This inspection took place on 11 and 12 September 2018 and was unannounced on day one.

At our last inspection the service was rated as good. At this inspection we found the level of compliance had not been sustained and we have rated the service as requires improvement. This is the first time the service has been rated requires improvement.

Oaklands Country Rest Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a 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.

Oaklands Country Rest Home is registered to provide care for up to a total of 44 people who require nursing or personal care. The service has a new unit, to provide care for up to 14 people, included in the overall numbers, who have memory impairment or dementia. The home is approximately ten miles west of York, close to the village of Kirk Hammerton. At the time of our inspection there were 38 people who used the service, with 49 percent of people requiring nursing care.

The service had a registered manager who registered with CQC in June 2016. 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 who lacked capacity did not receive the necessary prompts, encouragement and assistance to eat and drink to ensure their nutrition and hydration needs were met.

People received compassionate and caring support, but staff were not reviewing care plans and risk assessments on a regular basis even when people’s care needs had changed. The quality of the record keeping varied and some care records we looked at were inconsistent or incomplete. This meant staff did not have an up to date record of people’s care and treatment.

We found there were breaches to Regulations 14 and 17 in relation to not meeting nutrition and hydration needs and poor record keeping. We gave feedback to the quality manager and the registered manager about our concerns during and at the end of the inspection.

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

People and relatives told us how happy and satisfied they were with the service. However, we found that there was a lack of strong leadership from the nurses and senior care staff in the service. This meant care staff were disorganised at mealtimes and the oversight of their work practice was ineffective, resulting in some minor but important lapses in quality care. These included poor documentation of the care being given, a poor dining experience for some people and inconsistency in promoting people’s dignity. We have made a recommendation around reviewing staff numbers and deployment in order to meet people’s needs, especially those living with dementia.

Staff had completed an induction and attended relevant training to meet people’s needs.

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 were able to talk to health care professionals about their care and treatment. People could see a GP when they needed to and they received care and treatment when necessary from external health care professionals such as the district nursing team and speech and language therapists (SALT).

People and relatives said staff were caring and they were happy with the care they received and had been included in planning and agreeing the care provided.

People had access to community facilities and a range of activities provided in the service. People and relatives knew how to make a c

We carried out an unannounced comprehensive inspection of this service on 3 February 2016. After that inspection a Crown Court hearing was held in June 2016 where the provider was found guilty and then sentenced in relation to a health and safety charge against them. This related to a death from hypothermia, in 2012, of someone using the service. As a result we undertook a focused inspection to check and be satisfied that any necessary remedial action and lessons learned from the court case had been implemented.

This report only covers our findings in relation to those matters. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Oaklands Country Rest Home on our website at www.cqc.org.uk.

Oaklands Country Rest Home is registered to provide accommodation with nursing and personal care for up 44 people. The service is located approximately ten miles west of York, close to the village of Kirkhammerton. The service provides support for older people, some of whom have nursing needs and require support with living with dementia. There were 38 people living at the service at the time of our inspection.

There was a manager in post at the time of our inspection who was registered with the CQC. 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 service. Staff were confident about how to protect people from harm and what they would do if they had any safeguarding concerns. Risks to people had been assessed and plans put in place to keep people safe from avoidable harm.

There were robust systems in place to keep the environment safe. The provider had introduced a number of effective checks to make sure that people who used the service were kept warm.

There were sufficient numbers of staff on duty to make sure people’s needs were met.

Staff told us they enjoyed working at the service, that they were supported by management and kept informed about service developments.

People’s needs were regularly reviewed and appropriate changes were made to the support people received. Staff were kept informed about any changes in people’s needs.

There were effective management arrangements in place. The manager had a good oversight of the service and was aware of areas of practice that needed to be improved. There were systems in place to look at the quality of the service provided and action was taken where shortfalls were identified.

This inspection took place on 3 February 2016 and was unannounced. The last inspection was carried out in August 2014 when the service was found to be meeting the Regulations assessed.

Oaklands Country Rest Home is registered to provide accommodation with nursing and personal care for up 44 people. The service is located approximately ten miles west of York, close to the village of Kirkhammerton.

There was a manager in post at the time of our inspection who had applied to be registered with the CQC. 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 service. Staff were confident about how to protect people from harm and what they would do if they had any safeguarding concerns. There were good systems in place to make sure that people were supported to take medicines safely and as prescribed. Risks to people had been assessed and plans put in place to keep risks to a minimum.

There were enough staff on duty to make sure people’s needs were met. Recruitment procedures made sure staff had the required skills and were of suitable character and background. Staff told us they enjoyed working at the service and that there was good team work. Staff were supported through training and team meetings to help them carry out their roles effectively. Staff were led by an open and accessible management team.

The manager and staff were aware of the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). DoLS are put in place to protect people where their freedom of movement is restricted. The registered manager had taken appropriate action for those people for whom restricted movement was a concern. Where people were unable to make their own decisions, the MCA had been followed appropriately.

People told us that staff were caring and that their privacy and dignity were respected. Care plans were being developed to be more person centred and showed that individual preferences were taken into account. Care plans gave clear directions to staff about the support people required to have their needs met. People were supported to maintain their health and had access to health services if needed.

People’s needs were regularly reviewed and, where necessary, appropriate changes were made to the support people received. People had opportunities to make comments about the service and how it could be improved.

There were effective management arrangements in place. The manager had a good oversight of the service and was aware of areas of practice that needed to be improved. There were systems in place to look at the quality of the service provided and action was taken where shortfalls were identified.

Two inspectors carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people’s relatives and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continuously improve.

When people were identified as being at risk, their care plans showed the actions that would be required to manage these risks. These included the provision of specialist equipment such as pressure relieving mattresses, hoists and walking aids.

We saw that major improvements had been made to the environment of the home. Where risks were identified in some areas for example damaged carpets, these had now been replaced with new floor covering.

Recruitment procedures were rigorous and thorough. No staff had been subject to disciplinary action. Policies and procedures were in place to make sure that unsafe practice could be identified and therefore people were protected.

Is the service effective?

Staff we spoke with were knowledgeable about the people they supported and knew people very well. People's health and care needs were assessed with them, and they or their relatives were involved in developing their plans of care wherever possible. People told us they were included in decisions about how their care and support was provided. From speaking with staff they were able to demonstrate a good understanding of people’s care and support needs.

Suitable arrangements were in place for staff to receive updated training to ensure they had the skills, knowledge and experience to meet the needs of people who used the service. This ensured that the outcomes for people would continue to improve.

Is the service caring?

We observed a relaxed and friendly atmosphere at the service throughout our visit. Good professional relationships appeared to exist between people using the service and staff.

One person said “The girls are alright, they look after me. I do what I can for myself. I am happy here.” Another person said “I like living here. The staff are lovely they look after me well.”

People looked well cared for and we observed good care practices taking place. We observed the lunchtime experience and saw that staff were calm and unhurried and they spent time with people.

Relatives we spoke with described the home as being ‘very good’ and staff as being ‘helpful.’ One relative said “I am always happy with the care mum receives. The staff are really great –she’s my mum – if there was a problem I would be the first to say.” The relative went onto to give an example of when their relative was in pain and how staff ‘dealt with it straightaway.’ Another said “X is settled and well looked after. I would say to anyone to come here.”

Is the service responsive?

People’s needs were assessed and records we looked at showed they received specialist equipment or aids that they needed.

People we spoke with knew how to make a complaint if they were unhappy. People told us they were confident that any issues they raised would be looked into and action taken.

When we visited we saw a staff team that acted professionally and responded appropriately to people's care needs. People were being assisted promptly and we saw that the staff had time to spend socialising and engaging with people.

The service carried out an annual satisfaction survey. Results were being collated and analysed to see if the home could make further improvements.

Is the service well-led?

Effective management systems were in place to promote and safeguard people's safety and welfare. Such as health and safety records and peoples care records were up to date and had been reviewed regularly.

The quality assurance system included audits and checks carried out by staff at the service and by other people from within the organisation. Records showed that issues were identified and responded to in a timely way. As a result the quality of the service was continuously improving.

Staff we spoke with were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and the quality assurance systems in place. This helped to ensure that people received a good quality service. They told us the manager was supportive and promoted positive team working.

Effective management systems were in place to promote and safeguard people's safety and welfare. Such as health and safety records and peoples care records were up to date and had been reviewed regularly.

Relatives we spoke with told us they thought that overall the service ran well. One relative said “On the whole I am very happy it has been a relief. I could not have chosen a better place if I tried. Mum says she is treated like a queen.”

Some people were not able to tell us about their experiences. We therefore used a number of different methods to help us understand the experiences of people. This included observing the delivery of care and speaking to people who lived at Oaklands. We did not have opportunity to speak with any relatives or visitors to the home during this visit.

We saw from people's care plans that people were supported to live as independently as possible. Staff at the home had carried out an assessment of the needs of each person, and kept this under review, to enable appropriate care and support to be given.

People who lived at the home were protected from risks of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Staff had received training in this area.

We inspected the environment during our visit which included communal areas and people’s bedrooms. We found that overall all areas in the home were warm, although most areas were not clean or well maintained. We asked the provider to take immediate action to rectify these issues.

There were enough staff on duty to meet people’s needs. However there was a shortage of domestic staff, especially at weekends which may have impacted on the cleanliness of the home.Staff received training on a regular basis.

The home had systems in place to make sure people were safely cared for. This included policies and procedures and quality monitoring systems.

During our last visit to the home we identified some concerns regarding how people were cared for, and how people’s care was documented. This was a follow up visit to check that the provider had carried out the actions they had told us they were going to do in their action plan to address these concerns. We also looked to see if improvements had been made to the home’s auditing and quality monitoring systems. This was to ensure that people were protected from any risk of any inappropriate or unsafe care. We also checked that improvements had been made to the overall records the home kept such as risk assessments in people’s care plans and accident records.

We were able to speak with a few people about what it was like to live at Oaklands Country Rest Home. One person said “It is great here” whilst another person said “Yes it is very good here. You get well looked after.” We spoke to a visiting relative who told us that things had improved at the home. They said “The atmosphere has changed all together and the staff are happier and it is much friendlier.”

We saw that people were clean and comfortable and well cared for. We saw that care records had been completed properly and updated on a regular basis. This meant that people were receiving safe and appropriate documented care and support.

We did not speak with people in detail about what it was like to live at Oaklands Country Rest Home This visit concentrated on checking whether improvements had been made to the premises, mainly to the heating.

However during our tour of the premises we also spent some of the time in two of the lounges and dining room and saw that some people were sitting relaxed and contented, whilst others were having their breakfast or walking around the home as they chose.

Some people were not able to share their views with us about their experiences of living at Oaklands Country Rest Home. However, during our observations we saw that peoples’ needs were being met.

Those who did comment said, "Its okay here, I like it." Other comments included, "I’m comfortable, it’s alright", "It’s absolutely fabulous, staff are good but you miss the people you used to live with when you were at home", "I love it here, I sit here and watch the telly, no one bothers me." Some people said they thought the home was 'clean' and one person told us they regularly saw domestic staff 'busy cleaning'.

The people who used the service told us that they were happy with the care and support that they received from the staff and manager. One person said ‘The staff respect my wishes’.

Information about what the home could offer was provided to people or their representative so that they could make an informed decision about if the home could meet their needs. One person said ‘This is my home; they asked me what help I needed before I moved in’.

People receiving care and support were seen to be treated with dignity and respect by the staff. People said that they received help and support when they needed it.

We observed that staff from all departments helped people at mealtimes so that people did not have to wait for their meals. One person said ‘The food is nice’.

Medication systems in operation at the home had been improved; however we suggested that some improvements must be made. The manager had implemented a lot of changes to the medication procedures which helped to make sure that the requirements and recommendations made at the previous inspection had been met.

People were being looked after by adequate numbers of staff who had received training, however, some training for some staff was scheduled to be undertaken soon to make sure that all staff had their skills and knowledge updated which helps staff to deliver care safely. One person said ‘The care is very good, all the staff are nice, they have had the training to give good care’. However, we have suggested that staffing levels must continue to be monitored as occupancy levels rise and when part of the home is created into a unit for people with frail memory, so that there continues to be enough staff to meet people’s needs and staff do not feel under pressure.

People spoken to confirmed that they felt comfortable to raise any issues they were not happy with and felt issues raised would be dealt with appropriately. One person said ‘I have no complaints at all’.

The manager told us how he had worked to make sure that the requirements and recommendations made at the last inspection had been addressed which had helped to improve the services provided for people. He told us how he continued to monitor each department’s performance to address any shortfalls found.

North Yorkshire County Council informed us that the manager had worked hard to address issues that had been present in the home which had meant that a partial suspension on placing people there had now been lifted. A member of staff said ‘Things are picking up now, we are admitting more residents. The staffing levels have improved, we are moving forward now. The manager has brought us together as a team’.

We carried out this inspection as concerns had been raised with us about care, safety and welfare of people living at Oaklands Country Rest Home. One person said " I am well cared for here". Visitors made comments such as “It seems nice here, my relative is happier than they were.” Another said “My relative has settled well. I do think he is happy here and I am quite happy with everything.”

We looked at care records, observed how people were being cared for and inspected communal areas and people's bedrooms.

We found that some people were experiencing poor care and were being placed at risk of harm on some occasions.

We asked the provider to take immediate action to rectify some of these risks posed to people who lived at the home.