Oaklands is a purpose built residential care home without nursing for 53 people, some of whom are living with dementia. At our last inspection we rated the service Good. At this comprehensive inspection, which we carried out on 28 June 2018 we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. Because the rating remains Good, this inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Since our last inspection in December 2016, there has been a change of registered manager, however, the people who lived in the service told us that they continued to feel safe and well cared for. There were systems in place which provided guidance for care staff on how to safeguard the people who used the service from the potential risk of abuse. Staff understood their roles and responsibilities in keeping people safe. Risk assessments were still in place to identify how the risks to people were minimised. There continued to be sufficient numbers of trained and well supported staff to keep people safe and to meet their needs. Where people required assistance to take their medicines there were arrangements in place to provide this support.

Both the registered manager and the staff understood their obligations under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The manager knew how to make a referral if required. Meaning that people living in the home were still being supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People’s needs were assessed and the service continued to support people to eat and drink enough to maintain a balanced diet. They were also supported to maintain good health and to have access healthcare services.

We saw many examples of positive and caring interactions between the staff and people living in the service. People were able to express their views and staff listened to what they said and took action to ensure their decisions were acted on. Staff continued to protect people’s privacy and dignity.

People received care that was personalised and responsive to their needs. The service still listened to people’s experiences, concerns and complaints. Staff took steps to investigate complaints and to make any changes needed. People were supported at the end of their lives to have a comfortable, dignified and pain free death.

The registered manager told us that they had been well supported by the organisation while they settled into their position. The people using the service and the staff they managed told us that the registered manager was open, supportive and had good management skills. There were still good systems in place to monitor the quality of service the organisation offered people to ensure it continued to meet their needs.

Further information is in the detailed findings below

This inspection took place on 7 and 8 December 2016 and was unannounced. Oaklands is a care home providing personal care for up to 53 people, some of whom live with dementia. On the day of our visit 48 people were living at the home.

The home has had the current registered manager in post since March 2015. A new manager had been appointed as the current registered manager was due to leave the position in the near future. 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.

Staff were aware of safeguarding people from the risk of abuse and they knew how to report concerns to the relevant agencies. They assessed individual risks to people and took action to reduce or remove them. There was adequate servicing and maintenance checks to fire equipment and systems in the home to ensure people’s safety.

People felt safe living at the home and staff supported them in a way that they preferred. There were enough staff available to meet people’s needs and the registered manager took action to obtain additional staff when there were sudden shortages. Recruitment checks for new staff members had been made before new staff members started work to make sure they were safe to work within care.

People received their medicines when they needed them, and staff members who administered medicines had been trained to do this safely. Staff members received other training, which provided them with the skills and knowledge to carry out their roles. Staff received adequate support from the registered manager and senior staff, which they found helpful.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The home was meeting the requirements of DoLS. The registered manager had acted on the requirements of the safeguards to ensure that people were protected. Where someone lacked capacity to make their own decisions, the staff were making these for them in their best interests.

People enjoyed their meals and were able to choose what they ate and drank. They received enough food and drink to meet their needs. Staff members contacted health professionals to make sure people received advice and treatment quickly if needed.

Staff were caring, kind, respectful and courteous. Staff members knew people well, what they liked and how they wanted to be treated. They responded to people’s needs well and support was always available. Care plans contained enough information to support individual people with their needs. People were happy living at the home and staff supported them to be as independent as possible.

A complaints procedure was available and people knew how to and who to go to, to make a complaint. The registered manager was supportive and approachable, and people or other staff members could speak with them at any time.

Good leadership was in place and the registered manager and provider monitored care and other records to assess the risks to people and ensure that these were reduced as much as possible and to improve the quality of the care provided.

This inspection took place on 18 November 2014. It was unannounced.

Oaklands provides accommodation and care for up to 53 older people, many of whom may be living with dementia. When we inspected there were 46 people living there. People’s bedrooms are arranged over two floors with a lift between the floors. There is a variety of communal space including lounges, dining rooms and a conservatory. There is also an enclosed courtyard garden area in the centre of the home.

The service must 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. There has not been a registered manager working at the home since March 2014. The manager at the time of this inspection was not registered at Oaklands but did have experience as a registered manager in another home run by the same company.

At our inspection on 31 July 2014 we found breaches of regulations for care and welfare, staffing, staff support, monitoring of service quality and record keeping. After that inspection the provider sent us an action plan on 18 September 2014 showing how they were going to improve. The new management team had taken action to improve care and welfare, record keeping, staffing levels and the way the quality of the service was monitored.

Some aspects of people’s safety were compromised. There were some concerns about the way the building was operating which affected people’s safety in the event of fire or from falls on a staircase. Medicines were administered safely and stored securely. However, the discovery by staff of tablets on a floor had potentially compromised people’s safety.

Staffing levels had improved significantly since our last inspection so that people did not have to wait so long for assistance. New staff were subject to proper recruitment checks which contributed to people’s safety. Staff and the manager knew the importance of reporting concerns about staff conduct or abuse, to ensure people were protected and people said they felt safe in the home.

People at risk of dehydration could not be sure they had enough to drink to meet their needs and so maintain their health. However, people who needed assistance to eat their meals were given this and staff made sure they were referred for advice from health professionals promptly if people became unwell.

The staff were supported by the new management team and there were plans in place to improve this further. They understood how people’s capacity to make decisions and choices about their care may fluctuate and had training in the Mental Capacity Act 2005. They were less clear about the associated guidance for restricting someone’s freedom for their own safety but the manager understood the Deprivation of Liberty Safeguards and applied them appropriately.

Staff were caring and compassionate towards people. There were isolated incidents when people’s dignity was not wholly respected but staff offered people comfort and affection and reassured people if they became distressed or agitated. Staff working in a variety of roles within the home, including housekeeping, maintenance and care, were clear about their roles and responsibilities.

The manager was in the process of improving how people and their relatives were involved in reviews of their care plans. People’s needs, preferences and interests were recognised as important with time taken to find out what they enjoyed doing. There was a complaints system in place and the new management team dealt with concerns promptly. The management team empowered people, their relatives and staff to express their views about the quality of the service and to make improvements where these were needed.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These regulations were replaced by the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in April 2015. You can see what action we told the provider to take at the back of the full version of the report.

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

As part of this inspection we spoke with five people who used the service and spoke with five family members of people who used the service. There was no registered manager in post so we spoke to the person who was manager pending their registration with us. We also spoke with four other members of staff and the provider's operations manager. We carried out observations of people’s care, and reviewed records relating to the management of the service. This included four people’s care plans, daily records, some staff records and quality assurance monitoring records.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you wish to see the evidence supporting the summary, please read the full report.

Is it safe?

At the time of our inspection there were insufficient staff to meet people's needs safely and to deliver care which properly matched people's needs. Some staff deployed from housekeeping to caring tasks were not properly trained for the caring role. Staff, visitors and a person who was able to express themselves clearly told us they were concerned there were insufficient staff.

We found that records did not accurately reflect the support people received and, in one case, had omitted significant events affecting the person's safety and wellbeing.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to staffing and record keeping.

The home had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The service had support of regional management for dementia care services who could provide support and advice if restrictions on someone's freedom might be needed for their safety.

Is it effective?

People's health and care needs were assessed, including screening for risks associated with poor nutrition, vulnerability of pressure areas and associated with dementia. However, the care needed to minimise the risks to people was sometimes compromised.

Staff were not appropriately supported to deliver care to people. There was a lack of access to supervision and appraisal to discuss staff roles and development needs. There were gaps in training to ensure staff were up to date in the skills needed to support people effectively.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to supporting staff and the care and welfare of people living in the home.

Is it caring?

People who were able to tell us, said that they felt staff treated them well. One person said, “They don’t lose their temper with people. I couldn’t do their job.” However, staff told us they did not always have the time to deliver care to meet needs such as for hair care and nail care. We also observed that staff did not always engage and communicate with people effectively.

Is the service responsive?

We found that people were referred for advice from other health professionals where this was necessary. One person told us that, "They [staff] always get a doctor if I'm not well." We also found that the sample of care plans we examined had been reviewed and updated where necessary so that they reflected people's changing needs.

Is the service well led?

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because their application to cancel their registration had not been completed at the time of our inspection.

The service had a quality monitoring system in place but it was not implemented as the provider intended so that improvements could be made. This shortfall had not been identified. Staff and visitors to the service did not feel that their concerns and comments were always addressed and taken into account in making improvements.

There were checks in place to ensure that the risks to people visiting, living in and working at the home were managed - for example in relation to fire safety and testing for Legionella.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing and monitoring the quality of the service.

During our inspection we spoke with six people who used the service. They told us that they were very happy with the care and support they received. We also spoke with two relatives who were visiting a family member at the time of our inspection.

One person told us that, "I like living here, it's very nice and I have everything I need." They went on to say that the care staff, "Always ask me if I am Ok and make sure that I don't need anything." Another person we spoke with told us that, "We always have a choice of food, at breakfast dinner and tea time."

People we spoke with told us that the care and support was good and that there were a variety of activities available for them during the day.

Detailed care plans showed staff what the needs of the people who used the service were and how they could be met. However, the recording of how those needs were met was not always consistent.

Staff records showed that recruitment procedures were in place to ensure that people were looked after by staff who had the necessary skills and background and other records we examined were accurate and well maintained.

We did not speak with any people who used the service during this inspection. We examined care plans and discussed these with a senior member of the care staff.

During our visit we spoke with five of the 28 people living there. They told us that they were happy with the care received. One person said they felt "Very contented" another that the staff "Treated them well."

Electronic care plans were in place but people using the service were not usually given a copy of the care plan or involved in its preparation.

The service offered a comfortable and clean environment, and a new extension had recently been completed.

Staff were well trained, and we were told by one person that they always "Helped them with their medication"

A process is in place to gather the views of people using the service.