About the service:

Oakhill House Care Home is registered to provide nursing care and support to a maximum of 49 people. 26 people were living at the service at the time of our inspection. The service is intended for older people, who may be living with a physical disability or dementia.

People’s experience of using this service:

People told us and we observed that they were safe and well cared for and their independence was encouraged and maintained. Comments included, “This is a good place to live, I feel safe.”

• The service had made improvements since our last inspection. This meant people’s outcomes had improved. However, whilst the provider had progressed quality assurance systems to review the support and care provided, there was a need to further embed and develop some areas of practice that the existing quality assurance systems had missed. For example, an external Legionella and Water Safety Risk Assessment in December 2018 had made recommendations that required action within a certain time frame. There was no improvement plan relating to the work and the water checks on the empty floor were irregular.

• People’s safety was not always protected. The security of the building needed to be reviewed, to ensure people could not enter unannounced.

• The lack of opportunity to provide meaningful activities was known but not yet acted on, or a plan put in place to address this.

• These were areas that required further improvement.

We have made a recommendation about seeking expert advice about the administration and use of medicines given covertly (disguised in food/drink).

We have made a recommendation about seeking expert guidance regarding oral hygiene practices.

• People were protected against avoidable harm, abuse, neglect and discrimination. The care they received was safe.

• People's health risks were assessed and strategies put in place to mitigate the risks.

• Staff received improved supervision and training since our last inspection, which provided them with the knowledge and skills to perform the roles they were employed to do.

• People received their care and support from a staff team, who had a full understanding of people's care needs and the skills and knowledge to meet them.

• Staff were given an induction when they started and had access to a range of training to provide them with the level of skills and knowledge to deliver care efficiently.

• People and relatives provided consistently positive feedback about the care, staff and management. They said the service was safe, caring and well-led.

•Staff treated people with respect and kindness at all times and were passionate about providing a quality service that was person centred.

• People's care was more person-centred. Care delivery was designed to ensure people's independence was encouraged and maintained.

• People were involved in their care planning.

• There was a happy workplace culture and staff we spoke with provided positive feedback.

The service met the characteristics for a rating of Requires Improvement.

More information is in our full report.

Rating at last inspection: Requires Improvement. (Report published on 6 November 2018.)

This is the second time the service has been Requires Improvement. However, improvements were seen and there were no breaches of regulation.

Why we inspected:

• As part of our enforcement action following our prior inspection, we served a warning notice and this inspection was scheduled to look at their action plan and ensure improvements had been made.

• All services rated as ‘Requires improvement’ are re-inspected within one year of our prior inspection. This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received and the improvements made.

Follow up:

• We will continue to monitor intelligence we receive about the service until we return to visit as

per our re-inspection programme. If any concerning information is received we may inspect

The inspection took place over two days on 11 and 14 May 2018, the first day was unannounced and the second was announced.

Oakhill House Care home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home can provide accommodation and nursing care for 49 people in one detached building that is adapted for the current use. The home provides support for people living with a range of healthcare, mobility and sensory needs, including people living with dementia. There were 32 people living at the home at the time of our inspection.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered managers, 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.

This was the first inspection of Oakhill House Care Home since HC-One Oval Limited became the provider of the service and registered it with the Care Quality Commission in December 2017. At this inspection we identified areas that required improvement, including breaches of regulation in relation to ensuring staffing levels, safe care and treatment arrangements, quality assurance and governance systems were sufficient to enable staff to meet people’s preferences and care needs.

We were told that staffing levels had been assessed based on people’s care and support needs and that the service was working towards establishing more consistency in relation to the use of agency staff and recruiting. However, people, relatives and staff felt that there were times when there were insufficient staff or inefficiently deployed staff to ensure people’s preferences and care needs were met. One relative told us, “I have no experience of any other home to compare this to but they have a lot of people who need a lot of care. There are times when I come and it’s clear my relative needs changing but they have been left sitting there for a while because it’s either not time for the toileting round or not their turn. They get distressed then. I think the staff do their best but there’s not enough of them.” Our own observations in relation to people’s mealtimes, access to activities and communal spaces supported this.

People had not always been provided with suitable arrangements for their end of life care to ensure they could experience a respectful, comfortable, pain free, end of life. The provider had learnt lessons in relation to one person’s experiences and had refreshed staff awareness and training but people’s end of life preferences had not been fully embedded in their care planning. The provider was reviewing its pre-admissions processes to ensure that suitable assessments of need were in place and that relatives were fully consulted where they had the right to be.

Quality assurance systems were in place and being embedded. The provider had used these proactively since March 2018 to monitor the overall quality of the home and to identify any shortfalls and improvements necessary. However, during the four months before this date and as the systems were embedding the provider had not fully ensured that people were protected from the risk of harm or that risks were managed safely. People’s dignity and right to have their preferences met in relation to end of life care, eating and activities were also not consistently respected. People’s access to sufficient staffing levels and the consistency of their personal care need being met were not always ensured.

People were not always protected from the potential risk of abuse. Staff could demonstrate a good understanding of their safeguarding responsibilities and were confident that if they raised conc

We inspected Oakhill House Care Home on the 3 November 2017 and the inspection was a focused inspection. Oakhill House Care Home is situated in the town of Horsham. The service provides nursing care and support for up to 49 older people, most of whom are living with dementia. On the day of our inspection, there were 39 people living at the service. There are four communal lounges, two dining rooms and well maintained gardens.

The service did not have a registered manager in post. 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. A manager was in post on the day of the inspection and they had been in post four weeks. They told us that they would be submitting an application to become the registered manager and subsequent to the inspection, we were informed that the manager had submitted an application to become the registered manager.

At the last inspection undertaken on the 19 and 20 June 2017, the provider was in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014. This was because accurate and complete records had not been maintained. Recommendations were also made in relation to the administration of medicines. The provider sent us an action plan stating they would have addressed these concerns by October 2017. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Oakhill House Care Home on our website at www.cqc.org.uk

The inspection was prompted in part, by a notification of a serious injury involving a person who lived at the service. The incident is subject to an investigation and as a result this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident, indicated potential concerns about the management of risk in relation to falls.

The management of falls was not consistently safe. The provider was not consistently following their internal falls protocol and procedure. Where people had been assessed at high risk of falls, falls care plans were not consistently in place. Guidance did not always document the measures required to mitigate the risk of people falling.

Steps had been taken to drive improvement and the provider was now meeting the legal requirements. The administration of medicines was safe and care documentation had improved. However, further work was required to strengthen the provider's internal quality assurance framework. The care planning process failed to consistently identify and reflect how staff respected and upheld people’s equality and diversity. Care plans failed to consistently identify people’s involvement with the design and formation of their care plan. Systems were in place to determine staffing levels. Steps had been taken to recruit additional staff and the use of agency staff was reducing. However, staff members felt staffing levels were insufficient and a struggle. We have identified these as an area of practice that needs improvement.

Staff worked in partnership with other healthcare professionals to promote good outcomes for people. Where people displayed behaviours which challenged, staff completed behavioural observation charts; however, the findings from the behavioural charts did not consistently feed into the care plan and risk assessments. We have identified this as an area of practice that needs improvement.

People were protected from harm and abuse. There were appropriate, skilled and experienced, permanent staff who had undertaken th

We inspected Oakhill House Care Home on 19 and 20 June 2017. This was an unannounced inspection. Oakhill House Care Home is situated in the town of Horsham. The service provides nursing care and support for up to 49 older people, most of whom are living with dementia. On the days of the inspection, there were 42 people using the service. There are four communal lounges, two dining rooms and well maintained gardens.

There was a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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. On the days of the inspection, the registered manager was away and the service was being overseen by a regional management team.

At the last inspection undertaken on the 23 February 2016 we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) 2014 in relation to the management of people’s medicines. This was because medicines were not stored correctly, not everybody had access to their medicines and the recording of topical creams was inconsistent. A recommendation was also made in relation to people’s dining experience. The provider sent us an action plan stating they would have addressed all of these concerns by July 2016. At this inspection we found the provider had made improvements to people’s dining experience and to the management of medicines.

Systems were in place for the ordering, storage and disposal of people’s medicines. Each person had a medicine profile and people and their relatives confirmed they received their medicines when required. However, the administration of topical creams was inconsistent. Medication Administration Records (MAR charts) failed to consistently reflect if people were administered their topical cream as prescribed. The provider’s quality assurance framework had identified this shortfall, yet no action had been taken. Nursing staff were regularly disrupted when administering medicines which posed a risk. Nursing staff also confirmed they felt this was an area of concern. We have identified this as an area of practice that needs improvement and have made a recommendation for improvement.

Arrangements were in place for the provision of meaningful activities and stimulation. However, these arrangements were not yet consistently embedded into practice. Steps were being taken to reduce the risk of social isolation, but these required strengthening. We have identified this as an area of practice that needs improvement.

Appropriate recruitment checks took place before staff started work. Staffing levels were based on the individual needs of people and sufficient staffing levels were being maintained with regular use of agency staff. Staff felt staffing levels could be tough at times but agreed that despite these struggles, people received good care. The provider was actively taking steps to minimise the use of agency staff.

Oakhill House Care Home had been subject to a period of instability. Staff told us that morale had been low but confirmed things were starting to improve. The provider’s regional management team were supporting the service. A quality assurance system was in place and clear actions had been identified on how to drive improvement. However, these positive improvements were not yet embedded or sustained.

People told us they felt safe living at Oakhill House Care Home. One person told us, “I feel safe because everyone is very nice to me and they know my name. I have a bad memory but they all recognize me and nobody is quarrelling.” Staff worked in accordance with people's wishes and people were treated with respect and dignity. It was apparent that staff knew people's needs and preferences well. Positive relationships had developed amo