This inspection was conducted on 27 July, 3 August and 7 September 2017. The first day of the inspection was unannounced and we informed the provider of our intention to return on the second day. We gathered additional information for the inspection by reviewing staff files at the provider’s office on 7 September 2017. At our previous inspection on 19 and 21 May 2015 the service was rated as Good in all five key lines of enquiry and received an overall rating of Good.

At this inspection we found the service remained Good in four of the key lines of enquiry and had improved to an Outstanding rating in Caring. Overall the rating has remained as Good.

Old Oak Road is a six bedded care home for male and female adults with a learning disability, and there was one vacancy at the time of the inspection. The home has two bedrooms on the ground floor and four bedrooms on the first floor, with a passenger lift to connect the two floors. The bedrooms do not provide en-suite facilities; however there are communal bathrooms and toilets on each floor. There are other communal areas, including a combined lounge, dining room and rear garden.

The service had a registered manager 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 registered manager was present at the inspection and has managed the service for over 20 years.

The provider was outstanding in regards to the caring and compassionate way that staff supported people who use the service. People, relatives and external health and social care professionals stated that staff were exceptionally kind and respectful at all times. Throughout the inspection we observed that staff were committed to providing people with support and encouragement to enable them to lead enriched and fulfilling lives. People’s dignity and independence was promoted, and their achievements were positively recognised by the registered manager and the staff team. Actions had been taken by staff to gently and sensitively support people following a recent bereavement.

People using the service told us they felt safe living at their home and they trusted the staff to protect them from harm and/or abuse. Some people could not verbally express their views; however we observed that interactions between people and staff were warm and friendly. Staff were familiar with the provider’s safeguarding adults’ policies and procedures, and had received relevant training.

Detailed and up to date risk assessments had been developed to provide staff with appropriate guidance to support people in a safe manner, whilst promoting people’s independence and taking into account their wishes and choices. Staff understood their responsibilities in regards to ensuring that people’s medicines were safely stored and administered, and properly disposed of if necessary. Records showed that staff had up to date medicines training.

We saw that sufficient staff were deployed to ensure people received support with their personal care, and the support they needed to participate in their favoured social and recreational activities at home and in the wider community. During the inspection people went out as planned with staff to their chosen activities, which included restaurant trips, clothes shopping and a visit to a barber shop. The provider adhered to robust recruitment practises to make sure that newly appointed staff had suitable skills and knowledge to provide safe care and support.

Staff were supported with their training and development needs. The provider’s training programme was tailored to enable staff to meet mandatory training requirements and undertake training that specifically addressed people’s individual health care needs. Systems were

We spoke with five people who use the service, two relatives, one social care professional, three members of staff and three student nurses on placement at the home and the manager during this unannounced inspection.

People said "I go out", "I do the things I want to", "I can have visitors", "staff listen, respect and give me the support I need", "I see my keyworker and have meetings", "I am involved in choosing the care I need" and "we have regular meetings".

Relatives said that Old Oak Road was a good place for people to live saying "people are comfortable", "I am involved in care planning and reviews of the care provided", "I am made welcome when I visit" and "I have not needed to make a complaint in the last few years but have confidence that issues would be addressed".

Staff said they had the required recruitment checks before they started work and had induction, training and supervision to enable them to carry out their role. Staff said that one of the things the service did well was to involve people and meet their individual needs. Students were happy with their placement and said "it is a good learning experience" and "it gives us opportunities to learn" and "I am happy with the level of care and support people are given".

We saw staff had detailed knowledge of people and how to meet their needs. People were involved in the day to day running of the home. Records were up to date, medicines were administered safely and the home was kept clean.

We spoke to all six people living at Old Oak Road. They told us staff were very good and kind and supported them in being independent. One person commented “I am happy living here the staff are very good. I am more confident now with their support”. Another person told us “I like living here the staff help me when I ask them, they are really helpful and respect my decisions”. There were health check records for all six people with information showing where and when they had attended appointments.

Staff were trained in safeguarding vulnerable adults and all staff were aware of the procedure to follow if an incident occurred. There was a policy and procedure in place for how to report any concerns, including to the local authority.

When staff started at the service they received an induction. Staff undertook mandatory training on an annual basis, including safeguarding and health and safety. There was a procedure in place for them to undergo annual appraisals where their performance would be discussed and targets set for the coming year.

Staff at Old Oak Road monitored the services provided to the people living there and conducted health and safety checks to make sure the environment was safe. Regular questionnaires were completed by people using the service where they provided feedback on the services provided. People living at the home told us that they would be happy to raise any concerns with staff if they had any.

People told us that they were happy with the service being provided by staff at Old Oak Road. They told us they liked the food and that staff were very helpfull. We saw positive interactions between people who use the services and the staff and it was evident that staff know and understand the needs of the people who use the service.

We were told that if for any reason people were not happy about anything in their home, they would report it to staff.

This inspection took place on 19 and 21 May 2015. The first day of the inspection was unannounced and we told a deputy manager we were returning on the second day. At our previous inspection on 30 January 2014 we found the provider was meeting regulations in relation to the outcomes we inspected.

Old Oak Road is a six bedded care home for men and women with a learning disability. The home has two bedrooms on the ground floor and four bedrooms on the first floor, and there is a passenger lift. The bedrooms do not provide en-suite facilities; however there are communal bathrooms and toilets on each floor. There are other communal areas, including a combined lounge and dining room and a rear garden.

There was a registered manager in post, who has managed the service for several years. 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 service. Policies and procedures were in place to protect people from harm or abuse and staff had received safeguarding training. Staff told us about possible circumstances during which they might use the safeguarding procedure and/or the provider’s whistleblowing policy in order to ensure people’s safety.

Care plans contained up-to-date risk assessments. They provided guidance for staff about how to support people to make decisions about their lives, while making sure that their safety and well-being was promoted. For example, one person’s risk assessment showed how they could be supported to continue to socialise with friends and relatives in the local community, taking into account the person’s healthcare needs.

We observed that there was sufficient staff on duty to support people with their personal care and hobbies at home, and to go out for activities and entertainments. Staff showed us how medicines were stored, administered and disposed of safely. Staff had received medicines training and they were aware of their role and responsibilities when supporting people to safely take their prescribed medicines.

Staff had supervision and training, including training that focused on how to meet the needs of people living at the service. This meant that people received support from staff with appropriate knowledge and guidance to meet their identified needs.

People were involved in the menu planning and supported to meet their nutritional needs. The menu plans reflected people’s known preferences and people told us they enjoyed their food and beverages. We observed staff sensitively supporting people who needed assistance at mealtimes.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report upon our findings. DoLS are in place to protect people where they do not have capacity to make decisions and where it is regarded as necessary to restrict their freedom in some way, to protect themselves or others. Records demonstrated that staff had received appropriate training and understood how to protect people’s rights.

We observed positive interactions between people and staff. People told us they felt respected and they were supported to maintain important friendships and relationships. During the inspection we saw that people went out with staff for lunch and came into the office to speak with the deputy managers. People told us they particularly liked their days out with their keyworker, which took place once or twice a month.

People remarked that they were pleased with the quality of their care and support, and we also received positive comments from the relatives we spoke with. Care plans showed that people and their representatives were involved in the care planning and reviewing process. People were supported to access community medical and healthcare facilities, and to follow guidance from healthcare professionals.

People and their relatives told us they knew how to make a complaint and thought that the registered manager would take any complaints and concerns seriously.

People told us that this was a good home to live at and relatives said they were happy with how the service was managed. People’s views about the quality of the service and how it could be improved upon were sought during regular review meetings and through the provider conducting surveys. The service also sought and acted upon the views of their relatives. There were systems in place to audit the quality of the service, including unannounced visits from the provider.