We inspected Oakland House Nursing Home on 20 and 21 February 2018. The inspection was unannounced, so this meant they did not know we were coming.

We last inspected Oakland House Nursing Home on 9 and 10 January 2017 when we rated the service Requires Improvement overall. At that inspection we found breaches of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment and person centred care. We issued two requirement notices to the provider to inform them of the reasons they were in breach of the regulations and to tell them improvements must be made.

At this inspection we found that although there had been improvements to some aspects of the service, we identified ongoing concerns and continued breaches of the regulations. We found breaches of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment, person centred care and good governance. You can see what action we asked the provider to take at the back of the full version of this report.

Oakland House Nursing Home is registered to provide nursing and residential care for up to 38 people who have enduring mental health / complex needs. People in care homes receive accommodation and nursing and/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. At the time of our inspection there were 35 people living in the home. The fundamental purpose of Oakland House Nursing Home was to support people to recover, rehabilitate and become independent.

Oakland House Nursing Home currently comprises of three units, Elm, Cedar and Willow. Accommodation is provided over three floors and each unit comprises of a communal dining room/ lounge area and kitchen and all bedrooms are single occupancy. There is a lift to all floors and a sheltered smoking area is provided in the garden.

At the time of our inspection there was no registered manager in place. The previous registered manager had left the service shortly after our last inspection in January 2017. The provider recruited a new manager soon after this; however they withdrew their application to become the registered manager in November 2017 and left the service. Since then the provider appointed an interim manager who was the previous clinical manager at the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Existing staff received the training and supervision they required to be able to deliver effective care. However, we found the majority of agency workers the service used had not received training in mental health awareness and physical intervention. At the time of our inspection the provider and manager did not have an overview of what training the agency staff had completed. This meant the agency staff working at the service did not have the necessary training requirements to enable them to understand and know how to support people with their mental health needs.

There were enough skilled staff available to meet peoples' care needs and records showed planned staffing levels were routinely achieved. However, due to vacancies and staff sickness the service had recently relied on agency staff to cover nursing and care shifts at the service. The provider was proactive at recruiting new staff to the service, with three new nurses recently recruited. After the inspection we were provided with a report the provider had produced which indicated for the period of week commencing 03/12/2017 to week commencing 18/02/2018 a total of 15.3% of agency cover was required t

This inspection took place on 9 and 10 January 2017 and was unannounced. The second day was by arrangement. We last inspected Oakland House Nursing Home in November 2015 at which time the home was found to be non-compliant in relation to person-centred care and good governance.

Oakland House Nursing Home currently comprises of three units, Elm, Cedar and Willow which accommodates up to 38 people. At the time of our inspection there were 32 people living in the home. Accommodation is provided over three floors and each unit comprises of a dining room/lounge area and kitchen and all bedrooms are single occupancy. There was a lift to all floors and a sheltered smoking area was provided in the garden.

The service provides accommodation for people who require nursing or personal care and have enduring mental health needs. The fundamental purpose of Oakland House Nursing Home was to support people to recover, rehabilitate and become independent.

There was a registered manager in post, however the manager had recently stepped down and was in the process of deregistering. The operational and deputy manager were on hand to provide leadership and direction in the registered managers absence. The provider had already identified a new manager that would be soon appointed. A registered manager is a person who has registered with the Care Quality Commission (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.

At our last inspection we found that Oakland House Nursing Home was not supporting people to become independent; this was partially due to the model of care used at the home. We also found that care plans did not include people's goals and aspirations. At this inspection we could find no documented evidence that this had improved and people living at the home said it had not. The care records did not always document where people or their relatives had been involved in the creation of care plans and whether consent had always been obtained.

Appropriate plans were in place to guide staff in how to minimise risks to keep people safe. Staff knew what action to take to ensure people were protected if they suspected they were at risk of harm. They were encouraged to raise and report any concerns they had about people through safeguarding and whistleblowing procedures.

Improvements had been made to the management of medicines, for example the implementation of medicine profiles for people and a system of auditing. Medication records were well maintained and detailed policies and procedures were in place.

Checks were carried out to ensure the premises were safe, such as fire safety checks, water temperatures and health and safety. However, we found people’s personal emergency evacuation plans (PEEPS) did not accurately capture the person’s mobility. We have asked the Greater Manchester Fire and Rescue Service to advise the provider on fire safety arrangements in the home.

We observed people were treated with dignity and respect. Throughout the inspection we saw staff engaging with people in a positive and caring manner. Staff spoke to people in a respectful way and used language, pace and tone that was appropriate to the individual. Staff took time to listen to people and responded to comments and requests. People felt staff were kind and respectful to them.

At the last inspection some staff told us and records showed that not all staff had received all the necessary training and support needed to carry out their role. At this inspection all staff now had access to the provider's training and had completed updated training where required. New staff had completed induction and were signed off by the manager as being competent, following the provider's procedure.

The managers and staff understood their obligations under the Mental

Oakland House Nursing Home currently comprises of three units, Elm, Cedar and Willow which accommodates up to 38 people. Accommodation is provided over three floors and each unit comprises of a dining room/lounge area and kitchen and all bedrooms are single occupancy. People living at the home have access to a large communal garden area which also serves as the designated smoking area for people living at Oakland House.

The home was operating at full occupancy on the day of our visit.

The service provides accommodation for people who require nursing or personal care and have enduring mental health needs.

There is a deputy manager in overall charge of the home and a registered manager who works across different locations owned by the same provider. The manager is registered with the Care Quality Commission. 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 service was last inspected in April 2014. All areas we assessed at that inspection were judged to be meeting the regulations at that time. This was an unannounced inspection carried out on the 3 November 2015.

We found the provider did not always adequately assess risks. This was in relation to people’s mental health and well-being. People’s care records did not contain sufficient information to guide staff on the care and support they required. We found no evidence to show that people and/or their relatives were involved or consulted about the development of their care plans.

We found the system for managing medicines was not as safe as it should have been. The provider did not ensure the proper and safe management of medicines.

Systems were in place to assess and monitor the quality of the service provided but they were not robust enough to identify the issues of concern we found during the inspection.

Systems were in place to safeguard people from abuse. Staff we spoke with were knowledgeable about the correct procedures to follow to ensure people were kept safe and the home followed the correct processes to ensure people were not unlawfully deprived of their liberty.

Some areas of the home were not well maintained and attention was needed in some bathroom and toilet areas.

A safe system of staff recruitment was in place. This helped to protect people from being cared for and supported by unsuitable staff.

On the day of inspection we saw the staff worked in cooperation with other health and social care professionals to help ensure that people received appropriate care and treatment.

Checks were made to the premises, servicing of equipment and fire safety. Staff told us there was enough equipment available to promote people’s safety and independence.

Sufficient numbers of staff were employed to meet the physical needs of people living at Oakland House Nursing Home. The home was working to improve the training opportunities and continued professional development of the nurses.

During our visit we saw examples of staff treating people with respect and dignity. People living at the home and their visitors were complimentary about the staff and the care and support they received.

People were offered adequate food and drinks throughout the day ensuring their nutritional needs were met.

We recommended that the home reviewed their medicine policy to reflect best practice.

We recommended the home ensured people had a personal evacuation plan to keep them safe in the event of a fire.

We recommended the home ensured all staff received training in relation to The Mental Capacity Act 2005.

We recommended the home ensured audits were done in line with current best practice guidance.

We found breaches in the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014 in relation to the lack person centred care and poor record keeping.

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

We considered our inspection findings to answer questions we always ask:-

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

Below is a summary of what we found.

Is the service safe?

People were cared for in an environment that was generally clean and hygienic, and although we did find a small proportion of equipment that was in need of repair; this was quickly resolved by staff on the day of the inspection.

At the time of the inspection, there was one Deprivation of Liberty Safeguards procedure in place, which meant that people had measures in place to keep them safe from harm.

The management of medication procedures were followed and ensured that people received medication as required and it was administered safely.

The home had emergency procedures in place to keep people safe from harm, including adequate fire evacuation procedures and missing person’s protocols.

Is the service effective?

People told us that they were happy with the care that was delivered and their needs were met. It was clear from our observations and from speaking with staff that they had a good understanding of people’s care and support needs and that they knew them well. Staff had received adequate training to meet the needs of the people living at the home.

We spoke to relatives and one told us, “I have seen a great improvement since my relative moved in.” This showed evidence of an effective service.

Is the service caring?

Our observations showed that staff were supportive and gave encouragement to people living in the home. We saw one staff member comforting a person who had become distressed and another talking quietly to a person about how they were feeling that day. One person told us, “Staff help me to do things I struggle with.” Another said that staff had helped them with their future plans.

We asked three relatives if they had any concerns about the care provided by the home and they told us that were generally happy with the care provided.

Is the service responsive?

People’s needs had been assessed before they moved into the home. We could see from care records, that when a person’s needs changed appropriate actions were taken to ensure that needs were met, including for example; arranging for people to see a GP.

We saw evidence of meetings for people living at the home, including one meeting which was attended by a nominated person chosen by the people living at the home. These meeting provided an opportunity for people to raise concerns or issues and have them addressed.

Activities were organised throughout the home, although currently limited until the new activity coordinator if fully inducted into the service.

Is the service well-led?

We found a good management team in place, although responsibilities had changed since the last inspection, staff had a very good understanding of the ethos of the home and quality assurance processes were in place to ensure that this was maintained. We suggested that staff monitor these changes by regular feedback from people and their relatives or carers.

People using the service told us that the nursing and care support staff provided them with good care and treated them with respect and maintained their privacy and dignity. Comments made included;

“I love it here, I feel safe and the staff are great.”

“It is much nicer than the hospital here. The staff talk to you and help you when you feel bad.”

“I have lived here a long time. It is the best place I have been. The staff are very fair and look after me well.”

“My [relative] has been really well cared for during their time here. The staff are very responsive to my [relative’s] physical and mental health needs. I cannot praise them enough.”

Where people using the service did not have capacity to make their own decisions best interest meetings were held with people who understood that person. People using the service were being supported to access treatment and care from a wide range of community health services as their health needs required. We also found that people were being cared for in a suitable environment by adequate numbers of appropriately recruited and trained.

A suitable system was operated to manage complaints effectively.

People using the service told us that they were receiving good treatment, support and care at Oakland House Nursing Home. They also told us that they were involved in the planning and review of their care including how any risks in their daily life were to be managed. They also told us and that the food provided was good. Comments made to us by people using the service included;

“My staff treat me well and make sure I am ok”.

“I like it here and they (staff) look after me well.”

“The nurses and support staff are all decent with me and we get on really well.”

“I have lived here a long time and have always been treated well, the staff ask my views about how I am looked after”.

“The food is nice and there is always plenty to eat”.

“I like most of the meals. They (staff) ask you what you would like and there is always enough to eat”.

“I like some meals more than others but on the whole the food has been good”.

We found that the care, support needs and nutritional needs of service users at Oakland House Nursing Home were being met appropriately. We also found that systems were in place to keep them safe and ensure they were being supported by sufficient numbers of staff.

People using the services provided at Oakland House told us that they were receiving appropriate and safe support and care. They said that their care and support was based on them as an individual person and considered all aspects of their personal circumstances including their present and long term needs.