The inspection took place on 24 and 25 October 2017. The inspection was unannounced.

There was a registered manager based at the service who had taken up their employment since the last inspection took 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.

Oakdene Rest Home provides accommodation and personal care for up to 26 older people. There were 18 people living at the service at the time of the inspection.

People living in the service required care and support and had varying needs. All the people were living with dementia and some had medical conditions such as diabetes or respiratory conditions and some people were recovering from suffering a stroke. Most people living in the service were mobile, some independently mobile and others needed the support of one or two staff. Some people were unwell and cared for in bed.

The service was set over two floors with most bedrooms being available on the ground floor. A stair lift helped people to move between floors, this meant only people who were independently mobile or needed minimal support with mobility lived in the five upstairs rooms. Two lounges were available for people to use, one leading on to a private enclosed garden which was well maintained and easily accessible. A central conservatory area was used as a dining area where people could choose to eat their meals. There were no en-suite bedrooms available so people shared bathroom facilities.

Oakdene Rest Home was last inspected on 20 and 21September 2016. Four breaches of legal requirements were found in relation to Regulations 9, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider and registered manager to take action to meet the regulations. We also made three recommendations to improve the service provided.

After the inspection the provider did not send a formal action plan but sent updates via email informing CQC of the action taken to make improvements. Emails were dated 23 September 2016, 26 September 2016, 11 October 2016 and 12 October 2016.

At this inspection we found improvements had been made in all areas of concern found at the last inspection.

Risks had been identified and measures were now in place to mitigate and prevent harm, helping to keep people safe. Fire safety was considered and remedial work had been carried out to ensure fire precautions and procedures were safe.

Medicines were managed safely and people received them as prescribed.

There were now suitable numbers of staff deployed to meet the needs of people living in the service. The registered manager kept this under review.

The provider and registered manager had introduced a more robust and effective system for monitoring the quality and safety of the service provided. Improvements had been identified and action plans in place to make sure timely action was taken.

A more person centred approach was now taken and people had better opportunity to take part in meaningful activities. Further improvements were planned. The registered manager had started to involve people’s families more in their care plan reviews.

The provider had embarked on a refurbishment programme and many areas of the service benefitted people with more effective lighting and decoration.

People were supported to be safe by staff who knew what their responsibilities were in relation to keeping people safe from the risk of abuse. Staff recognised the signs of abuse and what to look out for. Staff had the information they needed to raise concerns they had with external organisations if necessary.

The registered manager followed safe recruitment practices by having appropriate arrangements in place to check the

The inspection took place on 20 and 21 September 2016. The inspection was unannounced.

Oakdene rest home was registered to provide accommodation and personal care services to 26 older people. 17 people were living at the home on the day of our inspection.

Oakdene rest home was situated on the Isle of Sheppey in a central location. There were two floors in the home providing care and support to older people with varying needs, many of who were living with dementia. Access between floors was via stairs or a chair lift so only people who were independently mobile were accommodated in the five upstairs bedrooms. There were two lounge areas for people to sit in or to take part in activities. One lounge led onto a garden area where people could sit out in fine weather if they wished. There were no en-suite bedrooms, people shared bathroom facilities. Some people chose to eat their meals in a small pleasant dining area.

We last inspected this service on 12 and 14 October 2015 when we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to Regulation 12, Safe care and treatment and Regulation 15, Safety and suitability of premises. Following the inspection the provider did not send an action plan to inform us how they intended to improve the service and meet the requirements of the regulations.

However, at this inspection we found that the provider had taken action to address the breaches from the previous inspection and had made some improvements to the service provided. Improvements had been made to managing infection control measures and the safe management of medicines. Improvement was still required to adequately assess risks to the health, safety and welfare of people receiving care. A new registered manager was in place who was addressing the areas of concern.

There was a registered manager based at the service who had taken her post since the last inspection. 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 and their relatives told us they felt safe living at the home. They told us who they would speak to if they were worried about anything and were confident they would be listened to. We spoke to staff who were able to tell us how they kept people safe. They understood their responsibilities in ensuring people were safe from abuse and their role in reporting any concerns they had. There was evidence that staff had previously raised concerns with the local authority and CQC, helping to keep people safe.

Risks to people’s safety and wellbeing were not always managed effectively to make sure they were protected from harm. The care home did not have all associated individual risk assessments in place to identify and reduce risks that may be involved when caring for people in the home.

Fire evacuation drills had not been undertaken to make sure staff understood the fire evacuation procedure and how to implement it. Personal emergency evacuation plans were not in place for individual people to guide staff how to support people appropriately in such an event.

There were not sufficient numbers of staff deployed effectively to meet the needs of people living at the home. Staff were expected to carry out a number of other tasks around the home as well as their primary responsibility of supporting people. This meant there were not always enough staff available when required to assist people.

There were no activities plans in place in order to ensure people were meaningfully occupied with activities that matched their hobbies, interests and preferences. Activity records showed the activities on offer were limited. An activities coordinator had been recentl

This inspection was carried out on 12 and 14 October 2015. The first day of the inspection was unannounced and we told the provider we would revisit on the 14 October 2015.

Oakdene Rest Home is a home for 26 older people who have a diagnosis of Dementia. The home is over two floors, have both single and double rooms. At the time of the inspection, there were 17 people living at the home.

The home was re-registered on 19 March 2015 to a new provider and 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 2014 and associated Regulations about how the service is run.

People made complimentary comments about the service they received. People told us they felt safe and well looked after. Our own observations showed that the staff were very caring, however the records we looked at did not always match our observation and the positive descriptions people had given us.

Some people may not have received their medicines as prescribed. Suitable arrangements were not all in place for managing medicines, and the recording of medicines did not follow guidance issued by the National Institute for Health and Clinical Excellence.

The planning of care for people included people’s physical, emotional, spiritual, mental, social and recreational needs. There was information about people’s likes and dislikes. However, six out of the seven family members we spoke with about care planning had not been involved and had not seen their relatives’ completed care and support plan. We have made a recommendation about this.

People and staff felt there were usually enough staff deployed in the service. However, the manager could not show us how the staff ratio had been worked out to make sure there was sufficient staff to meet the individual needs of the people. We have made a recommendation about this.

Staff felt well supported by the provider and the management team. The staff team in the home had remained stable for several years and currently there were no new staff. The staff training records showed that not all staff had received necessary training to make sure they have the skills and knowledge required to care for all people’s specific needs. Refresher training had also not been provided in a timely way. However, the provider had recognised this and had organised training for the staff, and further courses had been booked.

Staff supervision had not been arranged on a regular basis. However, the registered manager had identified this and supervision was now being diarised every six to eight weeks. Staff told us that they had opportunities to talk to the manager and the provider, if they had any issues or concerns. The registered manager told us that each member of staff was to have an annual appraisal to assess their performance and any further training needs.

People were complimentary about the food and were provided with enough to eat and drink. Choices of menu were offered each day. Some improvement was needed at mealtimes to make sure people ate in a pleasant and homely environment; the current dining room was not large enough for everyone to use. We have made a recommendation about this.

There was a system for managing complaints about the service. People and their families were listened to and knew who to talk to if they were unhappy about any aspect of the service. The complaints policy was on the notice board however it was out of date and did not have current information about external services people could complain to. We also found that complaints had been listened to and actioned however they had not been recorded. We have made a recommendation about this.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Some people were assessed as lacking capacity to make decisions for themselves at this service. Staff were supporting people following decisions they had made which were in their best interest. Not all staff had received training in the Mental Capacity Act 2015 or DoLS to enable them to do this effectively. We have made a recommendation about this.

Staff were kind and caring in their approach and had a good rapport with people. The atmosphere in the home was calm and relaxed and there were lots of smiles and laughter.

Safe recruitment procedures were followed to make sure staff were suitable to work with the people at the home. People were safeguarded from abuse.

People were supported to maintain their relationships with people who mattered to them. Visitors were welcomed at the service at any reasonable time and were complimentary about the care their relatives received. People were consulted through resident’s meetings and their views taken into account in the way the service was run.

During this inspection, we found a breach of regulation relating to fundamental standards of care. You can see what action we told the provider to take at the back of the full version of this report.