About the service: Stoneygate Oaklands is a residential care home that was providing personal care to 42 people at the time of the inspection.

This service was selected to be part of our national review, looking at the quality of oral health care support for people living in care homes. The inspection team included a dental inspector who looked in detail at how well the service supported people with their oral health. This includes support with oral hygiene and access to dentists. We will publish our national report of our findings and recommendations in 2019.

People’s experience of using this service:

People told us they felt safe living at Stoneygate Oaklands.

The risks to people had been assessed and people and where appropriate their relatives had been involved in compiling care plans. Staff were knowledgeable about the range of needs people had. People were supported with their medicines in a safe way.

Appropriate recruitment checks had been carried out to ensure staff were suitable to work at the service. Training relevant to people’s support had been undertaken by staff. The staff team felt involved in the running of the home and were supported by the registered manager.

People accessed healthcare services when they needed them, and they were supported to eat and drink enough to remain healthy.

People were involved in making decisions about their care and support and their consent about the care and services offered was obtained. People were supported by a staff team who were kind and caring and treated them in a considerate and respectful manner.

There were systems in place to monitor the quality and safety of the service being provided. People’s views of the service were sought through regular meetings, surveys and informal chats. A complaints procedure was in place and people knew what to do if they had a concern of any kind.

The manager understood their roles and responsibilities as a registered person. They worked in partnership with other agencies to ensure people received care and support that was consistent with their assessed needs.

More information can be found in the detailed findings below.

Rating at last inspection: The home was rated Good at the last inspection in 2016.

Why we inspected: This inspection was planned in line with our regulatory framework and took place within the specified period since the last inspection.

Follow up: We will continue to provide ongoing monitoring of this service.

The inspection took place on 29 November 2016, and the visit was unannounced.

Stoneygate Oaklands provides accommodation and personal care for 44 people who have specific mental health needs. There were 41 people living in the home at the time of the inspection.

Stoneygate Oaklands 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.

At the last inspection of the service in 25 November 2013 we asked the provider to make improvements where people’s medicines were administered. We received an action plan from the provider which outlined the action they were going to take. This advised us of their plan to be compliant by January 2014. At this inspection we found that improvements had been made in the management of medicines including the administration of medicines and any excess medicines disposed of safely.

At the last inspection of the service in 25 November 2013 we asked the provider to make improvements to demonstrate they acted in accordance with people’s wishes, and to ensure where people lacked capacity, that support was in place to assist them to make informed choices about their care or support. At this inspection we found that staff worked within the principles of the Mental Capacity Act 2005 and had a good understanding of their responsibilities in making sure people were supported in accordance with their preferences and wishes.

At the last inspection of the service in 25 November 2013 we asked the provider to make improvements to the choices of food people were offered and to ensure people were offered a nutritious diet. At this inspection we found that improvements had been made and people were regularly consulted about what the menu choices should include.

Staff felt there were enough staff to keep people safe and ensure people could go out when they wanted to. Staff worked as a team to ensure people received the appropriate level of support to keep them and others safe. The provider had recruitment procedures that ensured staff were of a suitable character to work with people at the home. Staff training was provided in areas considered essential for meeting people’s needs safely and effectively.

Some windows in the home required adjustments to ensure peoples’ safety. Tests to ensure that the environment was safe were undertaken regularly, and there was a business continuity plan to ensure the effective running of the service in an emergency. Risk assessments and management plans covered all aspects of people’s needs and included safety when outside the home, travel, finances, health and daily routines.

New staff received an induction which included working alongside more experienced staff. This helped them get to know people’s needs and establish a relationship with them before support them on a one to one basis. Staff had been provided with safeguarding training and the registered manager understood their responsibilities to manage any safeguarding concerns raised by staff.

Staff knew people's individual communication skills and abilities and showed concern for people's wellbeing in a caring and meaningful way. Staff were observant of people and responded to their needs quickly.

Care plans and support records were personalised and each file contained information about the person's likes, dislikes, preferences and the people who were important to them. Care plans also included information that enabled the staff to monitor the well-being of people. There were systems in place for staff to share information through detailed daily records for each person.

Audits and checks of the service were carried out by the management team and the provider. These checks ensured the service had co

As part of the inspection we spoke with eight people who used the service, the registered manager and three carers. We looked at numerous records including people’s care records, medication records and records in relation to the management of the service.

People we spoke with were positive about the home and the staff team. Our observations showed that people were comfortable and confident in approaching staff and that staff treated people with dignity and respect.

We looked at the records of five people who used the service and found care had been planned and delivered appropriately with regard to people’s health and safety. However, the service did not have suitable arrangements in place to demonstrate how they acted in accordance with people’s wishes. In addition, where people lacked the capacity to make an informed choice about their care or support, there was limited evidence that the provider had ensured their legal rights were upheld.

We found that people had been screened to see whether they were at risk of malnutrition and the service had taken appropriate action in response. However, we found that some people who used the service were not happy with the meals provided at the home. In particular meals that were received from ‘central kitchen’. This is a kitchen operated by the provider that prepares meals for a number of its services in the locality. We were concerned that people’s food preferences and choices were not being taken into account by the service and that people did not have the choice of eating a balanced diet due to the reliance on pre-packaged and processed foods. As a result we felt that some people may have been at risk of not receiving suitable or nutritious meals.

There were appropriate arrangements in place for the obtaining and storage of medication. However, we observed the manager administering medication in a way that posed a risk to people potentially receiving the wrong medication, or not receiving the medicines they required.

Staff we spoke with demonstrated a good understanding of the needs of people who used the service and were positive about their roles and the support they provided. We found that there were enough staff working at the home to meet the needs of people who lived there.

We did not speak with anyone using the service during this visit. We checked that the provider maintained the cleanliness of the premises by checking the home. We found the provider had refurbished bathrooms at the service, making them more hygienic and easier to clean. The provider was not keeping records to show how they checked the cleanliness of the premises.

We spoke with eight of 44 people using the service. Everyone we spoke with told us the service met their needs. Comments included, “The service is excellent.” and “The manager is the only lady that’s ever been able to help me.” They all said care workers were good. They said they thought they were properly qualified and supervised. Comments included, “They work really hard. They’re a good bunch of people.” and “You couldn’t wish for a better load of people.”

Only one person said they had given consent to their care and treatment. We saw the provider had a system for requesting and recording people’s consent. This had not always been used. The manager was in the process of auditing care records and had identified that action was needed to ensure people had given written consent to their care and treatment.

All of the people we spoke with said the home was clean. One person said, “The cleaning’s great. They’re always going round with a mop.” We found that the home was mostly clean and staff had a good awareness of infection prevention and control. There were not effective systems to check procedures to reduce the risk and spread of infection.

The people we spoke with had met to discuss their views about food at the service. The provider was taking action in relation to their comments. The registered manager used different ways to gather people’s views. The provider did not always feed back to people what action had been taken as a result of their comments.

People told us Stoneygate Oaklands was a friendly and welcoming place where people were made to feel at home. One person said, “This is an accepting place. No-one judges you and no-one tells you what to do.” Another commented, “I get on well with all the staff and residents. They’re very friendly and I never get lonely here because there’s always someone to talk to.”

There was a culture of openness in the home and people told us they were happy to speak out about anything and everything. One person told us, “You can say what you like here. Everybody’s very honest and we tell the staff what we think – good and bad.”

People said they had confidence in the manager and staff and knew they would act if anything was wrong. One person told us, “I’d tell the manager if I had a complaint and she would definitely sort it out. She’s that sort of person.” Another commented, “I fell safe living here. I trust the staff, they follow the manager’s lead. They will not allow bad things to happen.”

People told us they liked staff and made many positive comments about how they had been supported since being in the home. One person said, “It’s very friendly here. The staff look after you all the time. They’re there if you want to talk, any time, day or night."

All the people we spoke with said they liked the breakfast and teas which were prepared in the home. However some people said they did not like the lunches which were brought in from the provider’s central kitchen. One person told us, “The breakfast and the teas are made here and they are lovely. But I’m not keen on the lunches. They are mushy and horrible.”