This inspection took place on 24 April 2018 and was unannounced.

Silver Oaks Residential 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. The home provides single bedrooms for up to 19 older people over two floors, accessed by stair lifts. At the time of our inspection there were 19 people using the service, some of whom were living with dementia.

There was 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.

At our last inspection in November 2015, we rated the service overall as good. At this inspection we found the evidence continued to support the rating of good. There was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People remained safe using the service. Staff had been trained in safeguarding people and understood how to assess, monitor and manage the risks people faced. People were protected by safe recruitment procedures to help ensure staff were suitable to work in care services. There were enough staff to meet people's needs.

The provider had made improvements to ensure people's medicines were managed safely. Medicines were stored, given to people as prescribed and records managed safely. Staff received medicines training and understood the importance of safe administration and management of medicines.

People continued to receive care from staff who had the skills and knowledge required to effectively support them. Staff completed a range of training relevant to the needs of people using the service and were supported to undertake further development training to enhance their skills and knowledge in areas of interest.

People's human rights were protected because the registered manager and staff had an understanding of the Mental Capacity Act 2005 (MCA) and their responsibilities within the legislation. People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way.

People's health and well-being needs were assessed and met by staff who responded effectively to people's changing needs. The service worked closely with health and other professionals to ensure they met people's health and well-being needs. People were supported to have good nutrition.

People continued to receive a service that was caring. Staff showed kindness, patience and compassion for people through their conversations and interactions. Staff supported people to communicate in the way they preferred. Staff enabled people to maintain their independence as much as possible. People's privacy and dignity were promoted at all times.

The service remained responsive to people's individual needs and provided personalised care and support. People were able to make choices about their day to day lives, including how they spent their time. The provider had a complaints policy in place and records confirmed any complaints received were fully investigated and responded to.

People received good care from a well-led service. People used a service where the provider's person-centred values were embedded into the leadership and governance, management, staff working practices and culture of the service. The registered manager was experienced and took the time to listen and responded to people, staff and others.

The provider had systems in place to monitor, assess and improve

We carried out our inspection on 5 November 2015. The inspection was unannounced.

The service provides accommodation for up 19 older people living with dementia and similar health conditions. At the time of our inspection there were 15 people using the service.

The service has a manager who had applied to the Care Quality Commission to become a registered manager 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 and associated Regulations about how the service is run.

Staff understood their responsibility to keep people using the service safe. They put into practice the provider’s procedure to keep people safe from abuse and harm. There were enough staff on duty to meet the needs of people using the service. Staff had the necessary skills to meet people’s assessed needs. We observed that people’s medicines were administered safely. However, staff had not consistently followed specific instructions and provider’s guidelines for completing medicines administration records. This meant that people were at a small risk of not receiving their medicines as prescribed by their doctor.

The provider supported staff through effective training and frequent supervision. The managers understood the relevance of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards to their work. They had made appropriate applications to the local authority for people who required restrictions and these had been done in people’s best interest. Staff understood that restraint could only be used if legally authorised.

People were supported with their nutritional and health needs. They had access to a variety of healthy meals that they told us they enjoyed. They also had prompt access to healthcare services when they needed them.

We observed that staff supported people in a caring manner, and promoted people’s dignity and privacy.

People were supported to maintain links with their family and friends, and with the wider local community using various avenues including social media. Staff were knowledgeable about people’s individual needs and applied this knowledge creatively in the way they supported people. Staff had the skills and knowledge to support relatives through various stages of people’s care and support.

The provider had effective procedures for monitoring and assessing the service in a way that promoted continuous improvement. The service had an open culture, and people, their relatives and staff had access to the manager when required.

This was a follow up inspection to ensure that the service was compliant with outcome 4 we therefore did not speak with any people using the service on this occassion.

We looked at care plans and saw that where people had more complex and changing needs risk assessments did not always reflect those needs, however people told us that they were well cared for and that staff were kind.

We wanted to know how well the service liaised with other organisations such as the district nursing service and GPs. We saw that referrals were made in a timely manner to GPs and treatment recommendations from district nurses were followed. People using the service told us that they saw a GP when they needed to. "If I don't feel well they call a doctor for me."

Due to ongoing safeguarding concerns we wanted to ensure people were being cared for. People told us that staff are kind and relatives felt that their loved ones received good quality care.

Training is important to ensure that staff understand what they are doing. We saw that staff receive appropriate training and that the provider encourages staff to develop their skills and knowledge further. People told us "The staff know what they are doing."

We looked at the manager's fitness to manage in light of the ongoing safeguarding referrals. Not only did people using the service have confidence in the manager but so did relatives and the staff. The provider had recognised that he needed support and had arranged a "mentor" to provide this support.

This was a follow up inspection to look at whether the provider had met the compliance action set at the inspection in June 2012.

We looked at how people using the service were respected and involved in the service and saw that the provider had now created a survey that had already been issued to relatives and returned. This survey showed that relatives were happy with the care and support their loved ones received: "Everything is fine here staff treat my (relative) with dignity. This also formed part of the new quality monitoring system.

We also looked at care plans to see if people were involved in creating them and updating them. We saw that where possible people were involved or their relatives were. Relatives spoken with confirmed that staff had spoken to them about care plans and that they had seen them: "When my (relative) first moved in the manager went through what care and support they would need."

We looked at what quality monitoring was being carried out. We saw that the registered manager had now created a number of auditing systems to monitor the service and ensure people receive a good quality service. Relatives spoken with told us that they felt confident to raise concerns with the manager or provider: "Mark (the provider) is often here and he always asks us what we think and if we are happy."

At the last inspection the records were not fit for purpose during this visit we saw that improvements had been made.

We spoke with two people using the service and two relatives visiting during the day. They told us they were satisfied with the care and service they received, however they had not been involved in creating their care plans or reviewing them.

"The staff are very caring and supportive of my (relative) but no one talked to me about a care plan when we first came."

"The staff help me when I need help."

"We looked at lots of homes before we chose this one, both the manager and provider had such a good ethos about care."

"I feel very happy that I have left my (relative) in a home where staff will look after them properly. I have absolutely no concerns".

During our visits we did not speak to any people using this service. We intend to speak to them during our next follow up visit in 2013.