This inspection took place on 5 April 2017 and was unannounced. At the last comprehensive inspection of the service in February 2016 we rated the home as Requires Improvement due to breaches in Regulation 12: Safe care and treatment (because of our concerns about poor infection control), Regulation 15: Premises and equipment (due to poor maintenance of the premises) and Regulation 17: Good governance (due to concerns about quality assurance and the unavailability of some records).

At this inspection we found that improvements had been made to the cleanliness and safety of the premises and that quality assurance systems were more effective. This meant that the breaches of regulation identified at the last inspection had now been met. However, there had again been a delay in the registered provider arranging for the gas safety systems to be serviced. We will address this matter outside of this inspection process.

The home is registered to provide accommodation and care for up to 20 older people, including people who are living with dementia. On the day of the inspection there were 15 people living at the home. The home is situated in Preston, a village in the East Riding of Yorkshire but also close to the city of Kingston upon Hull. The premises are on two levels and the first and second floors are accessed by use of a stair lift.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager who was registered with the Care Quality Commission (CQC). 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 were protected from the risk of harm or abuse because there were effective systems in place to manage any safeguarding concerns. Staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm.

There was evidence that the registered provider was working within the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff had received training on these topics and understood their responsibilities.

Care plans were a good reflection of people’s individual needs and how these should be met by staff. There was a lack of consistency in recording on monitoring charts. This had not resulted in any harm to people but had the potential to do so. We observed that the registered provider discussed the importance of accurate recording with staff on the day of the inspection.

People’s family and friends were made welcome at the home. A variety of activities were provided and people were encouraged to take part.

There were recruitment and selection policies in place and these had been followed to ensure that only people considered suitable to work with vulnerable people had been employed. On the day of the inspection we saw that there were sufficient numbers of staff employed to meet people's individual needs.

Staff told us they received the training they needed to carry out their roles effectively and confirmed that they received induction training when they were new in post. Staff told us that they were well supported by the registered manager.

Senior staff had received appropriate training on the administration of medication. We checked medication systems and saw that medicines were stored, recorded and administered safely.

People who lived at the home told us that staff were caring and that they respected people's privacy and dignity. We saw that there were positive relationships between people who lived at the home and staff, and that staff had a good understanding of people's individual care and support needs.

People told us that they were satisfied w

We carried out an unannounced comprehensive inspection of this service on 8 January 2015. Four breaches of legal requirements were found. After the comprehensive inspection, the registered provider wrote to us to say what they would do to meet legal requirements in relation to the breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in respect of the administration of medication, the safety and suitablity of the premises, staff training and following published research and guidance.

We carried out a focused inspection on 11 September 2015 to check that the registered provider had followed their plan and to confirm they now met legal requirements. We found that appropriate action had been taken and that legal requirements had been met.

We undertook this inspection to look at the overall quality of the service, and to provide a new rating for the service under the Care Act 2014.

The home is registered to provide accommodation for up to 20 older people who require assistance with personal care, some of whom may be living with dementia. On the day of the inspection there were 17 people living at the home, including one person who was having respite care. The home is situated in the centre of the village of Preston, close to the City of Hull and in the East Riding of Yorkshire.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager who was registered with the Care Quality Commission (CQC). 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 registered manager is also the registered provider of this service.

During this inspection we identified three breaches of regulation; this related to the risks associated with the safety of the premises and the prevention and control of infection. You can see what action we told the registered provider to take at the back of the full version of the report.

The home was not being maintained in a safe condition. There was no current gas safety certificate in place and had found this to be the case at the previous inspection. In addition to this, the contractor who serviced the home’s bath hoist had stated that the stair lift needed to have a repair carried out within three months, and this had not been actioned.

The communal areas of the home and bedrooms were being maintained in a clean and hygienic condition. However, we saw that the seat on the only bath hoist in use was damaged to the extent it could not be kept clean. The two boilers in the laundry room were located in the ‘clean’ area but the tops were rusty and therefore difficult to keep clean. Both of these issues created a risk of cross infection.

Although the registered manager monitored the quality of care and support provided, we saw that areas that had been identified as requiring improvement had not been actioned. This meant that the quality monitoring systems at the home were not effective.

People told us that they felt safe whilst they were living at Oak Tree House. People were protected from the risks of harm or abuse because the registered provider had effective systems in place to manage any safeguarding concerns. Staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm. Staff also told us that they would not hesitate to use the home’s whistle blowing procedure if needed.

On the day of the inspection we saw that there were some staff vacancies but the rotas were being covered by existing staff to ensure people’s individual needs were met. The recording of recruitment and selection information needed to be more r

We carried out an unannounced comprehensive inspection of this service on 8 January 2015. Two breaches of legal requirement were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches regarding medication, some health and safety aspects of the environment, staff induction training and working towards making the home suitable for people who were living with dementia. We also asked the registered provider to send us an update to inform us of the progress they had made towards meeting their action plan; we received this on 10 July 2015. We undertook this focused inspection to check that they had followed their plan and to check that they now met legal requirements. This report covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Oak Tree House Residential Care Home on our website at www.cqc.org.uk

Oak Tree House Residential Care Home is a care home for older people, some of whom may be living with a dementia related condition. The home is located in the village of Preston, close to the city of Hull, in the East Riding of Yorkshire. It can accommodate up to 23 older people. The home is close to local amenities and transport routes.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a registered manager employed at the home. The registered manager is also the nominated individual for the service. 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 the inspection on 11 September 2015 we found that staff who had responsibility for the administration of medication had completed medication training, that there was always someone on duty who could administer medication and that medication was stored safely.

The health and safety hazards previously identified in respect of people walking on uneven carpets and using the stair lift had been alleviated; a new carpet had been fitted in the hallway and a lap belt had been fitted to the chair on the stair lift.

Induction training had improved and new staff had been enrolled on the Care Certificate, although training records needed to be more robust so that there was a clear record of the training the registered provider considered to be essential, and the training completed by each person working at the home.

Progress had been made towards the environment being more suitable for people living with dementia. Staff had undertaken training that gave them more information about how to support people who were living with dementia, and information to assist people with decision making had been considered.

This inspection took place on 8 January 2015 and was unannounced. We previously visited the home in October 2013 and found that the registered provider met the regulations that we assessed.

The home is registered to provide personal care and accommodation for 23 older people, some of whom have a dementia related condition. It is located on a residential housing estate in Preston, in the East Riding of Yorkshire but also close to the city of Hull. Most bedrooms are for single occupancy and three are double rooms. Only one of these is currently occupied by two people.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager registered with the Care Quality Commission (CQC); they had been registered since 4 February 2011. 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 had completed training on safeguarding adults from abuse and were able to describe to us the action they would take if they had concerns about someone’s safety. They said that they were confident all staff would recognise and report any incidents or allegations of abuse.

We observed good interactions between people who lived at the home and staff on the day of the inspection. People told us that staff were caring and this was supported by the relatives we spoke with.

People who used the service, relatives and health care professionals told us that staff were effective and skilled. Staff told us that they were happy with the training provided for them although training records were not robust so it was difficult for the registered manager to evidence that all staff had completed training that was considered mandatory by the home.

The registered manager and staff were aware of guidance in respect of providing support for people with a dementia related condition although more progress needed to be make towards achieving this. Staff had undertaken training on dementia awareness and the Mental Capacity Act 2005 (MCA). This helped them to understand the care needs of people with a dementia related condition.

Medicines were administered safely by staff but we found that the arrangements for storage and recording required improvement.

We saw that there were sufficient numbers of staff on duty to meet the needs of people who lived at the home. However, staff had not always been recruited following the home’s policies and procedures to ensure that only people considered suitable to work with vulnerable people had been employed.

People’s nutritional needs had been assessed and people told us that they were satisfied with the meals provided by the home.

People who lived at the home, relatives and staff told us that the home was well managed. However, we noted that quality audits undertaken by the registered manager had not identified the areas of concern that we identified on the day of the inspection.

People’s comments and complaints were responded to appropriately and there were systems in place to seek feedback from people and their relatives about the service provided.

We identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

We spoke with six people that used the service, two relatives and the staff. We looked at documentation and records held by the service and we carried out a 'short observational framework for inspection' (SOFI) to observe interactions between people, and interactions between people and staff.

We found that people were asked for their consent whenever staff wanted to support them and so staff acted in accordance with peoples' wishes.

We found that people were satisfied with the service of care they received. They said, "The staff are helpful and friendly and they know what we need help with", "I have settled in nicely", "I accept that I am not able to look after myself any more, so it is the best on offer to me" and "I am quite content here".

From the information we were given and the medication management systems we observed in operation, we found that medication management was safe and people received their medicines when they needed them. People were satisfied with how their medication was given to them.

There were appropriate security checks carried out on staff before they began working in the service and we found that staff had been recruited according to the service's policies and procedures that adhered to the requirements of the regulation on recruitment. This meant that people were cared for by appropriately recruited and vetted staff.

We found that the systems in use for assessing and monitoring the quality of the service enabled people to receive an improved service of care.

We spoke with two people that used the service and with two relatives visiting the home.

People told us they were well treated and that they had choices in their daily lives.

People we spoke with about their care and support said they were satisfied with the care they received. Relatives we spoke with were also satisfied.

People and relatives we spoke with told us they were happy with the food provision in the home and that they thought the home was a safe place to live.

People we spoke with told us they were well looked after and that they did not feel uneasy about anyone in the home. They said the staff were helpful and caring and the manager was approachable. Relatives said staff were kind and considerate.