About the service:

Oak Lodge Care Home provides nursing and personal care for up to 41 mainly older people.

People’s experience of using this service:

People’s medicines were not safely managed and accurate care and monitoring records were not always in place or able to be located. The manager took immediate action to resolve the concerns we identified.

People told us that they felt safe at the service. Staff were overall safely recruited to ensure they were safe to work with vulnerable people.

There were sufficient staff available to support people however we did see that people were left in the communal lounge areas without support and had to wait for assistance. This was brought to the attention of the manager who said they would address this immediately.

The environment was clean and free from unpleasant odours.

The new manager had made improvements to the attendance of staff training and ensured that where appropriate any outstanding deprivation of liberty safeguards (DoLS) had been made since they took up post.

People told us they enjoyed the food provided and their dietary needs had been catered for. They had access to the healthcare support they needed.

People were using the main communal area as both a lounge and a dining room. This was because the home was in the process of being refurbished. Work was well underway into changing the former dining room into a new spacious, open plan conservatory type lounge for people to use. Most of the bedrooms and corridors had been refurbished.

There was a calm and friendly atmosphere at the home. Overall people spoke positively about the staff. They told us they were treated with dignity and respect and their independence was promoted.

An activities co-ordinator who also had the role of quality assurance manager for people who used the service and relatives had recently returned to the home. People had started to see an improvement in activities and further developments were planned and would be put in place once the new lounge area was finished.

Feedback about the manager was very positive. The management structure had changed with two staff members supporting the manager in day to day operations and quality assurance.

One of the manager’s priorities for continuous improvement was promoting wider accountability and responsibility, which should in turn will strengthen the staff team.

The manager had made many improvements. They had introduced new management systems that had improved day to day oversight and communication at the home. The manager was in the process of ensuring that staff consistently incorporated the changes they had into routine everyday working practices.

However, we found shortfalls in the safety of medicines management for nursing patients at the home and in nursing patient records. The manager took immediate action to rectify the issues including contact with the supplying pharmacy and the local clinical commissioning team for support to make the improvements needed as quickly as possible.

Because of these issues identified we have changed the rating from good to ‘requires improvement.

Rating at last inspection: At the last inspection the service was rated Good (July 2016)

Why we inspected: This was a planned inspection based on the rating of the service at the last inspection.

Improvement action: Please see the ‘action we have told the provider to take’ section towards the end of the report

Follow up: We will continue to monitor the service and carry out a further inspection within 12 months.

This inspection was announced and took place on 27 June 2016. The last inspection took place on 5 January 2016. At that inspection, we found two breaches in the regulations that we reviewed. This related to Deprivation of Liberty Safeguarding (DoLS) authorisations not being in place for some people who lacked capacity and the need to ensure that all staff had received the training they needed to help ensure they supported people safely and effectively.

Following that inspection, we received an action plan from the provider telling us what action they intended to take to make improvements to the service provision in these areas.

This report only covers our findings in relation to what action the provider has taken to make the necessary improvement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Oak Lodge’ on our website at www.cqc.org.uk.

At this inspection, we found that the service had met these breaches.

Oak Lodge is registered to provide accommodation for up to 41 older people who require support with nursing and personal care. There were 38 people living at the service at the time of our inspection.

The service had a registered manager in place. 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.

We saw at this inspection that, where people lacked mental capacity to consent to their care in Oak Lodge, the necessary action had been taken to authorise their placement in the home. This should help to ensure their rights were protected.

We saw that the provider had retained the majority of staff that employed at the home at the time of our last inspection. These staff had completed the most of the training they needed to support people safely and effectively and any outstanding training was planned.

This inspection was unannounced and took place on 5 January 2016. The last inspection of Oak Lodge took place on 15 Janury 2015. At this inspection we found that there were six breaches in the regulations that we reviewed. The breaches included the lack of safe recruitment of staff who were suitable to work with vulnerable people, cleanliness, staff training, DNAR records and environmental risks that had not been picked up by the services health and safety monitoring systems. We received an action plan from the service that informed us what action they would take to make improvements.

At this inspection visit we found that the service had met these breaches.

Oak Lodge is registered to provide accommodation for up to 41 older people who require support with nursing and personal care. There were 36 people living at the service at the time of our inspection including people who were using respite care. Oak Lodge also had three places that could be used exclusively by the local authority Crisis Response Team. These beds were used to help prevent unnecessary admissions into hospital.

The service had a registered manager in place. 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 this inspection we found two breaches in the regulations that we reviewed. This related to deprivation of liberty safeguarding authorisations being in place for some people who lacked capacity and the need to ensure that all staff had received the training and supervision they needed to help ensure they supported people safely and effectively.

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

People we spoke with told us that they thought that the service provided a safe environment for them to live in. People said, "I can't say that I don't feel safe. It can be noisy at night," "I feel safe, I'm well fed and I'm warm" and "The home is brilliant. You can't beat it." The staff we spoke with told us that they knew what action to take if they thought a person who used the service was being abused or at risk of harm.

Relatives we spoke with commented on the cleanliness of the home and lack of unwanted smells. They said "It's kept clean. [My relative] is absolutely 100% safe here." "They do pretty well. Cleanliness wise they are good. We are more than happy." We saw that the service was clean and tidy and no malodours were detected during our inspection visit.

We found that the systems in place to manage people’s medicines was safe.

People who used the service told us about the food that was offered. They said,"I can't complain about the food. They do their best for you," "The food here is incredible, the quality and the fact that they do what you ask for. I'm a vegetarian and they meet my needs," and "The food is excellent. I have a diet, which they help me with."

People had access to the healthcare professionals that they needed to support them with their health needs.

People and their relatives told us that the care given by staff was very good. We saw good interactions between people who used the service and staff, which demonstrated close relationships and kindness.

The home employed an activities organiser who came into the home two days a week and provided the opportunity for people to participate in games, music and other activities. The activities organiser was highly thought of by people who used the service and family members. Plans were in place to increase the activities provided by the home through the employment of an additional staff member.

People who used the service, their relatives and staff told us that they thought the registered manager was doing an excellent job.

We considered all the evidence we gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

• Is the service safe?

• Is the service caring?

• Is the service effective?

• Is the service responsive to people’s needs?

• Is the service well led?

Below is a summary of what we found. The summary is based on a visit that took place on a Sunday afternoon, our observation of what was happening, speaking with eight people who used the service or their relatives, speaking with four staff members and looking at records.

Is the service safe?

People we spoke with said that they felt safe living at the home. They said if they had any worries or concerns they could speak to staff about them and were confident that action would be taken to address their concerns.

We saw that, although the lounge area was very busy, it was free from unnecessary clutter that could pose a potential trip hazard. We saw that when wheelchairs were in use foot plates were always used to prevent injury.

Is the service caring?

Everyone we spoke with confirmed that they were happy with the support they received from the staff team. They made the following comments, “I can’t fault them”, “I have no trouble with them”, “They are fantastic” and “When I need them they are there”.

Is the service effective?

The operations manager confirmed that there had been a number of staff changes recently with the departure of two qualified nurses and seven members of the care staff team. We were told that all the staff had been replaced and were undergoing induction.

Is the service responsive to people’s needs?

People we spoke with gave us examples of how the staff team were responsive to their needs. One person told us they had been “very” poorly when they had moved into the home and had not anticipated the recovery they had made. Another person who had been at the home for a short time following a fall at home gave an example of how they were being supported to mobilise again.

Is the service well led?

The operations manager for the home had come in on the day of our visit to provide additional support to the staff team which included two new members of staff.

We were told that both the named providers had visited the home on the day of our visit as they did most days to ensure the home was running smoothly.

The home has been without a registered manager since October 2013 and no registered manager application has been received by the Care Quality Commission (CQC). We were told that the present nurse manager came to work at the home on 31 December 2013 and was in the process of making arrangements to register. It is a condition of registration that the provider must ensure that a manager with the necessary skills and experience is employed by the home and is registered with the CQC.

During the inspection, we spoke with three people who use the service. They spoke positively about the staff at the home. The comments received included “the staff are marvellous, can’t do enough for you” and “I have had no issues at night”. We found that people were cared for by a sufficient number of nursing and care staff to meet people’s needs.

In this report the names of two registered managers appear who are no longer in post and were not managing the regulatory activities at this location at the time of the inspection. Their names appear because they were still registered managers on our register at the time.

During the inspection, we spoke with three people who use the service and the relative of another person using the service. They told us the staff kept them involved and explained what they were doing.

The relative of one person told us “My sister and I make all the decisions for our relative. We work with the staff, particularly the registered nurses and the manager but we also speak with the ordinary carers who all feedback information. I feel staff do respond to my input.”

We found that people were asked for consent and the provider acted in accordance with peoples’ wishes. People who use the service received care in a way that met their needs and preferences.

The people we spoke with told us they were happy with the care received and that they were looked after well. One person told us “The staff are absolutely lovely. They look after us perfectly. I shout if I need help and they come as soon as they can. There couldn’t be a better place than here.”

The people we spoke with told us they were happy with the staff. One person told us “The staff are marvellous. I don’t have to wait a long time for help.”

The relative of another person told us “I think the staff are lovely. They are really, really caring and considering the age of some of these young carers, they’re marvellous.”

We found the environment in the home to be clean, safe and well maintained. People were cared for by staff that had been through the appropriate recruitment checks. There was an effective complaints system available, in case anyone wished to raise a complaint.

We did not speak with any people who use the service as part of this review.

We spoke with three people who use the service. They told us that the staff were friendly, helpful and always listened to them.

The people we spoke with told us they were generally happy at the home. Two people told us that staff kept them involved and discussed their care plans with them.

People told us that they had no concerns about the care they receive. They told us that if they had any concerns or complaints, they would speak to the Matron.

This was an unannounced inspection which took place on 15 and 20 January 2015. Our last scheduled inspection took place on 3 September 2013 when we found that the service was compliant with all the regulations we reviewed. Since that visit we had undertaken two unannounced inspections on 17 October 2013 and 8 June 2014 in relation to concerns raised about staffing. We found that Oak Lodge was compliant on both our inspection visits.

Oak Lodge is registered to provide accommodation for up to 41 older people who require support with nursing and personal care. There were 38 people living at the service at the time of our inspection including people who were using respite care.

The service had a manager in place who was registered with us. 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.

We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the systems to ensure the safe recruitment of staff who were suitable to work with vulnerable people were not robust. The home was not clean and expected standards of hygiene were not achieved in some areas of the home. Not all the staff team had received the training they needed to support people safely and effectively. Environmental risks that we identified had not been picked up through the homes quality monitoring systems.

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

All the people who used the service and their family and friends we spoke with, said they thought they were living in a safe environment and felt very well cared for. One person told us “We feel safe here. It’s friendly.” And another said “The staff are very good. I feel safe.” A relative said “They keep her safe. When I’m at home at night I know she’s safe.”

We saw that the home was appropriately staffed and no agency staff were being used by the home which helped ensure consistent support to people who use the service. However, a staff member told us “I love this job. It would be good if we could find a little extra time to talk to residents.” A relative said “I wish staff had more time. They deal with her but it would be good if they could spend more time with her.”

We saw that systems were in place to manage the administration of medicines safely.

We were told that the registered manager carried out the pre-admission assessments for the home before a person moved in and in his absence a qualified nurse. This should help ensure people’s individual needs could be met at the service.

The registered manager told us that they had been in contact with the local authority about the recent changes in the law regarding people who might be considered as deprived of their liberty in residential care.

One person who was receiving respite care told us the food was “Nutritious and pretty good.” And there was, “Plenty of choice. You can have what you want no problem. The girls come and ask us what we want.”

We observed that there was no rush to get people up for breakfast. People appeared well dressed and cared for. A relative said “Their [staff] hearts are in the right place.” And another said “I think everyone is very nice. I think she’s very happy here.”

One person told us, “Anything you want they do for you.” And another person said “You can be yourself. You can ask for help if you need it but it’s not thrust upon you.” And “I wouldn’t change anything. The staff are absolutely wonderful.”

The volunteer activities organiser came into the home two afternoons a week. There was also a movement and music session once a week. “If this [activities] was going on every day it would be marvellous.”

We saw that there had been two complaints made by relatives of people who used the service and these had been responded to. One person told us, “They look after me. I’ve never had to complain.”

Staff told us that the management team were approachable and supportive they said “[Registered Manager] is very good. There has been a big difference since he took over. It’s more organised.” “[Registered Manager] is more organised. The staff respect him.” “They [the managers] do value me. They’ve looked after me on a number of issues. They are very approachable.”