The inspection took place on 1 November 2016. Oaklands House is a residential care home that provides accommodation and personal care for a maximum of 29 people. There were 29 people living in the service at the time of our inspection.

Our inspection of 27 July 2015 found that there were not sufficient staff. At this inspection we found that improvements had been made and there were sufficient staff to meet people’s assessed needs.

On the day of our inspection the manager had not registered with the Care Quality Commission but we are aware that they have applied to register and are going through the registration process. 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.

Medicines were stored, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records. However, we noted on the day of our inspection that one person was not getting their medicine as prescribed. This was immediately addressed by the manager.

People's individual assessments and care plans were person-centred, reviewed monthly or when their needs changed. However, one care plan we looked at contained errors and contradictions. The service was developing records of people’s life history but this was not detailed. Clear information about the service, the facilities, and how to complain was provided to people and visitors.

Staff knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow to make sure people were protected from harm. Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced.

There was a robust system of monitoring checks and audits to identify any improvements that needed to be made. The results of these audits were monitored by the provider. The management team acted on the results of these checks to improve the quality of the service and care.

There was a development plan in place which addressed areas for improvement identified by the manager and area manager. This identified timescales and the person responsible for driving the improvement.

Oaklands House Residential Home provides accommodation and personal care for up to 29 older people, some living with dementia.

There were 25 people living in the service when we inspected on 27 July 2015. This was an unannounced inspection.

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.

Systems for ensuring there were enough staff were not robust enough. This led us to be concerned about the service’s quality assurance processes because this issue had been identified as a shortfall at a previous inspection. People waited for long periods to have their call bells answered and staff were unable to tell us how people’s differing needs and dependency effected the staff numbers and deployment throughout the day. We saw some poor practice in regard to staff behaviour for example talking to colleagues instead of answering a call.

There were procedures in place which safeguarded the people who used the service from the potential risk of abuse. Staff understood the various types of abuse and knew who to report any concerns to.

There were procedures and processes in place to ensure the safety of the people who used the service. These included checks on the environment and risk assessments which identified how the risks to people were minimised.

There were appropriate arrangements in place to ensure people’s medicines were obtained, stored and administered safely.

Staff were trained and supported to meet the needs of the people who used the service. However, improvements were needed to provide more social interactions to people. Especially those people who remained in their bedrooms and were at risk of social isolation.

People, or their representatives, were involved in making decisions about their care and support. People’s care plans had been tailored to the individual and contained information about how they communicated and their ability to make decisions. However, improvements were needed in the ways that staff were provided with guidance in care records about people’s specific care needs.

Staff had good relationships with people who used the service. Staff respected people’s privacy and dignity and interacted with people in a caring, respectful and professional manner.

People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment.

People’s nutritional needs were being assessed and met. Where concerns were identified about a person’s food intake, or ability to swallow, appropriate referrals had been made for specialist advice and support.

A complaints procedure was in place. People’s concerns and complaints were listened to, addressed in a timely manner and used to improve the service.

During this inspection we identified two 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 four people who used the service and asked if the staff treated them with respect. One person answered, “Indeed.” Another person said, “They (staff) are all very nice and kind.” Another said, “The staff are smashing.” Two visitors to the service were spoken with and they confirmed that the staff treated their relative with respect.

We saw that the staff interacted with people in a caring, respectful and professional manner. Staff were attentive to people’s needs and they responded to requests for assistance promptly. One person told us, “If you need anything you only have to press the buzzer. They (staff) come straight away.”

People spoken with told us that they were consulted about the care and support they were provided with.

People told us that they felt that their needs were met. One person said, “You will get no complaints from me.” Another person said, “They are doing all that they should.” Another said, “We are well looked after here.”

We looked at the care records of four people who used the service. These records identified that people experienced care, treatment and support that met their needs and protected their rights.

We spoke with seven people who used the service who told us that the staff treated them with respect. Comments made by people included ‘they treat me with respect and humour which is important to me’, ‘they have never been rude’ and ‘they are very kind’. One person explained that during an illness ‘the staff were wonderful’, they said that the staff supported them in their recovery.

Two people told us that there were enough staff working in the home and that the staff answered call bells promptly.

Five people who were spoken with said that they felt that their needs were met and that they were consulted about the care and support that they were provided with. Two people told us that they were independent with their personal care needs and that the staff always respected their independence.

People told us that the quality of the food was good and that they were provided with choices of food and drink and always got enough to eat and drink. We asked a person if they had enjoyed their lunch and they said ‘it was better than I could have done’ and ‘I must have, I ate it all up’. Two people told us that their specific dietary needs were met.

One person told us that there were plenty of activities offered that they could participate in if they chose to. They showed us several pieces of art work that people had done which were displayed in the conservatory.

We spoke with 10 people who used the service about their experiences of the service they were provided with. People told us that they were happy living in the service. One person told us, “I am quite happy here…ever so pleased with my room.” Another said, “Wonderful retirement home, everywhere is clean, even the corners, it is very important to me.” Another said, “Very lucky to be here, very, very well looked after.”

People told us that the service was well led. One person said, that the registered manager, “Has a lot to do, comes around when you have not been feeling well and checks how you are.”

Everyone we spoke with praised the standard of food. One person remarked, “The food is lovely here, it is a delight to eat (chef’s) foods…never had a bad meal yet.” Another person told us, “You get choice, chef makes a lovely omelette.”

We found the majority of the staff treated people in a caring and respectful way and were attentive to people’s needs. One person told us, “When I call in the middle of the night they (staff) bring me a cup of tea.” Where we identified a shortfall, action was being taken at the time of our inspection to deal with the situation.

We found that the majority of time that there were sufficient numbers of staff to meet the needs of the people who used the service. Where we identified additional staff were required to support the tea time routines, the provider told us they were in the process of recruiting another member of staff.