Mile Oak Rest Home is a residential care home for up to 20 older people. The building offers accommodation over two floors with lift access to the first floor. People have access to communal lounge and dining areas, a conservatory and accessible garden. There were 19 people living at the home at the time of inspection.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People and relatives told us, without exception, that staff were extremely kind and that they could not wish to live at a better home. We were given several examples of the difference that the support from Mile Oak had made to people who lived there and everyone spoke with great warmth about the staff and the management. Professionals told us about the exceptional care that people received at Mile Oak and told us that they recommended the home to others. People were offered choices about how they spent their time and were supported with respect by staff who protected people’s dignity and promoted their independence. Visitors were welcomed whenever they wished to visit and were encouraged to feedback through regular meetings and annual surveys.

People were protected from the risks of abuse because staff understood the potential signs and how to report concerns. There were sufficient numbers of safely recruited staff available to meet people’s needs and staff knew people well and understood the risks they faced and how to manage these. Accidents and incidents were reported, recorded and learning shared with staff. People received their medication safely and these were recorded accurately.

People were involved in pre-admission assessments which identified their physical, religious, emotional and mental health needs to ensure that these could be effectively met. There were assessments of capacity and decisions made in people’s best interests where required. People had a choice of meals and drinks and spoke positively about the food. Staff received regular support through supervision and had access to relevant training opportunities to provide them with the correct skills and knowledge for their role.

People’s care records were reviewed regularly with their involvements and was therefore responsive to changing needs. People were supported by staff to engage in a range of social opportunities both in group settings and one to one time. People and relatives were aware about how to raise concerns if needed and felt that these would be listened and responded to. End of life care was person centred and planned with people to ensure that wishes and preferences were understood and respected.

Feedback from people, relatives and staff was that Mile Oak was well managed. Everyone spoke positively about the registered manager who placed an emphasis on ensuring they worked with staff on shifts and was available and approachable. Feedback was gathered and used to drive changes at the home and audits were used to identify any gaps or trends to continually improve the service people received.

Further information is in the detailed findings below.

This inspection took place on 13 January 2016 and was unannounced. The inspection continued on 18 January. The service is registered to provide personal care with accommodation for up to 20 adults. The service has 20 en-suite bedrooms some with walk in showers and others with baths. There is also an assisted bath on both the ground and first floor. The service has a large communal lounge and separate communal dining area that people are free to use at any time. The living area overlooks a patio area which leads into a level access garden. The accommodation is over two floors and the first floor can be accessed by stairs or a passenger lift. Each room has a call bell so that people can call for help when needed.

The service has 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.’

People commented to us they felt safe living in the service. A person told us, “I am happy here, I know I am safe and that’s important to me. I’m happy to spend the rest of my days here”.

Staff were able to tell us how they would recognise if someone was being abused. Staff told us that they would raise concerns with senior staff or management. Staff were aware of external agencies they could contact if they had concerns including the Care Quality Commission. A staff member said, “It’s a safe service, the Registered Manager makes sure it’s a safe working environment and we all make sure that people are safe from abuse”.

We reviewed three care files which identified people’s individual risks and detailed control measures staff needed to follow to ensure risks were managed and people were kept safe. A staff member told us, “One person is at risk of pressure sores. I reduce this through hourly checks and re-positioning as per the risk assessment”. We reviewed this person’s risk assessment which confirmed that these control measures were in place and re positing times were recorded. Risk assessments were completed by the Registered Manager and Senior.

The Registered Manager told us that they don’t use a specific staff dependency tool to assess staffing levels. They said that the management team work care shifts to assess the levels. The Registered Manager fed back that last year staffing levels were assessed and increased by one additional staff member per shift. This was in response to staff feedback and management observation. A staff member commented that they had concerns regarding night shift staffing numbers as some people require two staff for transferring. The Registered Manager told us they would look into this when they next review the staffing levels. Another staff member said, “I feel there are enough staff. Sometimes people who require two staff can call at the same time but this doesn’t happen all the time”. People we spoke to felt there were enough staff to meet their needs. A relative told us, “I think there are enough staff here. They are adequate to support mum”.

Medicines were managed safely. Medicines were securely stored and only given by staff that were trained to give medicines.

Staff were knowledgeable of people’s needs and received regular training which related to their roles and responsibilities. We reviewed the training matrix which confirmed that staff had received training in topics such as moving and handling, first aid, infection control and mental capacity act, to name a few. A staff member told us, “There are good training opportunities here, If I feel I need more training I can request it and nine times out of 10 it will be arranged. A refresher in Health and safety was my most recent”. A District Nurse told us, “Staff seem well trained and if they aren’t sure of something they contact us”.

Staff were