Oakland Rochdale (referred to in this report as Oakland) is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and both were looked at during this inspection.

This inspection took place on 25 and 27 September 2018. Our visit on 25 September was unannounced. The home is registered with CQC to provide nursing and personal care for up to 40 older people. At the time of our inspection there were 39 people living at the home. Accommodation is provided over two floors, with capacity for 18 people in a dementia unit on the ground floor, and 22 people in the residential unit on the first floor.

We last inspected this service in August 2017 when we found the registered provider was in breach of Regulations 9, 10, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because people were unable to pursue their individual hobbies and interests; their personal care needs were not always attended to, there were insufficient staff to meet people’s needs safely and the overall governance of the service had not been effective in improving the service. After our last inspection the provider sent us an action plan telling us how they would improve the service. These improvements had been effective, and we found the provider was now compliant with the regulations and consistently meeting people's needs.

The service had a registered manager who had been appointed immediately prior to our last inspection. They have completed the registration process and registered as the manager with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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.

People told us they felt safe at Oakland. Risk assessments identified and monitored individual and environmental risks and the registered manager conducted a daily walk around of the property to identify any maintenance issues or other concerns which were reported for repair. People told us, and we saw that staff took appropriate precautions when delivering care and the staff we spoke with understood their roles and responsibility to safeguard vulnerable people. They had a good understanding of safeguarding issues, and there was a system in place to report any suspicion of abuse.

Most of the people who used the service were unable to consent to their care and treatment, but the people supporting them at Oakland understood issues around capacity, and offered meaningful choices in a way people understood. Where people were unable to consent, the appropriate deprivation of liberty authorisations had been sought.

At our last inspection we found that there were not always enough staff to safely meet the needs of people who lived at Oakland. We found at this inspection that the service had developed a dependency chart to determine the right level of staff. There were sufficient staff on duty to attend to people’s needs and provide care and support in a timely and respectful way. They were well trained and had access to refresher training to ensure that their knowledge was up to date and in line with current best practice. The service made appropriate checks during the recruitment process to ensure that new staff had the right attributes and character to work with vulnerable people. All new staff received a full induction and systems were in place to provide one to one supervision for all the people who worked at Oakland.

We saw that care staff knew the people they supported and staff told us that they felt comfortable working on either the residential or the dementia unit. Care plans reflected people’s needs

Oakland is located in Rochdale. The service provides accommodation and care for up to 40 older people, some of whom are living with dementia. On the day of our inspection, there were 38 people living at the home. The home is on two floors, with capacity for 18 people on the dementia unit on the ground floor, and 22 people on the residential unit on the first floor.

The inspection took place on 2 August 2017 and was unannounced.

There had not been a registered manager at this service for a period of three months. However, a new manager had been appointed and had started the registration process. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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 this inspection, we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to person-centred care; dignity and respect and staffing. You can see what action we asked the provider to take at the end of this report.

Staffing levels were not sufficient to meet the needs of people. People had to wait for assistance with their personal care and continence needs, and were reluctant to ask for help because of this.

Staff were under pressure in their roles, which meant some interactions with people were abrupt.

People were sometimes placed in undignified situations and were not always treated with respect. People and relatives had voiced dissatisfaction about the lack of dignity afforded to people.

People could not enjoy their individual hobbies and interests, which led to feelings of boredom. Although people had life history care plans in place regarding their interests, not all had been completed.

Although there was a system for responding to complaints, not all complaints had been investigated fully.

The home had been through a period of managerial instability, which meant not all the issues identified at this inspection had been acted on. Staff morale had been low, and staff absence high.

People were supported to maintain their health. People's individual dietary needs were catered for , and people received assistance with their eating and drinking needs. People enjoyed choice and variety of meals and drinks.

The new manager had identified areas of improvement for the home and had started to instigate positive changes.

Oakland (Rochdale) provides accommodation for up to 40 older people who require help with personal care. Care and accommodation is provided over two floors. The ground floor provides 18 beds for people with dementia and the first floor has 22 beds for people with a range of care needs. All bedrooms are single rooms. A passenger lift is available.

The service were last inspected in July 2014 when the service met all the regulations we inspected.

We undertook this inspection on 20 and 21July 2016. This comprehensive inspection was unannounced and conducted by one inspector.

The service had 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff we spoke with were aware of how to protect vulnerable people and had safeguarding policies and procedures to guide them which included the contact details of the local authority to report to.

Recruitment procedures were robust and ensured new staff should be safe to work with vulnerable adults.

There were sufficient staff to meet the needs of people who used the service.

The administration of medicines was safe. Staff had been trained in the administration of medicines and had up to date policies and procedures to follow. Their competency was checked regularly.

People who used the service told us the food was good. We observed one mealtime which was a social occasion with staff talking to people and encouraging them to take a good diet.

We also saw that people were offered fluids regularly and during hot weather ice creams.

Electrical and gas appliances were serviced regularly. Each person had a personal emergency evacuation plan (PEEP) and there was a business plan for any unforeseen emergencies. There were regular fire alarm tests and staff fire safety training to help protect the health and welfare of people.

There were systems in place to prevent the spread of infection. Staff were trained in infection control and provided with the necessary equipment and hand washing facilities to help protect their health and welfare.

Most staff had been trained in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The registered manager was aware of her responsibilities of how to apply for any best interest decisions under the Mental Capacity Act (2005) and followed the correct procedures using independent professionals.

New staff received induction training to provide them with the skills to care for people. Staff files and the training matrix showed staff had undertaken sufficient training to meet the needs of people and they were supervised regularly to check their competence. Supervision sessions also gave staff the opportunity to discuss their work and ask for any training they felt necessary.

We observed there were good interactions between staff and people who used the service. People told us staff were kind, knowledgeable and caring.

We saw that the quality of care plans gave staff sufficient information to look after people accommodated at the care home and they were regularly reviewed. Plans of care contained people’s personal preferences so they could be treated as individuals.

There was a record kept of any complaints and we saw the manager took action to investigate any concerns, incidents or accidents to reach satisfactory outcomes. There had not been any complaints since the last inspection.

Staff, people who used the service and family members all told us managers were approachable and supportive.

Staff meetings gave staff the opportunity to be involved in the running of the home and discuss their training needs.

The manager conducted sufficient audits to ensure the quality of the service provided was maintained or improved.

During our inspection visit we collected evidence to help us answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on speaking with people who used the service, the staff who supported them and from looking at records.

Is the service safe?

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. All members of staff had been trained to understand when an application should be made, and how to submit one.

The relative of one person said, “They are so good with my husband, the staff are really helpful and they make me feel very welcome. I feel he is in a safe environment.”

Members of staff had received training in the management of medication and knew how to safely give medicines to people who used the service.

Is the service effective?

People’s health and care needs were assessed with them if possible, or their relatives and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. Care plans were reviewed regularly and amended to reflect people’s changing needs. The relative of one person said, “I’ve seen the care plan, they’ve just been updating it. They involve me at every stage whatever’s going on.”

We found that people’s weight and appetite was monitored. When any problems were identified advice was sought from the doctor and dietician. All the people we asked told us that the meals were good. One person said, “The food is good, if you don’t like what’s on the menu you don’t have to have it, they get you something else.”

There was a rolling programme of training in place so that all members of staff were kept up to date with current practice.

Is the service caring?

We saw that care workers were attentive to people’s needs and offered appropriate encouragement and assistance when necessary. One person said, “We are certainly looked after.” The relative of one person told us they were very happy with the care provided and said, “The staff are superb.”

People who used the service and their relatives were given the opportunity to regularly complete satisfaction questionnaires. These were evaluated at the company’s head office in order to identify any areas for improvement.

Is the service responsive?

The activities coordinator told us that activities were organised daily and included, arts and crafts, baking, table tennis, gardening, ball games and individual activities for people with a dementia. People were taken out for pub lunches, trips to Blackpool and a museum where reminiscence was encouraged. One person said, “There’s plenty to do.” The relative of one person said, “The activities person is brilliant, she took mum out for lunch yesterday.”

All the people we spoke told us they were happy with care provided at the home but would speak to the manager if they had any concerns.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

There were systems in place for assessing and monitoring the quality of the service provided. We saw that audits completed regularly by the manager covered all aspects of the service provided.

Members of staff had regular supervision meetings and an annual appraisal with their line manager. The two care workers we asked said they found these meetings helpful and supportive and gave them the opportunity to discuss issues relating to their work including training.

During our visit to the home we spoke with two visitors and had brief conversations with two people using the service.

The visitors told us that they had been involved in the care plans for their family members and had been asked for consent where appropriate. The people using the service told us they felt they were being looked after properly.

Some people expressed concerns that during some busy times they felt there were not always enough staff on duty but overall there were sufficient staff.

One relative told us, “It is absolutely excellent, the staff are kind, supportive and brilliant”. Another relative said, “Everything is alright, there is nothing to worry about”.

People's care records were kept secure and contained enough information to show how they were to be supported and cared for. They also showed that people gave consent to their care and treatment.

Systems were in place to protect people who lacked the capacity to make decisions about their own care and support.

All the people we spoke with felt that the environment was suitable for the delivery of care. One visitor told us that they had enjoyed decorating the room for their relative and had support from the home. Another visitor told us that they enjoyed being with their relative but felt that sometimes the temperature was cold for their relative.

We spoke with two visitors and one person who was living at the home. The visitors told us the staff were accessible, friendly good and treated their relatives well. One visitor said “The staff are brilliant, I have no issues with them.”

Both visitors confirmed staff asked their relatives for verbal consent before providing treatment and personal care. However, both visitors told us that they were not involved in the regular reviews of the care plans.

Neither visitor had any concern in relation to the wellbeing or safeguarding of their relatives. The person living at the home said “I feel safe living at the home.”

The visitors we spoke with told us they felt there were enough staff around to assist their relatives and other people. They told us that they had no concerns about the care they received and would speak to the manager if they had any concerns or complaints.

We talked to people who lived on the ground floor and the first floor. We saw that most of the people living in the home had some degree of forgetfulness or a dementia type illness. The people we spoke with told us that they were comfortable living in the home, that the food was good and that there were a choice of meals. We heard that the staff were “Very good” and “Good”. One person said that they chose when they went to bed and got up in a morning and that they joined in the activities in the lounge.

We saw the results of a relative’s survey sent out by the home in August 2011. Comments included “Staff are considerate and helpful” and “Staff keep me well informed about Mum’s care”.