Oaklands provides accommodation and personal care for up to 55 people some of whom may be living with dementia. At the time of our inspection 28 people were living at the service.

Oaklands is 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

At the last inspection, the service was rated Requires Improvement. At this inspection we found improvements had been made and the service is rated as Good. However, Well Led remains requires improvement, there had been significant instability in the management of the service and although the new manager has made significant improvements, they are not yet registered and will need to evidence consistent compliance over time to ensure continued safe delivery of care.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. There were systems in place to minimise the risk of infection. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. People’s needs were met by sufficient numbers of staff. Medication was dispensed safely by staff who had received training to do so.

People were safeguarded from the potential of harm and their freedoms protected. Staff were provided with training in Safeguarding Adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). People were 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.

People had sufficient amounts to eat and drink to ensure that their dietary and nutritional needs were met. The service worked well with other professionals to ensure that people's health needs were met. People's care records showed that, where appropriate, support and guidance was sought from health care professionals, including a doctor, district nurse and palliative care nurse. The environment was appropriately designed and adapted to meet people’s needs.

Staff were well trained and attentive to people's needs. Staff could demonstrate that they knew people well. Staff treated people with dignity and respect.

People were provided with the opportunity to participate in activities which interested them at the service. These activities were diverse to meet people’s social needs. People knew how to make a complaint should they need to. People were provided with the appropriate care and support at the end of their life.

The manager had several ways of gathering people’s views and held regular meetings with people and their relatives. The manager carried out quality monitoring to help ensure the service was running effectively and to make continual improvements.

Oaklands (Essex) provides accommodation and personal care for up to 55 older people who may have care needs associated with living with dementia. There were 35 people living at the service at the time of our inspection. The service does not provide nursing care.

We carried out an unannounced comprehensive inspection of the service on the 2, 3, 10 and 13 October. Previously the service had been inspected in February 2017 and received an overall rating of requires improvement with the domain ‘well led’ being rated as inadequate. At this inspection whilst improvements had been made, improvements were still required to ensure the safety, health and well-being needs of people were met.

At our previous inspection carried out on the 20, 21 and 28 February 2017 we found breaches of Regulations 9 [Person centred care],12 [Safe care and treatment], 13 [Safeguarding service users from abuse and improper treatment], 14 [Meeting nutritional and hydration needs], 17 [Good governance] and 18 [Staffing]. Two Warning Notices were served on the registered provider in respect of Regulations 12 and 17 requiring the registered provider to ensure they met with legal requirements by 24 April 2017. We carried out an unannounced comprehensive inspection on 2, 3, 10 and 13 October 2017 to confirm whether they now met those legal requirements .

The service has been placed in special measures as there have been continued breaches of regulation and a continuation of a key question rated ‘inadequate’. 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 this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to being the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of this registration.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Since our last inspection in February 2017 a manager had been recruited. They were registered with the Commission as registered manager for the service on 25 September 2017. 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 our previous inspection in February 2017 we found improvements were needed to ensure quality assurance systems were effective. Whilst we found improvements had been made at this inspection, further improvements were required to ensure the service was well led and the systems available for the monitoring and on-going improvements regarding the quality of the service were embedded and used effectively to ensure people’s care and support needs were met safely.

At our last inspectio

The inspection was completed on 20, 21 and 28 February 2017 and was unannounced.

Oaklands (Essex) provides accommodation and personal care for up to 55 older people who may have care needs associated with living with dementia. There were 37 people living at the service at the time of our inspection. The service does not provide personal care.

The service is required to have a registered manager however there was no registered manager at the time of our 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.

Overall we found that the quality assurance systems and processes in place were not effectively robust to ensure the health, safety and well-being of people using the service and to drive improvements. The registered provider lacked oversight of the service and there was poor quality monitoring. Some of the concerns found at our previous inspection on 27 and 30 September 2016 continued to be areas of concern at this inspection.

Improvements were required to ensure the management of medicines was safe. Improvements were also required to ensure that all care records were accurate and reflected people’s current care and support needs; and that any associated risks were clearly identified, monitored and mitigated.

Although staff were recruited safely upon completion of appropriate checks improvements were required to ensure the on-going monitoring to check staff’s criminal histories had not changed. There were sufficient numbers of staff to meet people’s care and support needs.

Improvements were required to ensure the registered provider learnt from safeguarding incidents. Staff received training regarding how to keep people safe from harm and abuse and were aware of how to report any concerns.

Staff had an understanding of the requirements of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards applications had been made where appropriate.

Generally people received sufficient amounts to eat and drink however we found sufficient action was not always being taken where people were at risk of malnutrition and dehydration.

People were supported to access healthcare services. However, where healthcare professionals were involved in people’s care their guidance was not always followed.

People had mixed views about the caring attitude of staff. Whilst most interactions between staff and people were kind and caring, some were task focussed. People’s privacy and dignity was respected.

Care plans and assessments did not always include sufficient information of how people’s care and support needs were to be met. Activities required improvement to ensure people living with dementia were encouraged and supported in taking part in meaningful activities.

There was an effective system in place for complaints.

At this inspection we found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 including continued breaches from our last inspection. You can see what action we have told the provider to take at the back of this report.

The inspection was completed on 27 and 30 September 2016 and was unannounced.

Oaklands (Essex) provides accommodation and personal care for up to 55 older people who may have care needs associated with living with dementia. There were 48 people living at the service at the time of our inspection. The service does not provide nursing care.

A registered manager was 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.

Although people told us they felt safe, we found that the systems and processes in place to help keep people who lived at the service safe required improvement. People were not protected from the risks associated with the unsafe use and management of medicines.

There were quality assurance processes in place to monitor the quality of the service and to make improvements, however the manager had not undertaken regular audits since they had been managing the service as they had been working to an action plan agreed with the registered provider.

There were processes in place to seek the views of people who used the service and those acting on their behalf but it was unclear how this feedback was used to improve the quality of the service. Improvements were required to ensure people’s concerns and complaints were acted upon.

Care plans were in the process of being updated and reviewed however some of the information in people’s care records was contradictory. People’s healthcare needs were monitored and advice and guidance was sought from healthcare professionals when needed.

Although the manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS), some staff had a limited understanding of the MCA and DoLS.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns.

People were supported to eat and drink sufficient amounts to meet their nutritional needs. People were able to choose alternative meal options if they did not like the choices offered on the daily menus.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of this report.

This inspection took place on the 30 November 2015 and 4 December 2015 and was unannounced.

Oaklands (Essex) is registered to provide care and accommodation for up to 55 older people. There were 52 people living at the service at the time of our inspection. The home does not provide 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 2008 and associated Regulations about how the service is run.

People told us they felt safe. There were systems in place to assess and manage risks and to provide safe and effective care.

We received mixed views about staffing levels. People told us that sometimes there were insufficient staffing levels particularly at weekends.

People were protected from the risks associated with nutrition and dehydration. People spoke positively about the choice and quality of the food. Where people were at risk of malnutrition referrals had been made to healthcare professionals.

People received support from trained staff who were well supervised. Staff knew people well and they were kind, caring and compassionate and they ensured that people’s privacy and dignity was maintained at all times.

The registered manager and staff were aware of their responsibilities under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS).

People’s care and support needs were assessed before they moved into the service. The care and support provided was personalised and based on the identified needs of each individual.

There were quality assurance systems in place which continuously assessed and monitored the quality of the service. This included feedback from people who used the service and their families.

The service had a visible and approachable manager who knew people and their families well. The registered manager told us they operated an ‘open door’ policy so people living at the service, their families, staff and visitors could discuss any issues they have.

We spoke with three of the 51 people who used the service and two visiting relatives. We spoke with the registered manager, two of the provider's management team and 11 staff members. We looked at four people's care records. Other records viewed included staff training, quality assurance and health and safety checks. We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

When we arrived at the service a staff member looked at our identification and the registered manager asked us to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the registered manager understood when an application should be made, and how to submit one. They confirmed that they had received training in this subject and explained when they had made referrals which further demonstrated their knowledge.

Staff were provided with training in safeguarding vulnerable adults from abuse. This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

The service was safe. Records and discussions with staff showed that there were regular health and safety checks carried out to make sure the service was well-maintained and met people's needs.

Systems were in place to make sure that managers and staff learned 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.

Is the service effective?

People told us that they were happy living in the service. One person said, "I get everything I need, I am very happy." Another person said, "I am happy with the care I get, I have no problems."

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were reviewed every month and updated which meant that staff were provided with up to date information about how people's needs were to be met.

Is the service caring?

The staff interacted with people living in the service in a caring, respectful and professional manner. People told us that the staff treated them with kindness and respect. One person said, “There is not one of them (staff) that I don't get on with. They are very loving, you can hear in their voice that they mean it.”

People’s preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People who used the service were provided with the opportunity to participate in activities which interested them. People's choices were taken in to account and listened to.

People's care records showed that where concerns about their wellbeing had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health care professionals, including a doctor and mental health professionals.

Is the service well-led?

Staff told us they were clear about their roles and responsibilities. We reviewed the minutes from staff meetings which showed that the management team had consulted with staff before implementing changes in the service. This helped to ensure that people were provided with a good quality service.

The service had an effective quality assurance system and records reviewed by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

People we spoke with said they were satisfied with the way 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 and improved arrangements for monitoring of the quality of the service.

People with whom we spoke were happy with the care they received at Oakland. Each person had an individual personalised care plan, which identified their care needs and choices. People spoken with stated that the staff provided the care they needed. Staff were observed speaking with people with dignity and respect and involving them in their care. People appeared relaxed with staff and were viewed making choices on how they wanted their care provided.

The home had systems in place to consult with people who use the service, relatives and visitors on the quality of the service provided by the home. Feedback from people with whom we spoke included "The staff are lovely", "I am happy here" and "They are very kind."

There were systems in place for people to use if they have a concern or are not happy with the service being provided to them. People with whom we spoke said they were happy with the care they received from the staff and knew how to raise any concerns they may have.

The provider has recently had support and guidance from the local authority following concerns raised, including the impact that new systems and paperwork were having on the care provided. We saw throughout our two day inspection that as a result of responding to these concerns staff were focused on driving improvements, for instance ensuring people were getting enough fluid and nutrition.

We found that whilst the service provided was safe sometimes staff were task orientated instead of person orientated.

During our inspection we spoke with five people, two relatives, three members of staff and one visiting healthcare professional.

People were generally happy with the care that they received. One person commented, "They look after me." Relatives told us if they had any issues they were dealt with as quickly as possible.

The healthcare professional told us that, "Since this manager's been on board I've seen improvements," and, "In general they are quite good."

Whilst there had been a recent turnover of staff, at the time of our inspection the provider was fully staffed and appropriate recruitment processes had taken place.