Three Oaks Residential Care Home

People's experience of using the service

• Governance systems were not consistently effective in recognising areas for improvement.

• People were kept safe and secure from risk of harm. Potential risks to people had been assessed and managed appropriately by the provider. People received their medicines safely and as prescribed and were supported by sufficient numbers of staff to ensure that risk of harm was minimised.

• Staff had been recruited appropriately and had received relevant training so they were able to support people with their individual care and support needs.

• Staff sought people’s consent before providing care and support. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

• People were treated with kindness and compassion. People’s rights to privacy were respected by the staff who supported them and their dignity was maintained. People were supported to express their views and be actively involved in making decisions about their care and support needs.

• People’s choices and independence were respected and promoted. Staff responded appropriately to people’s support needs. People received care from staff that knew them well.

• People using the service were confident about approaching the registered manager if they needed to.

Rating at last inspection:

At our last inspection in December 2016 the home was rated good. At this inspection we found the management of the service required improvement because governance systems were not consistently effective.

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remained rated overall as good.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

Three Oaks Care Home had two registered managers who shared management responsibilities. On the day of our visit we were supported by one of the registered managers and throughout the report we referred to this person as ‘the registered manager’. 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 told us they felt safe with staff. Relatives had no concerns about the safety of people. There were policies and procedures regarding the safeguarding of adults and staff knew what action to take if they thought anyone was at risk of potential harm.

Potential risks to people had been identified and assessed appropriately. There were sufficient numbers of staff to support people and safe recruitment practices were followed. Medicines were managed safely.

Staff had received essential training and there were opportunities for them to study for additional qualifications. All staff training was up-to-date with refresher course booked for people. Staff had regular communication with each other at handover meetings which took place between each shift.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found the registered manager understood when an application should be made and how to submit one. We found the provider to be meeting the requirements of DoLS. The registered manager and staff were guided by the principles of the Mental Capacity Act 2005 (MCA) regarding best interests decisions should anyone be deemed to lack capacity.

People were supported to have sufficient to eat and drink and to maintain a healthy diet. They had access to healthcare professionals. People’s rooms were decorated in line with their personal preferences.

Staff knew people well and positive, caring relationships had been developed. People were encouraged to express their views and these were communicated to staff verbally. People were involved in decisions about their care and had signed a consent to care form and were consulted before any care or support was given by staff. Their privacy and dignity were respected and promoted. Staff understood how to care for people in a sensitive way.

Care plans provided information about people in a person-centred way. People’s preferences and likes and dislikes were documented so that staff knew how people wished to be supported. People were free to go out into the community independently if they so wished. There were a variety of activities and outings on offer which people could choose to do. There was a clear policy and procedure for dealing with any complaints.

People could express their views and discuss any issues or concerns with staff or the registered manager. The culture of the service was homely and family-orientated. Regular audits measured the quality of the care and service provided.

Throughout our visit we observed staff interacting politely and respectfully with the people they were supporting.

Care and treatment was planned and delivered in a way that ensured people's welfare. We saw care plans were based on assessments that had been carried out to identify what help people needed and any potential risks to their welfare.

We saw that appropriate storage facilities for all types of medication were available and that these were secure when we visited, however medication records were not always completed as intended following administration of prescribed medication.

Effective recruitment and selection processes were in place which ensured people were cared for by suitably qualified, skilled and experienced staff.

We found that the provider had an effective system complaints process in place. People told us that they had no complaints about the service and that if they did they would speak to the staff or the manager.

Comments from staff were positive and included "this home is like being in your own home", "the residents are well looked after, they only have to ask if they want something they are not getting" and "we are lucky to have such a great team here".

A visitor told us that they were fully consulted in all aspects of their relative's care and that communication with the staff team was excellent. One relative told us: 'Staff members are very thoughtful and kind, nothing is too much trouble'.

We saw that people's privacy and independence was respected, people experienced safe and effective care based on detailed care plans and risk assessments that met individual needs.

People using the service were protected from abuse as they were supported by a staff team who had appropriate knowledge and training on safeguarding adults. We saw policies on whistle blowing and safeguarding. People's rights were respected.

The provider employed sufficient staff to meet the current needs of people at the home. Staff received ongoing training and supervision which provided them with the skills and knowledge to meet the needs of the people they were supporting.

The provider had effective systems in place to monitor quality assurance and compliance.