This inspection took place on 24 April 2017 and was unannounced. When the service was last inspected in January 2016 we found four breaches of the regulations of the Health and Social Care Act 2008. The breaches related to staffing, safe care and treatment, good governance and person-centred care. These breaches were followed up as part of our inspection.

Oakfield Care Home is registered to provide accommodation and nursing care for up to 28 people. At the time of our inspection there were 19 people living at the service.

A registered manager was not in post at the time of inspection. 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. A manager has recently been appointed and they told us that they intend to process their registered manager’s application.

People's rights were not consistently upheld in line with the Mental Capacity Act (MCA) 2005. This is a legal framework to protect people who are unable to make certain decisions themselves.

Staff were not consistently supported through a regular supervision programme. Supervision is where staff meet one to one with their line manager. Since their appointment the manager has introduced a regular programme of supervision. The supervision matrix identified that the majority of staff had received a supervision in April. New staff undertook an induction and mandatory training programme before starting to care for people on their own.

At our previous inspection the provider was not consistently responsive to people’s needs. The quality and content of care plans was variable. Although some were well written, with clear guidance for staff to follow, this was not consistent. Care plans were not consistently written in conjunction with people or their representative and people had not signed their care plans to indicate their agreement. Although some care plans required further development in relation to catheter care we found sufficient improvements had been made to care plans.

At our previous inspection the provider was not deploying sufficient numbers of staff to ensure they could meet people’s care and treatment needs. Although we received mixed comments about staffing levels we found sufficient improvements had been made. Staffing levels were in the main maintained in accordance with the assessed dependency needs of the people who used the service.

At our previous inspection risk assessments relating to the health, safety and welfare of people were not sufficiently detailed to mitigate potential risks to the person. At this inspection we found sufficient improvements had been made. Where risks had been identified, care plans detailed the steps staff should take in order to keep people safe.

At our previous inspection we found there were ineffective governance systems in place to monitor health and safety and the welfare of people. At this inspection we found sufficient improvements had been made. A full time maintenance person has been appointed. Regular maintenance audits relating to fire safety records, legionella, water temperatures, maintenance of safety equipment, gas safety, boilers, call systems, portable appliance testing (PAT) and window restrictors are now undertaken.

Arrangements were in place for reporting and reviewing accidents and incidents. This included auditing all incidents to identify any particular trend or lessons to be learned.

Medicines were managed safely. We observed part of a medicines round and the nurse administering the medicines knew people, their medicines and why they had been prescribed them.

People’s nutrition and hydration needs were effectively managed. Care plans contained nutritional assessments and where risks had been identified specialist advice

This inspection took place on 18 January 2016 and was unannounced. When the service was last inspected in February 2014 there were no breaches of the legal requirements identified.

Oakfield Care Home is registered to provide accommodation and nursing care for up to 28 people. At the time of our inspection there were 26 people living at the service.

There was a registered manager in post who was currently working their 3 months’ notice. 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 regional support manager told us that they are currently undertaking a recruitment drive to appoint a new manager.

The provider was not deploying sufficient numbers of staff to ensure they could meet people’s care and treatment needs.

Risk assessments relating to the health, safety and welfare of people were not effectively managed. Staff did not have appropriate guidance in place to mitigate potential risks to keep the person safe.

There were ineffective governance systems in place to monitor health and safety and the welfare of people.

The service was not consistently responsive to people’s needs. The quality and content of care plans was variable. Although some were well written with clear guidance for staff to follow, this was not consistent. Care plans were not consistently written in conjunction with people or their representative and people had not signed their care plans to indicate their agreement.

People spoke positively about the staff. We observed that people were treated with kindness and compassion by the staff. Staff were not always aware of issues of confidentiality and at times did speak about people in front of other people.

A range of checks had been carried out on staff to determine their suitability for the work. Staff were supported through an adequate training and supervision programme. Staff we spoke with demonstrated a good understanding of how to recognise and report suspected abuse. Staff were supported through an effective training and supervision programme.

People’s rights were being upheld in line with the Mental Capacity Act 2005. This is a legal framework to protect people who are unable to make certain decisions themselves. We saw information in people’s support plans about mental capacity and Deprivation of Liberty Safeguards (DoLS). DoLS applications had been applied for appropriately. These safeguards aim to protect people living in care homes and hospitals from being inappropriately deprived of their liberty.

People had their physical and mental health needs monitored. All care records that we viewed showed people had access to healthcare professionals according to their specific needs.

Relatives were welcomed to the service and could visit people at times that were convenient to them. People maintained contact with their family and were therefore not isolated from those people closest to them. People were encouraged to provide feedback on their experience of the service.

We found four breaches 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.

We conducted a follow up inspection to check the provider had achieved compliance. On our previous visit we set compliance actions because the provider was not fully meeting the Essential standards of quality and safety. We found there were not enough qualified, skilled and experienced staff to meet people's needs. The provider sent us an action plan which stated compliance would be achieved by 31 December 2013.

The six people we spoke with told us staffing levels had improved since our last visit. One person said “everything is wonderful the staff are really good. There is an occasional day when they are short.” Another person told us “sometimes it seems ages we have to wait for attention. They do their best.” The third person we spoke with said staffing levels had improved we were told “sometimes we have to wait. At night they are pretty good.”

The registered nurse (RN), one senior and two care assistants said there had been improvements in staffing levels. One member of staff said “staffing levels are ok. They try and cover sickness but it’s harder when staff go off sick.” We were told it was difficult to cover for staff that had rung in sick unexpectedly just before their shift began. Another member of staff said “staffing levels are much better. There is usually two staff on each floor and more staff are being interviewed to increase the staffing levels.”

When shifts needed cover existing and agency staff were used. The rota in place showed the manager took steps to maintain staffing levels. We saw bank and agency staff were used to cover shifts.

Systems to monitor staff performance were in place to ensure they were competent to meet people’s needs. The matrix in place showed staff had an appraisal and individual supervision in January 2014.

The purpose of our visit was to follow up on shortfalls we identified in our previous inspection. These shortfalls related to three areas; care and welfare of people, cleanliness and infection control and staffing levels. The provider sent us action plans to show how they intended to address these concerns.

During this inspection we found improvements had been made. We spoke with five people and six relatives. One person told us “I like it all.” We observed staff spoke kindly with people and were busy throughout the providing care and support.

We looked around all areas of the home and at equipment to check for cleanliness and how infection control was being managed. We observed communal areas and people’s bedrooms were clean and tidy. The manager told us new cleaning equipment had been purchased and showed us records of cleaning audits.

During this inspection we found the numbers of people living at the home had increased and staffing levels had remained the same. People told us they often had to wait for care and relatives told us they did not think there were enough staff to meet people’s needs.

We spoke to seven staff, five people who used the service and three relatives. People told us their permission was sought before their care was provided. We saw from care records where people were not able to make decisions for themselves staff consulted with family and other health care professionals to work in their best interests.

People and their relatives said they were satisfied with the care provided. We observed staff were caring and patient. We saw those care plans and risk assessments which were in place were reviewed regularly and were updated when people’s needs changed. Some care records did not have plans to support all care needs. Care plans did not contain appropriate detail to enable staff to provide safe, effective care .

Staff were knowledgeable about their role and responsibilities with regards to infection control. We found some areas of the home had not been cleaned effectively. People's equipment was not clean.

Relatives told us staff contacted visiting health care professionals promptly when they had concerns about a person's health. Staff maintained appropriate records of health professional visits.

There were not enough qualified, skilled and experienced staff to meet people's needs.

There were 23 people living at Oakfield on the day we carried out our inspection.

We met 12 people who used the service and three visitors during our inspection. We also met the regional manager, two registered nurses and three support workers.

People told us how they were supported by the staff team at Oakfield.

We were told “I think it’s great, the management are very intelligent”. “The food is good, they are respectful and we have nothing to complain, about”. “I would certainly recommend Oakfield to other people”. “Sometimes the staff have been a bit pressured”.

We saw people were properly supported by staff with their different nursing and/or personal care needs. We saw that care plans supported care practices, with up to date information to guide staff to give people the care they needed.

People were being helped and supported by staff who had an insight and up to date understanding of their range of nursing and personal care needs.

People felt safe and that they were treated with good manners and respect by the staff at Oakfield. There were effective systems in place to protect people from abuse.

We saw that people had been asked their views and thoughts about the care and support they received at Oakfield. We saw effective methods were used to check, monitor and improve further the quality of the service people received.

There were systems to review and learn from all critical incidents and occurrences that may have impacted on people's health and wellbeing.

The people that spoke to us were generally positive about how they are supported by the staff team and the acting manager who leads them. Examples of comments made included, “the staff are pretty good”, “the staff do their best”, “they do their best”, and “the girls work hard”.

We observed that people are being effectively supported by the staff team with their range of nursing and personal care needs. We saw that care plan records contain information to support the staff and guide them, to help to ensure that people who use the service receive the care they need.

We found that people who use the service are being provided with a varied and nutritious diet. People did say to us that the food can be a little bland and monotonous. However we found that where people are unhappy about the food that they are offered, every effort is made to address their concerns and to provide them with a diet that suits their needs.

We found that a sufficient number of competent staff employed to support and care for people who use the service.

We found that people benefit from the systems in place to help them make comments or complaints about the service. When complaints are made these are responded to promptly and resolved where possible, to the satisfaction of the person making the complaint.

We found that people who use the service are cared for by staff who have a good knowledge of their needs. The staff have done a variety of training to help them know how to provide people with the most suitable care and support.

We saw effective systems used to actively find out the views of people who use the service about the care and support they receive. This information is used to monitor and improve the quality of service and the care that people who use the service receive.