About the service: Oak Lodge Residential Home is service that provides accommodation and personal care for up to 16 people. At the time of our inspection, 14 older people were living in the home, some of whom may have a physical disability and/or dementia.

Oak Lodge is a ‘care home’. People in care homes receive accommodation and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is in one adapted building over two floors.

There was a registered manager at the time of the inspection, however we only spoke with them briefly before they had to leave the home.

Rating at last inspection: At the last inspection the service was rated Requires Improvement. The report was published 31 January 2017.

Why we inspected: This was a scheduled inspection based on the previous rating.

People’s experience of using this service:

¿ People were not always protected from abuse because the providers systems and processes to protect them were not in place to identify and respond to abuse.

¿ Potential risks to people had not always been identified in how to reduce the risk of harm.

¿ There were enough staff on duty to keep people safe and meet their needs.

¿ People’s medicines were managed in a safe way.

¿ Infection prevention and control practices were not monitored or reviewed.

¿ People were not supported to have maximum choice and control of their lives and staff did not work within the principles of the Mental Capacity Act (2005)

¿ Staff sought external healthcare professional’s advice and followed their guidance in how to support people.

¿ Staff spoke to people in a kind and caring way

¿ People’s care was delivered in a timely way, with any changes in care being communicated clearly to the staff team.

¿ People were not supported to go on outings. People with dementia were not provided with activities that stimulated them.

¿ People had access to information about how to raise a complaint. Record keeping of complaints was poor to enable the provider to demonstrate whether any had been received and acted upon in-line with their policy.

¿ The provider did not have quality assurance systems in place, to assess, monitor, mitigate and improve the service.

We found seven breaches of regulation at this inspection, Regulation 9, 11, 12, 13, 17 and 19 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 of the Registration Regulations 2009.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

Enforcement: Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on the 25 and 28 November 2016. At our last inspection in July 2015 we rated the provider as ‘requires improvement’. At this inspection we found although some improvements had been made there were still areas in the service where improvements were needed.

Oak Lodge is a residential home which provides accommodation for up to 17 people who require personal care. At the time of our inspection there were 16 people living at the home.

At the time of our inspection there was no registered manager in place. The service had been without a registered manager since October 2015. The provider had recruited a new manager who was present at this inspection. The manager told us they would be applying to the Commission to become the registered manager following our 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.

People told us they got their medicine’s on time, however medicines were not always stored safely and people’s medicine records did not always contain up to date information about their medicine routine. Systems were in place to ensure risks to people’s health and safety were managed by staff. People told us there was sufficient staff to meet their needs. Safe recruitment practices were operated by the provider.

Staff had received training which meant they were able to meet the needs of the people who lived at Oak Lodge. People’s rights were protected as the principles of the Mental Capacity Act (MCA) had been followed. People ‘s nutritional needs were met. When people’s health needs changed they received support from outside healthcare professionals.

People told us they were supported by kind and considerate staff. We saw staff supported people using friendly language. People were comfortable with staff. Staff gave people choices and respected decisions people made about their care. Staff told us and we saw they supported people to remain independent when they were able. People were supported by staff who respected their privacy and dignity. People were supported to maintain relationships that were important to them.

People told us and we saw they were happy with the care they received whilst living at Oak Lodge. People and their relatives told us they were involved with the planning of their care. People had access to activities. People and their relatives felt comfortable in raising concerns about their care and there was a system in place to record any complaints received. The systems in place to monitor the care people received were not always effective because they did not identify the areas we highlighted during our inspection. People enjoyed living at Oak Lodge and had the opportunity to be involved with the running of the service. Staff told us they were supported by the manager.

The inspection took place on 23 July 2015 and was unannounced. At the last inspection on 16 August 2013 the provider was meeting all the requirements of the regulations we reviewed.

Oak Lodge is a residential home providing care and accommodation for up to 17 people. There were 16 people living at the home on the day of the inspection.The home had a registered manager. 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 told us that they felt safe living at the home. Staff knew how to recognise when care was not safe. We found there was enough staff to meet people’s individual needs. People’s medicines were not always managed safely and some medicines were not stored in line with the manufactures guidance. Recruitment practices were in place to ensure that the right staff were recruited to keep people safe.

People told us that the staff understood their needs and that their consent was sought before carrying out any personal care. Peoples capacity to make decisions about their care had not appropriately assessed when they were provided with care which meant that their freedom could be restricted. Staff were not able to demonstrate their understanding of capacity. The registered manager was aware of her responsibility to make sure that the correct legal procedure was followed when peoples freedom was restricted. People told us that they had healthcare professionals visit them in the home and that they were taken to attend health appointments when necessary, sometimes by their own family.

We saw people were not always given sufficient food to eat and this left some people feeling hungry.

People were supported by staff who were caring in their interactions. We saw staff using warm tones when they spoke with people and respected their privacy when necessary. People told us that they were well looked after and that staff were always nice to them and listened to them when they had a concern.

People told us that they were involved in activities throughout the day.. We saw that people’s care plans did not always document care that was specific to the person’s individual needs. Risks to individuals were identified and assessed but did not always provide staff with sufficient information to ensure peoples safety.

There was an open culture promoted within the home. We saw that staff worked as a team and were happy to raise concerns with the registered manager. However, when the registered manager raised concerns with the proprietor they were not always listened to and the concerns were not always acted upon.

Systems were in place to monitor the quality of the service provided. Where the service had fallen below the expected standard,the registered manager had taken appropriate action where possible resulting in an improvement in the service provided.

During our inspection we spoke with the registered manager, the provider and two staff members. We spoke with three people who lived in the home and three visiting relatives.

People we spoke with told us that they were happy with the support they received and were involved in giving feedback about the service.

One person living at the home told us: "They are all good carers in their own ways. I get on with them all".

Everybody we spoke with said that they were happy to be living there and spoke highly of staff.

We completed a tour of the home. We found that the provider had taken steps to provide care in an environment that was suitably designed and adequately maintained. People we spoke with commented that the home could benefit from being redecorated. The provider told us they would send us a refurbishment plan by 23 August 2013.

Staff told us they were supported to deliver care safely and to an appropriate standard.

We found that the records we looked at were accurate and fit for purpose.

When we visited Oak Lodge, we spoke to five people who lived there. One person who had arrived recently told us that they were very happy with their room and that the staff at the home were lovely. They said they enjoyed joining in with the activities and valued the companionship at the home. Another person who had lived at the home for some time told us they all did very well at Oak Lodge. Another person told us, "I like it here and I want to stop here". Other people described the staff at Oak Lodge as respectful and the manager as helpful. A relative referred to the kindness of staff.

We looked at people's care plans and saw that these were thorough and personalised. People told us they enjoyed their food and we saw that nutritious meals were served. There were systems in place to promote people's safety. People were relaxed in their home. We saw there were sufficient staff on duty. Staff treated people kindly and were highly regarded by the people who lived there and their relatives. We saw that the registered manager had introduced systems to monitor and develop the quality of the service provided.