The inspection took place on 21 March 2017 and was unannounced.

Three Oaks Care Home provides accommodation and personal care for up to 16 people with learning disabilities who may also have complex associated needs. There were 12 people using the service at Three Oaks Care Home on the day of this inspection.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

When we last inspected the service on 16 May 2016 we found a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had failed to ensure that accurate records were maintained in respect of each person who used the service, the employment of staff and the overall management of the regulated activity. Following the comprehensive inspection, the provider wrote to us to tell us how they would make the required improvements to meet the legal requirements. At this inspection we found that the provider had made the majority of the required improvements with some minor ‘fine tuning’ still in progress.

People felt safe living at Three Oaks Care Home. Staff understood how to keep people safe and risks to people's safety and well-being were identified and managed. The home was calm and people's needs were met in a timely manner by sufficient numbers of skilled and experienced staff. The provider operated robust recruitment processes which helped to ensure that staff employed to provide care and support for people were fit to do so. People's medicines were managed safely.

Staff received regular one to one supervision from a member of the management team which made them feel supported and valued. People received support they needed to eat and drink sufficient quantities and their health needs were well catered for with appropriate referrals made to external health professionals when needed.

People’s relatives complimented the staff team for being kind and caring. Staff and management were knowledgeable about individuals' care and support needs and preferences and people had been involved in the planning of their care where they were able. Visitors to the home were encouraged at any time of the day.

The provider had arrangements to receive feedback from people who used the service, their relatives, external stakeholders and staff members about the services provided. People’s relatives were confident to raise anything that concerned them with staff or management and were satisfied that they would be listened to.

There was an open and respectful culture in the home and people’s relatives and staff were comfortable to speak with the registered manager if they had any concerns. The provider had arrangements in place to regularly monitor health and safety and the quality of the care and support provided for people who used the service.

The inspection took place on 16 May 2016 and was unannounced.

Three Oaks Care Home provides accommodation and personal care for up to 16 people with learning disabilities who may also have complex associated needs. There were 12 people using the service when we inspected.

The manager at Three Oaks Care Home had been in post since May 2015 and had submitted their application to register with the Care Quality Commission (CQC) under the Health and Social Care Act 2008 in April 2016. The registration application was being processed at the time of this inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

When we last undertook a comprehensive inspection of the service on 27 August 2015 we found that the management team had worked hard to improve the quality of service that people received. However, we found that the service still required some improvement across all five areas (Safe, effective, caring, responsive and well-led).

In January 2016 we undertook a focused inspection to confirm that the provider had suitable arrangements in place to support the manager in their role. At that inspection we found that there had been significant improvements in how the home was being managed but it was acknowledged that there was still work to be done to ensure that people received a safe, effective, caring and responsive service.

At this inspection on 16 May 2016 we found that, whilst some improvements were still needed overall there had been significant improvements made to the quality of the service provided. We noted that improvements were still needed in the quality of the records maintained specifically in areas such as care records, staff recruitment records and the systems to share information within the staff team. We found that, arrangements to store people's personal and private information did not always promote confidentiality and communal areas of the home were in need of refurbishment to provide a more stimulating and homely environment for people.

People who lived at Three Oaks Care Home were not able to share their views with us however, relatives we spoke with gave us positive and complimentary feedback about service and said that they had no concerns about the care and support their family members received.

Risks to people’s safety and welfare had been identified and support had been planned to enable people to live as safely as possible whilst enjoying a range of opportunities for engagement and stimulation. There were sufficient numbers of staff available to meet people’s care and support needs.

Staff members understood their roles and responsibilities and were supported by the management team to maintain and develop their skills and knowledge. People were provided with a varied healthy diet and their physical and mental health needs were well catered for.

The staff and management team were welcoming and we noted a respectful interaction between staff and people who used the service. People’s relatives were encouraged to be involved in developing people’s support plans and to visit the home at any time. People were actively supported to maintain family relationships.

There were arrangements in place to support people and their families to raise concerns. The provider had made arrangements for an external consultant to provide formal supervision and support for the manager. This was a new arrangement however, the manager told us that they felt this was a positive move as the consultant had a successful track record in this area and had so far proved to be a robust resource.

We found that the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what

We carried out an unannounced comprehensive inspection of Three Oaks Care Home on 27 August 2015 at which we acknowledged that some improvements had been made regarding the quality of the care provision. However, we found that further improvements were required across all areas to ensure that people received quality care which was safe and that the improvements were sustained in practice.

In November 2015, a member of the provider’s senior management team left the service and we received concerns from the local authority in relation to the support provided for the manager. We undertook a focused inspection on 06 January 2016 to check that the home was being managed in the best interests of the people who lived there and that the provider had the necessary arrangements in place to support the manager.

This report only covers our findings in relation to whether the home is ‘Well-Led’. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Three Oaks Care Home on our website at www.cqc.org.uk

Three Oaks Care Home provides accommodation and personal care for up to 16 people with learning disabilities who may also have complex associated needs. There were 13 people using the service when we inspected.

The manager was in the process of submitting their application to register with 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 and associated Regulations about how the service is run.

At our focused inspection of 06 January 2016 we found that there had been significant improvements in how the home was managed. People’s relatives and the staff team gave us positive feedback about the home manager and the stability they had brought to the service. It was acknowledged that there was still work to be done to ensure that people received a safe, effective, caring and responsive service however, it was clear that the manager’s vision and ethos had been communicated to the staff team and that improvements were being made.

The inspection took place on 27 August 2015 and was unannounced.

Three Oaks Care Home provides accommodation and personal care for up to 16 people with learning disabilities who may also have complex associated needs. There were 13 people using the service when we inspected.

There was a manager in post who has not registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

CQC is required to monitor the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection we found that applications had been made to the local authority in relation to people who lived at Three Oaks Care Home and they were pending an outcome.

When we last inspected the service on 17 February 2015 we found the provider was not meeting the required standards and that they were in breach of regulations 10, 13, 14, 17, 22 and 23 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These correspond to regulations 10, 12, 14, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found that the provider had taken some action towards addressing the identified concerns however further improvements were still required in some areas.

Improvements had been made in relation to the arrangements for the safe storage, management and disposal of people’s medicines. Some further work was needed to ensure that safe medicines management was sustained. Staffing levels had increased; staff and relatives of people who used the service told us that this had resulted in a positive impact for people. People had health care and support plans in place to guide staff how people liked their needs to be met.

Staff members understood their roles and responsibilities and were supported by the manager to maintain and develop their skills and knowledge. People enjoyed a varied healthy diet and their health needs were well catered for.

There was a warm interaction between the staff and people who used the service however, not all interactions noted were appropriate to promote people’s dignity. People received support from external advocacy services to help them make decisions about matters in their daily lives as needed. Relatives and friends were encouraged to visit at any time and people were actively supported to maintain family relationships.

The provider had made arrangements to support people and their families to raise concerns and meetings were held for relatives and staff members to discuss all aspects of the care and support provided at the home.

The manager was new in post however; it was clear from feedback from relatives and staff that they promoted a positive culture within the home that was transparent and inclusive. Staff felt valued and supported in their role. A representative of the provider had been appointed to develop systems suitable to monitor the safety and quality of the service provided and manage risks to people’s health, safety and welfare.

At this inspection we found that the management had made many positive improvements in the short term. The management team acknowledged that there was further work to be done across all areas to ensure that people were assured of receiving a safe quality of service and that the improvements were sustained in practice.

This inspection was undertaken on 17 February 2015 and was unannounced. Our previous inspection was undertaken on 01 August 2014 during which we identified breaches in relation to Regulations 10, 13 and 23. We found that some improvements had been made in all areas however, some issues relating to Regulations 13 and 23 remained unresolved at the time of this inspection.

Three Oaks Care Home Limited provides accommodation and personal care for up to 16 people with learning disabilities who may also have complex associated needs. At the time of our inspection 16 people used the service but two people were temporarily away from the home.

The service had experienced a period of instability in the management team which has had a negative impact on the quality of the service provided. The registered manager left the post in September 2014. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. We found that there was an acting manager in post who was working towards gaining the skills and qualifications to manage the service and become registered.

The Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection applications had been made to the local authority in relation to people who lived at the service. Staff members had not received training in this area and were not familiar with their role in relation to MCA and DoLs.

The administration of medicines did not always promote the safety and well-being of people who used the service. Healthcare professionals were contacted if people needed additional support and all people who used the service had recently had all areas of their physical and mental health reviewed. However, people’s care plans were not up to date and did not accurately reflect their needs.

There were insufficient numbers of staff employed to meet the needs of people in the home. A recruitment drive was underway and the manager described a safe recruitment processes. However, the established staff team had not all been recruited under safe procedures. Some training had been provided to give staff the skills and knowledge required to undertake their roles however, this did not cover all the basic core areas necessary to promote people’s safety and well-being.

People’s confidential information and medical histories were not always stored in a manner that promoted confidentiality. We saw many examples of kind and caring interaction between people and the staff team however, we also noted some examples where staff behaviours did not respect people’s dignity. People received a balanced diet and appropriate support to eat however; they were not supported to make meaningful choices around the food provision.

The provider did not assess the quality of the service provided or monitor and manage risks to people’s health, safety and welfare.

At this inspection we found the service to be in breach of Regulations 10,13, 14, 17, 22 and 23 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These correspond to regulations 10, 12, 14, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of the report.

During our inspection on 31 July 2013 we found that appropriate checks had not been undertaken before new staff began work at the home. We carried out a further inspection on 15 October 2013 and found that they had changed their recruitment procedures to ensure that all appropriate checks had been completed before any new staff started work.

We saw that the provider had changed the form that people completed when they applied for work at the home. The manager had introduced a recruitment check list. This prompted them to ensure that the appropriate checks were carried out prior to a confirmed offer of employment being sent to the new staff member

We spoke with three of the 14 people who lived at the home at the time of our inspection. People told us that the care workers always knocked on their door before entering the room and asked for their consent before any care was delivered. One person told us: "They do ask if it's okay to help me."

People told us that they were happy living at the home. One person told us: "I feel happy now." Another person said: "It's very nice. I like it."

The care plans we looked at included individual sheets that provided detailed information. One sheet we saw had information relating to 'This is how I wash' on one side of the page. 'This is the support I need' was on the other side of the page. This meant that care workers were able to see at a glance the support the person needed with each task.

We looked at the care records of four people and saw that where there were concerns identified people's weight was monitored on either a monthly or weekly basis as appropriate.

On the day of our inspection the premises looked clean and smelled fresh. We saw that all the bedrooms were clean and dust free. We saw that there was a rota that ensured that each are was deep cleaned at least once week and chairs and tables were thoroughly cleaned on a daily basis.

Records showed that a criminal records check had been completed for both new members of staff. However, one new staff member had started work prior to the service receiving the satisfactory check.

During our visit we spoke with four people who use the service. They told us that generally they were happy in the home. One person added that they did not feel very comfortable, “When someone else was upset and made me agitated. But I know how to deal with that, I just move away.” The same person showed us their room and proudly told us of the “Lovely colour of my bedding.” Another person told us that staff were, “Very good. They ask me how I want them to shave me.” The third person told us that they felt safe and the other two people agreed that they all felt safe.

All three people told us that they knew about their care plans. The fourth person did not remember, but was reminded by the first three people, “Yes, you know when staff ask you what you want them to do for you and they write that.”

Three people explained that staff were well trained and one person explained, “My care worker always asks if she needs training to help me.”

Three people told us how independent they were and how the staff encouraged them to do things for themselves. One person said: “They ask me if to help with cleaning my room, but that is their job, I only help them.”

All four people confirmed that they were consulted about the quality of the service, two of them confirmed that they, “Remember filling in surveys.”

We observed three more people who were not able to communicate verbally being engaged and supported by the staff to greet us, shake hands and showing us that they were relaxed and comfortable, all three of them smiled at us.

Prior to this inspection we had received information of concerns about various aspects of care and support for people who used the service. We carried out a responsive inspection to find out whether people were receiving safe and appropriate care.

An inspector from the Care Quality Commission (CQC) conducted this inspection. We looked at care records for four people. We spoke with six people who used the service and greeted the majority of people, some of whom had returned from the day centres. We spoke with two relatives who had visited the home on the day of the inspection and members of staff including the registered manager.

We used the information we had gathered to answer the five 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?

The people we spoke with said that they were well looked after and cared for. People had their needs assessed and were met appropriately. One person said “Staff are very good. I get good care and I feel safe here.” A parent said “My daughter is safe. The staff know her well. I am involved in the care plan reviews. I have no complaints.”

The system for the management and administration of medicines was ineffective because people were not protected against the risks associated with medicines. There were no proper arrangements in place to prevent medicine error from happening.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. There was one DoLS currently in place for restricted visits and eight applications had been submitted under this system.

Is the service effective?

People who used the service received care and support that met their needs. People and their relatives were involved in regular care plan reviews. One parent said, “I am involved in the care plan reviews. The staff know my daughter very well and they support her in a professional manner. Regular care plan reviews had taken place to ensure that people and their relatives were aware of the changes in their health and wellbeing. Where appropriate the support and advice of other health care professionals had been sought to ensure that people’s health care needs were met.

Not all staff members had received relevant training for the work they did. They did not receive regular formal supervision. This meant that their work had not been appraised regularly. Therefore, people were not supported to deliver care and support safely and to an appropriate standard to ensure that people’s needs were met.

Is the service caring?

People who used the service told us that they were well looked after and cared for. One person said “Staff are very good. I feel safe here.” A parent said, “My daughter took nearly one year to settle down. But now she is happy and her needs are met.” Another parent said “Staff are caring and they are welcoming. I have no concerns about the care my daughter received.”

Is the service responsive?

The care plans we looked at showed that people's needs had been assessed and met appropriately. People had been involved in the decisions about their care and any changes in their care needs had been discussed with them and their relatives.

One parent said, “The staff do respond quickly in an emergency. For example when my daughter had an epileptic seizure, staff called the ambulance because they had followed the protocol.”

We noted that the services of other health care professionals had been sought to ensure that people had been cared for and supported appropriately.

We saw that the home had a complaints procedure in place and there was evidence of complaints that had been dealt with in line with the home’s policy. One parent told us about a complaint they had made and that they were happy about the outcome. We checked the complaint that had been made which confirmed that it had been dealt with according to what the complainant had told us.

Is the service well-led?

The service had a registered manager in place.

People’s care and support had been planned and delivered in accordance with their identified needs. The provider had carried out an annual questionnaire survey for people who used the service, their relatives and other stake holders. However, we found that the system in place for assessing and monitoring the quality of service was ineffective. The audits carried out for the administration and management of medicines had failed to identify issues we had found. The provider did not have a system in place to ensure that all staff had received the required training for the work they did. There had been on-going problems with the phone system which had not been addressed.