The inspection took place on 16, 17 and 25 October 2018. The first day of our inspection visit was unannounced.

Oaklands Nursing Home is a 'care home'. People in care homes receive accommodation and nursing 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.

The home is registered to provide accommodation with nursing care for up to 39 older people some of whom are living with dementia. The accommodation is split across three floors within one large adapted building. At the time of our inspection, there were 33 people living at the home.

There was a registered manager in post who was present during our 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.

At our previous inspection in February 2018, we rated the service as 'Inadequate,' and it was therefore placed in 'special measures.' We identified seven breaches of the Regulations. These related to the provider’s failure to ensure people were protected from abuse and improper treatment, their dignity and privacy was maintained, and they received safe and person-centred care. In addition, the provider had not ensured the premises met people’s individual needs, the principles of the Mental Capacity Act 2005 were adhered to and the overall leadership and

governance of the service was effective.

As a result of the inspection, we asked the provider to send us a report explaining the actions they were going to take to improve the service. We also imposed conditions on the provider's registration. These conditions meant they needed to tell us, on a monthly basis, how they ensured the environment was safe and appropriately maintained and the known risks to people had been minimised.

At this inspection, the provider demonstrated to us that sufficient improvements had been made to the service that it was no longer rated as inadequate overall or in any of the key questions. Therefore, the service is no longer in 'special measures.' However further improvements were needed in relation to the promotion of people’s rights under the Mental Capacity Act 2005, the induction and training of staff and the effectiveness of the provider’s quality assurance processes.

The individual mental capacity assessments completed for people did not always clarify the specific decision under consideration. The provider had not reviewed their staff induction programme to ensure this incorporated the requirements of the Care Certificate. Some nurses and a minority of care staff were not fully up to date with their training. The provider’s quality assurance processes had not always enabled them to identify and address shortfalls in quality and inaccuracies in people’s care records.

People felt safe living at the home. Staff recognised their responsibility to remain alert to any form of abuse and understood how to report any abuse concerns. People received their medicines safely and as prescribed from nurses who underwent annual medicine competency checks. The provider had taken steps to address any potential hazards within the home environment. The management team and nursing staff had assessed, reviewed and put plans in place to manage the risks associated with people’s individual care and support needs. Staff read and adhered to people’s risk assessments. They were kept up to date with any changes in the risks to people, and showed good insight into these risks.

Staff recorded any accidents or incidents involving people who used the service and these reports were analysed by the management team. The staffing levels maintained at the home enabled staff to work safely and effectively. The

This inspection took place on the 16, 19 and 21 February 2018 and was unannounced on the first day and announced on the second and third day.

Oaklands Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing 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.

Oaklands Nursing Home is registered to provide accommodation with nursing care for up to a maximum 39 people. The accommodation was split across three floors, each of which have separate adapted facilities. At the time of our inspection, there were 35 people living at the home, one of whom was staying there on a temporary basis. Some people were living with dementia.

There was a registered manager in post who was present during our 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.

At our last inspection in September 2016, we rated the service at Good. At this inspection we found significant failings at the service and breaches of the Regulations.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still 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 this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to 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 so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The provider told us they do not intend to admit further people into the home until they have made the required improvements. Commissioners who fund people’s care at the home are monitoring and providing support around the improvements needed.

People were not always protected from the risk of abuse and concerns of abuse were not always appropriately dealt with. People’s medicine was not always managed safely or stored securely.

Risks associated with people’s needs were not always accurate and up to date. The provider had failed to ensure a safe and hazard free environment. The provider had failed to protect people from the exposure to infections. There were not enough staff suitably deployed to safely meet people’s needs in a person centred manner.

The principles of the Mental Capacity Act were not fully understood or followed to ensure people’s rights were protected. People’s nutritional needs were not always accurately assessed and monitored.

People were not consiste

This inspection was carried out on 7 September 2016 and was unannounced.

Oaklands Nursing Home provides accommodation and nursing and personal care for up to 39 people. At the time of our inspection there were 36 people living at the home.

The manager had applied for registration as a registered manager with CQC. This meant that at the time of inspection there was not 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 and associated regulations about how the service is run.

People received person centred care that maintained their health and wellbeing. People had support to maintain their hobbies and interests.

People were treated with dignity and respect. People had good relationships with staff.

Staff had good support and training to enable them to meet the need of the people living at the home. There were sufficient numbers of experienced and well trained staff to ensure people were supported safely and people’s health needs responded to quickly. Medicines were managed safely and people received their medicines in line with their prescription.

The service responded effectively to people's needs and preferences. People were supported by staff that knew the needs of the people they supported. The service was responsive and well managed. People knew the manager and the provider. People were actively involved in the running of the home through regular meetings. They felt that if they had any concerns they were able to speak with the manager or provider. The provider welcomed people's views and opinions and acted upon them.

People felt safe and knew how to raise concerns. Staff felt comfortable to raise any concerns about people’s safety and understood about how to keep people safe. People were supported to take positive risks. Where risks had been identified the risk had been assessed and action taken to reduce any risk.

People enjoyed the food and had the support they needed to enjoy their food and drinks safely. People were able to make choices about the food and drink they wanted. There was a choice of freshly prepared nutritious food.

People's health needs were monitored and changes were made to people's care in response to any changes in their needs. People had access to other health professionals and were referred to them by the manager if there were any concerns about their health needs.

There were a range of audits and checks to make sure that good standards of care and support were maintained. Feedback from the people and relatives was gathered on a regular basis and where any actions were identified these were actioned quickly.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records.

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

Is the service safe?

The people we spoke with told us they felt safe. People told us they would feel comfortable raising issues with staff and managers if required. There were opportunities to raise issues anonymously through resident meetings and surveys.

The provider had appropriate arrangements in place to manage medicines. Relevant staff had received competency based training and regular audits were undertaken by a pharmacist.

There were sufficient numbers of staff with the appropriate skills experience and qualifications to meet the needs of the people. Staff received appropriate supervision and appraisal. Staff were able to access a wide range of mandatory and additional relevant training. This meant Staff received appropriate professional development.

Systems were in place to ensure that learning took place from incidents, complaint and audits. Risk assessments were robust and reviewed regularly. This reduced the risks to people and helped the service to continually improve.

The home had appropriate policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Staff had all received training. We saw a Deprivation of Liberties application and subsequent response from the local authority. This demonstrated appropriate application of the safeguards in practice.

Is the service effective?

People were fully involved in developing their care plans. Risk assessments were completed for each person. Actions to reduce the risks identified were clearly reflected in care plans.

Information and guidance was available to staff to support them in delivering care. Training in dementia and the Mental Capacity Act had enhanced skills in caring for people who lacked capacity.

Staff received regular mandatory training and were able to access additional training relevant to their role.

Is the service caring?

People told us that they received good care delivered by kind compassionate staff. One person told us, “All the staff are excellent”. We observed staff treating people with dignity and respect. People’s likes, dislikes and preferences had been recorded and acted upon.

People were encouraged to personalise their rooms and to bring in things that made them feel at home. One person told us, “This is a real home from home”.

Visitors told us they could visit at any time and were always made welcome. Visitors were able to eat meals or snacks with their relatives.

Is the service responsive?

A range of activities were provided. People were able to attend activities outside of the home and there was sufficient staff to support this.

People told us that issues they raised and suggestions they made were acted upon. People knew how to make a complaint if they needed to. One person said that they had made a complaint and had been satisfied with the outcome. We looked at how complaints were dealt with, and found that complaints were investigated fully and action taken as necessary.

Regular surveys were undertaken. The response rate was low, however those that did respond were positive about the home and the care provided. There were systems in place to act upon and issues raised through the survey and informally.

Is the service well-led?

Staff told us that they felt supported by their managers. Regular staff surveys and staff meetings gave staff the opportunity to raise issues. Two members of staff told us they felt proud to work at Oaklands. Staff demonstrated they were clear about their role and responsibilities.

There were systems and processes in place to monitor the quality of the service. The views of people who lived at Oaklands was seen by staff as important. People told us they could raise issues with the manager and would be confident that they would be acted upon. Most people were aware of the complaints procedure. A written copy of this was in each room in the service user guide.

You can see our judgements on the front page of this report.

We found that the home had made improvements to the way that they gained consent for care and support. There was clear information for staff about people's wishes. Some people were unable to make decisions for themselves. There were effective systems in place for making sure that decisions were made in these people's best interests.

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 they were still a Registered Manager on our register at the time.

We saw that staff were kind and caring in the way that they supported people. People told us, "they're very good to me" and, "they are very helpful". We saw that staff were attentive to people's needs.

Care plans gave staff information about the importance of gaining consent. Staff did not always implement the care plans, and this meant that people's decisions about their care and treatment were not always carried out.

People told us that they enjoyed the food at the home. We saw that staff were supporting people at lunchtime in a sensitive and gentle manner. The home had an effective system in place to ensure that people were protected from the risks of inadequate hydration and nutrition.

There were effective systems in place for monitoring the quality of the service. People were asked for their views about their experience of living at the home. The provider's representative visited the home frequently.

We spent time in communal areas such as the lounge and dining room, watching the daily life of the home, and so that we could see how staff supported people. We also spoke with people in their own rooms and with relatives, staff and the provider, Miss Mawji.

People told us that the staff were kind and caring. Comments included “the staff are very nice, very friendly” and “they’re all good, I can’t fault any of them”. One person said “whatever I ask for I get” and “I’ve not had any problems whatsoever”.

We saw that staff were attentive to people’s needs and supported people in a gentle and calm manner. Staff were careful to make sure that they treated people with dignity and respect.

One relative told us “I’m pleased with the care she’s getting” and one person who had recently moved in said “it’s nice in here, very nice”. Staff had a good knowledge of the needs of the people they were supporting. The home had safe procedures for recruiting staff, which helped to make sure that only suitable staff were employed at the home.

Although there was no manager in post, senior staff at the home were working well together to ensure that people’s needs were being met. The provider and her representatives were visiting the home regularly to monitor the quality of the service being provided.

There were effective systems in place for communication between staff and the provider. This meant that the provider had a good knowledge of people’s individual circumstances and was therefore able to provide support to senior staff.

We spoke with six people who live at Oaklands and we also spoke with some relatives who were visiting the home. People spoke highly of the staff and the interim manager. One person told us “the care is absolutely brilliant” and described the staff as “so good”. A relative of someone living at the home said “I can’t fault how they look after her”. We spoke with one person and asked them what they liked most about living at Oaklands. The person said “I like the way they’re nice to you”.

We saw that staff spoke kindly to people and spent time explaining anything that needed doing. People told us that senior staff had discussed their care and support needs with them.

We saw that people were wearing appropriate clothing and footwear for the cold weather and that their hair and nails were neatly groomed.

The daily records were detailed and informative, and showed that staff were monitoring changes in people’s condition. The care records did not always give staff the information they needed to ensure that people were fully protected against some risks.