This was an unannounced comprehensive inspection, which took place on 5 April 2018. There have been many changes to the home since the time of the last inspection in July 2016 when the service was known as Merok House. At the last inspection the service was rated as ‘Requires Improvement’ with seven requirements to meet breaches in the Regulations. At this inspection we found considerable improvement and action had been taken to meet all these requirements.

The building work, commented on at the time of the last inspection had been completed and the new premises registered with the Commission. The home can now accommodate up to 33 older people. At the time of this inspection there were 20 people living at the home. 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 .

Since the last inspection the provider had appointed a new 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.

Following the last inspection the provider completed an action plan, as requested, to show what they would do and by when to improve. All the improvements made are detailed within this report.

The new management team provided better leadership and had made significant improvements.

People were kept safe as the provider had taken appropriate steps and had good systems in place to protect people. The registered manager had informed us through required notifications and had also made relevant referrals to the local authority for any safeguarding concerns. Staff had received training in safeguarding.

People’s needs had been assessed with plans to mitigate risks that may be involved in the delivery of care. These were now up to date and accurate. The premises had also been assessed and made as safe as possible for people.

Accidents and incidents were recorded, monitored and action taken if necessary.

Staff were recruited in line with robust policies and all the necessary checks had been carried out.

There were good systems to make sure medicines were administered as prescribed.

There were enough staff to meet the needs of people accommodated.

Staff were now trained to a higher standard with all core training undertaken and a system to make sure staffs’ training was kept up to date. The staff team were therefore able to deliver care in line with best practice.

People had up to date comprehensive care plans in place so that staff could refer to these and deliver consistent care. The care we observed was consistent with people’s plans and people received a personalised service.

The service was now compliant with the Mental Capacity Act 2005 (MCA). People were supported to make decisions. Where they did not have capacity for specific decisions, the home followed the requirements and principles of the MCA in arriving at ‘best interest’ decisions on their behalf. There were also robust systems to make sure that people were only deprived of their liberty in accordance with the Act, and that any conditions of that deprivation were applied.

Staff were now better supported though indirect and formal supervision as well as having access to on call managers. This is ensured staff were motivated, trained to a high standard and able to work effectively with people living at the home.

The home worked collaboratively with health services and social care services in meeting people’s health needs.

People were provided with a good standard of food with their having choice of what they wanted to eat and their individual needs catered for.

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This unannounced comprehensive inspection took place on 15 July 2016. Merok House provides accommodation and care for up to 22 older people. During the inspection 13 people were being accommodated. The home was undergoing extensive building work. This meant people had limited space in the communal areas, but all people had chosen to stay at the home during the building work.

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.

Staff understood the principles of keeping people safe, but in practice these had not been followed. We found serious injuries had not been reported to external bodies or investigated by the registered manager meaning people may not have been safeguarded from potential abuse. Some people had relevant risk assessments in place to meet their needs, but for some people relevant risk assessments were not up to date. This meant there may have been risks associated with people’s care which staff were not aware of. Staffing levels had not been planned to meet the needs of people, but these were increased following the inspection. There was a training programme in place for staff but this did not cover all the areas needed, which meant staff did not always have the knowledge to meet people’s needs. Recruitment checks had been completed before staff started work to ensure the safety of people. Medicines were administered and stored safely.

Staff had a basic knowledge of the Mental Capacity Act 2005 but this had not been properly followed or put into practice. This meant people did not have their mental capacity assessed and restrictions had been placed on people without their agreement or being in their best interests as authorised by proper processes. People enjoyed their meals and were offered a choice at meal times. People were supported to access a range of health professionals.

People did not always have their needs planned in a personalised way which reflected their choices and preferences had been considered. This meant staff may not always have the best information on how to meet an individual’s needs and preferences. People felt confident they could make a complaint and it would be responded to. Complaints were logged and there were recordings of investigations into complaints.

People felt the staff were caring and kind. However the lack of staff available and their lack of training in areas meant they did not always respond to people in the most appropriate manner. The home did not always have an open culture where staff felt they could raise concerns and they would be listened to. Staff felt supported by the registered manager. Records were not always accurately maintained and there was not an effective quality audit process in place. Notifications were not being submitted as required.

We found breaches in 7 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Registration Regulation 2009. You can see what action we told the provider to take at the back of the full version of the report.

As part of this inspection we spoke with three members of staff and seven people who lived at the home. We also spoke with two relatives and one visiting professional.

The registered manager, assistant manager and director were present for the inspection.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service caring?

Is the service effective?

Is the service responsive?

Is the service well led?

This is a summary of what we found

Is the service safe?

People told us they felt safe because “There’s always someone around.” A relative said, “No-one is left unattended.”

Staff told us the service was safe because there was a high staff ratio which meant they had time to get to know people well and gain their trust. They said this meant people living in the home could talk to them about things that were worrying them.

The home had appropriate procedures in place to support people who could not make decisions about their care and treatment. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw the home had made applications for DoLS and were waiting for the local authority to inform them of their decisions at the time of our inspection.

We found that the home had suitable procedures in place to protect people against the risks associated with medicines.

Is the service caring?

People who lived in the home said the staff were caring and they felt well looked after.

Staff spoke about people in a caring and respectful manner. They knew people well and treated them as individuals. One told us, “It’s so refreshing to be somewhere where everyone wants the best for residents.” When asked if they would recommend the home to a loved one, the staff and people we spoke with told us they would.

Is the service effective?

The service is effective because people were involved in their care planning and their individual needs were recorded in their care plans. We saw examples of how people’s needs were met and this was confirmed to us by the people we spoke with.

Is the service responsive?

We saw the home responded to people’s individual needs and preferences. We saw that action was taken if people’s needs changed or their health deteriorated. There was evidence that the home responded to concerns and was committed to improving the service.

Is the service well led?

The management team were very open about the improvements they had made and their plans to continue to improve the service they offered. People we spoke with said they thought the service was well led. Staff spoke highly of the management team as did the relatives we spoke with.

We spoke to one person who lived at the home and to relatives of two people who lived at the home. We also spoke to two health and social care professionals who had regular contact with the home regarding the care of people. We also spoke to three staff, the deputy manager and one of the owners.

There was limited communication with people because of their care needs. Consequently, we used our SOFI (Short Observational Framework for Inspection) tool to help us see what people's experiences at mealtimes were. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time and whether they have positive experiences. This included looking at the support that is given to them by the staff. We spent 35 minutes observing people and staff together at the lunch time meal. We saw people had positive experiences. Staff were observed to help people who needed it. People were offered choices of food.

We looked at care records for people. We saw people’s needs were assessed with care plans for needs such as personal care, continence care and mobility. We noted some of the care procedures being followed did not link with any instructions in care plans.

Relatives told us they considered the home provided a good standard of care. Comment was made by relatives and a health and social care professional that the home’s standards have improved. An example was given by two relatives of the introduction of an activities programme for people.

Records showed the home consulted people and their relatives about their care. For those people unable to consent to care the home had not assessed mental capacity as required by the Mental Capacity Act 2005. In addition, ‘best interests decisions’ were not completed or recorded.

We found the home made safeguarding referrals to the local authority when this was appropriate. The local authority told us the home worked with them regarding any safety issues for people.

We found the home was sufficiently staffed. Staff told us they felt supported in their work and received regular supervision.

The home sought the views of people and their relatives about the service it provided. The home’s management took action regarding staff performance issues. Records showed the home had looked into incidents and complaints.

Some of the people living in this home had dementia and were not able to tell us their views of the service so we observed the care and support they received from staff. We saw good interactions between people living there and the staff on duty. The atmosphere in the home was relaxed and friendly.

Comments from people living in the home who expressed their views included. “If you have to be in a place, this is a good place to be, the staff are good and they sort out any problems you have.” Another person said. “The people here are kind, my husband can visit whenever he wants and there is very nice food but not many activities”.

All of the relatives that were spoken with said that they felt positive about the home and said that people were treated with dignity and respect. We were told. “We are kept informed of any changes to our relative’s care and their doctors and other professionals involved are called as appropriate”.

Staff we spoke to knew how to support people and how to meet their needs.

Policies, procedures and staff training was in place to support people to keep safe and report any identified concerns.

Recruitment procedures were in place to make sure that people received care from suitable, skilled and knowledgeable staff.