Oakford Manor Nursing Home is a ‘care home with nursing’. 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. Oakford Manor Nursing Home accommodates up to 50 people in one adapted building. At the time of our inspection 30 people lived at Oakford Manor Nursing Home.

At our last comprehensive inspection in July 2016 we rated the service as 'Good.'

Risks associated with medicines were mostly well managed; however some medicines were not stored securely in people’s rooms. Staffing was mostly sufficient; however there was an occasion when staff were not free to respond and check a person was safe. Systems and processes were in place to safeguard people from abuse; these covered staff recruitment practices and staff training and knowledge on safeguarding procedures. Systems also ensured accidents and incidents were recorded and analysed and steps to improve and learn were identified. Actions were taken to reduce known risks including those from infection. Actions were taken to reduce falls however, the service had not always identified when control measures to reduce the risks associated with falls were not effective.

We have made recommendations regarding the deployment of staff and the management of risk.

People’s needs for a balanced diet, including any specific dietary needs, were identified and met. Where people required healthcare from other professionals this was arranged and helped to ensure good on-going healthcare support for people. The premises had been changed to ensure they were fully accessible to people. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Staff were supported and trained to have the skills and knowledge in areas relevant to people’s needs. Assessments of people’s needs were in place. They included assessments of any health related needs as well as any diverse needs including those in relation to a person’s religion or disability.

The staff team were caring, kind and friendly. Staff had developed positive relationships with people and knew them well. Staff were mindful of promoting people’s independence and respecting their privacy and dignity. People were supported to be actively involved in decisions about their care.

Systems were in place to ensure complaints could be made and were investigated. People had opportunities to give feedback and raise any issues and have them responded to. People’s care and support reflected their preferences and choices and identified what was important to them. People and when appropriate, their relatives, were involved in making decisions about their care. Staff understood how people communicated and involved people in their care and gave them choices.

A registered manager was in place and they understood their responsibilities for the quality and safety of the service. Systems and processes were in place to assess, monitor and improve the quality and safety of services. The service was focussed on achieving good quality outcomes for people and worked in partnership with other health and social care professionals to ensure people received appropriate care. People, relatives and staff had opportunities to engage and be involved in the development of the service.

Further information is in the detailed findings below

This unannounced inspection took place on 26 and 28 July 2016. The service was last inspected on 10 and 11 March 2015 when we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which correspond to breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to send us an action plan to demonstrate how they would make improvements to meet the regulations. The provider sent us their action plan, and on this inspection, we found that improvements had been made.

Oakford Manor is registered to provide accommodation for up to 50 people. At the time of our inspection, 40 people were living there. The service is registered to care for people who need nursing or personal care. The service provides personal and nursing care for adults and older people with a range of medical conditions, including dementia, multiple sclerosis, motor neurone disease and people who have experienced strokes.

The service has a registered manager. 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.

People were not consistently protected from the risk of infection. Although staff had recently received training in infection prevention and control and were knowledgeable about their responsibilities, they did not consistently demonstrate this in their practice.

There were sufficient staff to ensure that people’s needs were met in a timely manner. People’s care and nursing needs were assessed and recorded, risks identified, and steps taken to reduce the risk of avoidable harm. People had their care reviewed on a regular basis, and they and their relatives were involved in this.

Staff understood how to keep people safe from the risk of potential abuse. Where incidents occurred, the provider notified the local authority. However, the provider did not consistently notify CQC about these incidents. People, staff and relatives felt confident to raise concerns about care.

People felt the care provided kept them safe, and relatives also felt this was the case. People and relatives spoke positively about staff, saying they were cared for by staff who treated them with kindness, dignity and respect. They were encouraged to continue with hobbies and interests, and to maintain relationships that were important to them. People were also cared for by staff who were knowledgeable and skilled to provide personal and nursing care to the training standards set by the provider.

Medicines were stored, documented, administered and disposed of in a safe way and in accordance with current guidance and legislation.

Staff had a good understanding of the principles of the Mental Capacity Act 2005 (MCA), including how to support people to make their own decisions. The provider was working in accordance with the MCA, and people had their rights upheld in this respect.

People and their relatives were positive about the quality and choice of food and drinks. We also found that people were supported to maintain their health and to access healthcare services when required.

The provider had a clear complaints policy, and people and relatives felt able to make a complaint or raise concerns. The provider investigated complaints according to their policy, and created opportunities for people to provide regular feedback about the service, which was acted on.

There were systems to monitor and review all aspects of the service, and these were undertaken regularly. This meant the provider was able to identify areas of good practice and areas for improvement, and to make changes to improve the quality of the service. People, relatives, and staff felt supported to make suggestions or raise concerns about any a

On the day of our inspection visit to Oakford Manor there were 28 people living at there. 11 people were in receipt of nursing care and 17 people received personal care.

Our observations of care being delivered by the staff were good. We saw that staff were caring and spoke with people in a respectful manner, showing consideration and empathy.

We found the premises to be comfortable, well equipped, clean and safe. There were good systems in place for ensuring that the premises and the equipment were well maintained.

We saw that there were robust recruitment procedures in place and the provider had taken steps to ensure that people who lived at Oakford Manor were protected from the risks associated with unsafe recruitment.

We spoke with three people who lived at the care home. They all gave positive comments about the care they received: “The staff are very good, very kind. They always knock on my door before they come in, and ask me if I would like a bath or shower. There is lots of choice and no restrictions.”

“I’m very happy here, the staff look after me very well, they always ask me before we do anything, and I feel I’ve still got control over my life.”

“I feel very settled here, everyone is very nice to me, and if I need anything the staff are only too happy to oblige.”

We found two areas of non-compliance relating to consent to care and treatment and care and welfare. We discussed these areas of non-compliance with the area manager during feedback who acknowledged agreed with the concerns raised.

At the time of our inspection the provider did not have a registered manager in post.

People we spoke with told us they were happy with the way that the service managed their medicines. People were protected against the risks associated with medicines because the provider had improved arrangements in place to manage medicines.

People were largely protected against the risks associated with medicines because the provider had improved arrangements in place to manage medicines. However, improvements are needed to ensure the accuracy of medication administration records. Staff did not always follow the service's policy for the safe use of medicines.

We inspected Oakford Manor on 19 August 2013 to look for improvements since the last inspection in April, when compliance actions were set. The visit was unannounced, which meant that the registered provider and the staff did not know we were coming.

We met with two senior managers. The newly recruited manager was on holiday. The operations director received our inspection feedback. During the inspection we spoke with the agency nurse, six care staff, the activity organiser, two visitors and nine people who used the service.

We reviewed how staff gained consent to care for people and how people were safeguarded from abuse. We saw care records that were well written, informative and generally updated regularly. Staff told us and we saw records that the staff were trained to safeguard people from abuse.

The pharmacist reviewed the home’s medication administration and procedures. Staff we spoke with told us they were currently well supported by the senior staff and the management team. They told us they received supervision and an annual appraisal. We looked at how the managers monitored the quality of the service and the staff's record keeping.

People we spoke with told us they were settled living in the home and they were satisfied with the care they received.

Three areas of non-compliance relating to consent, care and medication administration were discussed at feedback and this was acknowledged and agreed by those receiving it.

There were 26 people living at Oakford Manor at the time of this inspection. We spoke with four people using the service, and with two relatives. People told us, “It’s alright here. They’re all very nice.”, and, “The staff always come when I ring my bell, and they make sure I’ve got everything I need.” A relative said, “Some staff are really nice”.

Generally we found improvements in most areas since our previous inspection in February 2013. We saw a number of improvements in how people’s care and welfare needs were met, particularly in respect of the care planning system.

We found that some improvements had been achieved in the management of medicines in the home. However, we still had concerns regarding the arrangements in place for stock control and record keeping. People told us that there were usually staff available when needed and our observations supported this. However, we found that there were some gaps in staff training. This meant that staff might not have the training they need to carry out their role and keep their skills up to date.

We saw that there had been improvements in quality monitoring at the care home, particularly in relation to improvements in the care planning system. However, our concerns relating to medication and record keeping showed that the quality monitoring systems in these specific areas were not always effective.

We found that people’s needs were assessed and care was planned to meet their needs. We saw evidence of people receiving the care they required to ensure their needs were met and to ensure their welfare and safety. However, we found that two people’s needs had not been met. This had resulted in avoidable pain and discomfort for these two people.

We looked at medication and records about medication for fifteen people. Although we saw some improvements, we found concerns about the safe handling of medicines for thirteen people.

We found that there were systems in place to assess and monitor the quality of the service provided. However, we found that these systems were not effective in ensuring that necessary improvements were made and sustained.

We saw that improvements had been made to people’s care records since our last inspection visit. However, we found there were still significant deficits in care and medication records.

We visited Oakford Manor Nursing Home in August 2012 and found that people were not protected against the risks associated with the unsafe use and management of medicines. We issued a Warning Notice to ensure that improvements were made in order to protect people.

At our inspection in October 2012 we found that people living at Oakford Manor were still not protected against the risks associated with the unsafe use and management of medicines.

On the day of our visit to the Oakford Manor Nursing Home there were 31 people living there. Of those 18 people were receiving residential care, and 13 people were receiving nursing care.

We spoke with three people who live at the care home. The comments we received were positive about the care that they were receiving. Among the comments that we received were:

“I’m very happy here, the staff are marvellous.” “They (the staff) look after us very well.” “I have no complaints.” “The staff are marvellous, nothing is too much trouble, and I’m very happy here, it’s now my home.” These comments were in relation to the care that people were receiving.

We asked people about the staff: “I think the staff do a good job.”

“It’s alright, they look after me, and I’ve got everything I need.”

Our observations during our inspection visit did not raise any questions or issues with regard to peoples’ safety at the care home.

We asked several people if they felt safe living at the care home, and they said that they did. One person saying: “Absolutely, I feel very safe.”

Our inspection of the medicines procedures at the care home raised concerns, however none of the people we spoke with had a view on how medicines were managed at Oakford Manor.

People said that they were satisfied with the care they received in the nursing home. They also said that they always received their medicines on time.

People said that they were satisfied with the care they received in the nursing home although relatives said that they had to prompt staff to provide care for one resident. They also said that there were sufficient staff on duty at all times.

People were complementary about the standard of care they received from Oakford Manor Nursing Home staff but were concerned that there was not enough staff to meet their needs and raised concerns about the standard of agency nursing staff. They also said that they had to wait before getting their medicines and in one case had to track down the staff to ensure they got their medicines.

We spoke with a service user who said that his pain relief medicine often arrived late causing him to remain in pain unnecessarily. He stated that when the nurses arrived he would complain but all they would say in response was that they were busy because they had a lot of other people to give medicines to.

This inspection took place on 10 and 11 March 2015 and the first day was unannounced.

Oakford Manor is a nursing and residential care home for older people some of whom have dementia. Accommodation is on two floors and there are two lifts for access. Oakford Manor provides residential and nursing care for up to 50 people; at the time of our inspection there were 40.

The service had a registered manager in post. The registered manager was providing temporary support until a new manager commenced their employment on 16 March 2015. 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 last inspection on 11 March 2014, we asked the provider to take action to make improvements on how consent was obtained. Where people did not have the capacity to consent, the provider did not always act in accordance with legal requirements. We also saw care and treatment was not always planned and delivered in a way that ensured people's safety and welfare. This was because care records and risk assessments did not always have all of the relevant information within them.

There were insufficient staff to ensure people received safe care in a timely manner. Insufficient staff resulted in inadequate recording in regards to care records.

People who used the service were not protected against risks associated with unsafe equipment because moving and handling equipment had not been adequately serviced.

Records relating to people’s care and support were not securely stored and confidential information was left unattended.

Staff members we spoke with did not have a full understanding of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS. Staff training records showed staff had attended training in MCA and DoLS however their knowledge was limited.

People who at the service were very positive and complimentary about the staff however some complaints had been documented from relatives. The complaints were concerning the lack of staff; we found no evidence of this being responded to.

People told us they felt safe living at the home, “Staff were caring and kind-hearted,” and the care they received was good. People remarked that the food was particularly good and relatives were always made to feel welcome.

We spoke with six people’s relatives, ten people using the service and ten members of staff, including the manager. We spoke with four health care professionals who were involved in the care of people living at Oakford Manor Nursing Home.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which correspond to breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we took at the back of this report.