We carried out an unannounced inspection visit on 21 June 2016 and returned announced on 22 June to complete the inspection.

Charnwood Oaks is a nursing home that provides accommodation for up to 84 people who require nursing or personal care. At the time of our inspection 84 people were using the service. Charnwood Oaks consists of four care units each with accommodation and communal areas. All bedrooms were en-suite.

The service had 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.’

Care staff and non-care staff, for example cleaners, knew how to identify and report concerns about people’s safety. Staff were suitably deployed to be able to meet the needs of people using the service. People who were assessed to be at risk of displaying behaviour that challenged others were discretely observed to protect them and other people using the service from harm.

People received their medicines at the right times. The provider had safe arrangements for the management and storage of medicines.

People were supported by staff with the right skills and experience. Staff were supported through training and supervision. A new organisational structure at the service meant that staff had easier direct access to senior staff for support.

Staff at all levels understood the relevance of and acted in accordance with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards when they supported people.

People were supported with their nutrition. People with special dietary requirements were supported with their specific needs. People were supported to access health services when they needed to. We saw several records that showed the service engaged with a variety of specialist health services to support people with their health needs.

We observed that staff demonstrated care and compassion in the way they supported people. A reason for this was that the provider had improved the quality of the training and support staff received about how to support people in a caring way.

People using the service and their relatives were involved in making decisions about their care and support. People and relatives we spoke with told us they received information they needed about the service before and after they began to use it.

Staff respected people’s privacy and dignity. They were discrete when they provided care and support. The provider had taken action to reduce the instances of people’s privacy being disturbed by other people walking into their rooms.

People’s care plans were focused on their individual needs. People were supported to maintain their independence and were supported to follow their hobbies and interests. An activities coordinator and care staff organised a range of social activities for people to participate in and people were supported with their interests and hobbies. People using the service and their relatives knew how to raise concerns and their views were acted upon.

The service was organised into near four sections each with a team leader and a senior care worker. The `hotel services’ manager who managed the kitchen, cleaning and laundry services was an integral part of the management team.

People using the service, their relatives and staff were involved in developing the service. The provider acted upon their feedback. The registered manger and senior staff monitored staff care practice. The provider had effective procedures for monitoring the quality of the service which included seeking people’s views about their experience of the service. The registered manager took action to make improvements in areas identified as requiring improvement.

At our inspection we gathered evidence that helped answer our five questions. Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with seven people who used the service, eight relatives, 14 staff and from looking at people's care records.

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

Is the service safe?

People we spoke with told us they felt safe at the home. A contributing factor to their feeling safe was that they felt comfortable living at the home. One person described their room "as my little home." People who used the service could summon help in their rooms by using call-alarms. When we looked in people's bedrooms we found that call-alarms were connected and accessible.

We saw that staff treated people with dignity and respect. Staff spoke politely to people and offered encouragement when they supported them. Staff we spoke with, including staff with no care work responsibilities, all knew the forms of abuse recognised in the Health and Social Care Act 2010. Staff knew how to identify and report concerns about people's safety using the provider's whistleblowing procedures. Staff also knew they could contact the relevant agencies.

Care plans we looked at contained risk assessments of things that could potentially harm people. Care plans included plans of how to protect people from risk of falls and risk of injury whilst receiving personal care. Risks associated with people's health had also been assessed.

We had mixed responses from people, relatives and staff about staffing levels. People told us that it sometimes felt to them as if not enough staff were on duty, but none expressed this as a concern. A relative told us that their husband had sometimes been uncomfortable because of delays in staff responding to requests for help. They attributed the delay to there not being enough staff. Staff were split 50 / 50. Half told us they felt enough staff were on duty at all times, but half told us they didn't have time to sit and talk with people which they thought was an important part of supporting people. No person we spoke with said that people were unsafe because of staffing levels.

Senior staff we spoke with understood the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This is legislation that protects vulnerable people who are or may become deprived of their liberty through the use of restraint, restriction of movement and control. Nearly half the staff had received training about MCA and DoLS.

We saw that people's bedrooms and communal areas including the garden were clean and tidy and free of hazards.

Is the service effective?

People's health and care needs were assessed with them or their relatives. Care plans included details of people's needs and information about how they were supported with their needs.

People who used the service told us that they had been well cared for and supported. A relative, referring to the quality of care and support, told us, "Everything is working like clockwork." We compared our observations of how staff supported people with what was in people's care plans and we found that staff supported people in line with their care plans.

Some people who used the service at times displayed challenging behaviour. We heard people repeatedly asking the same questions, often in a very loud tone, over prolonged periods of time. A relative described the situation as "pandemonium." The registered manager described it as "chaotic". After we spoke with staff it became clear that most staff we spoke with felt they had not been trained to deal effectively with the types of situation we witnessed.

The people who used the service were registered with a GP surgery. The provider had arranged regular GP visits so that people's health could be checked.

Is the service caring?

People told us they were well cared for. One person told us they had experienced, "tender love and care" and added, "Even when staff are rushed they don't let you think something is too much trouble." People told us that staff were "kind". Relatives told us that people were treated with dignity and respect. One relative's comments were typical of what others told us. They said, "The staff are very caring. They treat people with dignity and respect."

Staff did not wear name badges. A person who used the service told us, "I don't know staff names. I'd prefer to know their names." A relative told us that they knew the names of senior staff but not other staff. When we spoke with a group of five staff, three told us that they'd prefer to wear name badges.

The provider had taken steps to promote staff awareness and practice of dignity-in-care. The service had staff who acted as `dignity leads' who promoted dignity-in-care amongst staff. The registered manager and senior care workers observed care staff to ensure they treated people with dignity and respect.

People had been supported with their health and nursing needs because the service worked closely with providers of those services. We found that staff monitored people's health and made referrals to the appropriate specialists when required.

People's preferences, interests and diverse needs had been respected. People had been able to attend church services or receive visits from representatives of local churches.

The service had two activities coordinators who arranged activities for groups of people and supported people with individual interests and hobbies. The activities coordinators were further developing a range of activities for people with dementia.

Is the service responsive?

People told us they were well cared for. Records we looked at showed that people had been supported with their personal care, nursing and health needs. People told us that they knew they could make suggestions or raise concerns. Relatives told us they had been involved in decisions about their family member's care. One relative told us, "The home has had it's moments and I've had to bring things up with them, but they were all dealt with."

We found one instance of a care plan that had not been updated to reflect a person's needs, but that was addressed and rectified after we brought it to the registered manager's attention.

Staff told us they regularly read people's care plans to ensure they understood people's changing needs.

Is the service well-led?

The provider had a system for monitoring the quality of service. This included checks of documentation, records and observations of care worker's practice. Staff meetings took place at regular intervals. We saw from records of those meetings that the manager had shared information about the outcome of monitoring activity.

The service had procedures for reporting of accidents and injuries. We saw that reports were reviewed and analysed and that action had been taken to reduce the risk of the same type of accident occurring again. The registered manager regularly sought the views of people who used the service and their relatives. The provider also used a satisfaction survey to obtain people's views.

We spoke with seven people who used the service, one visitor to the service, seven members of staff and two visiting health professionals. We also reviewed six care records, six daily monitoring records, five staff files and four staff training records.

During this inspection we found that people did not always have their care delivered as planned. Whilst some improvements had been made, the lack of appropriate planning and delivery did not ensure people’s safety and welfare.

We saw that appropriate action had been taken when people had been identified to be at risk related to their nutrition.

All new staff completed a three month probationary period with an interim and final supervision before being signed off as competent to fulfil their role.

We spoke with six people who used the service, one visitor to the service, eight members of staff. We also reviewed eight care records, five daily monitoring records, four staff files and four staff training records.

We asked for and received the corresponding daily records and monitoring checks for four people using the service. We found them to show that, despite people’s needs being assessed, the care and treatment was not delivered in accordance with their care plan and in a way that ensured people’s safety and welfare.

Staff told us that people who were at risk of malnutrition had food and fluid charts completed for them on a daily basis. We reviewed some of these charts and found there were gaps in the recording of people’s food and fluid intake. This meant that people who were at risk of malnutrition had not always had their food and fluid intake appropriately monitored by the service.

One visitor to the service told us: “The staff do have time to look after my husband. They communicate well me us and always have time to liaise with me.”

Staff told us they were well supported. One member of staff told us: “The clinical leads are particularly supportive. We have had a difficult time recently and management has changed a lot. I find the present manager very approachable.”

People using the service and relatives told us they thought the care and support delivered was supportive and met people's care needs. They also told us that care was planned and delivered with their involvement and consent. We found the environment to be busy but the staff were in control and did not appear to be overwhelmed whilst carrying out their duties.

People told us that staff were patient and compassionate when they provided care and support and we observed a number of staff engaged in supporting people, doing so with patience and diligence.

We checked to see that the equipment provided for the benefit of people using the service was fit for purpose and appropriately maintained. We found the provider ensured all such equipment was regularly serviced and maintained in accordance with the manufactures recommendations. We discussed some issues with the manager regarding some types of equipment and they were aware of the issue and had planned a review to ensure all items of equipment are available in sufficient numbers to support people using the service and the staff delivering that support.

The management and staff fully understood the need to keep all aspects of the service under review to ensure all care was planned, delivered and recorded in such a way that best supported the needs of those using the service.

People who used the service and their relatives told us they were satisfied with the care and support they or their relative received. They also told us they believed the staff to be professional and caring. We saw people receiving care and support and observed the staff respecting people's dignity at all times.

People using the service and their relatives were asked for their views and these were taken into account during the development of people's care plans.

We found the staff to be appropriately trained and supported by the management. The management also ensured people's concerns were listened to and acted upon in a timely manner.

The inspection took place on 22 July 2015 and was unannounced. We returned announced on 24 to complete the inspection.

At our last inspection in July 2014 we identified a breach to Regulation 23 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which following the legislative changes of 1st April 2015 corresponds to Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breach occurred because some staff were not supported through training and supervision to effectively support people who at times presented behaviour that challenged others. At this inspection we found that the provider had made improvements to the quality of training and support. People who presented behaviour that challenged others were better supported although we saw an isolated example were a non-permanent care worker had not effectively supported a person. We were told that non-permanent staff had not received training at the time of the inspection, but training was scheduled.

Charnwood Oaks is a nursing home that provides accommodation for up to 84 people who require nursing or personal care. At the time of our inspection 84 people were using the service. Charnwood Oaks consists of four care units each with accommodation and communal areas. All bedrooms were en-suite.

The service had 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.’

The service had a history of safeguarding investigations most of which were connected to incidents between people using the service. The provider had taken action to reduce the risk of such incidents occurring, but a serious incident had taken place in May 2014 which might have been avoided if staff had been effectively deployed. We found lapses to attention, for example not ensuring that storage rooms were kept locked. We found a similar lapse at a previous inspection after which we were told that new coded locks would be fitted to storage rooms, but they hadn’t been fitted. We saw a door to a stairwell being held ajar by equipment in an area where people using the service were not supervised. This posed risks of injury through falls to those people. Staff acted after we had brought these matters to their attention.

Staff knew how to identify and report concerns about people’s safety. There were enough staff to meet the needs of people using the service, although staff were not always effectively deployed leaving people unsupervised, for example when they walked along corridors where people’s bedroom doors were open and storage rooms were unlocked.

People received their medicines at the right times. The provider had safe arrangements for the management of medicines.

People were mainly supported by staff with the right skills and experience. People told us that some staff were better than others. We observed that to be the case and found that `bank staff’ who worked at the service less regularly than other staff had not received the same level of training.

Staff understood the relevance of and acted in accordance with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards when they supported people.

People were supported with their nutrition. The service had not always responded promptly when people had experienced unplanned weight loss, for example by involving dieticians in people’s care. A safeguarding investigation by the local authority found that a person’s health had not been adequately monitored and that this was a contributing factor to a serious incident that occurred.

The majority of permanent staff we saw demonstrated care and compassion in the way they supported people. We saw lapses by a very small number of staff which we brought to the provider’s attention and they told us action would be taken to address this through training and closer supervision.

People using the service and their relatives were involved in making decisions about their care and support. People and relatives we spoke with told us they received information they needed about the service before and after they began to use it.

Staff respected people’s privacy and dignity. They were discrete when they provided care and support. The provider took action to reduce the instances of people’s privacy being disturbed by other people walking into their rooms.

People’s care plans were focused on their individual needs. People were supported to maintain their independence by being supported to follow their hobbies and interests. People using the service and their relatives knew how to raise concerns and their views were acted upon.

People using the service, their relatives and staff were involved in developing the service. The provider acted upon their feedback. The registered manger and senior staff monitored staff care practice. The provider had effective procedures for monitoring the quality of the service and took action to make improvements in areas identified by them as requiring improvement.