This inspection took place on 25 October 2016 and was unannounced.

Oaklands is a nursing home registered for up to 22 people. It provides nursing care and personal support to older people with nursing care needs usually over the age of sixty-five years of age. At the time of our inspection there were 17 people living at the service. The service is in a large detached house, arranged over three floors accessed by a passenger lift. The ground and first floor was used to provide people with nursing care, support and treatment. Long term care and respite care was provided.

There was a registered manager for the service. 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.

The last inspection was carried out on 13 October 2015 we found areas of practice which required improvement in relation to the quality assurance processes which were not fully in place to audit and quality assure the care and treatment provided. Where quality assurance audits had been completed these had not all been maintained or fully embedded in the running of the service. Staff demonstrated an awareness of the Mental Capacity Act (2005) (MCA) and the Deprivation of Liberty Safeguards (DoLS.) DoLS are the process to follow if a person has to be deprived of their liberty in order for them to receive the care and treatment they need. However, although a number of applications had been made for one person the use of bedrails had been omitted as part of the application. For another person there was no documentary evidence as to how special conditions in place were being met. The completion of the Do Not Resuscitate (DNAR) forms did not meet current guidance. Not all the charts such as food and fluid charts and turning charts had been fully completed. For one person who had a wound they did not have a written plan in place for the care and treatment to be provided or photographic evidence to help monitor the healing of the wound. There were areas where the décor and furnishings was in need of updating to improve the environment people lived in. There was not a copy of an electrical wiring certificate for the building and a business continuity plan was not in place to be followed in the event of an emergency. We looked at the improvements made as part of this inspection, and we found the provider had followed their action plan, improvements had been made.

Staff told us the service had been through a significant period of change, with a new registered manager and a number of changes in care staff working in the service. One visitor told us about the changes and said, “It’s so much more organised. She (Registered manager’s name) has got it moving. It’s a nice place to come to and it’s a better atmosphere. I enjoy coming in every week.”

People told us they felt safe. We received comments such as, ”Oh yes, very safe,” “I can’t complain,” “Day staff are very good,” and “Oh yes, I feel very safe, even at night.” They knew who they could talk with if they had any concerns. They felt it was somewhere where they could raise concerns and they would be listened to. Accidents and incidents had been recorded and appropriate action had been taken and recorded by the registered manager.

People and their relatives told us there were adequate care staff on duty to meet people’s care and support needs. People were treated with respect and dignity by the staff. They were spoken with and supported in a sensitive, respectful and professional manner. One person told us, “Staff are very understanding and listen to you.” Senior staff monitored people’s dependency in relation to the level of staffing needed to ensure people’s care and support needs were met. People were cared for by staff who had bee

This inspection took place on 13 October 2015 and was unannounced.

Oaklands is a nursing home for up to 22 people. It provided nursing care and personal support to adults but predominately older people with nursing care needs. At the time of our inspection there were 16 people living at the service. The service was in a large detached house, arranged over three floors accessed by a passenger lift. The ground and first floor was used to provide people with nursing care, support and treatment. Long term care and respite care was provided.

There was a registered manager for the service. 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. However, we have been subsequently notified that the registered manager has now left the service and a new manager was being recruited to the position.

This was the first inspection carried out since the registration of a new provider for the service in April 2015. A new registered manager had been appointed and there had been a number of changes in the care team working in the service. The building was going through a period of refurbishment.

Quality assurance process were not fully in place to audit and quality assure the care provided. Where quality assurance audits had been completed these had not all been maintained or fully embedded in the running of the service. This meant there was limited information available as to how the service was improving following feedback received. This was an area in need of improvement.

Staff demonstrated an awareness of the Mental Capacity Act (2005) (MCA) and of the need for people to consent to their care and treatment. Not all of the Do Not Resuscitate (DNAR) forms had a review requested where needed to ensure the information was still up-to-date. This was an area in need of improvement.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards. Staff had policies and procedures to follow and demonstrated an awareness of where to get support and guidance when making a DoLS application. Although a number of applications had been made for one person the use of bedrails had been omitted as part of the application. For another person there was no documentary evidence as to how conditions in place were being met. This was an area in need of improvement.

People had individual assessments of potential risks to their health and welfare, which had been regularly reviewed. However, the recording of checks completed had not been consistently recorded to inform the care staff of the care to be provided. This was an area in need of improvement.

Where people were being supported with wound care detailed treatment plans were not in place to fully protect people. This was an area in need of improvement.

There was a maintenance programme in place which ensured repairs were carried out in a timely way. However, there was not a copy of a current electrical wiring certificate. This was an area in need of improvement. There were areas where the décor and furnishings was in need of updating to improve the environment people lived in. However, there was a refurbishment plan in place to improve the environment in which people lived. There was an emergency on call rota of senior staff available for help and support. However, contingency plans were not in place to respond to any emergencies such as flood or fire. This was an area in need of improvement.

Medicines were stored correctly and there were systems to manage medicine safely, audits and stock checks were completed to ensure people received their medicines as prescribed.

People's individual care and support needs were assessed before they moved into the service. Care and support provided was personalised and based on the identified needs of each individual. People’s care and support plans and risk assessments were detailed and reviewed regularly giving clear guidance for care staff to follow. People’s healthcare needs were monitored and they had access to health care professionals when they needed to.

People told us they felt safe. They knew who they could talk with if they had any concerns. They felt it was somewhere where they could raise concerns and they would be listened to. People were treated with respect and dignity by the staff. They were spoken with and supported in a sensitive, respectful and professional manner. One person told us, “I am so lucky to be in such a nice place, with a large room overlooking a sea view.” One relative told us it was,“Home from home.”

People said the food was good and plentiful. One relative told us the food was, “Absolutely brilliant. All homemade and they select their choice each morning.” Staff told us that an individual’s dietary requirements formed part of their pre-admission assessment and people were regularly consulted about their food preferences.

Senior staff monitored people’s dependency in relation to the level of staffing needed to ensure people’s care and support needs were met. Staff told us they were supported to develop their skills and knowledge by receiving training which helped them to carry out their roles and responsibilities effectively. Training records were kept up-to-date, plans were in place to promote good practice and develop the knowledge and skills of staff. One relative told us, “Staff are absolutely brilliant. There is some really nice staff and they all work together as a team.”

People were cared for by staff who had been recruited through safe procedures. Recruitment checks such as a criminal records check and two written references had been received prior to new staff working in the service.

Staff told us that communication throughout the service was good and included comprehensive handovers at the beginning of each shift and regular staff meetings. They confirmed that they felt valued and supported by the managers, who they described as very approachable.

People and their representatives were asked to complete a satisfaction questionnaire, and people had the opportunity to attend residents meetings. We could see the actions which had been completed following the comments received. The registered manager also told us that they operated an 'open door policy' so people living in the service, staff and visitors could discuss any issues they may have.