This inspection took place on 26 and 27 September 2018 and was unannounced.

The last inspection of the home was carried out in July 2017. At that inspection the home was rated requires improvement but no breaches of regulations were found. We found that the home had made considerable improvements in the quality of care provided to people but these improvements had not been in place long enough to demonstrate they were able to maintain them. At this inspection we found improvements had been sustained and we have rated the service good.

Since the last inspection the provider has changed the name of the home from Sherford Manor to Oake Meadows Care Home. All other parts of the registration remain the same.

Oake Meadows 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. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Oake Meadows is registered to accommodate up to 105 people. However, the provider has informed us they are not able to accommodate more than 80 people as some rooms previously designed as double rooms are now for single occupancy.

Oake Meadows Care Home specialises in the care of older people living with dementia. The home is divided into three separate units - Rose provided care to people who had personal care needs, Redwood and Sutherland cared for people who had nursing care needs. At the time of the inspection an upstairs area of the building was closed off and there were 54 people living at the home.

There is a registered manager in post who had been at the home for approximately 17 months. 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 registered manager was part of a management team who had worked with the provider to plan and action continual improvements to the care and support people received. They involved people, visitors and staff to make sure improvements made were in accordance with people’s wishes and needs. One visitor told us, “I see improvements every week. I would recommend this home to anyone now.”

Improvements had been made to make sure care provided was person centred and respected people’s lifestyle choices. People made choices about their daily routines as far as they were able. One member of staff said, “It’s much better than when I started here. There’s a nicer atmosphere and we try to give people choices about everything.”

Improvements had been made to the environment to make sure it was comfortable and safe for people. Specific colours had been used to provide an environment which supported people living with dementia and there was some signage to help people to orientate themselves and move around independently. Further improvements were planned to make sure the environment was interactive and supported people living with dementia.

People received safe care and looked relaxed and happy with the staff who supported them. Where individual risks were identified, action was taken to minimise these risks whilst encouraging people to maintain their independence.

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 supported this practice. Staff worked in accordance with up to date guidance to make sure people’s legal rights were protected.

People were cared for by staff who were kind and patient. One person said, “They are all kind and caring.” Another person told us, “Staff are smiley.” Throughout the inspection we saw staff showed consideration and affection for the people who lived at the home.

Assessments

This inspection was unannounced and took place on 11 and 12 July 2017.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Sherford Manor Care Home specialises in providing care to people who are living with dementia and/or who have mental health needs. The home is registered to provide accommodation with nursing care to up to 105 people. Because of the configuration of the home, the maximum number of people they accommodated was 77. At the time of this inspection there were 50 people living at the home.

Sherford Manor Care Home consists of four separate units. The Rose and Sunflower units provided care and support for people who required assistance with personal care needs. Redwood and the Sutherland Unit provided nursing care. People were living with dementia which meant some people were unable to tell us about their experiences of life at the home. We therefore used our observations of care and our discussions with staff to help form our judgements. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We looked at seven care plans and spoke to 14 people and three visitors. We also spoke to 15 members of staff. The new manager and a peripatetic manager were available throughout the inspection. The nominated individual and provider's regional manager were available on the second day of the inspection.

We carried out a comprehensive inspection of this service on 7 and 8 December 2016. Breaches of legal requirements were found as people were not protected from receiving unsafe care and treatment and were not protected from avoidable harm. People did not receive care and treatment which met their individual needs and preferences and the service failed to ensure people were provided with opportunities to make choices in their day to day lives. There were ineffective quality assurance systems in place to make sure any areas for improvement were identified and addressed.

After the comprehensive inspection, we used our enforcement powers and served three Warning Notices on the provider on 22 December 2016. These are formal notices which confirmed the provider had to meet the legal requirement in respect of safe care and treatment and person centred care by 30 January 2017. They had to meet the legal requirement in respect of effective quality assurance systems/good governance by 20 June 2017.

We undertook a focused inspection in February 2017 to check the provider had taken action to meet the legal requirements relating to the two warning notices we issued for safe care and treatment and person centred care. Although we found some improvements had been made the provider still failed to fully meet the requirement of the warning notice to become compliant by 30 January 2017. This meant the legal requirements had not been fully met; the provider had therefore not fully complied with our Warning Notices.

Following our last inspection in December 2016 we placed the service in special measures because the overall rating for the service was inadequate. Following the focused inspection in February we did not change the rating for the service because some parts of the warning notices were not met and because further time was needed to demonstrate the improvements made could be sustained.

At this inspection we found the issues in the three Warning Notices had been met; the provider has therefore fully complied with our Warning Notices.

There was no registered manager in post, however a new manager had been employed and was in the proces

This focused inspection took place on 20 February 2017. It was carried out by two adult social care inspectors and was an unannounced inspection.

Sherford Manor specialises in providing care to people who are living with dementia and/or who have mental health needs. The home is registered to provide accommodation with nursing care to up to 105 people. Given the configuration of the home, the maximum number of people they accommodated was 77. At the time of this inspection there were 63 people living at the home. Sherford Manor consists of four separate units. The Rose and Sunflower units provided care and support for people who required assistance with personal care needs. Redwood and the Sutherland Unit provided nursing care.

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. The registered manager was on long term leave so was not available for this inspection or the previous inspection. The home was being managed by the provider’s regional manager and three of the provider’s peripatetic managers.

We carried out a comprehensive inspection of this service on 7 and 8 December 2016. ¿Breaches of legal requirements were found as people were not protected from receiving unsafe care and treatment and were not protected from avoidable harm. People did not receive care and treatment which met their individual needs and preferences and the service failed to ensure people were provided with opportunities to make choices in their day to day lives. There were ineffective quality assurance systems in place to make sure ¿any areas for improvement were identified and addressed.¿

After the comprehensive inspection, we used our enforcement powers and served three Warning ¿Notices on the provider on 22 December 2016. These are formal notices which confirmed the ¿provider had to meet the legal requirement in respect of safe care and treatment and person centred care by 30 January 2017. They had to meet the legal requirement in respect of effective ¿quality assurance systems/good governance by 20 June 2017.¿

We undertook this focused inspection to check the provider had taken action to meet the legal requirements relating to the two warning notices we issued for safe care and treatment and person centred care. Therefore this ¿report only covers parts of three of the five key questions we report on; Is the service safe? Is the service effective? And Is the service responsive? The ratings for the three questions and the overall rating for the service therefore remains unchanged. The requirement notices issued at the last inspection will be followed up at our next inspection, so are not included in this report. You can read the report from our ¿last comprehensive inspection, by selecting the 'all reports' link for on our website at ¿www.cqc.org.uk.

We found some action had been taken to improve the safety of the people who lived at the home. Care plans for people who had diabetes, those who were at risk of choking and those who were at high risk of falls had be reviewed and re-written so they provided more detailed information about how to minimise risks. We observed people were supported by staff in accordance with their plan of care. People had access to the specialised equipment they required.

Some action had been taken to ensure people received care which met their assessed needs and preferences. The majority of the care plans we read now contained information about a person’s life history and preferred daily routine. This meant staff had information which helped them support people This helped staff to understand what was important to people and of the things they liked to do. For example one person had certain prefere

This inspection took place on 7 & 8 December 2016. It was carried out by three adult social care inspectors.

At the last inspection carried out over three days in March 2016 we rated the service as requiring improvements and there were two breaches of our regulations which related to the failure to notify us of significant incidents and good governance. At this inspection we found that some action had been taken to improve the service and meet the actions set at the previous inspection. However; we found further improvements were needed.

Sine our last inspection we received a number of concerns from whistle-blowers and the local authority safeguarding team. Since then the provider has been meeting with the local authority and the clinical commissioning group and concerns were being investigated by the local authority. Investigations are on-going.

Sherford Manor specialises in providing care to people who are living with dementia and/or who have mental health needs. The home is registered to provide accommodation with nursing care to up to 105 people. The manager informed us that, given the configuration of the home, the maximum number of people they accommodated was 77. At the time of this inspection there were 63 people living at the home. Sherford Manor consists of four separate units. The Rose and Sunflower units provided care and support for people who required assistance with personal care needs. Redwood and the Sutherland Unit provided nursing care. People were living with dementia which meant some people were unable to tell us about their experiences of life at the home. We therefore used our observations of care and our discussions with staff and visitors to help form our judgements. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

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. The registered manager was not available for this inspection. The home was being managed by two of the provider’s peripatetic managers who were supported by one of the provider’s regional managers.

Prior to our inspection we received concerns about staffing levels at the home being insufficient to meet the needs of the people living there or to keep people safe. The peripatetic manager (the manager) told us staffing levels had been reviewed and increased and were now sufficient to meet people’s needs and keep people safe. The home used a high level of agency staff to cover vacancies and we were informed the home was actively recruiting permanent staff to reduce agency usage. No concerns were raised with us at this inspection about staffing levels or of the ability of staff to meet people’s needs with the number of staff available.

People who were able told us they felt safe living at the home however; individual risk assessments and care plans did not fully protect people from the risk of receiving unsafe or inappropriate care. For example one person’s care plan told us they were diabetic and they should not receive a diet containing high levels of sugar. Daily records and our observations showed the person had been given foods which were very high in sugar. Another person had been assessed as being at high risk of choking and required oral suction to be available when eating. We observed the person being assisted with their meal however the suction machine was unassembled in a box in the nursing office meaning it was not readily available. We read the care plan for one person who had been assessed as being at high risk of falls. We observed the person mobilising with a wheeled Zimmer frame however

This inspection was unannounced and took place on 14, 15 and 16 March 2016.

Sherford Manor Care Home is registered to provide care and accommodation for up to 105 people. However, the registered manager confirmed they only accommodated 77 people when full. The home specialised in the care of older people living with dementia. At the time of the inspection there were three units, with a fourth planned for people who were more mobile and independent. Rose unit provides residential and not nursing care. Redwood and Sutherland units both provide nursing care; registered nurses on these two units provide support and advice for the care staff on Rose.

At the last inspection carried out in April 2015 we identified concerns with some aspects of the service and care provided to people. The service was found to be in breach of two of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following the inspection the provider sent an action plan to the Care Quality Commission (CQC) stating how and when improvements would be made. At this inspection we found that action had been taken to improve the service and meet all the compliance actions set at the previous inspection. However; we found further improvements were needed.

At the last inspection we found people were not always protected against risks to their health and safety because some risks had not been considered or recorded. People’s care plans did not always reflect the care they received. At this inspection we found people’s care plans contained risk assessments and clearly reflected the care and support they needed.

There is 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.

Before this inspection concerns had been received about some areas of care provided in the home. These concerns included safeguarding concerns around the undignified treatment of people living in the home. They also involved people’s wishes and preferences not being recognised. People were got out of bed very early in the morning, whether they wished to or not. On receiving these concerns the registered manager had acted immediately and with the support of senior staff had carried out spot checks in the home throughout the day and night. The concerns and how they could improve had been discussed with staff at team meetings and supervision. The registered manager had taken further action and worked in partnership with relevant authorities to make sure people were protected.

Registered managers and providers are required to send statutory notifications to the Care Quality Commission (CQC) when a significant event occurs. One type of significant event is when a person living in the home experiences an accident that results in a visit to the accident and emergency department or requires medical intervention. Another is when a safeguarding incident occurs. We found the registered manager and person delegated by the registered manager to send notifications to CQC had not carried out the role correctly. They had failed to inform CQC of two falls and one safeguarding incident. The content of a safeguarding incident that was sent was not recorded correctly.

We found although there were quality audit systems in place they had failed to identify some shortfalls. For example the registered manager had failed to pick up issues such as an out of date list of staff and people living in the home provided in the emergency grab file. The lack of a dementia friendly environment in the new unit. They had also failed to identify the failure to send notifications to CQC and the incorrect monitoring of accidents/incidents by a delegated member of staff. However we found the audits

At our last inspection on 18 July 2013 we issued a compliance action for one of the essential standards. This inspection was to follow up on the area of non- compliance with the health and social care regulations.

We visited Redwood, one of the three units in the home. Redwood provided nursing care for people, most of whom had a dementia. Most people were not able to tell us about their experiences in the unit. We met one person’s relative who told us they were very pleased with the care given and the support they received themselves.

We spoke with a doctor who visited regularly who said they found staff to be caring and concerned about the people who lived in the home. We observed care for a short period at lunch time. We saw people looked relaxed and cared for. We saw staff assisted people with their meals in a patient and kind manner.

We had asked the home to improve the way in which it recorded people's care needs and to monitor people's weights more carefully. Action had been taken and it was now clear how much people weighed. We could see any possible reasons for weight loss and any actions that had been taken by staff.

We looked at four people’s care records in detail and checked other fluid and food charts. We spoke with three members of staff.

We visited the three units in the home. Rose provides residential care. Redwood provides nursing care. The Sutherland Suite provides care for people who are active and have a range of care needs. People who were able to express an opinion told us that they were able to make choices about aspects of their daily lives. We met people's families who told us that they were always welcome in the home and were able to be involved in their relative's daily life. One relative told us “We have no worries here. They always keep us informed.”

We spent most of the inspection observing care and talking to people who lived there. We saw that most people looked relaxed and cared for. We saw that staff provided care in a patient and kind manner. People who were able to talk to us about the care they received told us they were satisfied. We spoke with people on Rose unit where people received residential care. One person said “I have been here for just over a year now. I wouldn’t like to be anywhere else.” Another person told us “We are fine here. It is very nice, the staff are kind.”

We inspected the infection control in the home. We saw the home was clean and well maintained. We found there were safe systems in place to administer medication to people.

We have asked the home to improve the way in which it records people’s care needs and to monitor people’s weights more carefully. The manager has increased the number of care plans being monitored since the inspection.

People who were able to express an opinion told us that they were able to make choices about aspects of their daily lives.

One person told us “I have been happy here.” They told us about their friend who ate lunch with them and about their pleasure in choosing their own clothes and jewellery.

During our visit we observed that people moved freely around the home. People were able to go to their bedrooms and communal areas when they wished. On Rose unit we spoke to one person in their own room who told us “I love it here. Staff are lovely. Sometimes it gets too noisy. I love this room. I don’t like a crowd.”

One person living in the home had brought their dog with them. They were able to tell us how much they enjoyed going out for a walk with a carer and the dog.

Many people in the home were not able to tell us how they felt about the standard of care that they received.We saw that when staff approached people often smiled or reached out their hand. A visitor to the home told us “They know X well. They know how they like their tea. I do not worry about them when I am not there. I know they are safe.”

People told us that staff were “very good”. One person said “They talk to me all the time. Most of them are cheerful. We have a laugh.”

We saw that staff interactions with people throughout the home were skilled and confident.

We saw that people looked relaxed and free from anxiety. We saw that when one person became upset a member of staff spent time with them and tried to try and find out why they were anxious and offered a diversion.

This inspection took place on 27 and 29 April 2015 and was an unannounced inspection.

At the last inspection carried out on 24 and 25 July 2014 we identified concerns with some aspects of the service and care provided to people. The service was found to be in breach of five of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. Following the inspection the provider sent an action plan to the Care Quality Commission (CQC) stating how and when improvements would be made. At this inspection we found that action had been taken to improve the service and meet all the compliance actions set at the previous inspection. However; we found further improvements were needed.

Sherford Manor can accommodate up to 105 people. There are four units within the home; Rose provides residential care to older people who do not have nursing care needs. Sutherland and Redwood provide nursing care to older people who are living with dementia and the Corner House unit specialises in providing end of life nursing care to older people. The home is purpose built and all bedrooms are for single occupancy.

There is 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.

Care plans contained risk assessments which helped to minimise risks to people. Examples included risks which related to assisting people to move or mobilise, reducing risks to people who were at high risk of malnutrition and pressure damage to their skin. However; risks had not always been considered for the use of bedrails or for a person who went out independently. This meant there was no information for staff about potential risks to the individual or how risks could be minimised.

People received their medicines when they needed them. One person we spoke with said “I have a lot of pain but the nurses always make sure I get my pain killers. They also rub a pain relief gel on my shoulder twice a day which helps.” Another person told us “I always get my tablets on time. They are very good at that.” Procedures for checking expiry dates on clinical items required improvements to make sure they remained safe to use.

Staff knew about the preferences of the people they supported. The care plans we looked at contained life histories and information about people’s preferences. Staff had a good understanding about the assessed needs of people however; care plans had not always been updated to reflect people’s needs when they had changed.

People were supported to have enough to eat and drink. The lunchtime experience for people varied depending on which unit they lived. The lunch time experience for people who lived on the dementia nursing units (Sutherland and Redwood) needed to be improved. People were not always supported to make an informed decision about what they wanted to eat and drink. Meals were plated by staff and people were not supported to be as independent as they could be. People on the Redwood unit were not provided with opportunities to enjoy a sociable mealtime experience.

Staff were very positive about the leadership in the home. One member of staff said “The deputy manager is really good. If he doesn’t know something, he’ll find out. He’s the go to guy.” Another member of staff told us “I like the manager. She always makes a point of seeing how you are.”

People told us they felt safe at the home and with the staff who supported them. One person said “I do feel safe. Nobody has touched me. It’s quite nice staying here and I am quite happy here.” Another said “It’s very good and I don’t feel alone.”

There were sufficient staff on duty to support people. There was a good staff presence and people did not wait long for assistance. Call bells were answered quickly. The people we spoke with did not raise any concerns about the availability of staff. One person told us “I had to use my call bell last night and a carer came straight away. They are very good. You never have to wait for long.” Another person said “There’s always someone about to help you. I have no concerns.”

Staff spoke about people in a caring and compassionate manner. We saw affectionate embraces from people towards the staff and we heard staff chatting to people about their personal interests.

Staff sought people’s consent before assisting them and we heard staff offering and respecting people’s wishes. Staff knew about the procedures to follow where people lacked the mental capacity to make decisions about the care and treatment they received. This meant people’s legal rights were protected.

People could see a doctor and other health care professionals when they needed to. Examples included speech and language therapists, dieticians, opticians and chiropodists.

The home had achieved the National Gold Standard Framework. This is a comprehensive quality assurance system which enables care homes to provide quality care to people nearing the end of their life

The home offered a varied programme of activities for people. There were in-house activities, outside entertainers and regular trips out.

There were systems in place to monitor and improve the quality of the service provided. Whilst improvements had been made we have not revised the rating for this key question; to improve the rating to ‘Good’ would require a longer term track record of consistent practice.

We will review our rating for Well-led at the next comprehensive inspection.

The service was in breach of two 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 this report.