This inspection took place on 23 February 2018 and was unannounced.

Oakleigh is a ‘care home’ providing residential care for older people with dementia. 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. Oakleigh accommodates up to 50 people set over three floors, and is divided into five units; each unit accommodates approximately 10 people. There were 48 people using the service at the time of our inspection.

At the last inspection on 29 November 2016 we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found people were not always protected from unsafe care or treatment, the provider had not always safeguarded people by taking the appropriate action and notifying relevant bodies such as the local safeguarding team without delay. People were also not supported to be involved in meaningful activities to meet their individual needs and the provider did not regularly assess and monitor the quality of service provided to people. Following that inspection the provider sent us an action plan showing how they planned to make improvements. At this inspection we found improvements had been made.

The service did not have a registered manager in post. The previous registered manager left the service in January 2017. However, the provider had appointed a new manager to run the home. The new manager’s application to the CQC to become the registered manager was being processed. 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 sought the views of people who used the services, their relatives, and staff to improve the service. Staff felt supported by the manager. The provider had effective systems and processes to assess and monitor the quality of the care people received which helped drive service improvements. The service worked effectively with health and social care professionals, and commissioners.

Staff knew how to keep people safe. The service had clear procedures to support staff to recognise and respond to abuse. The manager and staff completed safeguarding training. Staff completed risk assessments for every person who used the service and they were up to date with detailed guidance for staff to reduce risks.

The service had an effective system to manage accidents and incidents, and to prevent them happening again. The provider recognised people’s need for stimulation and social interaction. People had end-of-life care plans in place to ensure their preferences at the end of their lives were met. Staff completed daily care records to show what support and care they provided to each person.

The service carried out comprehensive background checks of staff before they started working and there were enough staff to provide support to people. Medicines were managed appropriately and people were receiving their medicines as prescribed. Staff received medicines management training and their competency was checked. All medicines were stored safely. The service had arrangements to deal with emergencies and staff were aware of the provider’s infection control procedures and they maintained the premises safely.

The provider trained staff to support people and meet their needs. People and their relatives told us that staff were knowledgeable about their roles and that they were satisfied with the way staff looked after them. The provider supported staff through regular supervision and yearly appraisal.

The manager and staff understood their roles and responsibilities under the Mental Capacity Act (MCA) 2005 Deprivat

Oakleigh is a residential service which provides care and accommodation for up to 50 older people some who have physical needs and some people who are living with dementia. People have varied communication needs and abilities. The service is set over three floors, and is divided into five units; each unit has their own lounge and dining area. Each unit accommodates approximately ten people. On the day of our inspection there were 43 people living in the service.

The inspection took place on the 29 November 2016 and was unannounced.

At a previous inspection in 2015 we found the provider was not meeting the requirements of the regulations. The provider sent us an action plan stating when improvements would be made. We undertook a further inspection of the service in November 2015 to check that actions had been implemented and improvements documented in the action plan had been made and found that some improvements had been made however breaches in the regulations were identified. Another action plan was submitted by the provider to state that further improvements would be made to the quality of care people received.

This inspection took place on the 29 November 2016 and was unannounced.

The service did not have a registered manager. 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 2014 about how the service is run.

People did not always receive care and treatment that was appropriate to their individual needs and were at the risk of receiving unsafe care or treatment.

We observed people receiving care that was provided in a dignified way. Improvements made showed us that staff spoke to people in a respectful manner.

The manager and staff had not always reported safeguarding concerns to the local authority in a timely manner.

Information was displayed for people and visitors on how to raise any safeguarding concerns. Staff had received training in safeguarding adults and were able to tell us about the different types of abuse and signs a person may show. Staff knew the procedures to follow to raise an alert should they have any concerns or suspect abuse may have occurred. .

People received their medicines when they needed them or as they had been prescribed. Medicine procedures for the safe administration of medicines were in place.

There were sufficient numbers of staff to meet people’s needs.

Activities on offer to people were limited. We did not see any specific activities or pastimes which would be suitable or appropriate to meet people’s needs during the inspection. Staff did not always show an understanding of what people were interested in and what people could still do. People were able to see their friends and families as they wanted and there were no restrictions on when relatives and friends could visit.

Care was provided to people by staff that were appropriately trained and recruited. One staff member said “I think the training is fantastic. We get lots of online training and support from colleagues.”

People’s human rights were protected as the registered manager ensured that the requirements of the Mental Capacity Act 2005 were followed. Where people were assessed to lack capacity to make some decisions, mental capacity assessment and best interest meetings had been undertaken, however documentation about other individuals who held power of attorney was not evident. Staff were heard to ask peoples consent before they provided care

Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected.

People were provided with a choice of cooked meals each day. Facilities were available for staff to make or offer peopl

Oakleigh is a residential service which provides care and accommodation for up to 50 older people some who have physical needs and some people who are living with dementia. People have varied communication needs and abilities. The service is set over three floors, and is divided into five units; each unit has their own lounge and dining area. Each unit accommodates approximately ten people. On the day of our inspection there were 43 people living in the service.

The inspection took place on the 11 November 2015 and was unannounced.

At a previous inspection in January 2014 we found the provider was not meeting the requirements of the regulations. The provider sent us an action plan stating when improvements would be made. We undertook a further inspection of the service in November 2015 to check that actions had been implemented and improvements documented in the action plan had been made.

The service had a registered manager. 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 2014 about how the service is run.

There were not sufficient numbers of staff to meet people’s needs. People were left on their own unsupported in their needs, throughout the service which was a risk to their safety. We observed people being left unattended for periods of ten minutes or more. One relative said; “I cannot categorically say she is safe. I am not afraid of her being ill-treated but of being neglected through lack of adequate staffing.”

People did not always receive their medicines when they needed them or as they had been prescribed. Medicine procedures for the safe administration of medicines were not consistently in place. We could not identify consistent best practice for the administration and recording of topical creams. Records showed us that topical medicines were not applied as frequently as prescribed.

People did not always receive care and treatment that was appropriate to their individual needs and were at the risk of receiving unsafe care or treatment. Some people with specialist equipment such as wheelchairs had not been assessed based on their individual need.

We did not always observe people receiving care that was provided in a dignified way. Although improvements made showed us that staff spoke to people in a respectful manner.

Information was displayed for people and visitors on how to raise any safeguarding concerns. Staff had received training in safeguarding adults and were able to tell us about the different types of abuse and signs a person may show. Staff knew the procedures to follow to raise an alert should they have any concerns or suspect abuse may have occurred. However we noted on two occasions staff had not reported issues of concern to the registered manager.

Staff showed an understanding of what people were interested in and what people could still do. However activities on offer to people were limited. We did not see any specific activities or pastimes which would be suitable or appropriate to people living with dementia during the morning. People were able to see their friends and families as they wanted and there were no restrictions on when relatives and friends could visit.

Care was provided to people by staff that were appropriately trained and recruited.One staff member said “The training is so good here; it has given me confidence in supporting people.”

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLs) which applies to care services. The registered manager and staff explained their understanding of their responsibilities of the Mental Capacity Act (MCA) 2005 and DoLS and what they needed to do should someone lack capacity or needed to be restricted to keep them safe. They had undertaken the appropriate assessments on people who lacked capacity to make certain decisions and the appropriate DoLS had been submitted to the local authority.

People were provided with a choice of cooked meals each day. Facilities were available for staff to make or offer people snacks at any time during the day or night. One person said; “I always get a choice, the food is good.”

People and their families had been included in planning and agreeing to the care provided. We saw that people had an individual plan, detailing the support they needed and how they wanted this to be provided. Staff ensured people had access to healthcare professionals when needed. For example, details ofdoctors, opticians, tissue viability nurses visits had been recorded in people’s care plans.

People’s views were obtained by holding residents’ meetings and sending out an annual satisfaction survey. Complaint procedures were up to date and people and relatives told us they would know how to make a complaint if they needed to.

The registered provider had a satisfactory system of auditing in place to regularly assess and monitor the quality of the service or manage risks to people in carrying out the regulated activity. The registered manager had made improvements in identifying areas that could be improved. We found the audits undertaken by the care manager and senior staff had not identified ongoing issues such as medicine errors and the registered manager had not implemented actions that were required to make sure improvements to practice were being made.

The registered manager showed us the complaints log which detailed concerns raised by people or their relative. We saw that the registered manager had responded to people’s complaints and implemented actions, where necessary. People felt the management of the service was approachable; One person said “it’s been more consistent.” Staff generally said they felt supported. Generally I feel supported by management.”

We found continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which correspond to regulations 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 experienced care, treatment and support that met their needs and protected their rights.

We saw people were well cared for and were well groomed.

Staff interacted with people in a kind and sensitive manner and treated people with dignity and respect. People were addressed in an appropriate way.

People told us they were happy living in the home and they had a say in their daily routine. Some people told us they enjoyed the company of others and liked to take part in the activities provided. Other people told us trey chose to spend more time in their room as they liked to read and watch television.

We spoke with several staff who felt well supported by the management structure in place, and said they were provided with ample training to undertake their roles.

The home was clean, hygienic and well maintained. People told us they were more than satisfied with the facilities provided. We saw individual units and communal areas of the home had been decorated with Christmas trees and decorations, which every body was excited about.

People felt safe within the home and staff were aware of the safeguarding procedures in place.

Effective systems were in place to monitor quality assurance.

People told us that they enjoyed living in the home. They told us that the staff were kind and caring and treated them with respect.

We saw that people had the appropriate information to help them make a choice about living in the home.

Some relatives told us that they looked at other homes before making the decision to place their relative at Oakleigh. They said the home was welcoming and the staff were caring that gave them the reassurance the needed.

People told us that the food was good and that they had a choice of menu. We saw the catering staff talking to people on individual units about the food and people's needs.

We saw staff interacting with people who used the service in a caring and professional manner.

We saw that whenever possible people had been consulted about their care and treatment.

Staff told us that they enjoyed working in the home and felt that they had received the appropriate training to enable them to undertake their roles and responsibilities.

Some people told us that they liked living in the home.

Some people told us that they enjoyed joining in the activities arranged for them, while others said they preferred to pick and choose what they do.

Some people told us that staff were kind and caring.

We were also told that the staff are overworked and that there was a shortage of staff at busy times.

We had good feedback regarding the food and the meals provided. Some people told us that the meals are always very nice.

People living in the home and some relatives told us that sometimes the noise on the first floor was unbearable.

Oakleigh provides care and accommodation for up to 50 people who are elderly and are living with dementia. The home, which is set over three floors, is divided into five units; each unit has their own lounge and dining area. Each unit accommodates approximately ten people. On the day of our inspection 46 people were living in the home.

The inspection took place over three days on 23 & 29 January and the 2 February and was unannounced.

The home is run by a registered manager, who was present on the day of the inspection visit. 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 and associated Regulations about how the service is run.

People had different levels of understanding and communication in relation to their Dementia. Staff did not show a level of understanding that people living with dementia have specialist needs. We heard staff talking to people with advanced dementia in a non-dignified way using comments such as, “Good girl.”

Staff did not have written information about risks to people and how to manage these in order to keep people safe. One person had fallen on several occasions and their risk assessment had not been updated since May 2014 to show the persons increased falls, or identified that the person may need to be referred to the falls team. Another person had been diagnosed with epilepsy, but their care plan did not describe guidance to staff on how to manage the risks of this person having a seizure. Risk assessments and care plans did not reflect the individual need of the person and how their dementia and physical needs affected their daily life.

Staff had received training in safeguarding adults and were able to evidence to us they knew the procedures to follow should they have any concerns. One staff said they would report any concerns to the registered manager. They knew of types of abuse and where to find contact numbers and knew about the local safeguarding team.

Staff did not have the specialist training they needed in order to keep up to date with caring for people who live with dementia and responding to their physical health needs. For example; one person with dementia was also registered blind; staff did not understand how to effectively communicate with the person to give a choice and reduce the person’s anxieties.

Staff had not received regular supervision or appraisals. One staff member said; “One staff said they had monthly staff meetings and unit meetings on an ad-hoc basis.”

We identified a need for additional members of staff to be on duty as there were times when we found no staff available to assist people or keep them safe for example from the risks of falls, or to support someone if they became distressed. One visiting healthcare professional said they had noticed the home was sometimes very short staffed, more so at the weekends. Sometimes they arrived to find people not up and dressed. When they asked staff about one person, they were told the person didn’t have visitors at the weekend which made the healthcare professional feel staff prioritised who they got ready first.

Although people told us they were happy living at Oakleigh, we did not observe staff consistently respecting people and treating them as individual’s, focusing on their needs, abilities and achievements. We heard staff ask people constantly about task focused activities e.g. “Would you like a cup of tea, its lunchtime now, come and have your dinner.” We did not observe staff sit and talk to people about their life, how they felt or what they wanted to achieve throughout the day.

Staff did not show an understanding of what people were interested in and what people could still do. We saw some people sitting for long periods of time without supportive interaction from staff. Supportive interactions are relationships and communications that we have with people that are affirming and help promote a person’s sense of self-worth. Best practice guidance shows one-on-one time is very important to having supportive and emotionally worthwhile social interactions.

Activities were limited to people who had capacity to become involved. We did not see any specific activities or pastimes which would be suitable or appropriate to people living with dementia. One staff said there were not enough activities, “They are arranged but never really see them happen.”

The registered manager had taken immediate action to address issues and staff awareness of people’s specific dietary needs, following concerns about the support people needed to eat and drink in relation to special diets such as softened food. However not all people’s care plans correctly identified the support they required for eating and drinking. We observed lunch which was a choice of two main courses and desserts and it looked and smelt appetising.

People were referred to external health professionals when they needed extra support. One person said; “We get visits from a chiropodist and other professionals.”

Care plans did not reflect people’s current needs or individualised choices. They had not been reviewed on a regular basis. One person file stated the mobility assessment and Malnutrition Universal Screening Tool (MUST) were completed 28 January 2015, however, the Waterlow assessment (an assessment that identifies the risk to the person of developing a pressure wound), skin integrity and personal care plan were blank.

Some people were involved with their own plan of care. One person said; “They are very busy but they do speak to me about my care needs.” Other people who lacked capacity had not been involved in their care planning process.

Medicine procedures for the safe administration of medicines were not consistently in place. However we could not identify consistent best practice for the administration and recording of topical creams. Records demonstrating they were applied as prescribed were not up to date.

The legal framework around the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) had not been followed. Staff understood the requirements of the Act and how it affected their work on a day to day basis. One staff said, “MCA and DoLS is when people don’t have the capacity to make choices.” However the registered manager had not completed the necessary MCA two-stage assessment or applications to the local authority as required by the DoLS. This meant people without capacity had not been supported in agreeing to choices made about their care. People at the home were being restricted from leaving and in aspects of their care.

The registered manager did not have a satisfactory system of auditing in place to regularly assess and monitor the quality of the service or manage risks to people in carrying out the regulated activity. We found the registered manager had not assessed incidents and accidents including falls, staff recruitment practices, care and support documentation, and decided if any actions were required to make sure improvements to practice were being made.

Confidential and procedural documents were not stored safely or updated in a timely manner. We saw copies of the homes contingency and emergency plan and the registered manager was able to explain the process in the event of an emergency.

People’s views were obtained by holding residents meetings and sending out an annual satisfaction survey.

The registered manager showed us the complaints log which detailed concerns raised by people or their relative. We saw that the manager had responded to people’s complaints and implemented actions, where necessary. One person said; “I’ve never complained but would do so” and “They would sort out a problem.”

People felt the management of the home was approachable; One person said “X is the manager and seems to be OK, I see them sometimes” and “They seem to manage the home well.” Staff generally said they felt supported; however felt the registered manager could be more visible on a day to day basis. Comments from staff included; “We don’t see the registered manager much, they spend a lot of time in their office.” And “The registered manager spends a lot of time in the office. Occasionally we see the area manager. Generally I feel supported by management.”

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which correspond to regulations 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.