We undertook an inspection of The Oaks and Little Oaks on 2 January 2019. The inspection was unannounced. The Oaks and Little Oaks has been registered since September 2011. The service provides accommodation, personal care and support for up to 73 people in Newark. At the time of our inspection, 46 people were using the service. The service is focused on supporting older people, with a mixture of residential, nursing and respite packages.

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.

At the last inspection, on 27 February 2018, we rated the service as ‘Requires Improvement’. During this inspection we again rated the service as ‘Requires Improvement’. We found ongoing concerns about the safety of the service, staffing levels and leadership. This included a breach of regulation 9, regulation 17 and regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

There were insufficient staff to meet people’s needs. While staff worked hard to meet people’s needs, the limited number of staff impacted on the responsiveness of the service. This affected the safety of people living at the service. People’s care plans and risk assessments guided staff on how to support people.

We found medicines were managed safely and people received medicines as prescribed. Infection prevention and control procedures were followed. The home was clean. We found that systems and processes were in place to keep people safe from abuse. Lessons were learned when things went wrong.

People were not always supported to have maximum choice and control of their lives. Staff did not support them in the least restrictive way possible; the policies and systems in the service did not support practice. People were not always given adequate support to consume food and fluid. We found relatives sometimes attended to support people when staff were otherwise occupied. This lack of support could put people at risk of malnutrition. The home was not adapted to meet people’s needs as there was little navigation guidance for those that were confused. Staff worked effectively with health and social care professionals. We found that staff had received training and had a good knowledge.

Staff worked hard to meet people’s needs, however the insufficient amount of staff meant staff had little time to talk to people. Care was instead focused on completing tasks quickly to meet people’s needs. Delays in care effected people’s dignity. People’s privacy was respected and staff requested permission before completing tasks. People needed to be more involved with planning and reviewing their care plans.

People’s desired support could not always be responded to due to a lack of staff. There was a lack of activities to keep people engaged and people told us that they felt under stimulated. Formal complaints had been listened too. Further work was required to engage people who could not engage with a formal complaints process. End of life care was supported in a safe and respectful way.

At the time of our inspection there was a registered manager in place. A registered manager is a person who has been registered with the Care Quality Commission (CQC) to manage the service. Like registered providers they are “registered persons”. Registered persons have the legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated regulations about how the service is run.

This is our seventh inspection in nearly two years. The provider has failed to sustain improvements at the service. During this time the service has been assessed as either ‘requires improvement’ or ‘inadequate’. We saw that the registered manager had worked hard to impr

We inspected the service on 27 February and 8 March 2018. The inspection was unannounced. The Oaks and Little Oaks is a care home providing accommodation, nursing and personal care for people who live at the service. 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 Oaks and Little Oaks accommodates up to 73 people. On the day of our inspection 28 people were using the service.

A registered manager was in post and they were available during the 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

When we previously visited the service we found them to be in breach of a number of regulations of the Health and Social Care Act 2008 (regulated Activities) Regulations 2014.These related to risk assessments, staffing, dignity and person centred care, complaints and governance of the service. At this inspection we found evidence to show they were no longer in breach of these regulations, and had made significant improvements to the care provided for people. However there were still further improvements to be made at the service.

People felt safe at the service and staff understood their responsibilities in protecting them from potential abuse. Staff had attended safeguarding adults training, could identify the different types of abuse, and knew the procedure for reporting concerns.

The risks to some people’s safety were not always assessed. Risk assessments had not always been completed in areas where people’s safety could be at risk.

Safe procedures for the management of people’s medicines were not always in place.

Staff were recruited in a safe way and there were enough staff to meet people’s needs and to keep them safe. Accidents and incidents were investigated. Assessments of the risks associated with the environment which people lived were carried out and people had personal emergency evacuation plans (PEEPs) in place. Staff had the knowledge and equipment to manage any infection control issues and the cleanliness of the service was maintained.

People were supported by staff who received an induction, were well trained and received regular assessments of their work. People felt staff understood how to support them effectively. The service used nationally recognised tools to assess the needs of people who lived at the service.

People lived in an environment which met their needs and they had access to information in formats which they understood. People’s health and nutritional needs were well managed and staff acted on advice given to them by health professionals to manage people’s health and nutritional needs.

Staff knew how to support people to make decisions and ensure their rights were respected, working in line with the principles of the Mental Capacity Act 2005. 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 support this practice.

People were cared for by staff who showed kindness and consideration of their needs and had knowledge of their preferences and views on their care. They were supported with respect by staff who maintained their privacy and dignity whilst encouraging their independence.

People received individualised care from staff, however there were some aspects of care not clearly documented to give staff the support they needed to provide people with the care they required .

People were supported to take part in a range of social activities and maintain relationships that were important to them. Pe

This unannounced inspection was carried out on 12 and 20 June 2017. The Oaks and Little Oaks provides accommodation, nursing and personal care for up to 73 older people. On the day of our inspection visit there were 33 people who were using the service.

We carried out an unannounced comprehensive inspection of this service in 16 March 2016 Breaches of legal requirements were found and we took action to ensure the necessary improvements were been made to make sure people received safe care and support. The provider sent us an action plan detailing some of the improvements they intended to make.

At the time of this inspection the service did not have a registered manager in place. The previous registered manger left the service on 9 June 2017. 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 may be left at risk of harm or abuse because there was a risk that the procedures designed to protect them might not be followed. Some risks to people’s health and safety were not being identified and people faced risks in their daily living that could be prevented or reduced.

People were not being provided with their care and support when this was needed by staff on duty. People received their medicines as prescribed but the arrangements for the storage and recording of these needed some improvement.

People were being cared for and supported by some staff who had not kept their training up to date. People’s right to make decisions for themselves may be overlooked as the Metal Capacity Act (2005) was not being correctly followed.

People were not provided with a positive mealtime experience which could affect their nutritional and fluid intake. Staff understood people’s healthcare needs and their role in supporting them with these.

There were times when people were not shown respect and also had their privacy and dignity compromised. More effort could be made to involve people in planning their own care.

People received their care and support in a task oriented manner rather than in a person centred and proactive way. People’s care plans were not always kept up to date and staff rarely referred to these. The system in place for people to raise any complaints was not being followed.

The systems to monitor the quality of the service and identify where improvements were needed were not effective. Quality assurance questionnaires did not capture people’s concerns and dissatisfaction with the service.

“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 l

This unannounced inspection was carried out on 19 December 2016. The Oaks and Little Oaks is a care home with nursing and provides accommodation and personal care for up to 73 older people. On the day of our inspection there were 32 people who were using the service.

We carried out an unannounced comprehensive inspection of this service on 16 March 2016. Breaches of legal requirements were found. We undertook this focused inspection to check that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Oaks and Little Oaks on our website at www.cqc.org.uk

The service did not have a registered manager in place at the time of our inspection and has not had one since December 2014. The temporary manager told us a new manager has been appointed, who will apply to become the registered manager when they take up their 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.

There were sufficient staff on duty to meet the needs of people who used the service.

Where people lacked capacity to make their own decisions or had restrictions placed on their liberty their rights under the Mental Capacity Act 2015 were respected.

This unannounced inspection was carried out on 21 July 2016. The Oaks and Little Oaks is a care home with nursing and provides accommodation and personal care for up to 73 older people. On the day of our inspection there were 30 people who were using the service.

We carried out an unannounced comprehensive inspection of this service on 16 March 2016. Breaches of legal requirements were found. We undertook this focused inspection to check that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk

The service did not have a registered manager in place at the time of our inspection and has not had one since December 2014. The operations manager told us a new manager has been appointed, who will apply to become the registered manager when they take up their 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.

People were supported by staff who understood the risks people could face and were provided with appropriate care that promoted their safety.

People who used the service and care workers were able to express their views about the service which were acted upon. The management team provided leadership that gained the respect of care workers and motivated them as a team. There were systems in place to monitor the quality of the service and make improvements when needed.

This unannounced inspection was carried out on 16 March 2016. The Oaks and Little Oaks is a care home with nursing and provides accommodation and personal care for up to 73 older people. On the day of our inspection there were 37 people who were using the service.

The service did not have a registered manager in place at the time of our inspection. The previous registered manager left the service in December 2014. The provider had recruited an acting manager to manage the service who has applied 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 and associated Regulations about how the service is run.

People were at risk of experiencing harm because risks were not identified and planned for, or the procedures in place to protect them were not followed. Staff knew where and how to report any incidents of abuse.

People did not always receive care and support to meet their needs because there were insufficient staff to provide this. People could not be assured they would always receive their medicines as prescribed.

People did not always receive the assistance they required to have enough to eat and drink. People were supported by staff who had, or were learning to have, the skills and knowledge to meet their needs. People received support from staff who may not understand their health conditions.

People were at risk of decisions being made on their behalf that they may have been able to make for themselves. Some people had restrictions placed upon them without the required authorisation being obtained.

People were supported by staff who cared about them but did not always care for them in a way that met their individual needs and they could not be confident that action would be taken to promote their dignity.

People did not receive the care they require because this had not been properly planned. People did not receive sufficient opportunities to provide them with social stimulation and companionship.

People did not have confidence that if they had any concerns or complaints these would be acted upon. People did not feel there was an open and inclusive culture at the service and systems to monitor the service were not effectively implemented.

You can see what action we told the provider to take at the back of the full version of the report.

We inspected the service on 23 February 2015. The Oaks and Little Oaks is a care home with nursing and provides accommodation and personal care for up to 73 older people living with or without dementia. On the day of our inspection there were 53 people who were using the service.

The service did not have a registered manager in place at the time of our inspection. The previous registered manager left the service in December 2014. The provider had recruited an acting manager to manage the service who told us they will be applying to become the registered manager shortly. 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.

When we last inspected The Oaks and Little Oaks in October 2013 we found there were improvements needed in relation to obtaining people’s consent for their care and treatment. We found the provider made the improvements needed during this inspection.

Staff knew how to keep people safe and to raise any concerns if they suspected someone was at risk of harm or abuse. Staff understood the risks people could face through everyday living and how they needed to ensure their safety. There were sufficient staff on duty to meet people’s needs and any absences from work were covered.

Medicines were managed safely and people received their medicines how they had been prescribed. Medicines were administered by trained nurses who had been assessed to be competent in medicines administration.

Staff received training and supervision to ensure they had the knowledge and skills to provide people with safe and appropriate care. People’s right to make decisions for themselves when they were able to was protected.

People were encouraged to eat and drink sufficient to maintain their health and well-being. People were supported with their healthcare needs and accessed community based services for additional healthcare support. We observed people were treated with dignity and respect and people felt staff were always kind and respectful to them and provided them with the support they needed.

People’s care plans did not provide staff with all the information they needed to support people appropriately. People felt they could raise concerns and we saw when they had these were acted upon.

People who used the service, relatives and staff were able to express their views on how the service was run. There were systems in place to monitor the quality of the service and identify what was working well, and if any improvements were needed.

Prior to our inspection we reviewed all the information we had received from the provider. We spoke with three people who used the service and two visitors to the home to establish their views on the quality of service provision. We also spoke with the registered manager, the cook and three carers. We also looked at some of the records held in the service including the care files for three people. We observed the support people who used the service received from staff and carried out a brief tour of the building.

People told us that staff obtained their consent before any interventions were performed. One person told us, “They ask me about everything and respect my wishes. I could not be better looked after if I were the Queen.” However, people told us they had not seen their care plans and had not signed any agreements about how their care was provided

Suitable and nutritious food and drink was available in sufficient quantities to meet people’s individual needs and preferences.

People received their medication when required and the management of medication promoted peoples safety.

People told us they were very satisfied with the staff as they found them to be caring and attentive to their needs but told us there were not always enough staff on duty to meet all needs.

People felt confident in reporting any concerns or complaints to the management team and felt their opinions were valued and respected.

People who used the service told us that care staff involved them in their care, treatment and support programmes. They also told us that they received input and treatment from other health care professionals when required.

People who used the service told us that they were encouraged to undertake a range of social activities within the home and within the community and felt their social needs were being met.

People told us that they felt safe in the home and felt the staff had the right qualifications, skills and knowledge to perform their duties in a safe manner.

People who used the service were provided with the opportunity to comment on the quality of service provision at residents meetings and were also able to discuss any issues which were important to them with the management team.

We found that the organisation had an effective recruitment process in place which adhered to current legislative requirements. We also found that the support staff had received a training package to ensure they were competent and confident in performing their duties.

We carried out an unannounced comprehensive inspection of this service on 23 February 2015. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Oaks and Little Oaks on our website at www.cqc.org.uk

We undertook this focused inspection on the 20 and 21 October 2015 due to concerns we had received about the service. The inspection was unannounced.

The Oaks and Little Oaks is a care home with nursing and provides accommodation and personal care for up to 73 older people living with or without dementia. On the day of our inspection there were 55 people who were using the service

The service did not have a registered manager in place at the time of our inspection as the previous registered manager left the service in December 2014. The provider had recruited an acting manager who 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 and associated Regulations about how the service is run.

We spoke to the registered provider before our visit. They had also had concerns raised to them about the service which they had investigated. Additional management resources had been deployed at the home to support the acting manager. Processes and audits were in place to ensure that these concerns and any shortfalls in practice identified were resolved.

A long serving registered manager had left the service in December 2014. The new acting manager had begun making changes such as alterations to the meal times, shift times and frequency that people should be checked. Whilst some changes had brought about improvements, we found further developments were required to ensure those living in the service, their families and the staff team were fully informed ahead of changes being introduced.

The acting manager was visible and known to those living, working and visiting the service. People told us that they were confident that they could raise issues with the acting manager who would act on their concerns. Notifications required to be made to the local authority and to CQC had not always been made. This mean that those regulating the service may not have all of the information they needed to ensure that people are safe.

People told us that they were happy living at the home, and were complimentary about the staff. At the time of our inspection we found staff to be friendly and approachable. Whilst there had been some turnover in staffing, we found this was no higher than in the previous year.