This inspection was unannounced and took place on the 2 and 8 August 2018.

Oakridge House Care Home with Nursing is a care home service which also provides nursing care. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided. Both were looked at during this inspection.

Oakridge house is registered to provide nursing and residential care for up to 91 people who have a range of needs including diabetes, dementia and epilepsy.

At the time of our inspection 91 people were living at Oakridge House. Oakridge House is a two storey building set in secure grounds on the outskirts of Basingstoke. The home comprised two units; one for residential and one for nursing care. The units are further divided into areas. Each nursing area is managed by a registered nurse and includes a dining room with basic kitchen facilities as well as a lounge and quiet seating areas. There is a central, secure garden with seating and raised planting areas which are accessible to people living in the home.

The service was last inspected in July 2017 and was rated as ‘Requires Improvement’ overall. This was due to staff not taking appropriate steps to ensure people’s safety and wellbeing, ineffective systems to support staff in giving people maximum choice and control over their lives, incomplete documentation relating to the care people received, and quality assurance systems which were not always effective in identifying risks.

The provider had not ensured effective systems were in place to make sure they assessed and monitored the quality of the service provided. This was a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

At this inspection we found the provider had made the required improvements so that they were no longer in breach of this regulation.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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.

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.

Effective systems and processes were in place to protect people from harm and abuse. Staff had completed safeguarding training and were knowledgeable about actions to take if they suspected abuse. The provider deployed sufficient numbers of staff to meet people's needs and keep them safe.

The provider used safe recruitment processes to ensure only staff who were suitable to work in a care setting were employed. Medicines were stored, recorded and administered safely and people were protected from the spread of infection.

People received care from skilled, knowledgeable staff who had been appropriately trained. Staff were supported with regular supervision and training to help develop their knowledge.

Staff were aware of the legal protections in place to protect people who lacked mental capacity to make decisions about their care and support.

People were supported to maintain a balanced diet. Snacks and drinks were available at all times and risk assessments were in place for those at risk of malnutrition and dehydration. People were supported to access care from appropriate health professionals.

Staff had developed bonds with the people they supported and knew them well. Staff encouraged people to communicate their needs and protected their privacy, dignity and independence.

Care plans were written in partnership with people and their families or legally appointed representatives where appropriate.

There were procedures in plac

This inspection was unannounced and took place on the 22, 23 and 25 May 2017.

Oakridge House Care Home with Nursing (Oakridge House) is a home which provides nursing and residential care for up to 91 people who have a range of needs, including those living with dementia, epilepsy and diabetes and those receiving end of life care. The home also offers a discharge to assessment unit for 10 people. This unit is for people who require a period of short term care treatment and support upon their discharge from hospital. This placement is to ensure people are able to meet their own needs safely before moving home or seeking additional support in another social care setting. At the time of our inspection 87 people were living at Oakridge House.

Oakridge House is a large two storey building set in secure grounds on the outskirts of Basingstoke town centre. The home comprises of three distinct units, residential, nursing and discharge to assessment. Each unit includes communal areas such as dining rooms with basic kitchen facilities including a microwave, fridge and food storage and preparation areas with access to a lounge and quiet seating areas. There is a secure garden which sits in the middle of the units with seating and raised planting areas to ensure accessibility by people living at the home. This report will refer to all three units collectively as ‘the home’ throughout this report where not individually specified.

The home has a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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.

People using the service told us they felt safe. Staff understood risks to people’s health and wellbeing however we did not see this guidance was always documented. Where risks to people’s health and wellbeing were known staff did not always take steps to ensure these risks were minimised appropriately.

People told us they sometimes had to wait to receive care however; we could see people were supported by sufficient numbers of staff to meet their needs. The provider was able to adapt their staffing levels appropriately when required in order to meet changes in people’s needs.

People were not always supported to have maximum choice and control of their lives. Staff supported people in the least restrictive way possible however the systems in the service did not support this practice.

Where people lacked the capacity to make specific decisions for themselves that actions taken on their behalf were always in their best interests.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which apply to care homes. The registered manager showed an understanding of what constituted a deprivation of a person's liberty and was able to discuss the processes required in order to ensure people were not deprived of their liberty without legal authority.

Documentation relating to the completion of care were not always completed fully to demonstrate people received the care they required to maintain their health and wellbeing.

People were not always provided with the opportunity to participate in activities allowing them to live interesting and fulfilling lives. During the inspection the registered manager launched a new initiative that people would receive a minimum of 10 minutes of staff members time each day however, time was required to see if this practice was effective and embedded in working practices.

People were not always supported to eat and drink safely whilst maintaining their dignity and independence.

Quality assurance processes in place were not always effective in identifying the issues identified during this inspection. Where action had been identified as necessary the provider’s

This inspection was unannounced and took place on the 17, 18 and 19 May 2016.

We carried out an unannounced comprehensive inspection of this service on 16 and 17 December 2014 where one regulatory breach was identified. Following this inspection the provider wrote to us to say what they would do to meet these legal requirements. During the inspection we checked whether the provider had completed their action plan to address the concerns we had found. The provider had made the required improvements to address the original concerns; however at this inspection we identified some other improvements were required.

Oakridge House Care Home with Nursing is a home which provides nursing and residential care for up to 91 people who have a range of needs, including those living with dementia, epilepsy and diabetes and those receiving end of life care. This also included a discharge to assessment unit for 10 people. This unit is for people who require a period of short term care treatment and support upon their discharge from hospital. This placement is to ensure people are able to meet their own needs safely before moving home or seeking additional support in another social care setting. At the time of our inspection 91 people were living in the home.

Oakridge House is a large two storey building set in secure grounds on the outskirts of Basingstoke town centre. The home comprises of three distinct units, residential, nursing and discharge to assessment. Each unit includes communal areas such as dining rooms with basic kitchen facilities including microwave, fridge and food storage and preparation areas with access to a lounge and quiet seating areas. There is a secure garden which sits in the middle of the units with seating and raised planting areas to ensure accessibility by people living at the home. This report will refer to all three units collectively as ‘the home’ throughout this report where not individually specified.

The home has a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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.

Our inspection of December 2014 found that the planning and delivery of care did not ensure the welfare and safety or people using the service as care plans and records did not always reflect people’s current needs. At this inspection we found that improvements had been made and all the areas identified had been appropriately addressed. Care plans contained suitable guidance to allow staff to care for people in a safe and effective way including updating people’s care plans regularly to ensure they reflected people’s changing needs.

Relatives of people using the service told us they felt their family members were cared for safely. Staff understood and followed the provider’s guidance to enable them to recognise and address any safeguarding concerns about people.

People’s safety was promoted because risks that may cause them harm had been identified and guidance provided to manage these appropriately. People were assisted by staff who encouraged them to remain independent. Appropriate risk assessments were in place to keep people safe.

Robust recruitment procedures were in place to protect people from unsuitable staff. New staff induction training was followed by staff spending a period of time working with experienced colleagues to ensure they had the skills required to support people safely.

Contingency plans were in place to ensure the safe delivery of care in the event of adverse situations such as a loss of accommodation as a result of fire or floor. Fire drills were documented, known by staff and practiced to ensure people were kept safe.

People were protected from the unsafe administration of medicines. Nurses and

At the time of this inspection there were 71 people using the service. There were 40 people in the nursing unit and 31 people in the residential unit. This inspection focused mostly on the nursing unit.

We spoke with 12 people who use the service, three relatives, the manager and two deputy managers and 10 staff. We looked at care and treatment records for nine people who use the service.

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

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found –

Is the service safe?

There were enough qualified, skilled and experienced staff to meet people’s needs. Records of accidents or incidents were reviewed regularly by the provider and monitored for any trends and triggers, to reduce the risk of reoccurrence.

However, people were not protected from the risk of infection because appropriate guidance was not always followed. People were not always cared for in a clean, hygienic environment.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. This procedure is to ensure that an individual's liberty is restricted only when it is in their best interests and there is no other way to take care of that person safely. Since the last inspection two new applications had been submitted. Proper policies and procedures were in place and had been followed. Relevant staff had been trained to understand when an application should be made, and how to submit one. The manager was aware of recent changes to the legislation and was awaiting further guidance from the provider organisation.

Is the service effective?

Care and treatment was not always effectively planned and delivered in a way that met all people’s health and welfare needs. In particular, people we spoke with commented about a lack of mental stimulation.

One person who uses the service said “Sometimes the staff have time to talk to me, they are very busy. “I would like to go into the garden. I never can, I sit here”. Two other people commented about going outside. One told us “I would like to sit in the garden. I am not able to though”. Another said “I feel safe here I think. I have no memory. I never go in the garden. I think I might like it”.

Another person who lives in the home told us “The only trouble is there is nothing to do all day”. They remarked “Sometimes the staff have time to chat, they are busy”. A relative told us “There is no stimulation for my mother. She is now getting that she can’t be bothered to do anything. She just sits in her chair all day. She has not got dementia; there is just nothing for her to do”.

People were not always supported to be able to eat and drink sufficient amounts to meet their needs. The dining experience did not contribute toward encouraging people to enjoy their meals. There was not an effective system to regularly assess and monitor the quality of service that people receive.

Is the service caring?

We observed staff providing care and support in a friendly and respectful way. One person who uses the service told us “I am well looked after and the staff treat me kindly”. Another person who lives in the home told us “I am well looked after here and the staff are OK. There is no ill treatment here”. A relative told us “I love this home, it is calm and the carers are all very caring. They nip in and out to speak to my mum”. They also commented “There is a nice atmosphere here” and “The carers all know us by name. I would be happy to live here if I had to”.

Is the service responsive?

The care plans included detailed information about peoples’ health care and clinical needs. This supported staff to monitor peoples’ well-being over time, supporting a responsive and preventative approach to the management of conditions. Information in the care plans included records of liaison with other health and social care professionals and involvement of people’s families.

Is the service well led?

On the day of the inspection it was not possible to see, from the evidence provided, how the management was monitoring, reviewing and planning the service and its development in relation to specific areas of care practice.

There was a lack of evidence to show that people who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. Care staff we spoke with said there were no regular meetings and they did not receive regular one-to-one supervision.

We also received positive feedback about the leadership in the home. Two members of staff said if they had any issues they would raise them with the manager. They said they felt they would be listened to and any concerns would be taken seriously. Another member of staff told us it was a “Well-organised home. Another said the service had “Good relationships with families”.

We inspected Oakridge House in July 2013 and found there were shortfalls in the information held about people’s care and welfare needs. On this inspection we found that the provider had taken steps to address this.

We spoke with four people who lived at Oakridge House. They all told us they were happy. One person said “I have absolutely no complaints about the staff or the care and support they give me.” Another said “It has taken me a little while to adjust because it’s not the same as living at home, but the staff are great. We have a laugh and joke and that makes my day.” They also said “the staff listen to me and I am involved in making decisions.”

Care plans were complete and up to date. We noted that they reflected the care and support that we observed. Staff told us each person’s key worker was responsible for making sure their care and support plan was correct and regularly reviewed. One staff member said “it’s a system that works well and really lets us get to know people”

We spoke with six people who live in the home and a visitor. They all told us that they were happy with the care and thought that the staff were “great”. They all said that they got on well with staff. Three people were able to talk to us about their care planning. They said they were involved and could “change things” if they wanted to. They were confident they could raise concerns and that issues would be sorted out.

We saw that, where completed, care plans were personalised, detailed and relevant. However, three of the five care plans that we looked at had missing information. This meant there was a risk that people would not receive appropriate care.

People were offered a choice of suitable and nutritious food and drink. Where appropriate they were supported to be able to eat and drink sufficient amounts to meet their needs. All the people we spoke with told us there was enough food and they were generally complimentary about the variety and quality.

There were sufficient, trained and experienced staff on duty. People we spoke with said “the staff are great” and “the carers are very good, they work very hard”.

The provider had a system in place to record and process complaints. Complaints people made were responded to appropriately.

The people we spoke with told us that they had nice rooms which were clean and tidy. They said that the staff were “very good” and that they enjoyed the activities. They told us that they felt well looked after and safe. One person said that the food was very good and there was “plenty of it”, they said they had “no complaints”.

We did not, on this occasion, speak to people so cannot report their views.

We did not, on this occasion, speak to people about this outcome area so cannot report what people said.

We spoke with two people who use the service about whether they received pain relief medication when they need it. Their experiences were different; one person said they always receive their medicine promptly when they request it from staff and the other person said they didn’t always receive the pain relief medication they needed. The manager reported that there had been an error with this person’s medication in the past, which was addressed through the safeguarding process with adult social services.

This inspection visit took place on 16 and 17 December 2014.

Oakridge House can accommodate up to 82 people who require nursing or personal care, some of whom may be living with dementia.

The service is overseen by the registered manager. 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 the last inspection on 25 June 2014, we asked the provider to take action to make improvements to ensure people’s care and welfare, meeting nutritional needs, cleanliness and infection control, staffing, and assessing and monitoring the quality of service provision. These actions had been completed.

People were complimentary about the service they received. However, our own observations and the records we looked at did not always match the positive descriptions people and relatives had given us.

Although people told us they felt safe, we found there were some aspects of the medicines administration that needed improvement. These concerned record keeping and the administration of medicines that people take as and when needed on an ‘as required’ basis.

The planning and delivery of care did not ensure the welfare and safety of people who use the service, as care plans and records did not always reflect people’s current needs.

There were enough staff to meet people’s needs and a system was in place to monitor and adjust staffing levels if people’s needs changed. The service carried out appropriate recruitment checks to help ensure that staff were suitable to work with people at risk.

Staff were aware of their responsibilities to keep people safe and were confident to use relevant policies and procedures to raise any concerns. Staff received training and supervision to support them to deliver care effectively.

People received on-going support to meet their health needs and had access to relevant health care professionals. Where people lacked the mental capacity to make decisions, records showed that decisions were made in their best interests.

The atmosphere in the home was calm and staff interacted with people in a friendly, respectful and caring manner. Staff responded promptly to people’s requests for support and knew the people they were supporting well.

Staff were well supported by the registered manager to undertake their roles and responsibilities. A regular programme of monitoring and quality assurance supported the staff and registered manager to assess the quality of the service and implement improvements. The registered manager actively promoted good relationships with staff, relatives and other professionals.

At this inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have asked the provider to take at the back of this report.