Oakland Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Oakland Nursing Home accommodates up to 27 people in one adapted building. It is situated in the town of Whitby, close to local amenities and the town centre.

This inspection took place on 3 and 8 January 2019 and was unannounced. At the time of this inspection, 23 people were using the service.

At the last inspection in October 2017 the provider was found to be in breach of two regulations. These were Regulation 17 Good governance and Regulation 18 Staffing.

Following the last inspection, we met with the provider and asked the them to complete an action plan to show what they would do and by when to improve the key questions: Is the service safe, is the service effective, is the service caring, is the service responsive, is the service well-led to at least good.

There was a manager in post who had registered with 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.

Thorough quality assurance systems were now in place and had been effective in identifying and addressing any shortfalls. Clear action plans were in place to evidence action taken to address concerns that had been completed in a timely manner.

There was enough staff on duty to meet people’s needs. Call bells and requests for support were responded to a timely manner by staff who were friendly and approachable. Staff were clearly visible throughout the service.

Safe recruitment processes were in place and had been followed. The registered manager had implemented robust checks to ensure all pre-employment checks were completed before employment commenced. Staff had been provided with an induction to the service and received consistent support through regular one to one and group supervisions. Staff training had been further developed to ensure staff had the skills and knowledge to carry out their role. Medicines had been stored, managed and administered safely.

Risks to people had been assessed and management plans were in place. These had been regularly reviewed and updated when changes occurred. Risk relating to the environment were regularly reviewed and servicing certificates were in place to ensure equipment was safe and well maintained. Recent re-decoration had significantly improved the appearance of the service. Staff followed good infection control practices and the service was clean throughout.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People told us they were treated with dignity and respect. Staff addressed people by their preferred names and encouraged them to remain as independent as possible.

There was a range of meals on offer, although some people told us they would like more variety. The registered manager was already taking action at the time of this inspection to address this. People who were at risk of malnutrition were closely monitored to identify any further concerns.

Care plans contained person-centred information and it was clear people were at the heart of the service. Activities were now provided on a daily basis and staff understood the importance of social interaction.

People, relatives and staff spoke positively of the management team and their approach. People had been asked to provide feedback on the service and told us they were confident any concerns they raised would be addressed appropriately.

This inspection took place on 20 October 2017 and was unannounced. This meant the provider did not know we would be visiting. A second day of inspection took place on 30 October 2017 and this was announced.

Oakland Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Oakland Nursing Home can accommodate up to 27 people. At the time of this inspection, 24 people were using the service who had nursing care needs.

There was a registered manager in post who had registered with the Care Quality Commission (CQC) in May 2016. 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.

At the last comprehensive inspection in August 2015 we found the provider was meeting regulations and awarded a rating of ‘good’. At this inspection, we found some improvements were required and identified breaches in regulation.

The registered manager had not ensured staff had the appropriate skills and knowledge to provide effective care and support to people. Records showed that many staff had training which had expired and no refresher training had been arranged. Staff had not received effective support within their role. Records showed that regular one to one supervisions and appraisals had not taken place.

We judged this to be a breach of regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014.

The registered manager completed monthly audits to monitor the service. However, we found example's where the registered manager's quality assurance systems had not been effective in recognising and rectifying issues. Records of the provider’s audits contained very basic information and evidenced that they did not have robust systems and processes in place to assess and monitor the service.

Where people required support with their medicines, these had been administered as prescribed. Medicines were stored securely. However, assessments had not been completed on staff to ensure they were competent in administering medicines.

We judged this to be a breach of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014.

Safe recruitment procedures were not always followed. Full employment history was not always recorded. We also found that two references were not available for one of the staff files we looked at.

People were confident in approaching staff if they required assistance. However, people were not always supported to communicate effectively and observations showed that people were sometimes left for long periods of time at mealtimes without any interaction. There was a significant lack of activities on offer. Planned activities did not take place and we observed people sat in communal areas with no stimulation other than a television. We have made a recommendation about the lack of activities.

The adaptation and design of the building was not always suitable to meet people’s needs. We found that doors did not always contain appropriate signage.

The provider had a ‘Safeguarding Adults Policy & Procedures’ document which set out the responsibilities of employees. The staff we spoke with were all aware of the different types of abuse and what actions needed to be taken to report any concerns.

Care files contained detailed risk assessments which were specific to each person’s needs. People were kept safe from the risk of emergencies in the home.

New staff had completed an induction when they joined the service.

Care plans contained detailed information to ensure people who were at risk

This inspection took place on 13 August 2015 and was unannounced.

Oakland Nursing Home is registered to care for up to 27 older people. On the day of inspection there were 24 people resident there. The home is located on the West Cliff area of Whitby within easy reach of the town's amenities and has passenger lift access to all floors.

The home 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.

People told us they felt safe at the home. Risks to people were managed well without placing undue restrictions upon them. Staff were trained in safeguarding and understood how to recognise and report any abuse. Staffing levels were appropriate which meant people were supported with their care and to pursue interests of their choice. People received the right medicines at the right time and medicines were handled safely.

People told us that staff understood their individual care needs. We found that people were supported by staff who were well trained. All staff received mandatory training in addition to specific training they may need. The home had strong links with specialists and professional advisors and we saw evidence that the home was proactive in seeking their advice and acting on this.

People’s nutritional needs were met and they received the health care support they required.

People were enabled to make choices about their meals and snacks and their preferences around food and drink were listened to and acted on.

The home was clear about its responsibilities around the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLs) and supported people to make informed decisions about their care.

Most staff had developed positive, respectful relationships with people and were kind and caring in their approach. However, we noted that a small number of staff could improve in this area so that all people received kind and caring attention at all times. The registered manager was aware of this problem and was addressing it through supervision, monitoring and the home’s disciplinary procedure. People were afforded choices in their daily routines and their privacy and dignity was respected.

People were consulted about their care. People told us that most staff understood their needs and what was important to them and made sure that they received the care they needed and preferred.

People were assisted to take part in activities and daily occupations which interested them. People told us that they appreciated how staff had thought of ways to make sure they could continue with daily routines they enjoyed.

People were very well cared for in their final days. Health care specialists made comments about the good quality and compassionate care people received at this time.

People were encouraged to complain or raise concerns, the home supported them to do this and concerns were resolved quickly. The home used lessons learned to improve the quality of care.

There was good leadership which promoted an open culture and which put people at the heart of the service. Staff understood their roles and responsibilities which helped the home to run smoothly. Communication was clear from the manager to all levels of staff within the home. Staff were encouraged to give their views. The registered manager understood the home’s strengths, where improvements were needed and had plans in place to achieve these with timescales in place.

Systems were in place to assess and monitor the quality of the service and the focus was on continuous improvement.