Oak Court is a residential care home service which offers nursing care to a maximum of 19 adults who have a physical disability or neurological condition and require either long term or respite care or rehabilitation. At the time of our inspection 19 people were using the service. Oak Court is a very spacious, purpose built, bungalow, with large outdoor areas and gardens. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this 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.

At the time of our inspection there were two registered managers 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 service was safe and people were protected from harm. Staff were knowledgeable about safeguarding adults from abuse and knew what to do if they had any concerns and how to report them. Risks to people using the service were assessed and their safety was monitored and managed, with minimal restrictions on their freedom. Risk assessments were thorough and personalised.

The service ensured there were sufficient numbers of suitable staff to meet people’s needs and support them to stay safe. Records confirmed that robust recruitment procedures were followed. Medicines were stored, managed and administered safely. Staff were trained, and their competency checked, in respect of administering and managing medicines.

People using the service were supported to have sufficient amounts to eat and drink and maintain a balanced diet. People enjoyed their meals and were involved in discussions and decisions regarding the menus and options available.

Staff demonstrated a good understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards. Staff understood the importance of helping people to make their own choices regarding their care and support. People using the service were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible

The service ensured people were treated with kindness, respect and compassion. People also received emotional support when needed. People told us they were involved in planning the care and support they received and were able to make choices and decisions and maintain their independence as much as possible. Information was provided to people in formats they could understand.

Care plans were personalised and described the holistic care and support each person required, together with details of their strengths and aspirations. Information also explained how people could be supported to maintain and enhance their independence and what could help ensure they consistently had a good quality of life. People’s comments and concerns were listened to and taken seriously. The service also used any comments or complaints to help drive improvement within the service.

People who used the service and staff spoke highly of the management team and told us they felt supported. CQC’s registration requirements were met and complied with and effective quality assurance procedures were in place.

Further information is in the detailed findings below.

Oak Court is registered to provide accommodation and nursing care for up to 18 people who have neurological disorders and who are recovering from a brain injury. There were 11 people living in the home at the time of the inspection. The accommodation is all on one level and all bedrooms have en-suite facilities.

This unannounced inspection took place on 28 July 2016.

At the last comprehensive inspection on 8 and 13 July 2015 a breach of three legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to:

• staff deployment,

• notifications,

• Assessment and monitoring of the service.

During this inspection we found that improvements had been made in these areas.

There were two registered managers in post at the time of this inspection. 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.

Risk assessments had been undertaken. Staff were aware of the risk to people. Accidents and incidents were being were being reviewed to reduce the risk of any reoccurrence.

People were provided with a varied, balanced diet and staff were aware of people’s dietary needs. Menus were not available in appropriate formats so not all people were aware of the menu options on offer. Staff referred people appropriately to healthcare professionals.

People received their prescribed medicines in a timely manner and medicines were stored and disposed of in a safe way.

The Care Quality Commission (CQC) is required by law to monitor the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The provider was acting in accordance with the requirements of the MCA including the DoLS. The provider was able to demonstrate how they supported people to make decisions about their care. Where people were unable to do so, there were records showing that decisions were being taken in their best interests. DoLS applications had been submitted to the appropriate authority. This meant that people did not have restrictions placed on them without the correct procedures being followed.

Although care plans were brief, staff knew how to meet people’s current needs. Staff were trained, supported and supervised to do their job. Staff were able to demonstrate that they knew people well. Staff treated people with dignity and respect.

The provider had a recruitment process in place and staff were only employed within the home after all essential safety checks had been satisfactorily completed.

Staff treated people with dignity and respect.

The registered managers had carried out regular audits to assess what improvements needed to be made. Action plans had been put in place as needed. The provider had carried out visits to the home to ensure that the action plans for improvements were being met.

The inspection took place on 8 and 13 July 2015 and was unannounced. It was the first inspection of the service since it opened in September 2014.

Oak Court provides accommodation, nursing and personal care to a maximum of 18 people with a physical disability or acquired brain injury. It offers long term care and some respite care and rehabilitation.

There was a registered manager in post who also oversaw two other services close by. They were accessible by telephone and spent approximately a day and a half in Oak Court each week. 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.

There were oversights in ensuring risks to people’s safety in the event of an emergency were assessed and addressed that had to be rectified urgently. Systems for monitoring and auditing the quality and safety of the service did not always identify shortfalls like this and ensure that improvements were made and sustained.

Staff knew the importance of reporting concerns that someone may be at risk of harm or abuse and training in safeguarding for ancillary staff was initiated as a result of this inspection. Although arrangements had been made for training in restraint this was delayed. Staff did not have training to restrain people safely and within the law before needing to do so. Medicines were managed safely.

Staff had training in the Mental Capacity Act (MCA) 2005 and understood the principles of supporting people who were not able to make decisions for themselves. They could tell us about people’s needs. Where people did have capacity to make their own decisions about their care, their wishes were respected. The manager understood when an application to deprive someone of their liberty under the MCA and associated Deprivation of Liberty Safeguards should be made. However, they did not ensure that the expiry date of this authorisation was properly monitored so it could be renewed.

People had enough to eat and drink and assistance to do this if it was needed and most felt that the choice and variety of food was acceptable. People had access to advice and support from health professionals such as their doctor or dietician when this was needed. However, there was sometimes a delay in securing advice or providing therapeutic services if their needs changed. It was not always practicable to resolve complaints in the way people wished, but where they could be resolved action was not always taken promptly.

Staff responded to people with respect and offered reassurance when this was needed. However, they did not always work well together as a team and morale was low.

The service was in breach of three regulations. Sufficient staffing levels were not always maintained or deployed in a way that met people’s needs safely. The registered persons had failed to notify us of specific events affecting people who lived in the home. Systems for identifying where improvements were needed were not always operating effectively.

You can see what action we told the provider to take at the back of the full version of this report.