Twin Oaks is a small care home located in the Lake District town of Windermere. The home provides accommodation and personal care for up to seven older people. There were five people living in the home at the time of our inspection.

Twin 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.

At our last inspection we rated the service as good. At this inspection we found the evidence continued to support the rating of good. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

People told us this was a good home and said they would recommend it.

People received support from a small staff team that included the registered manager and the provider. The staff team were aware of how to identify and report abuse. The staff team were trained in how to provide people’s care safely.

People received their medicines safely and as their doctors had prescribed. The staff identified if people were unwell and contacted their doctors if they needed.

People enjoyed meals and drinks that took account of their personal preferences. They were provided with the support they required to enjoy their meals.

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’s rights were protected. They were asked for their consent before care was provided and the decisions they made were respected.

The staff team were kind and caring to people.

People had been included in planning and agreeing to the care they received. Each person had a care plan to guide staff on the support they needed and how they wanted this to be provided. The staff team worked with other appropriate services to support people who were reaching the end of their lives.

The provider had a procedure for receiving and responding to concerns about the service.

The register manager and provider were the owners of the home. They worked with the care staff providing people’s care. They were available to provide guidance to the staff and the staff felt well supported by the owners of the home.

The registered manager and provider asked people for their views and carried out checks on the quality and safety of the service.

Further information is in the detailed findings below.

We carried out an unannounced comprehensive inspection of this service on 13th and 16th February 2015. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We re-visited the service on 2 June 2015 and undertook an unannounced focussed inspection. We did this to check that they had followed their plan and to confirm that they now met legal requirements. We focussed on four of the breaches of those regulations where we had issued warning notices requiring the registered provider and registered manager to take action to comply with the requirements of those regulations. We found the registered provider and manager had addressed the breaches and taken action to comply with the requirements of those regulations.

During our inspection undertaken on 17 February 2016 we found no breaches of legal requirements.

Twin Oaks is a large detached property situated not too far from the centre of Windermere. The building has been adapted for its present use as a small family run care home for up to seven people. Communal space includes a large lounge and dining room. Accommodation is over two floors and the first floor is accessed by a stair lift. All bedrooms had ensuite bathroom facilities. At the time of our inspection visit there were seven people who lived at the home.

There was a registered manager in place. 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 the registered manager had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report any unsafe care or abusive practices. People we spoke with told us they felt safe and their rights and dignity were respected.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions.

We found care plans were organised and had identified care and support people required. We saw people or a family member had been involved in the assessment and had consented to the support being provided. We found care plans were informative about the care people received. They had been kept under review and updated when necessary to reflect people’s changing needs. People we spoke with said they were happy with their care and they liked living at the home. One person said, “They take very good care of me. Everyone is so kind.”

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

There had been no new staff members recently recruited to work at the home. We discussed recruitment procedures with the registered manager. We were satisfied safe recruitment procedures were in place and appropriate checks would be made before new staff commenced their employment.

We found sufficient staffing levels were in place to provide support people required. We saw the registered manager and staff member on duty could undertake tasks supporting people without feeling rushed. One person we spoke with said, “The staff are never far away if you need them.”

We found medication procedures in place at the home were safe. Staff responsible for the administration of medicines had received training to ensure they had the competency and skills required. Medicines were safely kept and appropriate arrangements for storing were in pl

This focused inspection took place on 2 June 2015 and was unannounced. Twin Oaks is a large detached property situated not too far from the town centre of Windermere. The building has been adapted for its present use as a small family run care home for up to seven people. There was plenty of communal space including a large lounge, dining room and outside garden areas. Accommodation was over two floors and the first floor is accessed by a stair lift. All bedrooms had ensuite bathroom facilities.

There was a registered manager in post. 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 our last inspection in February 2015 we found that the provider was in breach of six of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014 and Regulation 18 of CQC (Registration) Regulations 2009.

At this inspection we focused our inspection on four of the breaches of those regulations where we had issued warning notices requiring the registered provider and registered manager to take action to comply with the requirements of those regulations. We will complete another inspection at a later to date to check on the other three requirements we made to improve the service.

The recruitment procedures had been revised and updated to reflect the requirements required by law to ensure that fit and proper persons have been employed.

New systems had been established by the registered provider to ensure Notifications required by the Care Quality Commission (CQC) by law would be sent when required and without delay.

More formal audits and quality monitoring systems that were measurable and verifiable had been implemented to allow the service to demonstrate effectively the safety and quality of the home. At the time of this focused inspection we could not evidence that the newly implemented audit system were effective yet as they had not been fully embedded. We will review these at the next inspection.

A review of the policy and procedures relating to the reporting of allegations of abuse had been completed. Suitable arrangements were in place to ensure that people living at Twin Oaks were safeguarded against the risk of abuse.

Records relating to people’s care and treatment had been reviewed and updated to reflect accurately assessed needs in relation to people’s nutritional requirements and individual preferences.

We visited Twin Oaks as part of our planned schedule of inspections. We looked at outcomes for respecting and involving people, care and welfare, safety and suitability of premises, staffing, quality assurance of service delivery and complaints. We found the provider had achieved compliance with these outcomes.

People told us they were happy with the levels of care and support provided by staff at the home. One person told us, “It is the staff that makes living here a pleasure”.

We saw staff related to people positively and were supportive and knowledgeable about people who lived at the home. The family member of a person lived at the home told us, “We waited to get mum in here as it has such a good reputation”.

We spoke with people living at Twin Oaks. They told us that they were satisfied with the care they received:

"It's grand."

"Ten out of ten!"

We found that people were well looked after and treated respectfully. Staff demonstrated knowledge about issues such as consent to treatment and knew how to protect people from abuse.

We saw that the owners of the home recruited people in an appropriate way and had systems in place to monitor the quality of service that they provided.

This inspection took place on 13 and 16 February 2015 and was unannounced. Twin Oaks is a large detached property situated not too far from the centre of Windermere. The building has been adapted for its present use as a small family run care home for up to seven people. There was plenty of communal space including a large lounge, dining room and outside garden areas. Accommodation was over two floors and the first floor is accessed by a stair lift. All bedrooms had ensuite bathroom facilities.

There was a registered manager in post. 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 our last inspection in January 2014 we found that the provider was compliant with six of the Regulations that we looked at. During this inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which correspond to the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014.You can see what action we told the provider to take at the back of the full version of this report.

The systems and practices in place for managing medicines in the home were not always safe. There was limited information about individual people’s specific needs and records were not always accurate to be able to ensure that medicines were given correctly and consistently.

The recruitment procedures demonstrated that the provider did not operate a safe or effective recruitment procedure to protect the interests of people using the service.

Where safeguarding concerns had been noted by the staff these had not been acted upon to ensure that people who might be at risk were protected.

Where people had been assessed as being at a risk regarding their nutritional needs there were no clear records of how this risk would be managed. There was not always sufficient detail in some people’s assessments and care plans to ensure that care and treatment was provided appropriately in order to meet individual needs.

Notifications required by the CQC by law had not been sent as required when things had occurred relating to people who used the service.

Systems for the assessing and monitoring of the safety and quality of the home were informal. The systems were not measurable or verifiable and did not allow the service to demonstrate its safety or qualities.

The home was decorated and furnished to a high standard. The surroundings were homely and the finer details in presentation provided an outstanding quality of environment for people to live in.

Staff working in the home had not received training in a variety of areas including induction training into the home and any ongoing training to develop their skills to deliver and promote current best practice.

People living at Twin Oaks said they were cared for extremely well and were more than happy with the care and support they received. People living there had good relationships with all the staff and felt very much part of the family atmosphere in the home.

The home had good links with the community and people living in the home were involved in a variety of activities.