This inspection took place on 11 November 2016 and was unannounced. Tall Oaks provides residential care and accommodation for up to six people with learning disabilities, autistic spectrum disorder, physical disabilities or sensory impairment. At the time of our inspection five people were living in the home.

The home had been previously inspected on 21July 2015 and two breaches of the regulations had been found. At this inspection we aimed to see what work had been completed to ensure the quality and safety of the service had improved. The provider had told us that their action plans assumed they would complete all the actions required to meet the regulations by October 2015. During our inspection on 11 November 2016 we found that all the recommended actions had been completed.

We saw the home was a two-storey building, with wide corridors, clutter free rooms and a lift wide enough to accommodate a wheelchair. Ramps provided wheelchair access to the house from the front and to the garden at the rear.

The service had 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 were protected from the risk of abuse because staff were provided with relevant training to enable them to recognise and act upon a report or suspicion of abuse. Risks that people might experience had been assessed and action taken to minimise those risks, while enabling people to live active and fulfilling lives. Staff understood how to provide care that respected people's rights.

Systems were in place to make sure people received their medicines safely. Arrangements were in place for the recording of medicines received into the home and for their storage, administration and disposal.

Staff had been recruited safely to ensure they were suitable to work with vulnerable people. There were sufficient numbers of suitable staff to meet people's needs and people received their medicines as prescribed.

Staff had a good understanding of the Mental Capacity Act 2005 and we saw people’s consent was sought routinely. People were supported to make their own decisions wherever possible, and staff took steps to support people to do this. Where people were unable to make a decision, there was a best interest decision recorded within their support plan. We saw the person concerned and relevant people had been involved in making best interest decisions. This meant people were given the opportunity to participate in the decision making process. The service had effectively implemented the Deprivation of Liberty Safeguards (DoLS) as required.

Staff members understood their roles and responsibilities and were supported by the registered manager to continuously maintain and develop their skills and knowledge. People enjoyed a varied healthy diet and their physical and mental health needs were well catered for.

There were sufficient numbers of staff to meet people's needs and to keep them safe. Staff received training to ensure they had the necessary knowledge and skills to provide effective care and support. The service employed a small team of permanent staff who were knowledgeable about people's preferences and behaviours.

Care plans contained records of people’s preferences including their personal likes and dislikes. This helped staff to provide care and support in a way that suited each person’s individual preferences.

People were supported to be as independent as they wanted to be. People helped with daily living tasks such as meal preparation and cleaning. People were supported to meet their relatives and friends, access the community and participate in social or leisure activities on a regular basis.

The atmosphere in the home was welcoming and ther

The inspection took place on 21 July 2015 and was unannounced. Tall Oaks provides residential care and accommodation for up to six people with learning disabilities and/or autistic spectrum disorder, physical disabilities or sensory impairment. At the time of our inspection six people were living in the home.

The home was a two storey building, with wide corridors, clutter free rooms and a lift wide enough to accommodate a wheel chair. Ramps provided wheel chair access into the front of the house and the garden at the rear.

The home had a registered manager. 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 a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated regulations about how the service is run.

People were unlawfully restricted within the home, because the registered manager had not applied for Deprivation of Liberty Safeguards where these were required. Records did not demonstrate that the level of restriction people experienced was appropriate to protect them from harm. Although staff understood and followed the principles of the Mental Capacity Act 2005, documentation did not demonstrate that the process to support consent to care and decision-making had always been followed.

Records had not always been maintained and updated to reflect people’s current care and support needs. Reviews and updates of people’s risk assessments and support plans had not been completed as planned. Records of mental capacity assessments and decisions made in people’s best interest had not always been documented. There was a risk that people may not be cared for appropriately if staff unused to the home, such as agency staff, were required to support people.

However, effective communication between staff reduced the risk of harm to people caused by poor record keeping, because staff understood people’s needs and how to meet these safely. Other risks that may affect the safety of people and others, such as fire safety, were managed effectively to protect people from harm.

People were protected from the risk of abuse. Staff understood and followed guidance to recognise and address safeguarding concerns. Risks that may affect people’s or others’ safety had been identified, and actions ensured potential hazards were managed to reduce the risk of harm.

People were supported by sufficient staffing levels to meet their identified needs safely. Rosters were managed to ensure suitable numbers of staff were on duty for each shift, and the registered manager provided additional support as required. Robust recruitment procedures ensured suitable staff were appointed. People were involved in the recruitment process, and helped to select the staff who supported them.

People received their prescribed medicines safely. Staff followed training and guidance to ensure medicines were handled and administered safely. Medicines were stored appropriately, and checks ensured prescribed medicines were available as required.

People were supported by staff who had been trained to meet their health and support needs. The registered manager reviewed staff competency when working with staff, and supported staff development through regular supervisory meetings. Staff handovers ensured staff were kept updated on people’s changing needs, and understood how to support them effectively on a day to day basis.

People were supported to maintain a nutritious diet. They were involved in menu planning and meal preparation. Risks associated with eating, such as choking, were effectively managed. People’s nutritional intake and weight were monitored to ensure people were not at risk of malnutrition or dehydration.

Staff liaised with health professionals to support people’s needs and address health issues. When people’s health had altered, the registered manager and provider had ensured they received the care and support required to manage their changing needs.

People were supported by staff who understood and followed their preferences and communication methods. Staff treated people with kindness, and promoted people’s independence and dignity. Staff were respectful of people’s privacy. People and staff laughed together, and appeared to enjoy each other’s company.

Reviews and updates of people’s support plans and assessments of risks had not always been documented. However, other records documented that staff were responsive to changes in people’s needs, and managed risks to protect people from unsafe care or support. People and their representatives were involved in planning and agreeing their care. People were supported to attend a range of activities, and staffing rosters were managed to ensure staff were available to provide support to events at the times people wanted.

Complaints and concerns were managed to the satisfaction of people and their relatives. Effective communication channels ensured staff were responsive to relatives’ concerns, and relatives felt involved in their loved one’s care.

People, relatives and staff spoke positively about the registered manager, describing them as a person dedicated and determined to ensure people experienced high quality care. Staff lived the provider’s values in the way they supported people, ensuring they were empowered to live the lives they wanted. Audits ensured areas for improvement were identified, and the provider’s operational meetings provided opportunities for managers to share learning and identify appropriate actions to drive high quality care.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We spoke with one person who used the service and two people whose relatives used the service. The person who used the service said: “It’s really homely, I’m happy here. The staff always ask before doing anything and they sit down with me and explain things. I always feel well taken care of and I haven’t seen anything I don’t like.” One person whose relative used the service said: “I’m really happy about the way everything is being done, I have no concerns. My relative is given choices when they are capable of making them and the staff contact me for other choices. I can’t praise this place highly enough.” Another person whose relative used the service said: “My relative is happy living there. They do a lot of work to try and communicate with them, always involve them and tell them what’s going on. They do the best they can with my relative’s health and have done a lot of research into their health problems.”

We found people’s consent or that of their relatives was sought prior to any care or treatment being delivered. The home had ensured care was planned in accordance with people’s individual needs and risk assessments had been completed and regularly reviewed. There were appropriate systems in place to monitor the storage, handling, recording, administration and disposal of medicines. The service had an appropriate recruitment policy in place which had been followed when recruiting staff and had a statement of purpose which contained all required information.

As part of our inspection we spoke with one person who used the service and three people whose relatives used the service.

The person who used the service told us they liked living there and that they were able to do what they wanted. They told us they were given choices and were able to express their wishes to staff. They told us they were provided with lots of activities and that the staff were "welcoming" and "nice". They told us they always felt respected, well cared for and safe.

The three relatives of people who used the service told us they were very happy with the service. They all told us they believed their relatives were well cared for by staff who were well trained. They told us they felt they were kept well informed about their relative’s care needs and developments. They all told us they felt very comfortable raising concerns should they have any and believed these would be dealt with appropriately.