We inspected Oaklands Rest Home on 7 and 8 December 2017. Our visit on 7 December was unannounced.

We last completed a full inspection of Oaklands in December 2016, when we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: regulation 9 (person centred care), regulation 15 (premises and equipment), regulation 12 (safe care and treatment) and Regulation 17 (good governance) There was a further breach of the Care Quality Commission (Registration) Regulations 2009 as the service did not display the latest rating. We returned to conduct a focussed inspection in March 2017, when we found some improvements but the service remained in breach of regulations relating to the maintenance of premises and equipment, and good governance. At this inspection we found the service continues to improve, but we made one recommendation that the service responds quickly to external inspections and reviews to improve the safety of people who use the service.

Oaklands is registered to provide accommodation for up to 32 older people who require residential care. At the time of our inspection there were 18 people living at the home. When we visited the home there was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

When we toured the building we saw that the home was clean and free from any unpleasant odours. The registered manager showed us where improvements had been made since our last inspection, such as a new medicines room, so that medicines could be stored safely and efficiently; refitted bathrooms and new carpets throughout the building.

The building was secure and staff ensured the safety and well-being of the people who lived at Oaklands; they were aware of the safeguarding and whistleblowing procedures, understood signs of abuse and demonstrated an understanding of how to protect vulnerable people from harm. When we asked, people who used the service told us they felt safe. When accidents and incidents occurred we saw that there was appropriate follow up and investigation to minimise the risk of repeat occurrences. The manager kept a register which showed when any maintenance and safety checks were due.

People were treated with respect, and consideration of their cultural needs and background was taken into account when planning care, along with people’s ability to gauge their own risks. When we looked at care records we saw they reflected people’s needs and choices. Care plans were detailed and staff kept good daily notes which cross referenced and reflected plans of care. We saw that support was delivered in a timely manner.

There were enough staff on duty, and we saw that safe recruitment procedures were followed. A training timetable showed when staff had attended training courses and reflected good access to training from a variety of resources. Staff training was regularly reviewed and updated to keep in line with current best practices, and when we spoke to staff they were able to tell us how they had benefitted from their training.

People who lived at Oaklands told us that they enjoyed the food provided, and we saw that attention was paid to diet and hydration. Day to day health needs were monitored and the service worked well with external health and social care agencies, particularly commissioners and general practitioners (GPs).

Care was delivered in a person centred way by staff who knew the people who lived at Oaklands well, and we saw that all were treated with kindness and respect. People were involved in planning their care, and where they lacked capacity to consent to care and treatment the service complied with the relevant legislation around capa

This focussed inspection took place on 29 March 2017 and was unannounced. This meant the registered provider and staff did not know we would be visiting. This inspection was a focused inspection to check the safety of the premises and the people who used the service and to determine what, if any, improvements had been made since we visited in December.

We had inspected Oaklands on 8 and 9 December 2016 when we found breaches of five of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found that the registered manager had taken action to address some of the issues previously raised, for example, issues of infection control and disposal of waste, and the previous inspection rating was displayed. We also saw that the registered manager had purchased equipment for activities and when we spoke to people who used the service they told us that they had enough to do at Oaklands. However, the service remained in breach regulations relating to the maintenance of premises and equipment, and good governance.

Oaklands Rest Home Oaklands Rest Home is registered to provide accommodation for up to 32 older people who require residential care. At the time of our inspection there were 23 people living at the home.

When we visited the home there was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (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 that they were supported by staff who knew them well and felt safe at Oaklands. There were adequate staffing levels. Staff were willing to put extra time in unpaid to ensure the needs of the people who used the service were met, and the registered manager ensured the food budget was managed effectively, with any surplus being used to provide essential items to enhance the safety and comfort of the people who lived at Oaklands.

We saw that improvements were being made to the structure and décor of the building. The service had contracted a maintenance officer to repair the ground floor window frames. A number of bedrooms had been redecorated, with new carpets and curtains. However, a frayed carpet in the communal lounge which we had previously identified as a trip hazard had not been replaced..

The service had taken steps to address issues of infection control. When we toured the building we saw that hazardous materials were locked away when not in use and clinical waste was disposed of correctly.

The registered manager told us that the owners were providing some support to improve the quality of life of the people who lived at Oaklands Rest Home. She showed us some new equipment bought to help provide activity and stimulation, and some old equipment had been replaced. However, staff told us that they were still concerned that they may not get paid on time and we saw that the registered manager was using an old laptop which was incompatible with systems used by other agencies such as the local authority. This affected her ability to send reports to outside agencies.

People told us that the service promoted a homely atmosphere and that the staff were open and friendly. We saw that they worked well together and promoted the well being of the people who used the service. There was a low staff turnover, and staff would raise money to pay for events such as special lunches or to provide entertainment for the people who used the service. The registered manager was held in high regard, and although tied by financial constraints was able to use the resources at her disposal to meet the day-to-day needs of the people who used the service.

This inspection took place on 8 and 9 December 2016. Our visit on 8 December was unannounced.

We last inspected the home in June 2015. At that time we rated the service ‘Requires Improvement’ with a rating of ‘Inadequate’ in the ‘well-led’ domain. We identified breaches in five of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to make improvements in relation to infection control, storage facilities, maintenance of equipment, working within the principles of the Mental Capacity Act, monitoring the quality of the service, provision of activities, supervision of staff and gathering feedback from people who used the service. At this inspection although we found there had been improvements in some areas, some issues we identified at the last inspection had not been addressed.

At this inspection we identified breaches of five of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to infection prevention and control, maintenance of premises and equipment, disposal of offensive waste and unsafe storage of equipment; the provision of activities; failure to display the Care Quality Commission (CQC) inspection ratings and lack of governance.

We identified one breach of the Care Quality Commission (Registration) Regulations 2009. This was because the registered provider had failed to notify the CQC that they had entered into a Corporate Voluntary Arrangement. This is an arrangement that allows an insolvent company to pay creditors over a fixed period of time and continue trading during this period.

We made one recommendation. This was in relation to the communal living space. You can see what action we told the provider to take at the back of this report. We are currently considering our response in relation to enforcement for some the breaches of regulations and we will update the section at the end of this report once any such action has concluded.

Oaklands Rest Home is registered to provide accommodation for up to 32 older people who require residential care. At the time of our inspection there were 24 people living at the home. When we visited the home there was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (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.

Staff had a good understanding of how to keep people safe and what action they should take in order to protect vulnerable people in their care. Recruitment checks had been carried out on all staff to ensure they were suitable to work with vulnerable people. During our time in the home we observed there to be sufficient numbers of staff to care for people and to respond to their needs promptly.

The home was clean and free from unpleasant odours. However, we found that there were problems with the general maintenance in some parts of the home and steps had not been taken promptly by the registered provider to rectify them. Two storage rooms which contained equipment that could cause injury to people if they entered unsupervised were not locked. This had been identified during our previous inspection, but no action had been taken to rectify this.

Staff wore personal protective equipment (PPE) such as disposable gloves and aprons when carrying out care tasks and we found toilets and bathrooms were well stocked with soap and paper towels. This measure helped protect people from the spread of infection. However, waste bins were not foot-operated, which meant that staff risked contaminating their hands when disposing of soiled items.

The provider did not have a contract with an approved company for the safe disposal of offensive/hygiene waste, such as incontinence

The inspection team was made up of one inspector. We set out to answer the question is the service caring?

Below is a summary of what we found. The summary is based on our observations during the inspection; speaking with people using the service, the manager and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service caring?

The atmosphere in the home was found to be calm, relaxed and welcoming. Care staff were observed interacting with people using the service in a professional and attentive manner.

People were given time to make choices and decisions about the care they wished to receive. Care staff were seen to support people sensitively and with patience. One person using the service told us, “The staff are wonderful. Nothing is too much trouble; I wouldn’t want to live anywhere else.” One visiting relative told us, “I’m just so glad [relative] lives in this home.”

At our inspection on 15 October 2013 we found that care and treatment was not planned and delivered in a way that ensured people’s safety and welfare. During this inspection we saw that improvements had been made.

In October 2013 we found that we found that people were not fully protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to safely manage medicines within the home. At that time we also found that there were not enough qualified, skilled and experienced staff to consistently meet people’s needs. During this inspection we found that this remained the case.

During this inspection we asked the manager to produce a number of records for inspection. The manager was not always able to locate the documents requested. Records were not stored in an accessible way that allowed them to be located promptly when required.

Each person had a care plan which provided staff with instructions on how to meet their care and support needs. These were periodically reviewed to ensure they continued to meet peoples' needs.

The provider did not have procedures in place for dealing with emergencies which are reasonably expected to arise from time to time and affect the provision of service. The provider did not have arrangements in place to mitigate risks arising from such emergencies to service users.

When we inspected Oaklands Rest Home Limited on 6th March 2013 we found that people were not fully protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. The provider had made some changes to address the issues identified at our last inspection. However, we found further concerns at this visit.

The provider had protected the home against the risks associated with unsafe or unsuitable premises.

People living at the home generally spoke highly of the staff. However, there were insufficient numbers of suitably qualified, skilled and experienced people employed to safeguard the health, safety and welfare of people using the service. One person said “my only bugbear [source of irritation] is that there are not enough staff”. Another said they “didn’t’ like to complain because the staff have got a lot on”.

The provider had a complaints procedure in place which was readily available to people using the service.

This follow up inspection was to check whether the Registered Provider had taken action to address the area of concern that we identified at our previous inspection In March 2013. We found at that inspection improvements had been in many areas of the service provided but further work was needed to check the quality of service provided.

We saw that people received discreet care and support quickly. We spoke briefly with two people living in the home, two visiting families and one healthcare professional that visited the home regularly. Everyone spoke positively about the home, the quality of the service and the staff. The healthcare professional said “people are looked after” and “there are always staff at hand to assist me”. One visitor said “My [relative] is looked after properly" and “I wouldn’t change it [the home]. It is a friendly home and we are made to feel welcome”.

We found that checks were carried out on different aspects of the service but these were not always recorded. We saw that care records were reviewed monthly, records of medications entering and leaving the home were available and as were monthly checks on the home environment. We heard that additional weekly medication checks and monitoring of the quality of people’s laundry was also undertaken. The manager confirmed that these were not yet recorded.

This follow up inspection was to check whether the Registered Provider had taken action to address the four areas of concern we identified at our previous inspection in May 2012. These included the lack of checks on the quality of the service, poor record keeping, inadequate systems of staff support and concerns about staff’s understanding of safeguarding people from abuse.

At this inspection, we found that the manager had some taken action to address the identified areas of non compliance but she confirmed to us that there was a lot more work to do.

We found that care plan records had improved. They reflected the wishes of people who lived in the home, they explained to staff how to deliver care safely and they were reviewed and updated regularly.

We saw that staff files had been tidied up and these contained training certificates and records of individual one to one meetings (supervision).

Staff told us about what they would do if they witnessed or suspected that someone was being abused. One person living at the home said “I feel safe”.

We saw that people and visitors had been asked for their thoughts on the service. We spoke with people living in the home, visitors and two health care professional. They all praised the quality of care and the staff. However checks on the quality of service had not been undertaken.

At this visit, we saw that prescription medications were not stored securely enough. This was unsafe and put people at potential risk.

At the time of our visit, 28 people were accommodated at Oaklands Rest Home. The manager told us that many of the people living at the home had some form of dementia. This meant it was difficult for them to tell us of their experiences of living in the home.

However, we spoke with three people living at the home and visitors to two other people.

People told us that they liked living at the home; they told us that the staff were helpful and respectful.

One person living in the home told us “I feel safe and cared for”. Another person said “Staff are spot on. They are smashing any worries you can talk with them.” A third person said “It’s okay here. Girls are no problem, they are respectful”

We heard mixed comments about the meals. One person described them as “Reasonable” and another person said “The food is lovely”.

A visitor to the home told us that they believed their relative was “looked after”. We heard that the manager and staff were approachable to discuss any issues or concerns. They told us “We have no worries about here”. They said the home was “Very clean”.

Another visitor said that the home kept them informed of any changes in their relative’s health. They also said that the care provide to their relative “was good”. They told us that staff sought medical advice if there were any concerns about the health of their relative. They said that they had no complaints about the home and felt that their relative was safe, and treated respectfully.

We spoke with a visiting health care professional. They told us that they thought people living in the home received a good standard of health care. They said that they were contacted appropriately when staff had concerns about a person’s health and that staff followed the health care professional’s advice and instructions.

This inspection was carried out over two days on 22 and 23 June 2015. Our visit on the 22 June was unannounced.

We last inspected Oaklands Rest Home Limited in December 2014. At that inspection we found that the service was meeting all the standards we assessed. Since that inspection the Commission has successfully prosecuted this provider for a breach of condition of registration. The provider is now compliant with the conditions attached to their registration.

Oaklands Rest Home Limited provides accommodation for up to 32 people who require residential care. Accommodation is provided over three floors and consists of 30 single and one shared room. 21 of which have en-suite facilities. The home has two passenger lifts and chair lift provides access to the rooms on the third floor. There is limited car parking available.

The home had a manager registered with the Care Quality Commission (CQC) who was present on the second day of the 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.

We identified seven 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 this report.

People who used the service, who we asked, said they felt safe living in the home.

Staff who we asked demonstrated a good understanding of the need for safeguarding procedures and of their role in them.

During our tour of the premises we found a number of fire doors wedged open with furniture. This could result in people living and working in the home being at risk in the event of a fire.

We found a number of bathrooms being used inappropriately for the storage of equipment, furniture and other items. As these rooms were not locked, they were accessible to people who used the service and could place people at risk of falls or entrapment. This also reduced the number of bathroom facilities available for people who used the service.

There was a lack of appropriate infection control in various parts of the home, including lack of hand washing facilities for staff after using the laundry area.

The people we spoke with told us that they felt the staff were very caring and had the right attitude, skills and experience to meet their needs.

People who used the service told us they could make choices about the support they received. However, although the registered manager had an understanding of the basic principles of the Mental Capacity Act (MCA) 2005, staff were confused about the rights of people to make their own decisions. This meant that current systems in place to record whether people were able to consent to the support and care they needed were not sufficiently robust to ensure people’s rights were protected.

Information seen in those care records we looked at indicated that referrals had been made to the appropriate health care services and health and social care professionals when changes became apparent in a person’s health needs.

People who used the service, who we spoke with, told us the care provided by the service was good and responsive to their individual needs.

Although the people we spoke with told us they were happy with the care and support they received, they did tell us a lack of available activities sometimes meant the days could become boring, “just sitting around”. We have made a recommendation about activities.

Staff told us they were happy working in the service. They told us the registered manager and senior team were approachable and supportive.

There were systems in place to record any complaints, and people we spoke with told us they would be confident to approach the registered manager or any of the staff with any concerns.

The lack of robust systems being in place to monitor the quality of service people received had resulted in many of the shortfalls and breaches of regulations we found during the inspection process.

We are aware from information supplied to us by the utility company used by the provider that the provider is in debt to the company for electricity used. We are continuing to monitor this situation and have asked the provider for further assurance that the debt is being repaid.