Little Oaks is a ‘care home’ People in care homes receive accommodation and personal care to people as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Little Oaks accommodate 12 people, in one adapted building.

This was an unannounced inspection carried out on the 1 May 2018. At our last inspection 10 April 2017 the service was rated requires improvement. This was because we had concerns relating to the environment. At this time, these topic areas were included under the key question of Effective. We reviewed and refined our assessment framework and published the new assessment framework in October 2017. Under the new framework, this topic area is included under the key question of safe.

After the last inspection, we asked the provider to improve some aspects of the garden, to install a bath hoist and a ramp to the front of the building. These improvements had been carried out. At this inspection, the service was still rated requires improvement. This was because improvements to other aspects of the environment was now needed, and some parts of the service and external areas needed to be cleaner. This is the second time the provider has been rated as requires improvement. You can see what action we have asked the provider to take at the back of the full version of the report.

At our last inspection, we found that the provider had breached Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities). Regulations 2014; Good Governance. At this inspection on 1 May 2018, improvements had been made, a registered manager was in post and audits were carried out and used to monitor the quality of the service people received.

A registered manager was 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.’

All the people we spoke with said they felt safe at Little Oaks. Staff supported people to be as independent as they wanted to be and protected them from risks to their safety. Staff were trained in protecting people from abuse and understood their responsibilities to keep people safe.

Staff received regular supervision and had been given the training they needed to meet people’s needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Arrangements were made for people to see a GP and other healthcare professionals when they needed to do so.

People were cared for and supported by staff that understood their needs and knew them well. Staff treated people with dignity and respect and were sensitive to their needs regarding equality, diversity and their human rights. The care and support people received was individualised.

The service had appropriate systems in place to keep people safe and staff followed these guidelines when they supported people. There were a sufficient numbers of care staff available to meet people’s care needs and people received their medication as prescribed and on time.

The provider had a robust recruitment process in place to protect people from the risk of avoidable harm. They had been recruited safely with the skills and knowledge to provide care and support to people.

People’s health and emotional needs were assessed, monitored and met in order for them to live well. The service worked closely with relevant health care professionals and people received the support they needed to have a healthy diet that met their individual needs.

We have made a recommendation about the management of complaints and the accessible communication standards.

Little Oaks provides nursing care and accommodation for up to 14 older people. On the day of our inspection there were 11 people using the service. At the last inspection, the service was rated good. At this inspection we found the service required improvement.

At the time of the inspection the service did not 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.

The provider did not have a clear approach to monitoring the quality of the service and overseeing the day-to-day management. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities). Regulations 2014; Good Governance. You can see what action we asked the provider to take at the back of the full version of the report.

The service did not always look at ways it could continuously improve the service offered to people. Feedback was obtained via surveys, but changes were not always made quickly. The service had recently introduced new audits to review the quality of the service being delivered to people and they had identified areas for development but, despite this, action had not always been taken.

Improvements could be made to the general décor of the home and external area’s which would improve people’s day to day lives.

People would benefit from having more access to meaningful and stimulating activities. People had enough to eat and drink, but they thought the mealtime experience could be improved.

There were enough staff on shift to meet the needs of people who used the service and staff supported people in the least restrictive way possible.

Staff understood how to keep people safe and could describe the correct steps they would take if they were concerned that abuse had taken place.

Accidents and incidents were appropriately recorded and risk assessments were in place for people who used the service.

The general manager and staff involved people to make decisions about the service they received and obtained people’s feedback on how the service should be run.

People told us that staff understood their needs and preferences well, and they received effective care and support from well-trained staff.

Staff had developed caring relationships with the people they supported and that there was a positive and relaxed atmosphere.

Medicines were managed safely and staff member's understood their responsibilities.

People who used the service, family member's, and visitors were encouraged to make comments, complaints or compliments about the service.

Further information is in the detailed findings below.

We inspected this home on the 12 March 2015. Since our last inspection in June 2014 this home has been sold and is now under new ownership. This is the first inspection since the change of registration.

The service was registered for twelve people but has since increased to accommodate fourteen older people with or without dementia. On the day of our inspection there were twelve people at the service. There was a registered manager in post who was also the new owner. However, he had two full time members of staff in day to day control of the home.

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 enough staff to meet people’s needs and keep them safe. However, staffing numbers were reduced in the evening and we could not see how the provider assessed people’s needs to ensure they had enough staff.

There were safe systems in place to ensure people received their medicines safety. Staff were trained and observed by senior staff to ensure they were able to administer medicines competently.

Risks to people’s safely were identified and as far as possible reduced. People’s needs were kept under regular review and staff responded appropriately to changes in people’s needs.

Staff were aware of how to protect people as far as possible from abuse or harm. Staff received training to help them identify abuse and had access to policies and procedures which told them what to do.

Staff received training and support to help them fulfil their role and staff demonstrated that they had sufficient knowledge and skills.

People were supported with decision making by staff that knew and understood the Mental Capacity Act, so could act lawfully.

People were supported to eat and drink, but we found a number of people usually independent with their meal did not receive support and ate very little. We felt the meal time experience could be improved upon to ensure everyone received the support and encouragement they needed.

People’s care plans were written in a very detailed, insightful way and were individualised. They clearly described people’s needs and preferred routines. We observed staff meeting people’s individual needs. People were supported to have their health care needs met and there were records in place to support this.

There was good communication in the home and people and their families were aware of how to raise concerns should they need to. They also told us they were asked to comment on the service provided to them. This enabled improvements to be made. Both staff and people using the service told us the acting managers and the registered manager was available and approachable.

This was a run well service which put people first. Staff were well supported and the manager and acting managers were clear about how they wanted to improve the service and had consulted with people about how best to achieve this.

There were systems in place to monitor people’s safety and well- being and to enable staff to take the most appropriate actions to promote people’s health.