Oxendon House Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Oxendon House Care Home is registered to accommodate up to 42 people; at the time of our inspection there were 27 people living in the home.

At the last inspection in May 2016 this service was rated good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People continued to receive care that was safe. We saw that staff had been appropriately recruited in to the service and security checks had taken place. There were enough staff to provide care and support to people to meet their needs. People were consistently protected from the risk of harm and received their prescribed medicines safely. Staff followed infection control procedures to reduce the risks of spreading infection or illness.

The care that people received continued to be effective. Staff had access to the support, supervision, training and on-going professional development that they required to work effectively in their roles. People were supported to maintain good health and nutrition.

Staff understood the principles of the Mental Capacity Act, 2005 (MCA) and ensured they gained people's consent before providing personal care. People were encouraged to be involved in decisions about their care and support and information was provided for people in line with the requirements of the Accessible Information Standard (AIS).

People told us their relationships with staff were positive and caring. We saw that staff treated people with respect, kindness and courtesy. People had detailed personalised plans of care in place to enable staff to provide consistent care and support in line with people’s personal preferences.

People knew how to raise a concern or make a complaint and were confident that if they did, the management would respond to them appropriately. The provider had implemented effective systems to manage any complaints that they may receive.

The service had a positive ethos and an open and honest culture. The manager and deputy manager were present and visible within the home.

This unannounced inspection took place over two days on the 5 and 6 May 2016.

Oxendon House provides accommodation for people requiring personal care and is registered to accommodate up to 33 people. At the time of our inspection there were 31 people using the service many of whom were living with Dementia.

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.

At the last inspection in March 2015 we asked the provider to make improvements to the staffing levels. We also asked the provider to make improvements to the quality of food and drink provided to people and the processes used to measure and improve the quality of the service. We found that these actions had been completed.

People told us that they felt safe. Staff had a good understanding of safeguarding vulnerable adults and knew what to do to keep people safe. Individual risks had been assessed and measures put in place by the provider to manage risks to people.

There were enough staff on duty in the home to ensure that people received care and support when they needed it. Medicines were managed safely and people received their medicines as prescribed by medical practitioners.

People were supported by staff that had the skills and knowledge necessary to provide safe and effective care and support. People’s consent was sought prior to care and support being delivered by staff.

People received sufficient amounts to eat and drink and told us that they were happy with the food that they received. People’s nutritional needs had been assessed by the provider and their day to day health needs were met by the staff and external health professionals as required.

Care records were personalised and contained up to date information about people’s needs and how staff should meet these needs. People and their relatives were involved in the development of their plans of care.

There were a range of activities which people told us that they enjoyed. These included one to one activities as well as group activities and days out.

The registered manager and the provider had effective quality assurance systems in place to help maintain standards of care and support. Audits focussed on areas such as care plans, the environment and health and safety. Where shortfalls were identified action plans were developed and these were quickly addressed by the registered manager.

This unannounced inspection took place on 12 March 2015.

Oxendon House provides accommodation for people requiring personal care and can accommodate up to 33 people. At the time of our inspection there 18 were people using the service. The service provides care and many people at the home are living with dementia.

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.

At the last inspection on the 11 September 2014, we asked the provider to make improvements to assessing and monitoring the quality of service provision and the management of records and this has been completed.

There were systems in place to calculate staffing based on people’s needs and people received enough support to meet their basic care needs. However, feedback from people and staff indicated further improvements were needed. There were medicine management systems in place and people received the support needed to take their medicines as prescribed. Risks to people’s care were managed well and staff understood the measures needed to reduce the risk of unsafe care. There were robust recruitment processes in place designed to reduce the risk of unsafe staffing. People were safeguarded from the risk of abuse and there were clear lines of reporting safeguarding concerns to appropriate agencies.

People were supported to choose a nutritious diet; however some feedback indicated to need to improve this area. Staff monitored people at risk of not eating and drinking enough and provided appropriate support. There was a system of staff training and development and this had recently improved to provide more practical training for staff. The manager and staff were aware of their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Staff understood how to make best interest decisions when people were unable to make decisions about their care and people were supported to access a range of health services including that of their GP and dentist.

People received care that was respectful of their need for privacy and dignity. There were systems in place to support people to make decisions about their daily lives. People were encouraged to care for themselves and to live an independent life, where this was possible.

The system of care planning was responsive to people’s needs and people received a regular review of their care. People were supported to undertake a range of activities to support their social development. The provider had a system of complaints management in place to ensure people’s complaints were investigated and fully resolved.

The provider had made improvements to ensure any issues with cleanliness in the kitchen were identified and resolved quickly. The management of people’s care records had improved and these were an accurate reflection of people’s care needs. However, the arrangements for enabling people to feedback about the service required further improvement. Quality assurance systems were in place and identified potential failings in the service. The provider promoted an open and honest culture and staff raised any concerns about the service.

We considered all the evidence we had gathered under the outcomes we had inspected to answer questions we always ask; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well lead?

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

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

Is the service safe?

During our last inspection visits on the 5 and 9 June 2014, the provider had made several improvements to the safety of the service. People at risk of developing a health related condition were monitored regularly by the staff to keep them safe and well. People received their medication as it was prescribed by their GP and accurate medication records were maintained. The provider had safely recruited new staff to work at the home and there were improvements to the continuity of staffing at night time. The provider had improved training at the service and staff had recently undertaken emergency first aid training. This enabled the staff to manage a medical emergency. This meant that systems had been improved to keep people safe.

However we found that sometimes when people’s needs changed their care planning records did not always reflect accurate information. This meant there was a breach of the Health and Social Care Act regulations. A compliance action has been set and the provider must tell us how they plan to improve.

We also responded to anonymous concerns that people living at Oxendon House might be at risk of weight loss due to poor nutrition at the home. The provider had identified this as an area of concern and had taken action to ensure people’s welfare. This included the recruitment of a new cook and monitoring of people’s weights. Staff had also made referrals to health professionals such as the GP, dietitian and speech and language therapist. People’s nutritional plans of care had been updated to make sure they received appropriate support in meeting their nutritional needs.

Is the service effective?

People told us they were happy living at the service. People were of a clean and tidy appearance and had suitable and comfortable clothing. During the inspection, we observed some people enjoying the rock and roll music that was playing in the living area. People in another area of the home were enjoying watching a television programme in the company of one another. The provider had recently appointed a new staff member to assist people with their hobbies and interests. We observed that they assisted people to go for a walk in the local community. We also saw that some staff played a game with people which they really enjoyed. However, the game was of short duration and we saw that people were disappointed that they could not continue playing. A relative of a person using the service also told us that people needed more stimulation at the home. Staff told us that since the provider had made improvements to staffing at the home they had more time to spend talking and interacting with people.

Is the service caring?

The staff told us that there was a new ethos at the home which was to provide a comfortable and caring homely environment. During the inspection we observed that people appeared to be well cared for and staff interacted with people in a pleasant and positive way. People appeared calm and happy in their environment and they told us they liked living at the home.

Is the service responsive?

The staff had responded to a medical emergency at the home. Staff told us that receiving emergency first aid training had prepared them to manage the emergency. This had also resulted in a positive outcome for the person. We saw that staff had made appropriate referrals to health professionals such as the GP, dietitian and speech and language therapist. The manager received regular update information from staff about people’s nutritional and hydration levels and took appropriate action to ensure people’s welfare. A system to monitor the medical appointments requested for people at the home was in place and this made sure that people had improved access to appointments for a range of health related conditions.

Is the service well-led?

The service had appointed a new manager and they were in the process of registering as the registered manager of Oxendon House. They told us they wanted to have an “open and honest culture” at the home to enable staff, people and relatives to raise any concerns they had about the service. Staff told us that the new manager was approachable and had an “open door” policy, so they could raise any concerns they had about the service straight away. Staff were confident that the new manager would deal with any concerns they had about the home immediately.

The provider had a quality assurance system in place and this included using a system of audits to identify any areas of the home that needed improving. However, the system of audits did not go far enough to identify improvements required in the kitchen area of the home. This included the arrangements for the deep cleaning of the kitchen. This meant there was a breach of the Health and Social Care Act regulations. A compliance action has been set and the provider must tell us how they plan to improve. We also referred our concerns to the environmental safety officer at the local authority.

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.

Due to communication difficulties that people had, it was not possible to speak with many people who lived in the home. Instead, we mainly relied on observation as to how care was provided to people. We found that staff were positive and provided care in a friendly and encouraging way. We spoke with two people. They told us that staff were friendly and were largely meeting their needs. One person said she had felt cold the previous night. The manager said she would follow this up to ensure that heating was available on cool nights.

We spoke with six relatives of people living in the home. They told us that the care that staff provided was good or generally good. One relative said: ‘’care always seems to be pretty ok‘’. We noted that the manager followed up one relative's comment concerning people’s toileting needs always being met.

This was largely a positive inspection. People said that they were satisfied, or largely satisfied, with the care they received. We observed this to be the case. Relatives we spoke with people said that care was good, or generally good. There was a suggestion of ensuring staff were trained to meet all health conditions. The manager said she would ensure this was the case.

The provider was not meeting essential standards of care and safety when we last inspected the service, so we followed up these issues.

Due to peoples’ communication difficulties, we only spoke with one person living in the home at the time of the inspection. This person said that he was satisfied with the care he received.

We spoke with one relative. This relative was also satisfied with the care the home supplied.

The relative said; “My father is happy with the home. There have been no problems ’’.

Despite this positive picture, this was a mixed inspection. Some essential standards we inspected still had not been met. The care supplied had not always met people’s needs and premises had not been fully safe for people to use.

We spoke with one person living in the home at the time of the inspection. This person said that she was generally satisfied with the care she received. However, she wanted the radiator in her bedroom to work, rather than having to remember to put on the electric heater.

We spoke with three relatives. One relative was satisfied with the care the home supplied. The other two relatives thought that there was not enough staff on duty. One relative was unsure that staff were meeting her mother's diabetic needs. The manager stated that the person's diabetic needs were being met.

One relative said; “The care they have given to my mother is very good ’’. Another relative said: ‘‘Staff are good but sometimes I have to help residents because no one is around. There is one lady who is aggressive to people and she needs to be watched’’.

This was a mixed inspection. Relatives did not all agree that people's care needs were met. Most of the essential standards we inspected were not met. The service needs to ensure that care always meets people’s needs, that staffing levels are in place to meet all needs and fire precautions are fully in place. Premises need to be safe and the company needs to ensure that robust and complete quality assurance is carried out to produce high standards at all times.

As nearly all of the people living in the home of dementia, we were not able to speak in depth with them. We spoke with one person who did not have dementia. He was satisfied with the care that staff provided. We spoke with four other people living in the service. They all confirmed they were satisfied with the care provided by staff.

We spoke with three relatives. Two relatives were entirely satisfied with the care that staff supplied. One relative said; “this is the best place that my mother could have come to''. They are very good.” Another relative said she was generally satisfied with care, but thought there was not enough staff to provide some one-to-one care that people needed.

As most of the people in the home have dementia, with associated communication problems, we only spoke in some depth with four people. We also spoke with five relatives about their views of the care provided.

The people we spoke with were satisfied with the home’s care. Staff were seen as helpful and friendly. There was only one suggestion to improve the service, that of ensuring sufficient level of heating in a person's bedroom.

People and their relatives praised the service: '’Staff are nice to me. If I need help I get it.’’ ‘’If I need to discuss anything I go to the manager and she sorts it out quickly.’’ ‘‘I think it's comfortable here and there are activities if you want them.’’

As most of the people in the home have dementia, with associated communication problems, we only spoke in some depth with three people. We also spoke with four relatives/friends about their views of the care provided.

The people we spoke with were satisfied with the home’s care. Staff were seen as helpful and friendly. There was one suggestion to improving the service - to have more outside activities.

People and their relatives largely praised the service: '’Staff help you when you ask them’’; ‘’The manager follows up things if you bring them to her attention’’; ‘‘I can go to bed when I like.’’

As all the people in the home have dementia, with associated communication problems, we only spoke in some depth with three people. We also spoke with six relatives/friends about their views of the care provided.

Most of the people we spoke with were satisfied with the home’s care. Staff are seen as friendly and welcoming. Suggestions for improving the service were to have complaints to be properly followed up, more staff in the afternoons and evenings when there are only three staff on duty, more varied activities and for laundry arrangements to be better.

People largely praised the service: 'Staff are good’. ‘The manager will listen and act on anything you ask of her ’. ‘I please myself and go to bed when I like’. ‘I am welcomed by all staff when I visit’. ’The home is kept clean. My friend is always well turned out ’. ‘I feel safe here.’

All the people we spoke to were satisfied with the care they received from the service, and praised staff members and management for their work. Representatives of people also testified to the care that people received:

‘They are very good ‘. ‘The manager is very approachable and staff do their best’, ‘I have no complaints at all’.

There were a small number of suggestions for improving the service - more staff so that people did not have to wait for care on occasion, and laundry practices being improved.

We considered all the evidence we had gathered under the outcomes we had inspected to answer questions we always ask; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well lead?

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

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

Is the service safe?

People received regular assessments of their needs in order to identify any areas of risk in delivering their care. Staff regularly reviewed risk assessments to ensure any changes to people’s health and well-being were identified promptly. However, we found that some people at high risk of developing health conditions did not always receive care as indicated in their care plan records. Staff did not always maintain accurate records of care when monitoring people’s health and welfare needs.

We found that medication errors had been made by staff and some errors resulted in people not receiving their prescribed medication. This put people at undue risk of developing a health related condition. The provider’s recruitment processes for the employment of permanent and agency staff were not robust in safeguarding vulnerable people from the risk of unsuitable staff.

During our inspection visit, we also observed that staff did not seek medical advice when one person had a fall and injured their head. This was despite being told that the person felt dizzy and had a head ache. This meant there was a breach of the Health and Social Care Act regulations. Compliance actions have been set and the provider must tell us how they plan to improve.

Is the service effective?

We observed many people were happy living at Oxendon House. The provider had enabled a few people to have their pets live with them. We observed that people enjoyed taking their dogs for a walk within the safety of the home’s grounds. We also observed that the provider had made many improvements to the environment of the home. This included the refurbishment of people’s bedrooms and communal areas of the home. We saw that the improvements created a suitable environment for people to receive care. People told us that the meals served were of a good standard and we saw people enjoying their lunchtime meal. However, we found that new staff did not always receive suitable induction training in order to provide care that was effective and met people’s needs. This meant there was a breach of the Health and Social Care Act regulations. A compliance action has been set and the provider must tell us how they plan to improve.

Is the service caring?

We saw that some care workers showed patience and gave encouragement when supporting people. One person said “I’m well and their looking after me”. Another person said “the staff that work here are kind”. However, another person told us that they did not feel well and staff had not been back to check how they were feeling. They told us that they had been assisted by staff to dress, but staff had not supported them to shower or wash and had received no assistance to brush their hair. We found that people who were not well or were at risk of becoming unwell did not always receive regular monitoring by the staff.

We found that people or their representatives had not always been involved with the planning of care and their paper work had been signed by a manager on their behalf. We also found that doors leading to people’s bedrooms lacked personalisation, making it difficult for older people and people with a diagnosis of dementia to identify their own bedrooms. This meant there was a breach of the Health and Social Care Act regulations. A compliance action has been set and the provider must tell us how they plan to improve.

Is the service responsive?

We observed people sitting in the living room and saw that they enjoyed the company of other people using the service. We observed that the staff responded promptly when people used their call bells when they needed staff assistance. However, one person told us “I’ve been here all night and no one came”. We also observed the person’s call bell had not been working properly and they had been unable to alert staff for when they needed their support.

Is the service well-led?

The registered manager was not working as the manager of the home. We observed they were working as the deputy manager and as a senior care staff. The provider had appointed a series of manager’s to manage the home; however they had not registered as the registered manager and had ceased working at the home. This meant that the home lacked the leadership of a registered and legally accountable manager.

The service had a quality assurance system, and this included receiving regular feedback from people who used services. Staff told us that high standards of care were expected at the service. However they felt unsupported by the provider and had a series of manager’s who had worked at the service and continuity of leadership was not provided. Staff said when they raised concerns about the quality of care provided at the service; they had been made to feel uncomfortable working at the service. Some staff told us that a culture of “bullying” had been allowed to prevail, which made it difficult for staff to complain to the provider about any concerns they had at Oxendon House. This meant the provider did not always listen to the concerns raised by staff to improve the quality of the service provided.

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.