This unannounced inspection took place on 18 December 2018 and 11 January 2019.

Oak Grange is a purpose-built care home which can provide support for up to 70 people with varying levels of need. The home is split into four “communities” over two floors offering support to people with nursing and residential needs. The service also provides support to people living with dementia. At the time of the inspection there were 61 people living in the home.

The service had a registered manager who had been registered with the CQC since February 2016. 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 our last inspection in March 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of good.

There was person centred information in people’s care plans regarding their “Cultural, spiritual and social values” along with a personal life history of information that the person was happy to share. Staff used this information to start conversations with people to work out what was important to them and plan activities that may interest them and enabled them to carry on following their interests and passions. People had been supported to use their skills and talents and to gain new ones.

The service provided a wide range of activities that empowered people and enabled them to have enriching life experiences and to try new things that they may enjoy. The activities co-ordinators spent time planning and researching how activities could have a positive impact for people. Activities were planned with the aim of enhancing a person’s wellbeing with one of four aims; movement, joy, remembrance and socialising.

People had been enabled to maintain their relationships and make new connections in their community. For example, some people had joined the home’s choir, spent time with a local army regiment, been to religious services in the community, spent time with a local artist, musicians, local students and pupils from local schools. Also, people’s friends and family members were invited to be involved in projects at the home. One person’s family member told us that the activities were, “Amazing and very varied.”

Staff told us that doing this was part of a, “Culture of where people feel loved and valued.” One person’s family member said, “The activities are excellent and add to [name’s] quality of life.”

People and their relatives told us they thought the home was safe. We found the service to be safe. Staff were knowledgeable about safeguarding vulnerable adults. People had risk assessments in place, which assessed their needs and provided guidance for staff on how to meet these needs safely. Any accidents and incidents that happened at the home were recorded and learnt from. The management and administration of people’s medication was safe and the building and the environment of the home was clean, safe and well maintained.

The environment of the home and gardens were pleasant and interesting and met people’s needs. Everybody had access to interesting and pleasant outside space and there were adaptations in place ensuring all areas of the home were accessible.

People were supported with their health care needs and had appropriate care plans and assessments in place to provide guidance for staff to support them to remain healthy. People told us they enjoyed the food provided at the home. People relatives praised the food provided. One relative told us, “They look after [name] she has even put on some weight since she came in.”

People were positive about the quality of care they received. One person told us, “My care is very good.” People’s relatives praised the caring approach of staff members. We witnessed

The inspection was unannounced and took place on the 29 March 2016. The service had a manager who had been registered with the CQC since February 2016.

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.

Oak Grange provides care and support to up 70 people with varying levels of need. The service is split into four units which offer support to people with nursing, and residential needs. The service also provides support to some people living with dementia. At the time of the inspection there were 67 people living within the service.

At the last inspection in April 2014 we asked the registered provider to make improvements around the call bell system, and keeping risk assessments up-to-date. At this inspection we found that action had been taken to address these issues.

There were sufficient numbers of staff to meet the needs of people who used the service. The registered manager had recently employed new staff to address a staff shortage. The registered manager had also identified an issue with staff absences and was working to address this through the use of supervision and disciplinary procedures.

People were protected from the risk of abuse. Staff had undertaken training in safeguarding and knew the different types of abuse, and how to go about reporting their concerns. Staff were aware that there was a whistleblowing policy in place, and had access to the registered provider’s safeguarding policy and procedure.

People were supported to take their medication as prescribed. The system in place for administering medication was safe and helped to reduce drug administration errors. Medicines were stored offices which were kept locked when not in use. We looked at a sample of people’s medication and found that the correct quantity was being administered.

Staff had been supported to access training that enabled them to carry out their role effectively. Staff had undertaken training in areas such as infection control, manual handling and the Mental Capacity Act 2005. They had also been supported to access further qualification such as the qualifications credit framework (QCF) at various levels. New staff undertook a period of induction which gave them the opportunity to develop the necessary skills, and ensured that they were suited to the role.

Staff were skilled in their approach to people living with dementia. We saw examples where staff provided high quality care that promoted people’s independence and dignity. Staff treated people with kindness and there were examples which made it apparent that a good rapport had been developed between people and staff. During meal times we found that staff in one of the units spent time talking to people, whereas in another unit there was little social interaction. We discussed our experiences with the registered manager so that she could act upon this.

People told us that they enjoyed the food, and were provided with different options. People with special dietary requirements were provided with appropriate choices and received the correct level of support. Kitchen staff maintained a record of those people who required special diets, and provided the correct quantity to each unit.

Care records were personalised and contained information around a person’s likes, dislikes and preferred daily routines. These also contained up-to-date information around what level of support people required and how staff should meet people’s needs. Staff had a good understanding of those people they were supporting, and we saw that some staff had taken it upon themselves to do further research in an effort to better understand the people’s needs.

There were a range of activities on offer which people told us they enjoy

Oak Grange is a purpose built care home for up to 70 people. It provides support to older people who may have dementia and/or nursing needs. The home is built over two floors which offers single room accommodation with en-suite facilities. There are two units on each floor. The first floor is for people with dementia. At the time of this inspection there were 61 people living at Oak Grange.

Oak Grange had a new manager who registered with CQC in January 2014. People commented that positive changes have been made, however there has been some staff leaving and new staff employed. The manager has increased the staffing levels in some areas which has also increased the amount of new staff employed. Generally the management of the home is good with the new manager supporting staff with the changes being made.

People told us that they were happy living at the home and they felt that the staff understood their care needs.

We found that people, where possible were involved in most decisions about their care and support. Staff made appropriate referrals to other professionals and community services, such as the dietician, where it had been identified that someone was losing weight. We saw that the care staff team understood people’s care and support needs, and the staff we observed were kind and thoughtful towards them and treated them with respect.

We saw that staff had the skills and knowledge to support and communicate with people with dementia. For example people were offered choices at mealtimes in an unhurried way so that they had the opportunity to make a decision on what to eat. This was seen throughout the day regarding many aspects of daily life.

People spoke positively about the range of activities available within the home. They said these had improved and the new manager had employed two more activities co-ordinators to ensure activities were available every day of the week.

We found the home was clean, hygienic and well maintained.

Records showed that CQC had been notified, as required by law, of all the incidents in the home that could affect the health, safety and welfare of people.

We looked at the care records of four people who lived at Oak Grange. We found there was detailed information about the support people required and that it was written in a way that recognised people’s needs. This meant that the person was put at the centre of what was being described. We saw that two out of four records had been reviewed during the last month, which meant that staff did not always have up to date information about the people they supported.

We found Oak Grange had systems in place to ensure that people were protected from the risk of potential harm or abuse. We saw the home had policies and procedures in place to guide staff in relation to the Mental Capacity Act 2005 and deprivation of liberty safeguards, safeguarding and staff recruitment.

We found that good recruitment practices were in place and that pre-employment checks were completed prior to a new member of staff working at the service.

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

Oak Grange was newly built in 2012 and the accommodation was of a high standard throughout. A doctor visited the home every Friday, and an advanced nurse practitioner every Monday and Wednesday. This meant that people could be seen quickly if there were any concerns about their health. People’s medicines were managed safely and appropriately.

There were enough skilled and experienced staff to ensure that people’s needs could be met and they did not have to wait for attention. People could choose where they wished to have their meals and what they had to eat and drink.

People we spoke with were very happy with the care that they received. One person told us “I am so pleased that I made the decision to come and live here. I love my bedroom. If you want company it is always there and I have made some new friends.” People told us that they appreciated being able to have a bath or a shower as often as they wished. People told us that they enjoyed the social activities that were provided.

The nature of the disability of some of the people living at Oak Grange is such that it is not always possible to gain their experiences. We were able to gain views from three other people. For the purposes of this inspection, we spent time observing the care and support provided to those living at Oak Grange. We observed that staff were committed to involving individuals in the support they received and individuals related well to the staff team. We found that attention was paid to the needs of individuals with staff striving to ensure that the well being of individuals was paramount. We noted that people living there felt comfortable with the staff team and responded well to the attention given to them by staff. We noted that staff always sought the views of people to ensure that they were happy with the support they were provided with. Comments we received included: "I feel safe here", "Staff look after us well", "staff do a good job" and "I am happy here". No relatives were present to give their views during our visit.