About the service: Oak Manor is a residential care home that is registered to provide personal and nursing care for up to 61 people living with dementia or people 65 and over. At the time of the inspection 53 people were living in the home.

People’s experience of using this service:

¿ There were widespread concerns found at the service. The overall rating for this service is 'Inadequate' and the service is therefore in ‘special measures’.

¿The service was in breach of nine regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

¿People were not supported safely. Actions to assess and address risks to people’s health, safety, and wellbeing were not always taken.

¿People were not protected from abuse and improper treatment.

¿Infection control was not well managed.

¿The service was not always fully staffed. This impacted on the safety of people in the service and in ensuring people’s needs were met.

¿There was a negative task focused culture in the home. There were tensions amongst the staff team which impacted on the delivery of the care provided.

¿Staff were not always clear regarding their role and responsibilities.

¿Quality assurance processes had been ineffective in identifying issues in the home in a timely manner so action could be taken to prevent the service from deteriorating.

¿The provider’s own audits had identified issues within the home and they had started to take some action to make improvements. At the time of our inspection it was too early to assess how effective these actions would be and if improvements could be made and sustained.

¿Training and support for staff was not effective in ensuring good quality care was provided.

¿People were not always supported to eat enough and preferences relating to food were not always provided for.

¿Staff did not always seek people’s consent when supporting them.

¿Staff did not always support people in line with best practice guidance and legislation.

¿Staff did not work effectively with each other and other professionals to provide effective and high-quality care.

¿The environment, including the design of the service, did not meet people’s individual needs.

¿People were not always treated respectfully and their dignity was not always promoted. People’s human rights were not consistently upheld.

¿People and relatives were not fully involved in assessing and planning their care. Care was not provided in a way that met people’s individual needs and preferences, this included in relation to social activities and interests.

Rating at last inspection: Good (report published 4 November 2017)

Why we inspected: The inspection was brought forward because we received information of risk and concern.

Enforcement: See end of full report for action we told the provider to take.

Follow up: The overall rating for this service is 'Inadequate'. This means that it has been placed into 'Special Measures' by CQC.

¿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.

¿For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special m

Oak Manor Nursing Home provides accommodation and personal care for up to 61 people. At the time of our inspection, 53 people were living at the home.

There was a manager in the home who applied to become a registered manager with the Care Quality Commission. 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 home is run.

At the last inspection, the home was rated Good overall. At this inspection we found the home remained Good.

Why the home is rated Good…

People received support to take their medicines safely. Staff knew how to keep people safe from the risk of harm. Actions had been taken to reduce risks to people’s safety. There were enough staff to keep people safe and meet their needs.

Staff were competent to carry out their roles effectively and had received training that supported them to do so. People were supported to eat freshly prepared meals, and their individual dietary needs were met. People were able to access and receive healthcare, with support, if needed.

At our last inspection, we rated the key question of “Is the home effective?” as requires improvement. This was because although staff knew how to support people to make day to day decisions about their care, the principles of the Mental Capacity Act had not always been followed when some decisions had been made on behalf of people. Although improvements had been made to the environment to help the people who lived there to orientate themselves around Oak Manor, some areas were in need of redecoration and refurbishment. Improvements had been made by the homes management team to address this and an action plan put into place. Sufficient progress had been made, with a timescale for completion of the outstanding work to be done.

People were able to make choices and decisions that affected their daily lives. Staff supported them in the least restrictive way possible; the policies and systems in the home complimented this practice.

Staff were kind and compassionate in the way they delivered support to people. People were treated with dignity and respect. Staff ensured that people were able to have visitors, and enabled people to maintain relationships with relatives and friends who did not live nearby.

People and their relatives were confident that they could raise concerns if they needed to and that these would be addressed.

The manager ensured that the home was well run. Staff were committed to the welfare of people living in the home. The manager ensured they kept links within the local community and people were part of regular events.

Further information is in the detailed findings below.

This inspection was unannounced and took place on 30 March 2016.

At the last inspection in November 2014, we found the provider in breach of two Regulations of the Health and Social Care Act 2008 (Regulated Activities) 2010 in relation to infection control and the environment for people living with dementia. The provider sent us an action plan to say they would be meeting the relevant legal requirements by February 2015. We found that the necessary improvements had been made and that the provider was no longer in breach of these Regulations.

Oak Manor Nursing Home is a care home that provides accommodation and nursing care for up to 61 older people who are living with dementia. On the day of our inspection, there were 58 people living within the home.

There was a manager working at the home who is registered with us. 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 who lived in the home were safe. Risks to their safety had been assessed and actions taken to reduce any risks that had been identified. People received their medicines when they needed them and they received enough food and drink to meet their needs. The staff supported them to maintain their health.

There were enough staff available to meet people’s needs, preferences and to keep them safe. These staff had received appropriate training and supervision to enable them to provide people with effective care.

The staff knew how to support people to make day to day decisions about their care. However, the principles of the Mental Capacity Act had not always been followed when some decisions had been made on behalf of people.

Improvements had been made to the environment to help the people who lived there to orientate themselves around Oak Manor. However, some areas were in need of redecoration and refurbishment.

People were cared for by kind, compassionate and caring staff who knew them well. The staff were polite and treated people with dignity and respect.

People had a choice about how they wanted to live their lives and the staff promoted this. People were encouraged to maintain their independence and to participate in activities that complemented their hobbies, interests and that promoted their wellbeing.

Any concerns raised were dealt with quickly and the staff were happy working in the home. They were supported by a management team who were good leaders and who promoted care that was based on people’s individual needs and choices. Communication within the home was good and therefore, the staff understood their individual roles and responsibilities which contributed to the provision of good quality care.

There were effective systems in place to assess and monitor the quality and safety of the care that was provided to people living at Oak Manor.

We have made a recommendation regarding following the principles of the Mental Capacity Act 2005 when making best interest decisions on behalf of people.

We inspected Oak Manor on 19 November 2014. This home supports people with complex behaviour as a result of their dementia. Many of the people were in receipt of continuing health care funding due to their complex behaviour.

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 and associated Regulations about how the service is run.

Relatives told us one of the things they valued about this home was that staff were able to support their family member throughout the duration of their dementia They were reassured and confident that the staff at the home would be able to manage whatever symptoms their relative developed and they would have their end of life care from familiar people in a familiar setting. Health and social care professionals we spoke with reported that staff managed people’s very difficult and complex physical and behavioural problems well. They told us that they would recommend the home if they had a relative with advanced dementia.

The Care Quality Commission is required by law to monitor the operation of the Mental capacity Act 2005 and Deprivation of Liberty Safeguards, and to report on what we find. We found that staff had a good understanding of this legislation and how to use it effectively it to protect people who could not make decisions for themselves.

Staff were trained and competent to do their job, and there were sufficient numbers on duty to meet people’s needs. We found that people’s health care needs were monitored closely and they were supported to access health care professionals when needed. People were supported to take their medicines as prescribed. People’s challenging behaviour was managed well by staff and they were provided with appropriate stimulation and activity for their cognitive ability. However we found that the provider was in breach of two regulations as aspects of the premises did not meet people’s needs well and not all areas of the home were clean, pleasant and hygienic. Not all interactions between staff and people were respectful or caring. You can see that action we have told the provider to take at the back of the full version of the report.

In November 2013, we carried out an inspection of Oak Manor Nursing Home. We found that the service was not acting in accordance with legal requirements where people were potentially unable to make some of the bigger decisions in their life. We found that the service failed to protect one person from the risks of inadequate nutrition. We also found that the service was not ensuring people were protected from the risks of unlawful or excessive restraint. We told the service to make improvements. In January 2014 we returned to the service to see if they had made these improvements.

We found that the service had put in place decision specific mental capacity assessments for those who required one. These assessments set out the best interest process staff should follow if they found someone was not able to consent to care which would be in their best interest. We found that care planning no longer made reference to people's ability to make decisions and instead referred staff to the assessment of capacity. Staff had undertaken face to face training in the Mental Capacity Act and now demonstrated a much improved knowledge of this.

We observed the lunch time meal service and found that there was a much improved procedure in place to ensure that staff protected people from the risks of inadequate nutrition.

We found that staff were aware they should not be restraining people and that staff had undertaken face to face training in challenging behaviour.

At the time of visit there were 53 people living at Oak Manor, and we looked at the care records for eight of these people.

We found that people using the service or their relatives, were involved in their care planning and decisions about their care. People were involved in making decisions on a daily basis.

We found that the service was not undertaking assessments of people's capacity to make informed decisions. The provider was not acting in accordance with the Mental Capacity Act.

We found that there was appropriate assessment of people’s physical care needs, leading to plans of care and assessments of risk for people using the service. One relative told us, "...I'm very satisfied". Another told us, "...They do exceptionally well".

We found that that the service was not safeguarding people against the risk of unlawful or excessive restraint. Staff were restraining people using the service without being trained to do this, so placing people at risk. On one occasion, staff did not act appropriately to make a safeguarding referral where this would have been appropriate.

We found that staff had training in key subjects relating to providing care to people using the service. However, staff said they would benefit from more training in managing challenging behaviour. Staff had access to regular supervision and annual appraisals were booked for all staff.

We found that the service had a programme of audits to monitor and assess the quality of the service.