We carried out a comprehensive inspection on 1 and 2 August 2018. The first day of inspection was unannounced; we arranged the second day of inspection before we visited.

We brought this comprehensive inspection forward as we had received concerns about the environment and aspects of the care delivered to people, including staff’s approach. We did not find evidence that people’s needs were not being met. We received consistently positive feedback about staff’s approach and behaviour. Work had been undertaken to improve aspects of the environment, including new water pipes.

Oaklands Residential Care 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.

Oaklands offers care and support for up to 25 older people. At the time of the inspection there were 25 people living at the service. Some people were living with dementia. The service uses a detached house over two floors with a stair lift to provide access to the upper floor.

We last inspected the service on 17 October 2017. Following that inspection, the service was rated ‘requires improvement’. This was because systems for the management of medicines were not always safe and the provider’s quality assurance arrangements had failed to address the known shortfalls. The service had also received a one-star rating by the Food Standards Agency and had been told to carry our immediate improvements to the kitchen to meet the requirements.

At this inspection we found significant improvements had been made. A new electronic medicines system was in use which significantly reduced errors. A new kitchen had been fitted since the last inspection and the Food Standards Agency officer confirmed the kitchen was refitted to a high standard. The service was waiting for a new Food Standards Agency rating.

There was 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.

Medicines management had improved with the introduction of a electronic system, which had reduced errors significantly. However, during the inspection the ambulance service raised a safeguarding alert as during a night visit to the service, staff on duty had not been trained to administer medicines. We have recommended that a trained and competent member of staff is on duty at all times to administer medicines safely. The registered manager had plans in place to ensure staff were trained by the end of August 2018.

Staff received appropriate training for their roles. However formal supervision of staff had lapsed. We have recommended that formal staff supervision is reinstated in order to ensure staff have the appropriate support.

The staff team were exceptionally caring. People, their relatives and health care professionals were extremely complimentary about the care and support provided at the service. Comments included, “They’re nice people and kind. They go beyond the expected and make our lives meaningful”; “It’s very nice. The staff are exceptional…” and “They are very loving towards her and tactile which is what she likes. They’ve made a home for her rather than her being in a home. In a word, fantastic”. Staff provided sensitive, compassionate care and responded very promptly to people’s needs. They understood each individual’s diverse needs and ensured they met them. People were treated with dignity and respect by staff who promoted their independence and choice. People and their relatives were involved in the planning of care and support.

People who used the service were s

This unannounced comprehensive inspection took place on 17 October 2017. The last inspection took place on 24 August 2015. The service was meeting the requirements of the regulations at that time. However, there was a concern that recruitment processes were not always robust. The staff files did not have clear records of when they started their induction, and one file did not have a Disclosure and Barring check or references from their previous employer. The service gave assurances that this matter would be addressed immediately.

Oaklands is a care home which offers care and support for up to 25 predominantly older people. At the time of the inspection there were 23 people living at the service. Some of these people were living with dementia. The service uses a detatched house over two floors with a stair lift to provide access to the upper floor.

Systems for the management and administration of medicines were not robust. We found it was not always possible to establish if people had received their medicine as prescribed. There were many gaps in the Medicine Administration Record (MAR) where it could not be established if doses of prescribed medicines had been given. We checked these gaps in the blister packs and found some medicine doses had been given, but not signed for. Tablets remained in the blister packs for some people but the MAR had been signed to indicate the medicine had been given. Entries on the MAR recorded that a person was asleep and their medicine was not given. Two people had not been given five doses of their prescribed medicines over a period of two weeks either due to being asleep , refusing or having been missed by staff. One person had their pain relieving patch changed 24 hours later than indicated on the MAR. The service was not carrying out regular audits of their medicine records and had not identified the errors found at this inspection.

The premises were regularly checked and maintained. However, a recent Food Standards Agency had given the kitchen at the service only a one star rating. This was due to the kitchen needing immediate necessary work to meet the standards required. The provider showed us the plans for the new kitchen installation which was due to start in the next few weeks.

We walked around the service which was comfortable and personalised to reflect people’s individual tastes. People were treated with kindness, compassion and respect.

Staff were supported by a system of induction training, supervision and appraisals. The service had addressed the concern found at the last inspection. Staff t records clearly stated when each member of staff had begun their induction. Staff files contained all the necessary checks such as references and Disclosure and Barring service checks.

People were supported by staff who knew how to recognise abuse and how to respond to concerns. Staff received training relevant for their role and there were good opportunities for on-going training and support and development. More specialised training specific to the needs of people using the service was being provided such as skin care and diabetes care. Staff meetings were held regularly. These allowed staff to air any concerns or suggestions they had regarding the running of the service.

The service had identified the minimum numbers of staff required to meet people’s needs and these were being met. The service did not use any agency staff and covered any staff absence from existing staff resources.

People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. The principles of the Deprivation of Liberty Safeguards were understood and applied correctly.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy.

The service was in the process of changing the flooring to some bedrooms at the time of this inspection. Th

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

Is the service safe?

Is the service caring?

Is the service effective?

Is the service responsive?

Is the service well led?

This is a summary of what we found.

On the day of our inspection there were 24 people living at Oaklands, although two were in hospital. The summary is based on conversations with six people living at the service, two relatives, five staff, four visiting health or social care professionals, the registered manager and provider. We looked at records of people's care and quality monitoring systems used with the home. We also spent time observing how care and support was being delivered to people. Following the inspection we spoke with the community nurse team who make regular visits to the home.

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

Is the service safe?

We found the service was safe because usually there were enough staff in place to meet people's identified needs. We did find some weekends were short by one staff member, but heard this was due to staff sickness rather than there not being enough staff rostered on. We have asked the providers to monitor this carefully as the manager and head of care were not usually on duty at the weekends, so there was no additional back up support except in an emergency, which could impact on timeliness of people's needs being met.

We saw care was being well planned and where people's needs had increased a GP or other healthcare professionals were consulted. One social care professional commented on how the service had improved it's record keeping to make sure people's weight and other aspects of their care were being closely monitored.

We found people were being cared for in an environment which was clean and safe. One person had raised an issue of the water in an ensuite sink being too hot. The provider was addressing this. There were quality monitoring checks made to ensure the environment and equipment were fit for purpose.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Whilst no applications have needed to be submitted, we heard from the manager how she had referred some people for assessment of this safeguard. We also heard from staff about training they had completed or were booked on which covered how these safeguards applied to people to protect their rights.

Is the service effective.

The service was effective. People who were able to give their views about their experience said they were happy at the home. Comments included ''We are very well looked after''. Another person told us ''I would prefer to be in my own home, but this is not a bad place, the staff look after us well.''

When we spoke with staff, they were able to show an good understanding of people's needs and preferred routines. Our observations of how care and support was being delivered supported this. This showed the staff had the right knowledge and skills to provide effective care and support to people.

Is the service caring?

The service was caring. We saw people were supported by staff in a kind and respectful way. For example, when one person expressed dissatisfaction with their lunch option, the care staff showed patience and brought in other options for them to consider. We saw staff worked with people at a pace which suited their needs, for example when supporting people to move safely from the lounge to the dining area. A visiting relative told us ''I visited most days and know the staff are very good here.''

Is the service responsive?

We saw the service was responsive. People's needs had been assessed before moving into the home and their care plan was reviewed regularly to ensure all needs were being monitored and met. Plans included key questions about people's life history as well as their known likes and dislikes. This helped staff to deliver care in a more person centred way.

We saw some activities were organised such as therapy dog visiting, music and local school children visits. We heard other activities were usually carried out in the afternoons, including bingo, quizzes and hand massages. This showed the service were responding to people's emotional well-being.

Is the service well-led?

We found the service was being well-led. We heard from staff how they were having regular staff meetings as well as one to one supervisions about tehir work. Staff we spoke with felt their opinion was listened to. People who lived at the home told us they could talk over any concerns with staff. We also saw people and their families had been asked to complete questionnaires about all aspects of their care. The provider has not yet collated all the results, but planned to do this and action any suggestions. They also planned to ask people living at the home, and their relatives for suggestions about how they could improve their menu choices. This showed the provider used people's views to improve the quality of the service provided.

When we inspected this service as part of our planned inspection schedule in June 2013, we found improvements were needed in relation to record keeping for people where they had lost weight. We found people had lost weight, which should have triggered the need for closer monitoring of their daily food and fluid intake. This had not been happening. We set a compliance action and asked the provider to send us an action plan to show how they intended to be compliant in records. We received an action plan and this follow up inspection was carried out to see if their action plan had been implemented and records were improved to protect people.

We looked at the care plan records and daily notes of four people. We spoke with five staff and we observed people having their lunch. We spoke to two people who were at risk of being nutritionally compromised and had lost weight, but who were able to give us a clear picture of their experiences of living at Oaklands and explain what staff had been doing to help them improve their appetite. We heard the service had introduced new menus with more choice. This included providing fresh fruit snacks and smoothies for afternoon snacks. One person said ''They are always offering me food and drinks, they really take care of me.''

We saw records of people's food and fluid intake had improved and where people were at risk of poor nutritional intake, referrals had been made to their GP. This meant people were protected by accurate records.

We brought forward this planned inspection as we had received some anonymous information of concern. This related to poor quality and quantity of food being offered to people.

We spent time talking to people at the home, we also observed care and support being delivered. People who were able to give a view about their experience of living at Oaklands were positive about the care and support provided. Comments included ''I have no complaints, staff are all very good, otherwise I would tell you.'' ''Oh yes, it's very good here, the staff are all lovely, but I still want to go home.'' We observed care and support being provided in a kind and respectful way. One visiting relative told us they had no concerns about the care of their relative.

We saw that whilst care and support had been well planned, the risk assessment for good nutritional intake had not always triggered the need to monitor food and fluid intake more closely, and we have said this needs to improve. Menus were being revised to include more fresh fruit and other options for main meals.

Staff told us they were well trained and supported and they demonstrated they understood the needs and wishes of people they cared for. Staffing levels were sufficient for the number and needs of the people who lived at the home, but need to be kept under review to reflect the dependency levels of people at the home as these change.

We carried out this unannounced inspection on 29 May 2012 as part of our planned inspection programme. We brought forward this inspection as we also wanted to check on compliance of previous actions set during an inspection carried out in February 2012.

We spent time at the home talking to ten people who currently live there as well as four members of staff and the management team including the registered provider. At the time of this inspection there were 19 people living at the home with three care staff per shift, with an additional carer for the busy periods of the morning to assist people in getting up. The service had also employed an additional support to help get teas ready during the afternoon/evening shift. This had been implemented following our last inspection.

We observed how care and support was delivered through different times of the day. Most people that live at this service have dementia and therefore not everyone was able to tell us about their experiences. To help us understand the experiences of people we used our SOFI (Short Observational Framework for Inspection) This tool allows us to spent time watching what is going on in a service and helps us record how people spend their time, the type of support they get and whether they have positive experiences. Some people using the service were able to tell us their views. We also spoke with three visiting relatives and one health care professional following the inspection.

We looked at some of the key records kept by the home. These included care plans, risk assessments, staff recruitment records and medication records. This helps us to better understand how well the home is run.

People we spoke with who were able to share their experiences of living at the service were very positive. Comments included ‘‘I have come here for respite and really enjoyed my stay, they have really looked after me well,’’ ‘’the staff are always lovely.’’ ‘‘We think there have been real efforts made with the food and menus in the last few weeks, it’s not the same old boring stuff, they have tried new things and we like it.’’

We spoke with one health care professional following the inspection and were told that they had no concerns about the care and support provided at the home.

We looked at how well care and support was planned and reviewed. The plans contained good basic information about what personal, health and emotional care needs people had and how staff should meet these needs. Risk assessments were in place to show how the home identify manage and minimised any risks for people. Plans also included details about people’s social history and their likes and dislikes. Previously the service kept records in a number of books, but this had been streamlined and everything was being recording within the care plan, which made auditing and understanding any changed needs easier to identify.

We observed staff providing care and support in a kind and sensitive manner and we were told by staff that they felt well trained and supported to do their job.

We observed people experiencing positive interactions with staff trying hard to engage people. The service had worked hard to improve activities and simulation for people.

People were safe because the provider had used robust recruitment processes to only employ those people who were suitable to work with frail and vulnerable people.

We carried out this responsive review in response to some information of concern and safeguarding issues that had been raised about care and support not being delivered in a timely fashion, care plans and other records not being kept up to date, and poor communication between the care staff shifts. All of these areas could mean that people were at risk of their needs not being met.

We carried out an inspection on 18 October 2011 to follow up on compliance actions set following an earlier inspection in June 2011. During this inspection we found that the home had made some improvements, but that further work was needed to ensure that their quality monitoring included more robust checking of care plan records to ensure a consistent approach.

We visited the service on 29 February 2012 unannounced, to look at the issues identified via safeguarding and to check on compliance of previous compliance actions set in October 2011.

We spent time talking with eight people who currently live at the home and to one visiting relative. We also spoke with four care staff, the registered manager and registered provider of the home. We spent time observing care and support being delivered in different parts of the day. We looked at some of the key records within the home including care plans, risk assessments, daily records relating to how care and support was being delivered and records to show how staff communicated between shifts.

People we spoke with who were able to give their informed view about the home, were very positive about the care and support provided. Comments included “we are very happy here, have settled well and are well cared for.’’ “It was difficult to accept at first, but now we have, we know this is the best place for X’’ “the staff are all very good, kind and helpful.’’

We observed people being supported at different times of the day, including the lunchtime period. We saw staff interacting with people in a kind and respectful way. We saw that some small changes could be made to enhance people’s choice and decision making. For example being offered a choice of drinks at meal times, and a choice of meals.

We looked at three care plans in some detail and saw that they gave care staff clear information on what people’s assessed needs were and how their needs should be met.

We saw that the home had introduced fluid and food charts to monitor anyone who may be at risk from not eating or drinking sufficient quantities. We saw that these had been reviewed daily by the manager, who had added up the quantities of fluid and assessed whether this was sufficient to maintain reasonable health.

We saw that communication between shifts had improved, because all care staff were now recording what care and support they had completed for each person in one record. Previously this had been recorded in a number of different places. There was a communication book for staff on each shift to read that highlighted main issues for anyone with significant changes to their needs. Staff we spoke with said that in their view the improvements in communication and the clearer care plans had made working in a more consistent way easier.

Improvements had been made to the way records were monitored, but it was clear that some of the issues relating to why records got missed and care compromised, was due to insufficient staffing levels for the needs and numbers of people currently using the service. We spoke to the registered provider about this and asked that they fully consider increasing care staffing levels. This would ensure that people’s needs were met in a timely fashion, that activities could be completed and that care plan records and monitoring would be less likely to be missed. The service needs to be able to demonstrate that they have carried out a needs analysis and risk assessment as the basis for deciding sufficient staffing levels.

We carried out an inspection on 18 October 2011 to follow up on compliance actions set following an earlier inspection in June 2011.

The home provides care and support for older men and women. Most of the people that use the service at Oaklands Residential Care Home have dementia or a cognitive impairment and therefore not everyone was able to tell us about their experiences. To help us to understand the experiences people have we observed care.

We found that improvements had been made at the home with care planning and care practices. People told us they were well cared for at the service and we observed positive interactions from staff when providing care and support for people living at the home. We found that the service needs to make more improvements to quality assurance systems to ensure that records are robustly monitored.

When we made our visit to the home we met all the 24 people living there. There were a mixture of both older men and older women living at the home. There were one married couple sharing a room at the home and the ethnicities of the people living at the home were white/British or white/Western European. Many of the people living at the home had problems of cognitive ability from, for example, dementia type illnesses. This affected some people’s ability to hold a conversation with us, so we observed how they interacted with staff working at the home. We heard only positive comments about the home from people living there. People told us how kind the staff were and that it was a friendly place to live in.

Prior to our visit to the home we had received information from relatives of two people who had lived at the home expressing dissatisfaction with some aspects of the service. The concerns related to communicating with other health care professionals in a timely way to ensure care needs were met, cleanliness of the home and assessment of care needs. We have looked into these issues across the home in terms of compliance with the essential Standards and have recorded our findings in this report.

This inspection was unannounced and took place on 15 and 18 June 2015. The inspection was brought forward in response to some information of concern the Care Quality Commission (CQC) received in relation to there not always being the right equipment in place. We asked the registered manager for some information about this issue and was assured by her response. We did not find any concerns about equipment during this inspection.

Oaklands is registered to provide accommodation for up to 25 people requiring personal care. Nursing care is not provided.. There is 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 living at the home felt safe and well cared for and were complimentary about the staff team. Recruitment processes were checked to ensure that the right checks and referecnes were followed up so people were fully protected and only suitable staff were being employed. We found one out of four recruitment files where this had not occurred. The registered manager said she had sought advice and acted in good faith as the employee in question had previously worked for them. She agreed to immediately seek the references and checks required.

Staff understood people’s needs, preferred routines and worked in a way which ensured people’s privacy and dignity were maintained. People were offered a choice about their everyday lives and where people’s capacity was limited; measures had been put in place to ensure staff worked in a way to protect their best interests. Care was planned and being delivered by a staff group who understood people’s needs and there was sufficient staff to meet people needs in a timely way. Risks were being managed and reviewed in line with people’s changing needs.

Staff were supported to do their job with regular training and supervision to explore their strengths and training needs. Staff described there being good team work and said the registered manager had an open and inclusive approach.

Activities occurred most afternoons, they were not planned each day but staff had games and craft materials to provide stimulation for people. There were some paid entertainers who visited the home on a regular basis. This included singers, pet therapy dogs and shopping sessions.

Medicines were managed appropriately and people received their medicines and pain relief when required. There was a planned training programme covering all aspects of health and safety and some more specialised areas such as working with people with dementia care needs and care of the dying. Staff had regular opportunities to discuss their work and receive support and supervision.

People, relatives and staff felt their views and concerns were listened to. The service used surveys and meetings to ensure people’s views were gathered and any actions taken to address ideas or complaints were clearly recorded. Relatives reported they were made to feel welcome and had opportunities to talk to staff and management about concerns or ideas.

Systems were in place to review the quality of care given, records and maintenance of the building. These were audited by senior staff as well as the registered manager and provider.