Oakland Grange is registered to accommodate up to 43 people who require personal care. At the time of the inspection, 42 people were living at the home. The home is based on four floors with two interconnecting passenger lifts and an ample choice of communal areas where people could meet and spend their day. All bedrooms had en-suite facilities.

The inspection was conducted on 19 and 20 October 2017 and was unannounced. There was 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 our last inspection, in September 2016, we identified breaches of Regulations 13 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Bruising to people was not always investigated or reported to the local safeguarding team; and the quality assurance systems were not always effective. At this inspection we found action had been taken. There were no longer any breaches of these regulations and quality assurance processes had been enhanced. However, some further improvement was required in other areas.

Staff sought consent from people before providing care or support and acted in their best interests. However, people’s capacity to make specific decisions was not always recorded and decisions that staff had taken on behalf of people were not always documented to show why they were in people’s best interests.

People felt safe living at the home. Staff knew how to identify, prevent and report abuse. They assessed and managed most risks to people effectively.

Arrangements were in place for the safe management of medicines. People received their medicines as prescribed.

There were enough staff to meet people’s needs in a timely way. Appropriate recruitment procedures were in place and pre-employment checks had been completed fully before staff started working with people.

People’s needs were met by staff who were competent, trained and supported in their role. People’s dietary needs were met and they received appropriate support to eat and drink enough.

People were supported to access healthcare services when needed. The home was taking part in a pilot project with other professionals to help reduce unnecessary hospital admissions.

People were cared for with kindness and compassion. Staff knew people well and supported people to maintain relationships that were important to them.

Staff protected people’s privacy and dignity. They encouraged people to remain as independent as possible and involved them in planning the care and support they received.

People’s needs were met in a personalised way. Each person had a care plan that was centred on their needs and reviewed regularly. Staff empowered people to make choices and responded promptly when people’s needs changed.

People had access to a meaningful activities based on their individual interests, including regular access to the community. They knew how to make a complaint and a complaints procedure was in place.

People and their relatives felt the service was run well. There was a clear management structure in place. Staff were organised, motivated and worked well as a team. They enjoyed working at the home and told us they felt valued.

People described an open culture where visitors were welcomed at any time. Staff enjoyed positive working relationships with external professionals and positive links had been developed with the community.

This inspection took place on 7 September 2016 and was unannounced.

Oakland Grange is a registered care home and provides accommodation, support and care for up to 43 people, some of whom live with dementia and mental health needs. Support is provided in a large home that is across four floors. Communal areas included two lounges and two dining room areas. At the time of our inspection there were 31 people living at the home.

Following an inspection in May 2015 enforcement action had been taken by the Commission and the Commission had served warning notices for multiple breaches of regulations. In addition we rated the service as inadequate and placed them in special measures. A second inspection in November 2015 showed some small improvements had been made but these were not sufficient to meet the regulations and the Commission took further enforcement action and placed a condition on the registration of the home to restrict admissions, meaning that the provider could only admit people to the home with our written permission. At the inspection one key question remained rated as inadequate and as such they remained in special measures. At this inspection the service had made enough improvement to come out of special measures.

A registered manager was 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 staff knowledge of safeguarding was good and they were confident concerns would be reported and action taken where needed. The manager held records of safeguarding issues that had been reported, investigated and action taken however we found a number of injuries including skin tears and bruising that could not always be explained, had not been reported and there was no evidence of any investigation into these. We referred these concerns to the Local Authority Safeguarding team.

The CQC monitors the operation of the Mental Capacity Act 2005 (MCA 2005) and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff understanding of the MCA and how this impacted on the support they provided to people had significantly improved. Day to day, people were supported to make their own decisions. Where people were unable to make these decisions, staff knew the process they should take to ensure that any decisions made were in the person's best interests. However records did not always reflect this process.

The registered manager and staff understood when a DoLS application may be needed and these had been submitted following a capacity assessment. Care plans had been implemented to reflect the DoLS, although they didn’t detail the conditions set with the DoLS. However where conditions were included in the DoLS approval, these had been carried out.

People said they felt safe and well cared for by staff who were knowledgeable of their needs. Observations showed staff were kind and caring. They were respectful in their interactions with people and engaged people positively. Staff showed a good understanding of people's right to privacy, dignity and person centred care.

Risks associated with people's needs were well known and managed effectively by staff. Information about risks for people and how to manage these were available in care records however, at times they lacked detail. The management of medicines had improved. However, some medicines related records required further improvement.

Tools were in place to determine staffing levels and this was being followed. Our observations and findings showed sufficient numbers of staff at the time of the inspection. However, we have recommended the provider review the call alarm system to ensure they are able to assess the times taken for staff to respond.

This inspection took place on 11 May 2015 and was unannounced. The service provides care and accommodation for up to 43 older people some of whom live with dementia. There were 34 people living at the home when we visited. Support is provided in a large home that is across four floors. Each room is single occupancy. Communal areas included two lounge and two dining room areas.

The home did not have a registered manager at the time of our inspection. This person had deregistered in April 2015, however we were aware they had left this employment during our last inspection in June 2014. 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. The provider had employed a manager who had not registered with CQC, however we were told this person had not worked in the service for approximately eight weeks. The provider had a deputy manager in post at the time of the inspection and this person was providing the management support.

At the last inspection on 25 June 2014 we asked the provider to take action to make improvements to the medicine management systems and recruitment processes. The provider sent us an action plan on 31 October 2014 stating the action they would take to meet the requirements of the regulations. The provider had taken action to address the concerns we had identified, however we identified further areas of concerns.

The provider had not ensured that staff only started work following receipt of satisfactory pre-employment checks. At times there was not enough staff to meet people’s needs in a dignified manner. Staff had not received training that would support them in their role. Supervisions of staff were inconsistent and staff had not received an appraisal.

Risks associated with people’s care had not been appropriately assessed and plans were not in place to minimise these risks. This placed people at risk of receiving inappropriate care and support.

Care plans for the support people required with their medicines were not in place and where people were prescribed medicines on an “as required” basis no guidance had been produced so that staff could be sure when this was needed and how to monitor its effectiveness. Areas of the home were unclean and not appropriately maintained.

People’s care plans were not personalised and did not cover all aspects of their changing needs. There were limited opportunities for people to give the provider formal feedback about their experience of living in the home. People were not supported to express their views or suggest ideas for improvement. However, people gave us positive feedback about their experience of living in the home and we saw staff cared about the people they were supporting.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. People could make choices about their day to day lives but where a person lacked capacity the Mental Capacity Act 2005 had not been used to guide practice. People were not able to leave the home without support. The door was locked with a keypad and the code was not visible for people to see. This was a potential restriction on people. However, no consideration had been made about Deprivation of Liberty Safeguards (DoLS) and no applications had been made by the home to the local authority responsible for authorising DoLS to ensure any restriction was lawful.

People enjoyed the food and staff ensured there was a choice of meals available. People were also supported with special diets and were given equipment, where needed, to promote their independence whilst eating. Healthcare professionals visited people when necessary.

Staff felt the deputy manager was supportive and approachable. They felt they could raise any concerns with them at any time and they would take action to address these.

There was not a system for auditing aspects of how the home was run and as such issues we had identified had not been found by the provider. Policies and procedures were not always adhered to and this had not been identified by the provider. Some policies did not relate specifically to Oakland Grange. Whilst information about risks to people was gathered this was not used to ensure plans were developed to mitigate such risks.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The overall rating for this service is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration. You can see what action we have taken at the back of the full version of the report.

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We spoke to four people who living at the service and to one relative of someone living at the service.

People told us they liked living at the home and commented that they were treated with respect and dignity. Staff were said to knock and wait before entering bedrooms. One person said, “I like everything about the home.”

People said they liked the environment, commenting it was clean and that they were able to personalise their rooms with their own belongings.

People said there was a choice of food and that they were asked in advance what they would like to eat. Comment was made that the food was of a good standard. We were also told by people that they were able to get up and go to bed at their preferred times. People said they were also able to spend their time as they wished. Two people said they chose not to join in with the activities.

People said they received the care and support they needed and were well looked after. Reference was made by people to a consistent staff team who knew people’s needs and how they liked to be helped with personal care. A relative also commented there was a low turnover of staff members and that this benefitted people. One person said of the staff, “They listen to whatever you say,” and, “They always help you with a smile.”

People said they felt safe at the home.

Staff were said to be polite and helpful. One person said, “They treat me well.” We were also told that staff were responsive when people asked for help by using the call point in their bedrooms.

People told us they were not aware of the home’s complaints procedure but said they would raise any concerns with the home’s staff and management. A relative told us the home kept them informed of any progress or developments regarding their relative’s well being. The relative also said they felt comfortable discussing any issues with the home’s staff.

This unannounced comprehensive inspection took place on 30 November 2015 and 1 December 2015.

Oakland Grange is a registered care home and provides accommodation, support and care for up to 43 people, some of whom live with dementia. There were 30 people living in the home on the first day of our visit and 29 on the second day. Support is provided in a large home that is across four floors. Each room is single occupancy. Communal areas included two lounge and two dining room areas.

A registered manager was not in place at the time of this 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. The provider had recruited a person to undertake this role and they had submitted an application to us to become the registered manager.

We carried out an unannounced comprehensive inspection of this home on 11 May 2015. Multiple breaches of the legal requirements were found in relation to the recruitment of staff, the cleanliness and maintenance of the premises and the unlawful deprivation of people’s liberty. We issued warning notices requiring the registered provider to be compliant by 15 July 2015 for breaches in relation to the failure to ensure consent was gained and the Mental Capacity Act (MCA) 2005 was appropriately applied, the failure to ensure the appropriate and effective assessment and management of risks for people, the failure to ensure adequate numbers of trained and supervised staff and the failure to ensure robust quality assurance systems and clear records. The provider sent us a service improvement plan detailing the actions they would take to make the necessary improvements. We were concerned that the completion dates in the provider’s plan were later than the date by which CQC required the provider to be compliant. We advised the nominated individual of this but did not receive a response.

At that last comprehensive inspection this service was placed into special measures by CQC. This inspection found that not enough improvement has been made to take the service out of special measures. Although feedback from people, their relatives and external professionals was often positive, our own observations and findings did not always match their feedback.

Some improvements had been made to the assessment of risk associated with people's care as risk assessments had been implemented, however, at times these lacked detail to support staff to understand how they could reduce risks. Care plans were not always followed and information gathered about risks was not always used to assess the effectiveness of plans of care. The management of medicines was not safe, controlled medicines were not stored in line with legislation and gaps in recording of administration of medicines could not be explained.

Improvements had been made to the cleanliness of the environment. Some improvements had been made to the environment but further work was required. The provider had a maintenance plan in place.

Some improvements to staffing had been made since our last inspection and new roles had been introduced. A dependency tool had been implemented to assess the level of staffing required some observations reflected that staff were not always available to meet people’s needs at all times. We have made a recommendation about this. Improvements had been made to the supervision of staff and they had received further training. However the training remained ineffective in supporting staff to understand their roles.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. People could make day to day choices but staff understanding of their role in Mental Capacity Act 2005 and Deprivation of Liberty Safeguards had not improved enough to ensure staff applied these appropriately.

People enjoyed the food and staff ensured there was a choice of meals available. However, it was not always clear how decisions about people’s nutritional needs were made. Relatives confirmed their involvement in the development of care plans although people couldn’t recall this. Care plans had improved since our last inspection and some were personalised and contained clear information. However this was not consistent and they were not always followed by staff. Healthcare professionals visited people when necessary and we saw how staff responded promptly to a change in a person's needs.

Whilst staff understood the importance of respecting and promoting people’s dignity and privacy, their actions did not always demonstrate they did this. Resident meetings had been introduced and surveys undertaken to gain feedback, however actions had not always been planned to address concerns and use the feedback to make improvements.

A new manager was in post and people and staff spoke positively about the impact they had had on the service since they started. They described the new manager as open, transparent and approachable. They were confident they listened and took action to make positive changes in the service. Some audits had begun to be undertaken by the manager but it was too early to assess their effectiveness.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are taking further action in relation to this provider and will report on this when it is completed.