We inspected the service on 28 December 2017. The inspection was unannounced. Oakdene Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

Oakdene Care Home is registered to provide accommodation, nursing and personal care for 35 older people. There were 31people living in the service at the time of our inspection visit.

The service was operated by a company who was the registered provider. The company was run by a sole director. 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. In this report when we speak about both the company and the registered manager we refer to them as being, ‘the registered persons’.

At the last inspection on 14 April 2016 the service was rated, ‘Requires Improvement’. Although there were no breaches of the regulations we found that improvements were needed to ensure that people reliably benefited from receiving safe and responsive care. This was because there were not always enough care staff on duty, people did not always receive meals that met their expectations and care was not consistently provided in a person-centred way. In addition, there were shortfalls in the arrangements that had been made to ensure that the service was well led. In particular, quality checks had not always been completed in the right way and this had resulted in the persistence of the concerns we had noted.

At the present inspection the service was, ‘Good’. We found the individual concerns we had previously raised had been addressed. Suitable quality checks were being completed and had ensured that there were enough care staff on duty. In addition, people told us that they enjoyed their meals and we saw that they received person-centred care.

Our other findings were as follows. There were systems, processes and practices to safeguard people from situations in which they may experience abuse including financial mistreatment. Risks to people’s safety had been assessed, monitored and managed so they were supported to stay safe while their freedom was respected. This included occasions when people became distressed and needed support in order to keep themselves and others around them safe. In addition, medicines were managed safely. Background checks had been completed before new nurses and care staff had been appointed. Furthermore, there were robust arrangements to prevent and control of infection and lessons had been learned when things had gone wrong.

Nurses and care staff had been supported to deliver care in line with current best practice guidance. People were helped to eat and drink enough to maintain a balanced diet. In addition, suitable steps had been taken to ensure that people received coordinated and person-centred care when they used or moved between different services. Also, people had been supported to live healthier lives by having suitable access to healthcare services so that they received on-going healthcare support. Furthermore, people had benefited from most of the accommodation being adapted, designed and decorated in a way that met their needs and expectations.

People were supported to have maximum choice and control of their lives and care staff supported them in the least restrictive ways possible. The policies and systems in the service supported this practice.

People were treated with kindness, respect and compassion and they were given emotional support when needed. They had also been supported to express their views and be actively involved

The inspection took place on 14 April 2016 and was unannounced.

Oakdene Care home is registered to provider personal and nursing care for 35 people who are over the age of 65. It is situated in a grade 2 listed building in the centre of Sleaford. There were 34 people living at the home on the day we visited.

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.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS were in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect themselves. The registered manager had made appropriate requests for people to assessed under the DoLS and all the care provided minimised the restriction on people. Where people were unable to make decisions for themselves processes were in place to ensure decisions were made in the person’s best interest.

Systems were in place to identify the number of staff needed to support people and to ensure that staff employed has the appropriate qualifications and skills to meet people’s needs. However, staffing levels at night did not support people to receive care in a timely manner. Staff were supported to maintain and improve their skills through ongoing training and support from the nurses and the registered manager. Checks were completed before staff started to work in the home to ensure that they were of good character and safe to work with the people living at the home.

Risks to people while receiving care had been identified and care was planned to keep people safe and healthy and where need equipment was in place and used safely. Risks around people being able to eat safely and maintain a healthy weigh were assessed and advice from healthcare professionals sought when appropriate. However, there was a lack in the variety of food offered to people. In addition information related to fluid intake was not immediately acted upon following a person’s discharge from hospital. Medicines were safely managed by staff and available to people when needed.

Staff were kind and courteous when speaking to people. However, we saw at times that staff were focused on the task instead of delivering person centred care and did not always take account of people’s feelings or need. In addition the care provided was not always delivered in a timely fashion.

Care plans had been developed with people’s involvement and accurately reflected their individual needs. They recorded the care needed to help people to retain and improve their skills in caring for themselves. However, call bells were cancelled by staff and people experienced delays in staff returning to provide the care they rang to receive. People were engaged by a well developed activities programme which supported them to be entertained with crafts, events and visits out. People who were cared for in their room were also supported to access a variety of entertainments.

The provider has systems in place to monitor the quality of care they provided to people living in the home and took appropriate action when they identified areas of concern. People were able to offer their views on the care they received through meetings and surveys and the provider listened to their concerns and worked to resolve them.

We used a number of different methods to help us understand the experiences of people who used the service, because some of the people who used using the service had complex needs which meant they were not all able to tell us their experiences. These included talking with three people who used the service and two of their relatives. We also spoke to seven members of staff, the registered manager and a visiting healthcare professional. We looked at records held by the provider. We also reviewed information we had received from other sources.

On the day of our visit we toured the building and observed the interactions between staff and people who lived at Oakdene.

People were provided with information about what they could expect while living at Oakdene and were encouraged to contribute their views about how the service ran and could be improved.

We found that the environment was very clean and bright, yet homely and well adapted to meet the needs of the people who lived there.

Staff were friendly and professional and supported people sympathetically whilst they helped them to maintain their dignity and respect. We found the staff very caring.

People told us they were well cared for and felt safe. They said they had sufficient food and drink to meet their needs and food was of good quality.

We saw that the provider was responsive and met people’s changing support needs.

The provider had in place a suitable process for ensuring there were sufficient numbers of suitably trained and experienced staff to meet people’s needs.

We have judged that the home was well led and managed by senior staff and the owners who were well regarded by other members of the staff team and the people who lived at Oakdene.

We used a number of different ways to help us understand the experiences of people who used the service. This was because some people had complex needs which meant that they were not able to tell us about their experiences.

Prior to our visit we reviewed all the information we had received about the service. During the visit we spoke with eight people who used the service, two relatives and one visitor. We also spoke with four members of the staff team, the registered manager and one of the owners of Oakdene Care Home.

We looked at some of the records held in the service including the care files for four people. We conducted a walk around of the home.

People who used the service were supported to make their own decisions where they were able to do so. We saw staff asking people for their views and preferences. One person said, " The staff don't do anything until they've asked. They show the utmost respect."

The provider had taken action to enure that vulnerable people were protected from abuse and were safe. One person living at Oakdene said, " Of course I'm safe. If I felt any differently I wouldn't be here would I ?"

The building was clean and odour free. A visiting relative told us, " I used to be in the cleaning business. This place is clean."

Members of the staff team that we spoke with told us that they felt well supported and had the right training to deliver good quality care.

We spoke with five people who were living at the home. They told us, “I’m being well looked after, the food is very good.”

Another person said, “The staff know what you like, they are all very kind,” and, “I’ll admit the food is good, it’s all good really.”

We spoke with two relatives. One told us, “I’m happy with the care my Mum is getting, I’ve no complaints.” Another relative had concerns that staffing levels are too low and staff only get to provide people’s basic care needs. She also told us that she was concerned that the people who sat in the conservatory during the day time were not being properly monitored as staff didn’t regularly check on people.

We spoke with a nurse who was visiting the service, she told us, “As far as I can see people are being well looked after. I have no concerns.”

Every one we spoke with told us their care needs were fully met and staff told us they had enough time to meet people’s needs. We did identify issues in relation the lack of monitoring of people who sat in the conservatory and have made a compliance action as people’s safety was not being fully protected.