Oakview Care Home is a ‘care home’. People in care homes receive accommodation and nursing or 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. Oakview care home accommodates 72 people in one building across four separate units, each of which have separate adapted facilities. Two of the units specialises in providing care and nursing care to people living with dementia.

At the last inspection, the service was rated Good. At this inspection we found the service remained good.

People told us they received safe care, relatives who we spoke with told us staff were trained to support their family members in a way which kept them safe. Staff demonstrated good knowledge in how they were to protect people from harm. We found staff understood and recognised the signs of abuse and knew how to report this. The registered manager had identified potential risks to people and had put plans in place to support staff to reduce the risk to people without taking away people’s right to make decisions about their care. People and relatives told us the registered manager ensured there were enough staff to support their care needs. People were supported with their medicines in a safe way. Staff followed appropriate guidelines to reduce the risk of infection. Accidents and incidents were investigated and action taken to reduce the risk of further harm.

People received care and support which met their needs and preferences and was in line with their consent and agreement, and staff understood the importance of this. Staff received regular training which was relevant to the people they cared for. We found people were supported to eat a healthy diet which was tailored to their individual preferences. Staff worked with external healthcare professionals and where necessary followed their guidance and advice about how to support the person in the right way. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

People’s views and decisions they had made about their care were listened to and staff acted upon these in a dignified and respectful way. Staff worked as a team to ensure people were supported with respect and their dignity maintained. Relatives felt the staff team treated their family members in a kind and friendly way, which was done so respectfully. People benefitted from the staff using different approaches and communication equipment to support them to make choices and be involved in their care decisions as much as possible.

People were involved in the planning and ongoing reviews of their care. People were supported to maintain their hobbies and interests. Staff recognised if people’s healthcare needs changed, and responded to these in a timely way. The registered manager had provided people with information around how to raise a complaint should they need to. People and relatives we spoke with knew who they could speak with to raise any concerns. People and relatives felt listened to where they had raised a concern. The registered manager had received some complaints and had taken action to address these and share the learning with the staff team to improve practice. People and their families were supported by staff that were compassionate and knowledgeable to meet their end of life needs.

People and their relatives felt involved in the way the service was run. They felt they had the opportunity to share their views and discuss aspects of the service. Staff felt supported by the registered manager to carry out their roles and responsibilities effectively, through training and daily contact. Staff felt involved in the service and felt able to influence their ideas in the way in which the service was run. People, relatives and staff felt the registered manager was approachable a

We considered our inspection findings to answer questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

This is a summary of what we found-

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic.

There were enough staff on duty to meet the needs of the people living at the home and members of the management team were available to support staff on the units. .

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We found that proper policies and procedures were in place and the manager demonstrated a good level of awareness of this area.

We carried out this inspection because we had received comments expressing the view that unsafe care had been provided to one person. In addition to carrying out this visit, we referred the comments to the local authority, who has responsibility for investigating safeguarding concerns. At the time of writing this report, the local authority had not completed their investigation.

Is the service effective?

People told us that they were happy with the care that had been delivered and their needs had been met. It was clear from our observations and from speaking with staff that they had a good understanding of the people’s care and support needs and that they knew them well. One person told us. "We are lucky to be here.”

Staff had received relevant training to meet the needs of the people living at the home.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people.

People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this. One person told us “They are friendly and gentle with us”. A healthcare professional who visits the home told us, “the nurses listen and I find them knowledgeable…they follow what they are expected to do.”

Is the service responsive?

People’s needs had been assessed before they moved into the home.

Records and people’s comments confirmed that people’s preferences, interests, aspirations and diverse needs had been recorded. Care and support had been provided in accordance with people’s wishes.

People had access to a range of activities and had been supported to maintain relationships with their friends and relatives.

Is the service well-led?

There were good systems for quality assurance.

People in the home and their relatives had completed customer satisfaction surveys and had opportunities to attend regular feedback meetings. The manager demonstrated that changes which had been made as a result of comments from people living in the home and their relatives.

Staff, relatives and people living in the home told us that the managers were accessible and took account of their comments.

The manager and senior staff demonstrated a good level of awareness about the performance of the home and the plans for the future.

At the previous inspection the home was found to be in need of improvement in relation to meeting people’s needs concerning nutrition and hydration and in record keeping. We found at this inspection that the necessary improvements had been made in these areas.

We found that people’s needs were assessed and their care and treatment was delivered in a safe way, according to their needs and preferences.

There were suitable arrangements for making sure that people were provided with adequate nutrition and hydration.

There were sufficient numbers of staff with appropriate experience and qualifications to meet people’s needs.

There were good arrangements for assessing the quality of care provided and for identifying areas for possible improvement. These included asking people and their representatives about the quality of care they received. These systems had been used to identify a need for improvement in the quality of activities for people and for a more formal system for staff development.

The records were well maintained and stored in a secure way.

We received comments from several relatives and fifteen people who lived in the home. Most were positive and included, “It’s a very nice place to be in. The staff are warm and friendly, helping us as much as they can. They never shout or raise their voices to me.” One person said, “This home is lovely to live in, and the staff are very good and kind to me.” A relative told us, “Overall it’s a good home and it’s getting better.” We received a minority of negative comments about specific events and we passed these to the manager for investigation and action.

This inspection was undertaken in response to concerns we had received about the home and had identified in previous reviews of the service. During our visit we spent time on Elm and Ash units.

Most people who used the service were not able to tell us about the care they received due to their health needs. We therefore used a number of different methods to help us to understand their experiences.

We spoke with the relatives of six people who used the service and two visiting healthcare professionals. Overall the comments we received about the service were positive. One relative told us “I’m very satisfied with care.” Another relative said, “The staff have got patience.”

We also spent time observing care being given. We found there had been improvements in the care people received since our previous visit. Interactions between staff and the people who used the service were positive. People received their medicines as prescribed and staff were following appropriate infection control practices.

We found improvements had been made to support people’s nutritional needs and in the maintenance of people’s care records. However we still had some minor concerns about people’s meal time experience and the quality of people’s care records.

The report refers to two managers. Mr James Parkes has been the registered manager since February 2012. The previous manager has not yet applied to be de-registered.

We used a number of different methods to help us understand the experiences of people using the service. This was because some of the people using the service were unable to share with us their experiences due to their health needs. We were supported by an expert by experience who has personal experience of using or caring for someone who uses similar types of services. The expert by experience spent time talking to people and observing the care provided.

During our visit to Oakview Care Home we spoke with three people who used the service, five relatives of people who used the service, four members of staff and three members of the management team. We spent most of our time on Elm unit which provided nursing care and Beech unit which provided residential dementia care.

The people that we spoke with were satisfied with the care they or their relative received at the home, they found staff friendly and the home clean. Comments from people who lived in the home included: “I’m comfortable here”; and “I’m quite happy because I can talk, I’m perhaps one of the lucky ones. I see the carers as friends. Can have a joke with them. I get on all right with all of them.”

Relatives we spoke with were also satisfied with the care that was provided. They told us, “I think my (relative) is being well cared for, this place is nice and I know most of the staff by name”. Another relative said, “The staff come straight away if they are needed’.

We spent a considerable amount of time in communal areas such as the lounge and dining rooms. We saw some evidence of good interactions between staff and the people who used the service. However, our observations of mealtimes on Elm unit raised concerns about how the home was meeting people’s diet and nutritional needs.

We found that people were happy with the service looking after their medicines and when their medicines were being administered.

This review followed earlier reviews we completed at Oakview in January and August 2011. We identified some concerns about the quality of the care; support and treatment of people using the service were receiving.

Following our visit in August 2011 a warning notice was served on the registered provider in October 2011. This was because we observed some poor staff practices on Ash Unit in relation to staff not following people’s care plans. This left people at risk of harm and at risk of not having their care needs met.

Some of the people that use the service at Oakview have dementia and therefore not everyone was able to tell us about their care. To help us to understand the experiences people have, we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences.

During our observations we saw that staff practices had improved since our last visit in August 2011. We saw that staff were able to move people safely. Staff communicated with people in a respectful way, ensuring that their choices and preferences were met.

Staff had received training over a range of topics including dementia care. We saw that they applied their skills and knowledge in practice, which enhanced the well being of people living in the home.

Four people told us that they were satisfied with the care and support they were receiving. They commented, ‘’staff are really good’’, ‘’Just press the buzzer and along they come’’. We spoke with three relatives of people living in the home they told us they were satisfied with the care their relatives were receiving.

Some of the people were not able to verbally communicate their opinions due to their health needs. Because of this we spoke with some of their relatives who told us that the care was good and that they had no concerns about the care received.

We saw some positive staff interactions with people who lived in the home. Staff were engaging people in relation to social stimulation and activities to enhance their general feelings of well being.

People told us that the food in the home was good and that individuals had choices of what they ate.

We had serious concerns about some of the staff practices we observed on Ash Unit. These included poor manual handling, lack of respect towards people’s choices, care planning and staff’s lack of insight into dementia care.

We inspected this home on 16 and 17 December 2015. This was an unannounced Inspection. The home was registered to provide residential care and accommodation for up to 72 older people. At the time of our inspection 66 people were living at the home.

The registered manager was present during 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’s feedback about this service told us that people felt safe and protected. People confirmed that they were encouraged to raise any concerns they had .Staff had a good understanding of how to recognise potential harm people might be at risk from and knew what action to take should they have any concerns.

People using the service and their relatives told us there were enough staff on duty to meet their individual needs. People told us that staff knew them well and we saw respectful communication between staff and people.

Staff we spoke with had the knowledge and skills to ensure people were supported with their care and support needs. Staff were recruited in a safe way and had received support through their induction into their roles.

People told us they received their medicines safely. Staff responsible for administering medicines had received relevant training.

Most staff we spoke with understood and could describe the requirements and their responsibilities in line with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Applications to protect the rights of people had been submitted to the local supervisory body for authorisation.

People had appropriate support to eat and drink when necessary. People told us they had access to a variety of food and drink. People’s health was supported by access to a range of health care professionals in order to maintain good health.

People told us that they were happy with the care they were receiving. We saw that people enjoyed a range of activities tailored to their individual interests and hobbies that they enjoyed.

People told us that they were involved in the planning and reviewing of their care. People’s needs had been assessed and person-centred care plans were in place to inform staff how to support people in the way they preferred.

People using the service and their relatives told us that they knew how to raise any complaints or concerns and felt confident concerns would be dealt with in a timely manner.

The systems in place to monitor and improve the quality of the service provided were effective in ensuring the home was compliant with the regulations and consistently well led.