This was an unannounced inspection which took place on 30 and 31 October 2018.

West Oaks is a care home with nursing which is registered to provide a service for up to 63 people who require assistance with personal care and nursing needs. The service currently offers a service to 63 people whose needs are related to old age and dementia, some of whom may require nursing support. The service, a detached purpose built building, offers single occupancy rooms and one double bedroom across the two storey home, which is divided into five units.

At the last inspection, in March 2016, the service was rated as good in all domains. This meant the service was rated as overall good. At this inspection we found the service had improved to outstanding in two domains and therefore had improved to an overall rating of outstanding.

Why the service is rated outstanding.

The service provided an individualised and creative approach to people's care and support needs, which enhanced people's quality of life. People had access to information technology, which enabled them to communicate to people important to them.

People were an important part of their own local community. The service encouraged integration within the community, with volunteer and apprenticeships posts offered to external people.

The provider valued and embraced diversity and equality, which included their approach to their own workforce.

The service was managed by a registered manager who was extremely experienced in social care, and respected by staff, families and external professionals. The registered manager and the management team ensured the service was exceptionally well-led and delivered care and support to people and their families that was responsive and caring in all ways. The registered manager and the staff team were committed to ensuring they offered people the very best care possible and that people and their relatives were as involved as possible in running the service. The quality of care the service provided was constantly assessed, reviewed and improved by the provider and registered manager. The group “Friends of West Oaks”, sought to offer continuous guidance and support to the development of the home.

The service was exceptionally responsive and strove to meet people’s continuously changing needs, wishes and lifestyle choices. It was extremely flexible and readily adapted to meet people’s, diverse and complex needs. It was very person-centred and people were seen and responded to as individuals. Activity programmes were creative and designed to meet people’s preferences and choices. Menus were created to offer a diverse and healthy diet. Care planning was individualised and regularly reviewed ensuring people’s needs were met continuously. The management and staff strove to keep people at the heart of the service.

A well-trained and knowledgeable staff team remained able to offer people effective care. They met people’s diverse needs. Care plans were kept up to date ensuring people’s current and changing health and emotional well-being needs were documented and as far as possible met. The service worked very closely with health and other professionals to ensure they offered individuals the best care in the most effective manner, within a highly responsive timeframe. Feedback provided to us by healthcare professionals about the care and support provided was extremely and consistently positive.

People continued to be supported by good staffing ratios, which were reviewed and increased as required. The management supported staff and assisted people on a daily basis, with their presence on the units. Staff were able to meet people’s specific needs safely. Robust recruitment systems were implemented to ensure as far as possible, that staff were safe and suitable to work. People were supported to take their medicines correctly by trained and competent nurses who were encouraged to maintain and develop their professional competence.

People were pro

This inspection took place on the 1 and 2 March 2016. The inspection was unannounced on day one and announced on day two.

West Oaks is a care home which is registered to provide care with nursing for up to 63 people. The people they support have varying needs, including people who live with dementia. At the time of our visit 61 people were using the services. The home is a detached purpose built building in a residential estate close to the shops and amenities of Wokingham and Reading. People had their own bedrooms and use of communal areas that included enclosed private gardens.

The people living in the home needed residential or nursing care and support from staff at all times and have a range of care needs. These included dementia care and palliative care.

The home has a registered manager who works full-time within the home. 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 safety was promoted within the home and they were, where possible, involved in the recruitment of staff. The recruitment and selection process helped to ensure people were supported by staff of good character. There was a sufficient number of qualified and trained staff to meet people’s needs safely.

Staff knew how to recognise and report any concerns they had about the care and welfare of people to protect them from abuse. There were risk assessments that identified risks associated with personal and specific health related issues. They helped to promote people’s independence whilst minimising any risks.

People’s medicine was managed safely although there were some omissions within people’s medicine records. This was immediately addressed by the registered manager by reminding staff of the importance of signing people’s records following application of their prescribed cream.

West Oaks was being refurbished within an anticipated timeframe of eight weeks. People’s privacy was placed at risk due to the refurbishment programme. This was reviewed and risk assessments put in place to promote people’s safety and respect their privacy at all times.

People were provided with effective care from a dedicated staff team who had received regular supervision with their line manager to identify their development needs. Training was provided by external sources, electronic processes and was also delivered by the in-house trainer. This made sure staff were supported to receive the training and development they needed to meet people’s individual needs.

The service had taken the necessary action to ensure they were working in a way which recognised and maintained people’s rights. They understood the relevance of the Mental Capacity Act 2005 (MCA), Deprivation of Liberty Safeguards (DoLS) and consent issues which related to the people and their care.

Staff were held in high esteem by people and their families. They treated people with kindness and respect and had regular contact with people’s families to make sure they were fully informed about the care and support their relative received.

Meals were nutritious and varied to meet individual needs and were being reviewed to improve presentation of soft foods.

People were encouraged to live a fulfilled life with activities of their choosing that were structured around their needs and individual to each person. However, these were being further developed to minimise the risk of social isolation, particularly for those people who remained in their room through choice or frailty. The provider had approved extra staff hours to take this forward.

People told us that they were very happy with the care and support they received. They benefitted from living at a service that had an open and friendly culture. There

We spoke with five people who told us they felt the staff were "kind and respectful" they told us they felt involved with planning their care and that they could make changes if they wished. People told us that they liked the activities the home provided and that they felt it was "a wonderful place". They told us they felt the staff were well trained and they got to know them really well.

We spoke with four staff who told us they felt well supported to do their job, they told us they did a variety of training and visited other homes within the company to further their training which they felt was really good. The staff told us they gave people choice and that they read the care plans to help them know the "capabilities" of each person. We observed the staff in the home and saw that they were kind and caring towards people and the staff were able to tell us people's individual preferences regarding their personal care and daily routines.

The manager gave us a tour of the home we saw that there were a variety of areas for people to spend their time including quiet areas, a television room, a garden room and the garden. Each area was themed with the decoration to enable people with dementia recognise their surroundings. We saw the garden and saw that it was secure so that people were able to use it freely and a private area was available for people to use with their families.

People we spoke with told us the manager was approachable and gave us positive comments about them. The manager was knowledgeable about how to deal with any complaints.

Two people we spoke with told us they felt safe in the home. They told us if they did not feel safe, they could talk to care workers, the managers or one of their relatives.

People's needs were assessed and care was planned in line with their individual needs. Staff we spoke with were knowledgeable about the people who use the service and how they were supported and cared for.

We spoke with two people who use the service and two relatives of people living in the care home. One relative told us, "It's a wonderful home. I wouldn't want X anywhere else". People told us they were able to make choices regarding many aspects of their care.