The inspection took place on 26 October 2016 and was unannounced. The service was previously inspected on 3 and 6 November 2015 when we found the service required improvements. The service was not fully compliant with Regulation 13: Safeguarding service users from abuse and improper care or treatment. At this inspection we found the provider had taken actions to address the concerns we had found.

Little Oaks Residential Care Home is registered to provide accommodation and personal care for up to eight people with a learning disability. There are two houses within the registration; the houses are linked by a garden gate. There were eight people living there at the time of this inspection (five in one house and three in the other). Staff worked across both houses. Most people had good verbal communication skills and were able to talk to us about their daily lives and the care and support they received. We also relied on our observations of interactions with staff during our inspection to help us reach our judgements on the service.

There was 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.

There were sufficient staff on duty to help keep people safe. The registered manager told us they had increased staffing levels when people’s needs had changed. Staff told us they felt the staffing levels were good. For example, a member of staff said “They are bringing in more staff. I feel we have enough now.”

People were protected from harm and abuse by staff who had been carefully recruited and well trained. A member of staff told us they were confident they would recognise any signs of abuse but said “I have no concerns.” People living in the home told us they felt safe, and had no concerns about the way staff supported them. Staff had received training on essential health and safety related topics and also on topics relevant to the health and personal care needs of the people living there. Staff told us they enjoyed their jobs and they felt well trained and well supported. For example, one member of staff said “I think it’s absolutely fantastic. I absolutely love it.” They went on to say, “There are always plenty of courses.”

People were involved and consulted about all aspects of the support they received. Care plans contained detailed information on each person’s health and any risks associated. People were supported to maintain good health and to access health and social care professionals when needed. Staff knew each person well and recognised the warning signs of ill health.

Medicines were stored and administered safely. There was a clear audit trail of all medicines entering and leaving the home. Medicines were only administered by staff who had received appropriate training. Records of medicines administered were well maintained. People told us they thought their medicines were administered safely. For example, one person said “I have a tablet every day at 3 o’clock. They never forget to give it to me.”

The service acted in line with current legislation and guidance where people lacked the mental capacity to make certain decisions about their support needs. Applications had been submitted to the local authority for those people whose liberty may be restricted. A member of staff told us “We always make sure the residents get what they want. They are always offered choices. They get what they want as close as possible.”

People were supported by staff who were caring. A person told us “They are very caring here. It’s very comfortable. Sometimes I get anxious and then I talk to the staff.” Each person had their own bedroom that had been decorated and personalised to suit their individual tastes and preferen

Little Oaks Residential Home provides accommodation for seven people.

Little Oaks residential care home is situated in a residential area of Taunton. The accommodation comprises of two properties adjoining each other.

We spoke with all seven people who lived there and all five staff who were on duty at the time of our visit. Some of the comments from people who lived at Little Oaks included "I am happy here" "I choose my own clothes" "I look at my care plan, they treat me properly" "sometimes we do cooking here" "staff do tablets for me" "I have a one to one worker and they are wonderful" and I like living here"

Staff told us "I love working here" "People are well looked after" " I have had an exceptional amount of training" "They have been amazing here" and "I get a chance to say what I think"

A person from the rapid intervention team told us "They have done great work" "They respond appropriately and compassionately" and "Very good communication and always checking if they are doing the right thing"

The home was warm and comfortable and people obviously relaxed and at ease. We saw photographs of all the people living in Little Oaks on the walls undertaking various activities, there were activity schedules in accordance with people's choices and abilities. We saw evidence of people supported to make their own choices and taught independent living skills.

The garden area was used to grow vegetables as a therapeutic activity and people showed us the chutney they had helped to make. People told us that they had chosen their own holiday destinations and had been supported to try out a number of recreational activities.

We met with three of the five people living in the home. One person was not there as they were working and another person was visiting a relative.

All the people we spoke with confirmed that they felt respected and well treated. People were supported to maintain their independence as much as possible. We saw evidence that people's health and independence improved in the home. We saw that care and support was being delivered in an individual way.

During the inspection people we met looked smart and individually dressed. People told us that they felt safe in the home. They told us the names of staff they would talk to if they had any concerns about anything.

We heard that staff were helpful and kind. Staff we spoke with told us that they well supported in the home and enjoyed working at Little Oaks.

The majority of the people living in the home are independent and said the staff team support them to maintain their independence. People told us that they felt there was enough staff on duty each day to support them.

Some people told us they liked the staff team and had a good relationship with them. People who were able spoke highly of the new manager. People said they found the manager approachable and friendly. Some people require more care and support. Staff members were observed providing this in a caring and patient manner.

Some people told us how they are involved in decisions about their lives and the running of the home. They said key workers help to support them and make decisions. People said that staff members always explain any care or treatment they need in ways that help them to understand. They told us they are supported to attend appointments, such as the dentist, doctor and hospital.

People said their care, support and risks are discussed with them. Some said they have care plans that are in a pictorial format that helps them understand and agree to its content. They said they also attend regular house meetings where the running of the home is discussed. Some people said they have completed surveys about the home and the care they receive. People who were able said they felt that they were listened to and felt the home is run to suit their needs.

People who were able told us they liked living in the home because of its convenience to the town centre, local shops and public transport. People liked their bedrooms which were decorated and furnished to their own personal tastes and preferences. Bedrooms had locks with keys which most people used. Some people said they had access to all parts of the home and used the kitchen freely. Some people enjoyed the garden and were involved in doing gardening work on the day we visited. Most of the people living in the home do not require any specific equipment for mobility. People said they were happy with the standard of furnishings and fittings in the home. During a visit we observed that the home and furnishings were of a good standard.

Some people told us how menus are discussed at house meetings. They said they can be involved in the shopping, preparing and cooking meals if they wish to. People said that drinks and snacks are available at all times. Some people require a lot of support in the kitchen and some utensils are locked away for the safety of others. People who do not need the same level of support are able to access these utensils.

We were shown menus that are displayed in a pictorial format in the kitchen. They showed a well balanced healthy diet is provided. People said that their dislikes and preferences are always taken into account.

Some people told us staff support them with their medication, others manage independently. Some people said that staff remind them to take medication or explain side effects and remind them of total amounts that can be taken.

People who were able said that if they had any concerns they talk to their key worker, any member of staff or the manager. Some people said any issues they have raised in the past have always been resolved quickly. Some people knew about the home’s complaint’s procedure and said it was in a format that helped them understand it.

This inspection was unannounced and took place on 3 and 6 November 2015. The last inspection of the home was carried out on 3 December 2013. No concerns were identified with the care being provided to people at that inspection.

Little Oaks is a care home providing accommodation and personal care for up to 8 people with learning disabilities. During our inspection there were 8 people living at the home. There are two houses within the registration; the houses are linked by a garden gate. There are five people living in one house and three in the other. Staff work across both houses.

There is 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.

We saw people were unable to remain safe in one part of the house and therefore they were supported in the second part of the home. We found some examples where people were potentially at risk due to other people’s behaviours. Systems were not in place to protect people. For example staff had not received the relevant training in protection for themselves or others. One member of staff informed us “I am new to caring for people with learning disabilities and would welcome some training on learning disabilities. Another member of staff informed us “I have never done this kind of work before but enjoy it”. People talked about being hurt, having to stay in their rooms or moving to the other house. People sometimes displayed complex behaviours due to their anxieties. Communication took place using objects of reference to assist them when they were distressed. This method of communication sometimes seemed to work well on other occasions it did not support the person.

The registered manager had systems to monitor the quality of the service provided. Audits covered a number of different areas such as care plans, infection control and medicines. However we found the audits were not always effective at identifying shortfalls in the service. Incident forms were not being completed that identified events happening in the home. For example following the first day of our inspection we saw incidents that were not recorded on our second visit an incident log was set up with regarded incidents witnessed. People’s rights were not always protected because the provider did not follow legal processes appropriately. Following the inspection the provider informed us they were addressing this concern.

The service had appropriate systems in place to ensure medicines were administered and stored correctly and securely. Care plans identified people health issues with guidance for the correct support. People received their medicines safely and were protected from risk of infections.

Recruitment procedures were in place and staff received pre-employment checks before starting work with the service. New members of staff received an induction which included shadowing experienced staff before working independently. We found staff needed further training around supporting people with complex needs and learning disabilities.

People were supported by sufficient numbers of staff during the day, although these numbers were reduced during the evenings and weekends. The registered manager informed us that they were on call alongside their deputy, and staff knew they could call them at any time during the day or night. Staff did not express any concerns about staffing levels.

There was a homely feel to both houses with staff finding time to sit and chat with people. We observed people were cared for with kindness and respect. The home was clean and tidy throughout. An outside wall was in need of repair due to cracking. The registered manager informed the provider, who organised for this to be repaired.

People and relatives were confident they could raise concerns or complaints with the registered manager and they would be listened to. However the provider did not have systems to collate and review feedback from people and their relatives to gauge their satisfaction and make improvements to the service.

We found breaches 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 this report.