This comprehensive inspection on 21 August 2018 was unannounced and was planned to check whether the provider and the service had met the breaches previously identified in our inspection of 07 and 08 November 2017. After that inspection, the service had been required to submit an action plan which they did and they voluntarily submitted monthly updates to the action plan which showed that improvements had been made to the service.

Oxton Grange 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.

The service is registered to provide accommodation to up to 60 people. At the time of our inspection there were 38 people living there. The building had been purpose-built 23 years ago. An extensive refurbishment programme is currently being undertaken. The building for use by people living there, was over four floors, the ground, first, second, and third. The first floor was designated for people with general care needs; however due to the current refurbishment programme, with the permission of themselves and relatives, they had been accommodated elsewhere in the home. The second floor was devoted to people who lived with dementia and the third floor was a mixture of people who needed general care or who were living with dementia. The ground floor was mainly devoted to the communal areas such as the dining room and the lounge, a relative’s room and the administrative offices and had some bedrooms for people with general care needs. There was also a basement to the home, which accommodated the laundry, kitchen and the staff room, lift access equipment and had other storage for items such as cleaning materials.

At our inspection in November 2017, we found breaches of several of the regulations of the Health and Social Care Act 2008, namely, regulations 10,12, 14, 17 and 18. These related to concerns about dignity and respect, safe care and treatment, staff training, supervision and appraisal, meeting nutritional and hydration needs, oversight of the service and having sufficient staff.

At this inspection, we found that the service was no longer in breach of these regulations as the home had made improvements in its provision of care to the vulnerable people it looked after, its staffing numbers, the way staff treated people with respect and dignity, the nutritional aspects of the care provided and the overall management of the service.

This service requires a 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 of the Health and Social Care Act 2008 and the associated regulations about how the service is run. A registered manager was in post for this service and had been for three years.

We saw that people were treated with care and respect and dignity. This was confirmed to us by people and their relatives.

People living in the home (service) had individual care plans and risk assessments which had been recently reviewed. People's risks were assessed and staff had guidance on how to prevent or mitigate these risks, which we saw was being followed. People, their relatives and friends and relevant health care professionals were involved in the writing and review of the care plans.

The home used safe recruitment methods. Staffing levels had increased and there were sufficient staff on duty to meet people’s needs. The home had introduced a new training system since our last inspection, which included improved records and monitoring of staff induction and training for new staff. The vast majority of staff were now up to date with their training.

Peoples’ mental health needs had been appropriately assessed and the registered manager

This inspection was unannounced and took place on 07 and 08 November 2017. At our last inspection on the 23 and 24 March 2017, the service was required to improve the governance of the service by improving the records they kept in relation to the care they were providing to people.

Following the last inspection, asked the provider to complete an action plan to show what they would do and by when to improve the key question of Well-led to at least ‘good’. At this inspection, we found that they had not met this requirement or implemented a procedure to update and monitor care plans and associated records.

Oxton Grange 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.

Oxton Grange Care home is a purpose built home providing care to elderly people who require personal care. The home can accommodate up to 60 people with dementia type conditions and physical health needs. At the time of our inspection, there were 48 people living in the home.

The accommodation is provided over four floors with several communal areas and the building was purpose built. It is surrounded with gardens, has a large car park and is on a main road in a residential area.

The home required a registered manager and one had been in post for several months, having previously worked at the home as a 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.

We found breaches in relation to Regulations 10, 12, 14, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities). Regulations 2014. These breaches related to dignity, safe care and treatment in relation particularly, to staffing levels and medication administration, nutrition and hydration, good governance, and staff support.

We saw that during our inspection, at times, there were no staff apparent on one of the floors or in one of the lounges. We saw that people had been left alone in precarious positions in one lounge. There appeared to be a shortage of staff overall, medication rounds were not able to be completed in a timely or possibly safe way due to the staff administering medication being frequently interrupted and the staff were not able to meet people’s dependency needs.

Medication administration was not adequate; dates of opening of some medication were missing and other records were not completed properly and were misleading.

We saw that although the care documentation was designed to be person centred, it had not been correctly or comprehensively completed and there were omissions and contradictions in the care records. We saw that care records were incomplete, contradictory or missing important information. Monitoring was not done or recorded appropriately. Food and fluid charts were not completed properly and when a person was noted in the records to have lost a lot of weight, there were no records to show that suitable action had been taken.

Although the management had completed audits of policies and procedures, there were no action plans created to address any issues and no root cause analysis of the problems had been undertaken.

There was no effective overview of the home and its practices and records, or actions to address issues found, by the managers in the home and by the provider.

It was not obvious to the inspection team that there was good partnership working and the records indicated that some referrals to external health professionals had not been made.

The provider followed the Mental Capacity Act 2005 and its guidance although records showed that some staff needed re

This inspection was unannounced and took place on 23 and 24 March 2017. At our last inspection on the 25 March 2015, the service was required to improve the procedure for assessing people’s capacity in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). We saw at this inspection, that they had met this requirement and implemented a procedure that all staff were aware of and had completed training for.

Oxton Grange is a purpose built home providing care to elderly people who require personal care. The home can accommodate up to 60 people with dementia and EMI needs (elderly mentally impaired). It is set within well maintained landscaped gardens and has a large car park. At the time of our inspection, there were 56 people living in the home.

There was no registered manager in post; a manager had been in post since November 2016 and was in the process of applying to become 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.

We found breaches in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Good governance, because the provider failed to recognise that staff were not maintaining records to inform of what care they were providing to people. You can see what action we told the provider to take at the back of the full version of this report.

Medication records confirmed that people received the medication prescribed by their doctor. There were medication administration records (MARs) in place that were completed by the senior carer staff. The MAR sheets however did not have a space on the record to inform what time the medication was administered, this could impact on time specific medication not being administered at the correct time with the amount of time required between each administration. One MAR had not been completed appropriately as the wrong dates were recorded.

We have recommend that the provider ensures that the medication records provided by the pharmacy used have all of the relevant details in place to inform the time medication administered and that expiry dates are on the bottles and packaging of medicines.

People had a choice in the meals that they received. People told us they received sufficient quantities of food. People’s satisfaction with the menu options provided had been checked and 95% of people said they were happy with the food provided. Where people had lost weight this was recognised with appropriate action taken to meet the person’s nutritional needs with dietician referrals and food supplements prescribed. However records for food and fluid intake had not been completed in full by staff to show what people had consumed each day and the provider had not monitored these records.

People told us they felt safe at the home with staff. The manager who was the safeguarding lead had a good understanding of safeguarding as did all the staff spoken with. They had responded appropriately to allegations of abuse and had ensured that incidents of a safeguarding nature were reported to the local authority and the CQC, as required.

The staffing levels were seen to be adequate on the days of this inspection and were sufficient to meet the care and support requirements of the 56 people living there.

Staff told us they felt supported by the manager. Supervision meetings took place but not all staff had recently had one with the new manager. Annual appraisals had been provided but not to all staff. We saw that there was a schedule for all staff to have completed supervision and appraisal by April 2017.

People’s care records were person centred and contained information about their needs and prefe