This inspection was carried out on 9, 16 and 18 January 2019.

Oaklands nursing home is a care home. People in care homes receive accommodation and nursing or personal care as a single package and one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

Oaklands is located in Littleton on the outskirts of Chester. The home is a three-story building with access to all levels being provided by a passenger lift. There are 45 bedrooms; most have ensuite facilities. The home can provide care for up to 50 people. At the time of our inspection there were 31 people living at Oaklands.

There was no registered manager in post at the time of our inspection, however the acting manager was in the process of registering with the Care Quality Commission. The new manager had commenced in post during October 2018. A registered manager is a person who is 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection in April 2018 the service was rated as requires improvement. We recommended that improvements be made to the management of ‘as required’ medicines and that governance processes continued to be developed and improved.

Improvements had been made with the management of medicines and PRN ‘as required’ medicines protocols were now in place. Medicines were ordered, stored, administered and disposed of in accordance with best practice guidelines. The registered provider had medicines policies and procedures in place. Medicine administration records (MARs) were fully completed and regularly audited for accuracy. Staff that administered medicines had all received training and had their competency regularly assessed.

Improvements had been made to the governance systems undertaken by the registered provider at the home. Quality assurance systems were in place that were consistently completed. Areas for development and improvement had been identified and action taken to complete these. Accidents and incidents were analysed to identify trends and patterns within the home.

Safe and robust recruitment practices were in place and sufficient staff were employed to meet the assessed needs of the people living at the home. All staff had completed an induction at the start of their employment and undertaken shadow shifts. Staff completed mandatory training required for their role and undertook regular refresher updates. Staff told us they felt supported and that they attended regular team meetings and daily handovers.

Staff had all undertaken safeguarding training and felt confident that they knew what to do if they had any concerns regarding the people they supported. The registered provider had safeguarding policies and procedures in place staff knew how to access.

People were assessed before they moved into the home and this information was used to produce detailed risk assessments and person-centred care plans. These documents included clear guidance for staff to follow to meet people’s individual needs. People’s needs that related to age, disability, religion or other protected characteristics considered throughout the assessment and care planning process. Care plans and risk assessments reviewed and updated regularly.

People had their dietary needs assessed and reviewed regularly. Guidance was developed and used by staff to support people with their individual needs. Staff were participating in a hydration project which had shown positive results for people supported. People spoke positively about the food and drink.

We observed positive interactions between people and the staff that supported them. People told us that staff respected their privacy and promoted their independence where pos

We carried out an unannounced comprehensive inspection of this service on 16 and 20 November 2017. After that inspection we received concerns in relation to the care and treatment of people using the service. As a result we undertook a focused inspection to look into those concerns and to check that improvements to meet legal requirements planned by the provider after our comprehensive inspection had been made. The team inspected the service against two of the five questions we ask about services: is the service safe and is the service well-led. This was because the service was not meeting some legal requirements.

This unannounced focused inspection took place on 4 and 17 April 2018.

Oaklands nursing home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Oaklands is located in Littleton on the outskirts of Chester. The home is a three storey building with access to all levels being provided by passenger lift. There are 45 bedrooms; most have en-suite facilities. The home can provide care for up to 50 people. At the time of our inspection there were 32 people living at Oaklands.

There was no registered manager in post at the time of our inspection however the acting manager was in the process of registering with the Care Quality Commission.

During the previous inspection we found that staff did not carry out appropriate checks on visitors to the service to ensure that people were safe. During this inspection we found improvements had been made; we were greeted at the front door by a member of staff before being allowed to enter the main building.

During the previous inspection we found there was a lack of effective systems and processes in place to monitor and improve the quality of the service. During this inspection we found that improvements had been made and the manager was in the process of implementing new systems and processes to monitor and improve the quality of the service.

Prior to the inspection we received information of concern in relation to staffing levels; during this inspection we found that sufficient staffing levels were deployed to meet the needs of people living in Oaklands.

Medicines were stored securely, however medicine administration was not always accurately recorded.

Risk assessments were in place for people living at Oaklands; the manager told us that not all risk assessments accurately reflected people’s individual risks. However, this was being looked at as a priority.

Supplementary records were being used by staff to record daily information such as food and fluid intake, night safety checks and repositioning charts.

Each person living in Oaklands had a Personal Emergency Evacuation Plan (PEEP) that was accurate and reviewed regularly.

Accidents and incidents were reported and recorded accurately by staff.

There were no concerns regarding the safety and cleanliness of the environment; regular safety checks were completed.

Staff had received training in areas such as infection control and manual handling; the service had recently delivered practical training in relation to manual handling.

Staff and people living in Oaklands spoke positively about the current management team and the improvements that had been made.

Staff had access to policies and procedures for the service to assist them to follow legislation and best practice.

The management team were very responsive during the inspection and able to provide information on request.

The manager and registered provider showed a desire to improve on the quality of the service being provided for people living in Oaklands.

We carried out an inspection on the 16 and 20 November 2017. The first day was unannounced.

Oaklands nursing home 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.

Oaklands is located in Littleton on the outskirts of Chester. The home is a three storey building with access to all levels being provided by a passenger lift. There are 45 bedrooms; most have en-suite facilities. The home can provide care for up to 50 people.

The service has had a registered manager in post since April 2015. 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 service has not been previously inspected by Care Quality Commission under the new inspection methodology. During this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see the action we have told the provider to take at the end of the report.

Appropriate checks on visitors to the service were not always completed by staff to ensure people were safe in their home environment. We raised concerns to the management team regarding the safety and security of the building and asked them to address this with immediate effect.

Quality assurance systems in place were not always effective. Action plans had not always been put in place to address the improvements needed. There was a lack of management oversight to ensure that checks were carried out as required across the different areas of the service.

Supplementary records were not properly maintained to make sure they were accurate and fully complete. Care plans were not always personalised.

The management of medicines was safe. Records we viewed were completed appropriately and people told us they had received good support to take their prescribed medications. However, the registered provider’s medication audit required improving. The audit did not clearly identify what actions had been taken to improve practice when medicines errors had occurred.

People told us and observations showed that they were offered choices at mealtimes and a variety or regular snacks and drinks throughout our visits. However, further improvements were required to improve the mealtime experience for people living at the service. We have made a recommendation to the registered provider.

Improvements were required in relation to the management of rotas. The registered provider’s recruitment procedures were followed appropriately. All staff were subject to a range of checks to ensure that they were suitable and safe to work with vulnerable people.

Regular supervisions and team meetings had been recently re-introduced and staff confirmed that communication had started to improve at the service. People were supported by staff who had received appropriate training. All staff received training to enable them to fulfil their roles which included essential subjects such as moving and handling, safeguarding people and medication training.

Risk assessments were completed for each person supported, and identified any risks to their health and safety. Assessments provided information to guide staff on how to minimise risks to people and themselves when providing care and support.

Staff worked well with external health and social care professionals to make sure people received the care and support they needed. People were referred onto the appropriate service when concerns about their health or wellbeing were noted. Staff spoke kindly to people and respected their privacy and dignity. Staff knew people well and had a caring approach.

P