We inspected Oakdene on 14 August 2018. The service 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.

Oakdene provides personal care and accommodation for up to 40 people living with mental health needs. At the time of our inspection 38 people were using the service.

At the last inspection in September 2016, the service was rated ‘Good’ in all the key questions. At this inspection, we found the fundamental care standards were not being fully met, resulting in the rating for the service changing to ‘Requires Improvement.’

At the time of our inspection there was a registered manager in place but they were unavailable on the day of the inspection due to being on leave. 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.

Risks associated with people’s needs had not always been effectively assessed, planned for or monitored. Information to guide staff of how to manage risks lacked detail or was not consistently followed.

Some shortfalls were identified in the management of medicines, this was in relation to medicines prescribed to be used ‘as and when required’. Staff were not consistently provided with guidance of the administration of these medicines. Body maps were not routinely used to instruct staff where prescribed creams should be applied and two staff signatures were not used for transcribing hand written entries.

Infection control and cleanliness of the service had been improved. This included new systems for monitoring how infection control measures were met. However, further time was required for these to be fully imbedded and improvements to be sustained.

People were protected from the risk of abuse as far as possible because staff had received safeguarding training and followed the provider’s safeguarding policies and procedures to safeguard people. Staffing levels and skill mix were sufficient at the time of this inspection. The provider had a dependency tool used to review staffing level requirements, staff covered any shortfalls and new staff were being appointed to fill vacancies.

Staff received an induction and ongoing training opportunities to formally review their work, training and development needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the provider’s policies and systems in the service supported this practice. Where people lacked mental capacity to consent to their care and treatment, assessments to ensure decisions were made in their best interest had been completed. The provider was making further improvements to support staff by implementing new documentation to support the assessment of people’s capacity.

People received a choice of meals and their nutritional care needs were known, understood and followed by staff. The staff team worked well with external healthcare professionals when required in meeting people’s health needs. The internal and external environment met people’s individual needs. There was a well maintained and secure garden with a smoking shelter.

Staff were aware of people’s needs, routines and what was important to them. Staff were kind, caring, and they supported people ensuring their privacy, dignity and respect was met. Independence was encouraged and supported. Information about independent advocacy services was available.

People’s care plans were not consistently detailed. Staff were aware of people’s needs but there was a risk new staff, would not have sufficient written informa

We carried out an unannounced inspection of the service on 1 September 2016.

Oakdene provides accommodation and personal care for up to 40 people living with mental health needs. At the time of our inspection there were 38 people living at the service.

Oakdene is required to have 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. At the time of the inspection a registered manager was in post.

People received a safe service. Staff were aware of the safeguarding adult procedures to protect people from abuse and avoidable harm and had received appropriate training. Risks were known by staff and managed appropriately. Accidents and incidents were recorded and appropriate action had been taken to reduce further risks. People received their medicines as prescribed and these were managed correctly.

Staff were recruited through safe recruitment practices. Staff received an induction, training and appropriate support. There were sufficient experienced, skilled and trained staff available to meet people’s needs. People’s dependency needs had been reviewed and were monitored for any changes.

People received sufficient to eat and drink and their nutritional needs had been assessed and planned for. People received appropriate support with their eating and drinking needs and choices were offered and respected. People’s healthcare needs had been assessed and were regularly monitored. The service worked well with visiting healthcare professionals to ensure they provided effective care and support. When concerns were identified about people’s healthcare needs swift action was taken.

The manager applied the principles of the Mental Capacity Act 2005 (MCA) and Deprivations of Liberty Safeguards (DoLS), so that people’s rights were protected. People were asked for their consent before care and support was provided and this was respected.

Staff were kind, caring and respectful towards the people they supported. They had a clear understanding of people’s individual needs, preferences and routines. The provider asked people, relatives and representatives, including visiting professionals to share their experience about the service provided. Feedback given on ways to improve the service was acted upon.

People were involved as fully as possible in their care and support. There was a complaint policy and procedure available and confidentiality was maintained. People had access to independent advocacy services should they have required this support. There were no restrictions on people visiting the service.

People were supported to participate in activities, interests and hobbies of their choice and had no restrictions placed upon them. People accessed the community independently and some people were supported to develop their independence and life skills with the goal to live more independently in the future.

There were systems in place for the registered manager to ensure all areas of the service were regularly checked and the overall quality of care was monitored by the director of operations on behalf of the provider.

We found people who used the service did not always consent to their care and treatment, but we saw that care and treatment was planned and most people were satisfied with the help they received. One person told us, "They (staff) come and talk to me a lot and I go out with one of them to the shop most days." We saw people were taking part in various activities.

We toured the premises and saw all shared areas and a sample of bedrooms. We found that appropriate standards of cleanliness and hygiene were not maintained in all areas. Two people shared their concerns with us about the lack of cleanliness in a shower room and we found other areas where adequate cleanliness was not maintained.

We found the premises were not adequately maintained. There were some long term problem areas that had not been rectified and no maintenance had been carried out at all for the last five weeks. We were particularly concerned about people who had no heating in their bedrooms, but action was taken the following day to provide some heating for them.

The people we spoke with told us the staff were very kind and knew how to help them. We saw there were effective recruitment and selection processes in place, so that people were cared by suitable staff.

In this report the name of a registered manager appears who was not in post and not managing regulatory activities at this location at the time of the inspection. Their name appears because they were still on our register at the time.

People had the opportunity to be fully involved in planning the care and support they needed. People that used the service told us the staff were very respectful and they liked the individual one to one support they had. They said they could choose what they did at all times.

People who used the service told us they received the support they needed. One person told us, "They come and talk to me when I need support." We saw staff talking individually with people in private. Other people were engaged in activities in the home or out in the community.

All the people we spoke with told us that they liked staff to look after there medicines to keep them safe. One person said, "They always give me my tablets when I need them."

Staff we spoke with told us they felt supported by the provider company and by the manager. We saw that regular training was provided for all staff.

People were consulted about the service in regular group meetings and individually. The registered manager maintained files of information that showed that he was continually monitoring the service.

Prior to our inspection we reviewed all the information we had received from the provider. We used a number of different methods to help us understand the experiences of people who used the service. We spoke with six people who used the service. We spoke with the manager and a director of the service and two support staff. We also looked at some of the records which included care plans and quality systems.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

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

Is the service safe?

People told us they felt safe.

We saw that the home was clean and well maintained and there were systems in place to monitor the cleanliness and infection control in the home.

People were effectively assessed to identify the risks associated with nutrition and hydration. A person who used the service told us, “The food here is brilliant.”

There were systems in place to protect the rights of people who used the service that were unable to give consent to care and treatment or they refused.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Staff were able to describe the circumstances when an application should be made and knew how to submit one. This meant that people were only deprived of their liberty when it was in their best interests and there were no other less restrictive ways to keep them safe and well.

Is the service effective?

We looked at four care plans which showed people who used the service received personalised care and treatment that was centred on their needs. The care plans were written in a way that reflected their preferences, interests, aspirations and diverse needs.

There were arrangements in place to speak to people about what was important to them. People who used the service told us they were safe and being cared for. Comments included, “They know me here.” And, “It’s brilliant here, best place I have been. I love the atmosphere, we can do the activities we like and choose. I have a problem with my knee and this is sorted. I see the chiropodist; they come here to treat me. I am very satisfied.”

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, “I am always asked what I want, I have choices, nobody makes me do anything I don’t want to do.”

Our observations of the care provided, discussions with people and records we looked at told us that individual wishes for care and support were taken into account and respected.

Is the service responsive?

Care records we looked at showed that people using the service had access to independent advocates. This meant that people who used the service could be assured that the staff were respecting their right to have an advocate to assist them in understanding their options and help them to make an informed decision.

People told us and we observed, that they were able to participate in a range of activities both in the home and in the local community.

People told us they were involved in reviewing their plans of care when their needs changed. Records we saw showed that when people had an accident their care plan was reviewed to ensure that any risk to their health and safety was minimised.

Is the service well-led?

The provider had systems in place to make sure people who used the service were not harmed as a result of the care they received. Care plans and risk assessments were reviewed regularly. The manager regularly audited a number of care plans to ensure staff kept them up to date. Infection control practices and environmental risk assessments ensured the safety of the premises.

Information from the analysis of accidents and incidents had been used to identify changes and improvements to minimise the risk of them happening again.

People’s personal care records, and other records kept in the home, were accurate and complete.