who lived at the home. This was in response to information we received, relating to the safeguarding of a person using the service which concerned their safety and well-being.

The inspection took place over three separate days. The manager was not available during the first two days, as she was out of the country on leave. On these days we spoke to the person in charge, who was a senior carer. The manager was present at the home on the third day.

We spent time in areas of the home, including the lounge and the dining areas. This helped us to observe the daily routines and gain an insight into how staff spent time supporting people. We saw staff members were responsive to people’s needs.

Although the care we observed on the inspection was good, there were significant concerns staff had not responded appropriately to allegations of abuse. We found that whilst staff had received training and support, suitable arrangements were not in place to safeguard people against the risk of abuse.

There was no evidence that any comments or complaints had been taken into account and dealt with through the home’s complaints procedure. This meant that there wasn’t an effective system in place to record people’s views and to understand where improvements were needed.

We found that the manager did not notify the Care Quality Commission of a serious injury to a service user. In addition they had not notified the Commission of an allegation of abuse in relation to a service user. It is a requirement of the Care Quality Commission (Registration) Regulations 2009, that we are notified of such incidents. This is so that we can monitor services effectively and carry out our regulatory responsibilities.

The nominated individual for the company, who works at the home as manager is not registered with the Care Quality Commission. It is a condition of the home's registration that a manager is registered with the Commission.