We inspected the service on 25 January 2017. The inspection was unannounced. The Oaks Residential Home is registered to provide accommodation for up to 42 older people, some of whom live with a dementia related condition. The home is owned and managed by Nottingham City Council and is split into six different units with each unit having lounges and dining areas. On the day of our inspection 40 people were using the service.

The service had a registered manager in place at the time of our 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.

People felt safe in the service and they were supported by staff who knew how to recognise abuse and how to respond to concerns. Risks in relation to people’s daily life were assessed and planned for to reduce the risk of harm.

People received their medicines as prescribed and received care and support when they needed it from staff who had the skills and knowledge to provide safe and appropriate support.

People were supported with decision making and had their rights protected if they lacked the capacity to make certain decisions.

People were supported to maintain their nutrition and staff had the information they needed to monitor and respond to people’s health conditions.

People lived in a service where staff treated them as an individual and encouraged them to maintain relationships. People were supported to follow their hobbies and interests.

People had the opportunity to give their views and make suggestions about how the service was run and there were systems in place to monitor and improve the quality of the service provided.

We inspected the service on 22 October 2014. The Oaks Residential Unit is registered to provide accommodation for up to 33 older people. The home is owned and managed by Nottingham City Council. On the day of our inspection 31 people were using the service.

The service had a registered manager in place at the time of our 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.

When we last inspected the service on 30 July 2013 we found there were improvements needed in relation to how people received care and support which met their needs. The provider sent us an action plan telling us they would make these improvements by December 2013. We found at this latest inspection that the provider had made some improvements in line with the action plan they provided us with. However we found further improvements were still needed in respect of care plans to ensure people were receiving safe and appropriate care. The new manager had identified the shortfalls and was already in the process of implementing new care plans.

We have recommended the provider considers the National Institute for Health and Care Excellence (NICE) guidance on the prevention and management of pressure ulcers.

People felt safe in the service and we the manager shared information with the Local Authority when needed. Staff knew how to respond to incidents if the manager was not in the home. This meant there were systems in place to protect people from the risk of abuse.

Medicines were managed safely and people received their medication when they should. Staffing levels were matched to the needs of people who used the service to ensure they received care and support when they needed it.

People were supported by staff who had the knowledge and skills to provide safe and appropriate care and support.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The DoLS is part of the MCA, which is in place to protect people who lack capacity to make certain decisions because of illness or disability. DoLS protects the rights of such people by ensuring that if there are restrictions on their freedom these are assessed by professionals who are trained to decide if the restriction is needed. We found this legislation was being used correctly to protect people who were not able to make their own decisions about the care they received. We also found staff were aware of the principles within the MCA and had not deprived people of liberty without applying for the required authorisation.

People were supported to maintain their nutrition. Referrals were made to health care professionals for additional support or guidance if people’s health changed. Improvements were needed in relation to pressure care monitoring to reduce the risk of people developing a pressure ulcer.

People were treated with dignity and respect and had their choices acted on. We saw staff were kind and caring when supporting people.

People enjoyed the activities and social stimulation they were offered. People also knew who to speak with if they had any concerns they wished to raise, and they felt these would be taken seriously.

People were involved in giving their views on how the service was run through the systems used to monitor the quality of the service. Audits had been completed that resulted in the manager implementing action plans to improve the service.

We saw there were meetings held to support people in having choices about meals and activities. People told us they were able to make choices about how they spent their day.

We saw people were given opportunities to participate in a wide range of activities and trips outside of the home. Intervention was sought from external health professionals when people's health needs changed. There were care plans in place telling staff how to provide care and support to people. However we saw from the care plans of two people that there was a lack of risk assessing and care planning for some needs such as pressure ulcer prevention.

All three people we spoke with told us they felt safe in the home and they felt they could speak with staff or a team leader if they needed to.

We saw staff were given training to enable them to do their job safely. They were also given supervision to discuss the way they were working and identify any further training needed. People spoken with gave positive feedback about the care staff were delivering. They said things like, “Staff are very good” and “I get on OK with them, they are pretty good.”

People told us they knew who to speak with if they had any concerns. None of the people we spoke with had any concerns about the service. One person said, “I have nothing to grumble about, if I did I would tell them.”

We observed staff interactions with people using the service and we saw that they were kind, polite and respectful. We saw staff supporting people to make decisions about their day such as when they got up in the morning.

We spoke with one person using the service and asked what they liked about living in the home and they said, “the food is good and the staff are a good crowd. The cook is good and if you tell them you don’t like something they ask you what you would like and get it for you.”

We spoke to two people who use the service about the support with medicines that they received from staff. One person said ‘If ever I need a doctor or hospital they see to it. The doctor comes round if necessary. They are very good I have only to ask. My daughter keeps a check on things.’

We asked two people using the service if staff were available when they wanted support or assistance. One person said, “there is usually someone around and I don’t have to wait long if I need something.” The other person said, “if I ask for something it arrives quickly.”

One person using the service told us they had attended a recent meeting in the home and had talked about what activities they would like to do. Another person told us that the cook spent time talking about what food they liked.

We asked two people using the service if they thought staff were respectful to them and they told us they were. One person said, “the staff are very patient with me, they have to be really as I am very slow.”

There was no evidence staff had put practical plans in place to manage the risk of pressure sores for two people using the service. One of these people had developed a pressure sore. The district nurse had visited and had told staff that the sore was healing well and did not require a dressing.

One person using the service has been granted authorisation to have a Deprivation of liberty Safeguard in place. This is due to behaviour the person sometimes displays when staff deliver personal care. This authorisation has been managed well with the person’s capacity being assessed and the authorisation being deemed as being in the person’s best interest.

We asked people using the service about the staff and we received positive comments such as, “they (the staff) will do anything for you”, “they are very good, I get on well with them all” and “staff are always helpful.”