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Tall Oaks Requires improvement

Inspection Summary

Overall summary & rating

Requires improvement

Updated 31 July 2019

About the service:

Tall Oaks is a residential care home providing personal care for six people at the time of inspection who were living with a learning disability or/and autism. The service can support up to six people.

People’s experience of using this service:

The service was partially working in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.

People did not consistently receive a service that was safe, effective, responsive and well led. People did receive a service that was Caring.

Some systems were in place to keep people safe from the risk of harm and abuse, but these needed to improve. People’s needs were met by suitable numbers of staff, but the provider used a high level of agency staff which meant not all staff knew people well. People received their medicines as prescribed, however the process of administering medicines could be improved to mitigate risks of medicines errors. People were protected from the risk of infection.

People using the service received planned person-centred care and support that was appropriate and inclusive for them, however this was not always consistent. The service worked closely with other health professionals to ensure people’s health needs were met.

People enjoyed a range of activities which they chose to do, however this for some time had not been consistent and people were not able to carry out activities as much as they would like to. People had support plans in place which covered a range of information about them, their life histories, preferences, likes and dislikes and their support needs. These could be improved as some people’s care files were more detailed and person centred than others. The provider sought little feedback from people and their families to improve the service.

The manager was new and had recognised that systems and processes to manage the service needed to be improved. They had started to improve this but there were still many improvements needed such as involving people, relatives and staff in the running of the service, and having robust systems in place to monitor the quality of the service. The manager was also in the process of recruiting permanent staff to minimise the use of agency staff used.

People were treated with kindness and respect and staff spoke fondly about them. People’s privacy and dignity were respected, and they received personalised care.

For more details, please see the full report which is on the CQC website at

Rating at last inspection:

At the last inspection the service was rated good (15 December 2016).

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.


We have identified breaches in relation to Good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up:

We will be seeking an action plan. We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection areas


Requires improvement

Updated 31 July 2019

The service was not always safe.

See our safe findings below.


Requires improvement

Updated 31 July 2019

The service was not always effective.

See our effective findings below.



Updated 31 July 2019

The service was caring.

See our caring findings below.


Requires improvement

Updated 31 July 2019

The service was not always responsive.

See our responsive findings below.


Requires improvement

Updated 31 July 2019

The service was not always well-led.

See out well-led findings below.