About the service: The Oaks provides personal care and support for up to nine people who have a learning disability, in one adapted building. The service was full at the time of our inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service: The registered manager had ensured improvements were made to medicines storage and administration practices in light of our previous inspection. Auditing and oversight of medicines and other aspects of the service were in place and effective. Staff demonstrated a good understanding of people’s medicinal needs.

The registered manager continued to be supported by a team of dedicated staff, including an administration officer with comprehensive knowledge of the service. People spoke highly of the registered manager, as did staff. People were comfortable in the presence of the registered manager and staff had evidently developed strong bonds with them.

Regular meetings were held with staff and people who used the service. These meetings were an opportunity to openly discuss a wide range of topics, from safeguarding and complaints to activities and menus. People who used the service and staff confirmed they could raise queries or suggestions in a welcoming, inclusive atmosphere.

Good community links remained in place, particularly with a local community centre, where people attended a range of activities. The registered manager ensured people had opportunities to engage in their local community and beyond.

Records were accurate, up to date and person-centred.

The registered manager had been in post for several years and demonstrated an excellent knowledge of the needs people. Relatives and external professionals spoke of their confidence in the registered manager and staff team.

Turnover of staff remained low and staff morale was high.

Staff at all levels continued to deliver the caring, homely environment the service advertised and we found the culture remained focussed on ensuring people felt at home.

The care service was managed in line with the values that underpin Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities using the service can live as ordinary a life as any citizen.

Rating at last inspection: We previously inspected The Oaks in February 2018, at which time the service was rated requires improvement. At this inspection the registered manager had made the necessary improvements and the service was rated good.

Why we inspected: We inspected the service in line with our scheduled programme of inspections and to see if the registered manager had made the required improvements identified at the last inspection.

The inspection took place on 15 February 2018 and was unannounced. This meant the provider and staff did not know we would be coming.

We previously inspected The Oaks in November 2015, at which time the service was meeting all regulatory standards and rated good. The service was rated requires improvement at this inspection.

The Oaks 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. The Oaks provides care and support for up to nine people who have a learning disability, in one adapted building. Nursing care is not provided. There were nine people using the service at the time of our inspection.

The service had 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.

Pre-employment checks of staff were in place, including Disclosure and Barring Service checks, references and identity checks. The registered manager did not have in place processes to formally risk assess the suitability of persons for whom there may be relevant information on pre-employment checks. We have made a recommendation about this area of risk assessment.

The ordering, storage, administration and disposal of medicines was generally safe, although we identified areas of poor practice that the registered manager’s audits had not identified.

Auditing arrangements in place required improvement, with some areas of inaccuracy and poor practice identified in the inspection not picked up in the registered manager’s audits of the service. We have made a recommendation about this.

People who used the service interacted in a relaxed fashion with staff and told us they felt safe, whilst relatives and external professionals raised no concerns about the service.

There were sufficient numbers of staff on duty, day and night, in order to keep people safe and meet their needs. Staff had received appropriate safeguarding training and were able to tell us what types of abuse they were mindful of and how they would raise concerns if they needed to.

All areas of the building were clean and staff adhered to cleaning schedules to reduce the risks of acquired infections. The registered manager agreed to improve hand-drying facilities on the first floor, which were limited, during the inspection. The premises were generally well maintained, with external servicing of equipment in place.

Risk assessments were person-centred and staff had clear guidance regarding how to manage the risks people faced. There were detailed strategies in place to help people reduce specific risks.

People had access to external healthcare professionals such as GPs, psychiatrists, nurses and occupational therapists to get the support they needed.

Staff told us they were well supported and we saw they received a range of mandatory training, such as safeguarding, health and safety, moving and handling, fire safety and infection control, and this was monitored by the administration officer.

People were encouraged to have healthy diets and were protected from the risk of malnutrition, with staff adhering to external advice from speech and language therapists.

The premises had been adapted to people’s needs, with a wet room, bathroom, shower room and a number of w/c’s accessible to people and a chairlift in regular use.

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. The registered manager had ensured care plans relating to Deprivation of

We considered our inspection findings to answer questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

This is a summary of what we found -

Is the service safe?

Risks to personal safety were assessed and managed. This enabled people’s care to be given safely and prevented them from being harmed. A relative told us, “X always has someone with him when he goes out. He feels safer that way”.

People were cared for in a safe and comfortable environment that was adequately maintained.

Staff were checked and vetted to make sure they were suitable to be employed to work with vulnerable adults.

Is the service effective?

People living at the home were provided with care and support that was well planned and met their needs. People and their relatives told us they were satisfied with their care. They said, “I am happy here”; “He gets all the support he needs”; and, “The staff are lovely, she’s treated very well”.

The service supported people to meet their nutritional needs and sought specialist advice when necessary. People were given choices of food and told us they liked the meals.

Is the service caring?

We saw people’s care was focused on their individual needs and promoted their independence. Staff were patient and encouraged people to do things at their own pace. Relatives told us, “The staff have been super, they’re very good in the way they look after her”, and, “I find them (staff) to be very caring and helpful”.

Is the service responsive?

Care was provided according to people’s preferences, interests and diverse needs. When people’s needs changed, their care was adapted to make sure their welfare and safety was protected.

People were able to access a range of activities to meet their social needs. They were supported to be involved in the community and to maintain relationships with their families.

Is the service well-led?

The manager and staff had good understanding of the ethos of the service and their roles and responsibilities. Quality assurance processes were followed to check on the standards at the home and get people’s feedback. People and their relatives told us they were satisfied and had no complaints about the service.

The inspection took place on 17 and 20 November 2015 and was unannounced. This means the provider did not know we were coming. We last inspected The Oaks Care Home in July 2014. At that inspection we found the service was meeting the legal requirements in force at the time.

The Oaks Care Home provides care and support for up to nine people who have a learning disability. Nursing care is not provided. At the time of our inspection there were seven people living at the home.

The service had 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.

We found that people received care that protected their personal safety and welfare. Risks had been assessed and measures were taken to prevent people from being harmed. Staff understood their roles in safeguarding people against the risk of abuse and knew how to protect people during their care and support. Relatives confirmed that they felt their family members were safely cared for at the home.

New staff were properly checked and vetted before they were employed to work at the home. There were enough skilled and experienced staff to provide people with continuity of care. The staff were provided with training and support that enabled them to meet people’s needs effectively.

Arrangements for the management of medicines were not fully robust. We have made a recommendation about assessing the competency of staff who handle medicines. People were appropriately supported to stay healthy and accessed a range of health care services. Relatives told us that staff were very good at keeping them informed of any changes in their family member’s well-being.

Nutrition was assessed and monitored to ensure people’s dietary requirements were met. People were offered choices of food and drinks and mealtimes were a pleasant experience where people and the staff dined together.

People and their families were consulted about and agreed to the care and treatment provided. Where people were unable to give consent or make important decisions about their care, formal processes were followed under mental capacity law to uphold their rights.

Staff had a good understanding of people’s diverse needs and the ways they preferred to be supported. They treated people as individuals and were kind and caring in their approach.

People and their relatives were satisfied with the care and support provided and had no complaints. A complaints procedure was in place that people were made aware of and could use if they were ever unhappy with the service.

Staff worked well with people in promoting their life skills and independence and meeting their social needs. People were given personalised care which was reflected in extensive and individualised care plans. We have made a recommendation about care planning in relation to Deprivation of Liberty Safeguards.

The registered manager was supportive and provided leadership in the home. They encouraged people, relatives and staff to express their views and influence the service. The quality of the service was routinely checked to ensure that standards were being met.