Oakhurst Court Nursing Home 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. Oakhurst Court Nursing Home is registered to provide nursing and personal care for up to 42 people. There were 24 people living at the service at the time of our inspection.

This inspection site visit took place on 9 February 2018 and was unannounced.

There was no registered manager in post on the day of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. Instead we were supported by the senior nurse for part of the day and the interim deputy for the remainder of the inspection.

At the last inspections on 4 July 2017 and 22 September 2017, we asked the provider to take action to make improvements in relation to the safety of people, how people were being safeguarded against the risk of abuse, staff training, the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS), the involvement of people in their care, how people were respected, activities for people, the leadership at the service, the quality assurance and how complaints were being responded to. We found at this inspection that these actions had addressed and improvements had been made.

There were appropriate levels of care staff to support people when they needed it. The management of medicines was safe by staff that had the appropriate training.

The environment was not always set up to meet the needs of people living at the service for those people living with dementia. We have made a recommendation around this.

People and relatives felt that staff were competent in their role. Staff received training and supervision and staff felt supported. However we have recommended that all staff are provided with dementia training given that this is what the service specialises in.

There were appropriate plans in place to ensure that risks to people were managed. Staff understood what to do to minimise risks in relation to people. Emergency evacuation plans were in place and staff understood what to do if an emergency occurred at the service. Where people had accidents and incidents actions were taken to reduce this risk of them reoccurring.

People told us that they felt safe with staff. Staff had received training in safeguarding people from abuse and they had a good knowledge of what they needed to do if they suspected abuse. Staff at the service had robust recruitment undertaken before they started work.

People’s rights were protected because staff acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Appropriate assessments had been completed where people’s capacity was in doubt and applications to the Local Authority were submitted if people were being restricted in their best interest.

People enjoyed the meals at the service and said they had sufficient choices. People’s health care needs were monitored included weight loss and any changes in their health. People had access to appropriate health care professionals where needed.

People and their relatives told us that staff were kind and caring and treated people in respectful and dignified way. This was confirmed through our observations. People had choices around their care and felt involved in their care planning. Relatives and friends were welcomed at the service to visit people. People and their relatives were given support when making decisions about their preferences for end of life care.

People had a range of activities that they could be in

This inspection was carried out on evening of 22 September 2017 and was unannounced. Oakhurst Court Nursing Home provides nursing care for older people and people living with dementia. The services also provides end of life care and respite care. On the day of our inspection 42 people lived at the service.

The registered manager was present on the evening of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 Nominated Individual was also present at the inspection.

The service was last inspected on the 4 July 2017 where breaches of regulations were identified in relation to the lack of appropriate training and supervision for staff, risks that were not always being identified and managed appropriately ,the lack of mental capacity assessments, people not always being treated with dignity and respect, the lack of detailed care planning and the lack of effective governance. Recommendations were also made around how staff were deployed. At the inspection on the 4 July 2017 the service was rated as Inadequate and the service was placed into special measures.

After that inspection we received concerns in relation to the lack of infection control, the suitability of the environment and equipment, the lack of staff and the suitability of the management oversight of the service. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Oakhurst Court Nursing Home on our website at www.cqc.org.uk.

People were not always protected from the risks of unsafe care. Staff did not adhere to basic infection control measures when needed to reduce the risks of cross-contamination. People were at risk of acquiring infections because appropriate action was not taken to reduce the risks of cross contamination. Areas of the service were untidy and in need of a deep clean. People’s bedroom smelled strongly of urine. The premises and equipment at the service was not always stored or maintained appropriately to keep people safe.

The management of medicines was not always safe which put people at risk. The room where medicines were stored was not fit for purpose. There were errors on the medicine charts where it was not clear if people had received their medicines when needed.

People did not always have access to call bells and were unable to alert staff when they needed support. Staff levels at the service were not appropriate to support people when they needed.

People were not always treated with dignity and respect. People had to endure a strong smell of urine in their rooms. There were times where people were unable to access their rooms when they wanted. There was a lack of stimulation for people living with dementia.

Quality assurance was not effective and there were no appropriate actions in place to address the standards of care that staff were providing. The provider had not met breaches in regulation from the previous inspection.

There was a lack of management oversight at the service. Staff were not being supported or supervised effectively.

The overall rating for this service is 'Inadequate' and the service remains in 'Special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within t

Oakhurst Court is a large nursing home that provides nursing care for up to 57 older people and people who may be living with dementia. The service can also provide respite care and palliative care. At the time of out inspection there were 45 people living in the home.

The service was run by a registered manager, who was not present on the day of the 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 and associated Regulations about how the service is run. The registered manager was away on leave on the day of the inspection. The deputy manager was in charge; however she had only worked at the home for two weeks. The provider told us that the deputy manager was supported by the senior care team.

At the last inspection in March 2016 we found concerns with the support provided. Following the inspection in May 2016 we told the provider and registered manager to take action to make improvements to ensure people’s care and treatment was safe. We told them to ensure staff had the right skills and knowledge to care for people safely. We also told the provider to take action to ensure that the requirements of the Mental Capacity Act 2005 (MCA) were met and that people received dignified and person centre care. We also told the provider to take action to ensure that there were robust systems in place to monitor, review and improve the quality of care. These actions and requirements had not been met.

People were not always protected from harm. Risks to people had not always been identified and assessed and therefore put them and others at risk of harm. People did not have their own individual slings. This puts people at risk of poor positioning and is an infection control risk. This put people at potential risk of serious harm. The registered manager had not informed CQC of safeguarding allegations.

People were not always safe from avoidable harm. One potentially serious safeguarding had not been reported to the local authority and staff had not recognised it as an incident of abuse.

There was enough staff on duty to ensure people were safe, however staff deployment needed to be reviewed at meal times and other busy times. We have made a recommendation in this area. There were recruitment practises in place to ensure that staff were safe to work with people.

People’s medicines were administered safely. Medicines were always stored and disposed of safely.

People’s human rights could have been affected because the requirements of the Mental Capacity Act were not always followed. For people who lacked capacity to make decisions about their care, mental capacity assessments and best interests decisions had not occurred. The registered manager had applied for some Deprivation of Liberty safeguards (DoLS), when people had restrictions to their care, however some were missed.

People did not always receive effective care. Staff did not always have the knowledge; skills and regular supervision to enable to them care for people safely and effectively.

People did not always receive care that met their cultural or religious needs. Staff were not always aware of people’s choices and preferences. People’s care provided was not always dignified.

People and their relatives said that they were involved in their care. However this was not always evident in peoples care records. People and relatives said that the staff were kind and caring.

People did not always receive personalised care. Care plans were in place; however they were not detailed or personalised. Care records were inconsistent, for some people who had health conditions they did not have the appropriate care plan in place to tell staff how to manage the health condition. People’s preferences and wishes were not always recorded in their c

Oakhurst Court is a care home that provides accommodation, nursing and personal care for up to 57 people. Many of the people at Oakhurst Court are living with dementia. The service also provides respite and palliative care to people. At the time of our inspection 49 people were receiving care.

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

There was a registered manager in place, who was present on the day of the 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 and associated Regulations about how the service is run.

The registered provider has been in breach of regulation 18 since June 2015, Staffing. They had failed to take action in response to requirements for regulation 18 of the Health and Social care act which had highlighted risks to the safety of people and the effective operation of the service.

During this inspection the home did not have a sufficient number of staff deployed to meet the needs of the people who lived there. Care was provided to people by staff who were not always competent to carry out their role effectively. Staff did not always show they had an understanding of the needs of people living with dementia.

People were not always safe living in the home and risks they took were not always minimised. Risk assessments had not been completed for people and staff were not always aware of people’s needs.

People’s rights were not protected because the staff had not acted in accordance with the Mental Capacity Act 2005.

We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty were being met DoLs. We saw related assessments and meetings to make a decision in someone’s best interest had not been undertaken.

Care plans did not always contain information to guide staff on how someone wished to be cared for. People were not involved in their care and support. We did not see staff encourage people to do things for themselves. We found staff did not always make people feel as though they mattered or treated them with consideration.

We saw people sitting for long periods of time without social interaction from staff. Appropriate personalised activities for people living with dementia were not always provided.

Medicines were managed appropriately and people received most of their medicines in a safe way. However PRN (as required) protocols were not robust. We have made a recommendation about this.

Staff understood what safeguarding meant and different types of abuse. We were assured by some staff they knew how to report any concerns they may have. However staff were not always able to identify situations that constituted ill-treatment.

People’s views were not obtained by holding residents’ meetings and sending out an annual satisfaction survey.

The provider did not have effective quality assurance systems in place, including regular audits on health and safety, infection control, dignity, care plans and nutrition.

At our last inspection we found people were not always supported to have enough to eat. During this inspection we saw a choice of meals was provided to people and people were involved in making decisions about what they ate. However staff did not always support people to eat and drink to support their wellbeing.

At our last inspection we found the environment was not always clean at this inspection the provider had started the process of refurbishment and we saw floors and some beds had been replaced.

The registered manager met CQC registration requirements by sending in notifications when appropriate. We found both care and staff records were stored securely and confidentially.

The provider had ensured they followed good recruitm

Oakhurst Court is a care home that provides nursing and personal care for up to 57 people. Many of the people living at Oakhurst Court are living with dementia. The home also provides respite care and palliative care. At the time of our inspection 49 people were living at the home.

This inspection took place on 11 June 2015 and was unannounced.

The home is run by a registered manager, who was present on the day of the 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 and associated Regulations about how the service is run.

We found the home did not have a sufficient enough number of trained staff deployed to meet the needs of the people who lived there.

Where restrictions on people were in place to deprive them of their liberty, staff had followed legal requirements to make sure this was done in the person’s best interest. The registered manager had submitted Deprivation of Liberty Safeguards (DoLS) applications to comply with their responsibilities.

Complaint procedures were available for people. The registered manager had received complaints and was responding to them.

People were involved in their care and support however we did not see staff encourage people to do things for themselves. We found staff did not always make people feel as though they mattered or treat them with consideration.

Staff told us and we saw ways in which staff supported and enabled people to maintain their independence and take part in various activities. However we saw people sitting for long periods of time without social interaction from staff. Appropriate activities for people living with dementia were not always provided.

Care was provided to people by staff who were not always competent to carry out their role effectively. However staff did not always show they had an understanding of the needs people living with dementia have.

Staff told us they received supervision, and appraisals.

Checks had been carried out to make sure people were safe living in the home and any risks they may take were minimised. Incidents and accidents were recorded and investigated in a timely manner by the registered manager.

Medicines were managed appropriately and people received their medicines in a safe way.

The provider had ensured they followed good recruitment processes to help them employ suitable staff to work in the home.

Staff understood their responsibilities in relation to safeguarding. We were assured they knew how to report any concerns they may have.

A choice of meals was provided to people and people were involved in making decisions about what they ate. However staff did not always support people to eat and drink to support their wellbeing.

Staff referred people to external healthcare professionals when appropriate and the local GP was actively involved in the home.

Care plans contained information to guide staff on how someone wished to be cared for. When people's needs changed, staff did not responded to these appropriately and provided effective, responsive care.

People’s views were obtained by holding residents’ meetings and sending out an annual satisfaction survey. Complaint procedures were up to date and people and relatives told us they would know how to make a complaint if they needed to.

The provider had effective quality assurance systems in place, including regular audits on health and safety, infection control, dignity, care plans and medicines. The registered manager met CQC registration requirements by sending in notifications when appropriate. We found both care and staff records were stored securely and confidentially.

During the inspection we found 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 the report.

We spoke with some people who used the service and comments included “I am very happy here, they can’t do enough for you”, “and The staff are kind and look after me well”. A relative told us they were happy with the care and treatment that they or their relatives received and were satisfied that it met their needs.

We saw needs were assessed and care and treatment was delivered according to people’s wishes. A relative told us they were involved in developing their family member’s plan of care. They were also aware that regular reviews of their care plans took place and they were informed of any changes that were required.

People told us the food was nice and they had a choice. They said the food was “very good”.

Staff we spoke to told us they liked working in the home. They said they had the training and supervision required to undertake their roles and responsibilities.

A relative that we spoke with told us that they were able to express any concerns to the manager or senior staff at any time. They said their concerns were usually addressed fairly quickly. They also told us they had access to the home’s complaints procedure.

Some people told us that they were happy living in the home. Relatives told us that they were very satisfied with the care provided. They said that the were always made welcome when they visited and were kept informed of any changes in care and events in the home.

We spent time observing people who were not able to communicate their views directly to us. They were well cared for by a team of staff who had a good understanding of their assessed physical and emotional needs.

People told us that they enjoyed the activities that were offered and we saw people enjoying a game of musical bingo in the activities room.

People had individual care plans that outlined agreed care and treatment.

People told us that the food was very good and that they were offered a choice of meals. We saw someone enjoying a sandwich for lunch as they did not wish to eat a cooked meal.

One person told us that their room was very comfortable and that they had personal items that mattered with them.

We saw that there were sufficient staff on duty to care for people and staff told us that they enjoyed working in the home.

All residents consulted with told us that they liked living at Oakhurst Court. This was because it had a relaxed, friendly atmosphere and it was a comfortable place to live with residents telling us “It’s a lovely home” and “I like living here as I can do what I want”. Residents we observed showed relaxed body language and enjoyed interacting with staff. We observed a resident deriving much comfort from the gentle affection shown to them by a staff member.

Carers spoke positively about the care their relative receives, commenting: “the care is fantastic” and “it’s very reassuring to know that my dad is so well looked after”. A carer spoke about the individualised care their relative receives and how staff are knowledgeable about their relatives needs. Another carer told us how impressed they have been when their relative has needed medical intervention and how quickly the doctor has been called.

Three residents confirmed that their preferred times of rising and retiring was respected by staff and that they could vary these times according to their personal choice. Several residents told us about the choices of meals that were available. A resident told us that staff “always try and encourage me to do things for myself”.

Residents consistently told us that staff respect their privacy and will always knock on bedroom doors before entering. A resident spoke about their frustrations of another resident walking into their bedroom uninvited. Residents told us that their visitors are generally offered refreshments. Carers and residents confirmed that they could meet in private if they wanted and felt confident to ask staff for assistance in order to do this.

Residents told us that they felt safe from abuse. A resident told us that when they are hoisted they always felt safe. Carers told us that they had not witnessed care that they felt was inappropriate. Residents and carers told us that they felt confident to raise any concerns they had with senior staff and felt that this would be dealt with promptly.

Carers told us how the improvements made to the environment which has included new carpeting and flooring to many parts of the service has removed unpleasant odours that were previously present. A carer commented “the home is looking lovely”.

Residents described staff as: “very helpful and gentle” and “I can laugh with some of the staff”. Residents told us that they receive the help they need when they want it. Carers spoke positively about staff saying how caring staff were and that staff had the skills and knowledge to support the complex needs of their relatives. We observed that the interactions between staff and residents they were supporting were relaxed and sensitive with residents clearly at ease in the company of staff.

A carer told us that they are frequently asked if everything is ok and if there is anything that could be improved. A carer told us how they have raised issues about the standard of laundry in the past and how this was addressed at the time, but occasionally laundry standards can become variable.

All the people we spoke to told us that the food was good. People said the staff were lovely, they were treated well and they felt safe at the home. They said it was a lovely garden and they would love to sit in it. Some people told us they were lonely and others told us that they needed to go to the toilet.

One relative told us that they were concerned about other people who live at the home wandering in to their relative’s bedroom.

Three People’s relatives told us that there was no choice of activities, and that they just saw people sitting in chairs in the lounge all day long doing nothing.

Two were also concerned about the numbers of care and nursing staff, now that the manager/matron had left.

Care managers told us that they saw examples of people waiting for care and have had to find and ask staff to support people on occasions. They also told us that records were not organised efficiently and that information is hard to find.

All the people’s relatives we spoke to and a care manager told us there is usually a smell of urine in the home.