We inspected the service on 19 March 2018. The inspection was unannounced.

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. Haywood Oaks Care Home accommodates up to 20 people over two floors. On the day of our inspection, 13 people were using the service and two people were in hospital.

At the last inspection in January 2016, the service was rated overall ‘Good’ and ‘Requires Improvement’ in ‘Responsive’. At this inspection, we found the service remained overall ‘Good’. Improvements had been made in ‘Responsive’ but ‘Safe’ had deteriorated to ‘Requires Improvement’.

A concern was identified with the stock of one medicine but people received their prescribed medicines safely. Risk assessments associated with people’s needs had not always been completed. Some records relating to people’s needs had not been stored appropriately.

The service was clean and infection control measures were in place. People were supported by sufficient staff that had been deployed appropriately, staff skill mix had been considered. Safe staff recruitment checks had been carried out when new staff commenced.

Staff received an induction and continued training and support to carry out their work. Recognised tools and best practice guidance was used when assessing people’s needs. People’s nutritional needs had been assessed and planned for. Health care needs were monitored and referrals were made to external health care professionals when needed. The premises were well maintained and were appropriate for the needs of people who used the service.

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 support this practice. The principles of the Mental Capacity Act (MCA) were followed.

People who used the service and or their relatives where appropriate, were encouraged to contribute to the planning and ongoing review of their care. People received care that respected their privacy and dignity and independence was encouraged. Staff understood people’s needs, routines and preferences. Advocacy information was available for people should they have required this support.

People received opportunities to participate in social activities and interest and hobbies were encouraged. People’s end of life wishes had been discussed with them. People felt able to raise concerns or complaints and the complaint procedure had been made available for people.

People who used the service and their relatives were encouraged to give feedback about their experience of the service. Systems were in place to monitor the quality of the service.

Further information is in the detailed findings below.

We carried out an unannounced inspection of the service on 18 January 2016.

Haywood Oaks Care Home provides accommodation and personal care for up to 20 older people including people living with dementia. At the time of our inspection there were 13 people living permanently at the service and two people receiving short term care.

Haywood Oaks Care Home is required to have 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. At the time of the inspection a manager was in post who had submitted their registered manager’s application to CQC and this was being processed.

At our last inspection of the service in June 2015 we identified the provider was in breach of four Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had not assessed the risks to the health and safety of people receiving care and treatment. This included the proper and safe management of medicines and assessing the risk, prevention and control of infection control. People’s nutritional needs had not been appropriately assessed and planned for. There were not effective systems to assess monitor and improve the quality and safety of the service. The provider had failed to notify CQC of all reportable incidents.

After the inspection the provider sent us an action plan to tell us of the action they would take to make the required improvements. At this inspection we found the provider had made significant improvements to protect people’s safety and wellbeing. The breaches in regulation had been met.

Improvements had been made with the cleanliness and hygiene of the service and infection control measures were in place.

At the time of this inspection people told us that they felt staff provided a safe service and risks were managed appropriately. Staff were aware of the safeguarding procedures and had received appropriate training. Improvements had been made to the management of medicines; people received their medicines as prescribed. Safe recruitment practices meant as far as possible only people suitable to work for the service were employed.

The manager had processes in place to apply the principles of the Mental Capacity Act 2005 (MCA) and Deprivations of Liberty Safeguards (DoLS).

Accidents and incidents were recorded and appropriate action had been taken to reduce further risks. Risk plans had improved; they were detailed and regularly monitored and reviewed. Improvements had been made to the internal environment, including the replacement of some equipment available for people.

There were sufficient numbers of staff available that were suitably qualified and experienced. Staff were deployed appropriately to meet people’s individual needs. Staff responded to people’s needs in a timely manner and spent quality time with people. People’s dependency needs were reviewed on a regular basis and staffing levels amended to meet people’s needs.

People said that they received sufficient to eat and drink. They were positive about the choice, quality and quantity of food and drinks available. People received appropriate support to eat and drink and independence was promoted.

Staff were knowledgeable about people’s individual needs. People’s healthcare needs had been assessed and were regularly monitored. Additionally, people were supported to access healthcare services to maintain their health and well-being.

The support and training opportunities for staff had improved. Staff received an induction and ongoing training. Staff were appropriately supported, this consisted of formal and informal meetings to discuss and review their learning and development needs.

People we spoke with were positive about the care and approach of staff. They described them as caring, compassionate and knowledgeable about their needs. People’s preferences, routines and what was important to them had been assessed and recorded. Support to enable people to pursue their interests and hobbies was limited. This was an area identified by people who used the service that required further improvements.

Whilst people had been involved in discussions and decisions about their care and support they received, care records did always show this involvement.

People told us they knew how to make a complaint and information was available for people with this information, including information about independent advocacy information. Confidentiality was maintained and there were no restrictions on visitors.

The provider had improved the checks in place that monitored the quality and safety of the service. People and their relatives and representatives, received opportunities to give feedback about their experience of the service.

We carried out an unannounced inspection of the service on 23 June 2015.

Haywood Oaks is a care home for older people and people living with dementia. On the day of our inspection there were 13 people using the service.

Haywood Oaks is required to have 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. At the time of the inspection an acting manager had been in post for two weeks and two days. At the time of our visit they were unable to tell us what their plans were about applying for the registered manager position. We will monitor this situation.

People we spoke with told us they felt safe and cared for appropriately. This included sufficient staff to meet people’s individual needs.

There were limited systems in place that checked the safety of the environment. Fire risk assessments and personal evacuation plans were out of date or information was missing. People’s individual needs had not been appropriately assessed, planned for or effectively monitored. The procedure in place for the storage and management of medicines required some attention.

Immediate action was taken by the provider to ensure appropriate qualified staff were available at night to administer medicine if required. Additional staff recruitment was ongoing. Safe recruitment checks were in place that ensured as far as possible people were cared for by suitable staff.

People told us they found staff to be competent and knowledgeable and that staff gained consent before care and support was provided. People were satisfied with the food choices available. People’s dietary and nutritional needs had not always been assessed or planned for.

Staff had not been appropriately supported or received opportunities to discuss and review their learning and development needs. Training opportunities to develop staff’s skills and knowledge had been limited. Permanent staff received an induction but agency staff did not. These issues were being addressed by the acting manager.

The acting manager understood their role and responsibility in ensuring the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards legislation was fully adhered to. Staff involved people as fully as possible and gained consent before care and support was provided. There were some shortfalls in terms of procedures being consistently followed.

People were positive about the approach of care staff. Some people were supported to pursue their interest, hobbies and pastimes but this was limited. The lack of information available to staff impacted on their ability to provide a personalised service.

Staff told us that they felt the acting manager had made a positive contribution to the service and that they felt supported, valued and included in how the service was developing. The provider was in the process of sending out feedback questionnaires and meetings to enable people to share their views about the service.

The provider had insufficient checks in place that monitored the quality and safety of the service and had failed to notify us of important events registered providers are required to do. The acting manager had developed an action plan that identified the areas that they had assessed as requiring improvements.

We found the service was in breach of four 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 the report.

During the inspection we spoke with three people who used the service, two relatives, the cook, two care assistants, a senior care assistant, a health care assistant, the registered manager and the owner. We conducted a tour of the building and reviewed records relevant to the management of the service.

People we spoke with told us that staff gained their consent before providing care. One person who used the service told us, "Staff talk to me all day. They like to talk about my care. They give me choices.”

We saw that the food and drink provided met people's needs. A relative told us, “The food is all homemade, it looks fresh, it’s great.”

There were enough qualified, skilled and experienced staff to meet people's needs. A person who used the service told us, “There are plenty of staff to help us all, I have never used the buzzer in my room and have never been left alone.”

We saw there was an effective complaints system available. A person who used the service told us, “I know how to complain, I’m certain the manager would act on any complaint, they are very easy to talk to. The owner is also very helpful.”

The personalised records for people who used the service were accurate and reflected the day to day needs of people who used the service.

We spoke with three people who were living at the service. One person said, “I wouldn’t change anything about the home”. Another said, “They are good carers and will go out of their way to help” and “Dawn (the manager) is an excellent lady”.

A relative told us, “I can’t praise the place high enough, the staff are excellent”. They went on to say “I would trust the manager to sort out any problem I may have. She is very approachable and knows the residents and her staff very well.”

We also spoke with three members of staff. All three told us they enjoyed working at Haywood Oaks. One said “It’s very friendly and because it is quite small, we get to know all the residents and their families. This is very helpful because it means we can provide exactly what they want