About the service: Oaktree Care Home is registered to provide personal and nursing care for up to 78 people. The service is divided over two separate floors. The ground floor, called Bluebell is for those who require nursing care and the upper floor is dedicated to those people living with dementia and has two units called Primrose and Snowdrop. Snowdrop, provides support to people living with dementia but do not need nursing care. There were 59 people living at Oaktree Care Home when we inspected.

People’s experience of using this service:

Since our last inspection, improvements had been made to ensure complaints were dealt with promptly with feedback given to the complainant. It was evident people felt their concerns were listened too and acted upon swiftly.

As seen at the last inspection, there was a heavy reliance on agency staff whilst the registered manager was recruiting to the vacant posts. This was having an impact on the delivery of care. People were not receiving the care when they needed or wanted it. This was in part due to the high agency usage and many of the people needing two staff to support them, which was not taken into account when calculating the staff on the nursing unit.

Staff were not being fully supported thorough regular supervisions and annual appraisals. Whilst staff had received training on a variety of topics, overall the home had not achieved the provider’s own internal compliance figures. Staff had not received training relevant to the needs of people they were supporting, such as diabetes.

Care was planned and delivered but not always in a person centred way in line with people’s preferences. This was being addressed by the registered manager, who was reviewing practice around the times when people were supported to get up for the day.

People felt safe living at Oaktree and risks to people were minimized through risk assessments. There were plans in place for unforeseeable emergencies. However, some people felt safer when supported by regular and familiar staff.

We have recommended the service review their menu planning to ensure it includes variety and all the food groups. There was a vacant chef post which was impacting on the quality of the food provision. Agency catering staff were covering the vacant hours.

People were consulted about their care and support needs and involved in decisions about their care. Staff had a good understanding of the legislation to protect people where they lacked capacity involving family and other professionals. People and their relatives told us the staff were kind and caring. Feedback was complimentary about the regular and familiar staff.

There was an ongoing decoration programme in place. The home was clean and free from odour.

There were systems in place to monitor the quality of the care and support. However, there were no improvement plans in place to ensure ongoing compliance from findings of the provider visits.

Rating at last inspection: Requires Improvement. (Report published June 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection. We saw improvements had been made since our last inspection. Our findings at this inspection have meant the rating remained Requires Improvement. This is the second time this service has been rated Requires Improvement.

Follow up: We will meet with the provider following this report being published to discuss how they will make changes to ensure the provider improves the rating of the service to at least Good. We will revisit the service in the future to check if improvements had been made.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This was a focused inspection because we had received some concerns about the service from relatives. This was about the response from the service to complaints, electrical equipment and pressure mattresses and concerns about care delivery. There has also been an increase in notifications of incidents that affect the well-being of a people in the last three weeks prior to the inspection around falls and unexplained bruising. We focused on these areas to check whether the service was safe, responsive to people needs and whether the service was well led.

The inspection was completed on the 25 April 2018 and was unannounced. The service was last inspected in February 2017 and was rated as good in all areas with no breaches in regulation.

Oaktree Care 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.

Oaktree Care Home is registered to provide personal and nursing care for up to 78 people. The service is divided over two separate floors. The ground floor was called Bluebell is for those who require nursing care and the upper floor is dedicated to those people living with dementia and is called Primrose. Since the last inspection, a further unit had been opened on the first floor called Snowdrop, which provided support to people living with dementia but did not need nursing care. There were 59 people living at Oaktree Care Home when we inspected.

There was a registered manager in post. A registered manager is a person who has registered with the 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.’

From our inspection, it was evident that not everyone felt their concerns were listened too and acted upon swiftly. This was because people and their relatives were not receiving an acknowledgement or a prompt response on what action had been taken to address their concerns. Some concerns were taking longer time to investigate than the provider’s complaint policy and not all concerns/complaints were recorded on the central record. This meant the provider and registered manager were unable to look for any themes. We have asked the provider and registered manager to make improvements in this area.

Concerns were raised with us prior to this inspection on how some of the equipment was maintained such as electrical appliances and pressure relieving mattresses. We saw that checks were completed on the electrical appliances annually. However, it was evident that the external contractor had missed items in people’s bedrooms and two bedrooms had not been checked. The provider has reviewed their contract with this company and new contractor has been commissioned. This was because they could not be assured all items had been checked. Assurances were provided that this would be completed the day after the inspection.

Staff completed regular checks on the mattresses with records maintained. Where the family had raised concerns, this had been addressed with actions being taken to reduce further risk. Where staff were checking floor and chair sensor mats the records could potentially indicate there was a gap in recording because there was no record to indicate that they had changed position such as moving to another area of the home or had retired to bed. Assurances were given by the unit manager and the registered manager that this would be addressed. The registered manager was aware that there were some shortfalls in recording and was addressing this through team meetings and via one to one with staff members.

People told us the staff were usually responsive to their requests for assistance when using their call bell. One person told us they h

This inspection took place on 22 and 24 February 2017. We carried out this inspection because we found two breaches of regulation at the last inspection in February 2016. The provider sent us an action plan which we reviewed during this inspection.

Oaktree Care Home is registered to provide personal and nursing care for up to 78 people. The service is divided over two separate floors. The ground floor was called Bluebell is for those who require nursing care and the upper floor is dedicated to those people living with dementia and is called Primrose. There were 47 people living at Oaktree Care Home when we inspected.

There was a registered manager in post. A registered manager is a person who has registered with the 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.’

We found at our last inspection in February 2016 there were some areas the service had to improve to ensure people were safe in respect of the management of medicines and the recording of complaints. Improvements in these areas were noted. The registered persons had taken appropriate action to address these areas.

It was evident that since our last inspection the service had sustained and continued to make improvements where required. Feedback from people, their relatives and visiting health professionals was positive about the care and support that was in place. The service was well led with good leadership from the registered manager and the unit managers in ensuring these improvements continued. Staff told us they were working as a team to support people in an individualised way. Feedback from visiting health and social care professionals provided us with evidence that the staff understood and knew the people they were supporting well. This was echoed by people who used the service and their relatives.

People were safe because where their care needs had changed or an incident had occurred, appropriate action had been taken. Where incidents were identified as potential abuse; staff were reporting and an investigation was completed. This included reporting incidents and accidents to the local safeguarding team and submitting notifications to the CQC. Notifications tell us about significant events that happen in the service. We use this information to monitor the service and to check how events have been handled. People’s rights were protected and where restrictions were in place this was done with the appropriate authorisation involving other professionals. This was kept under review.

Systems were in place to ensure people were safe including risk management, checks on the environment and safe recruitment processes.

People were receiving care that was responsive and effective. Care plans were in place that described how the person would like to be supported. The care plans provided staff with information to support the person effectively. People’s health care needs were being met. Other health and social professionals were involved in the care of the people living at Oaktree. Referrals were made in a timely manner for people where required.

People’s nutritional needs were being met. Where there were risks to people there were clear plan of care in place, additional monitoring and good communication between the care and catering staff.

Staff were caring and supportive and demonstrated a good understanding of their roles in supporting people. Staff had received training and support that was relevant to their roles. This had included all staff at all levels in the working towards an accredited training programme for supporting people with dementia. Systems were in place to ensure open communication including team meetings and daily handovers. A handover is where important information is shared between the staff during shift changeovers. This ensur

This inspection took place on 17 and 18 February 2016. We carried out this inspection because we found a number of breaches of regulation during the last inspection in September 2015. The provider sent us an action plan telling us they would be compliant by December 2015.

Oaktree Care Home is registered to provide personal and nursing care for up to 78 people. The service is divided over two separate floors. The ground floor called Bluebell is for those who require nursing care and the upper floor is dedicated to those people living with dementia and is called Primrose.

There was a manager in post. The manager commenced in post in October 2015. They had not submitted an application to become the registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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.’

After the last inspection we took enforcement action against the provider. This was to prevent them considering any new admissions on Primrose without prior written authorisation from the Commission. There had been no admissions to Primrose since the last inspection. The regional manager, the manager and the unit manager said they felt that they were now satisfied people were receiving safe and appropriate care and would like to start to admit people to Primrose using a phased approach. The provider must contact the Commission prior to any new admissions.

There had been significant improvements since our last inspection in respect of how people were being treated, how staff were responding to their care needs ensuring they had access to appropriate professionals. There was a clear and committed management team working across all areas of the home. Staff confirmed since the last inspection there had been improvements on Primrose and they felt there were a more cohesive team which was being led by the unit manager.

There were some areas that required further improvement including the management of complaints and ensuring people received their medicines safely. This was because there was a lack of guidance for staff about ‘when required’ medicines such as pain relief and medicines to reduce anxiety. Improvements were required in respect of stock control where medicines were not given from pre-packaged ‘blister’ packs. This would mean there would be a system to pick up quickly if medicines had not been administered at the correct time.

People were supported by sufficient staff. However, it was recognised by the provider, the manager, staff, relatives and people who use the service that there was a high usage of agency staff. This was having an impact on the delivery of care because the agency staff were not always responsive to people’s changing needs. Health care professionals had seen some improvement but remained concerned that the agency staff did not always know the person well enough. Steps were being taken by the provider to recruit to the vacant staff posts.

People were safe because where their care needs had changed or an incident had occurred, appropriate action had been taken. Where incidents were identified as potential abuse; staff were reporting and an investigation was completed. This included reporting incidents and accidents to the local safeguarding team and submitting notifications to the CQC. Notifications tell us about significant events that happen in the service. We use this information to monitor the service and to check how events have been handled.

People were receiving care that was responsive and effective. This had significantly improved since our last inspection. Care plans were in place that described how the person would like to be supported. The care plans provided staff with information to support the person effectively. Other he

The home is divided into two parts; upstairs provides care for people with complex needs and the downstairs which accommodates those with residential and nursing care needs. We spoke with eight people who lived in the home and their relatives. People told us that staff always asked them what they wanted and would never do anything without their permission. People agreed that staff treated them respectfully.

Staff had been employed for a number of years and it was evident that relationships with the people had been established over a period of time. Visiting relatives spoke positively about Oaktree and that they were “happy with the care that is being provided”. The staff team were knowledgeable about people’s needs and this was evident when we spoke with them.

One visitor told us they had visited the home three times before making a decision for their relative to move in. They said that on each occasion they found the home to be “the same” and felt it was the “best home in the area”. They described how supportive, helpful and friendly the staff were. They said their relative had “settled well” and that staff were ”knowledgeable about how to meet their relative’s needs”. They were very happy with the choice of home and added that other members of the family had expressed this to them.

Several visitors told us their relatives had previously used the home for short stay ‘respite’ care. They said this was the reason they had chosen to move in permanently. They expressed that they were happy with their relative’s care needs being met and spoke about the “good” communication within the home.

We carried out this inspection because previously we did not follow up on arrangements where there were concerns expressed. These related to safeguarding and arrangements for the administration of medicines. In addition there were some concerns a bout staffing arrangements.

At this inspection we found the home to be compliant with the outcomes. Staff had received safeguarding training and knew about the importance of reporting suspicions of abuse. The home had continued to alert the local council to suspicions of abuse.

There were regular audits of the arrangements for administering medicines and where actions were identified these were responded to.

Recruitment of staff ensured there were sufficient numbers of workers to support people.

We visited the home to follow up minor concerns we had with people's care and welfare following our visit to the home in July 2012. At that time we felt that people experienced care, treatment and support that met their needs and protected their rights. However, the provider had introduced a new care recording system and it was not fully implemented. Record keeping needed to be improved to demonstrate that people received safe and appropriate care and treatment.

During our follow up visit we looked at the care records for six people and found them to be accurate and up to date. Assessments of needs were carried out to enable care planning. There were written comments in relation to people's care needs and monthly evaluations were completed. Where necessary care plans were complemented by charts for monitoring food and fluid intake, weight and vital signs.

We had previously felt that the lunchtime dining in the dementia unit was drawn out and not the best experience for people. During this visit we saw that alternative arrangements were in place and people were engaging with each other in a more relaxed environment.

We spoke with two people who lived in the home. They told us they were happy and felt well looked after. They said staff were good and gave them the assistance they needed. They told us their relatives were made to feel welcome and they liked the variety of food. People told us staff called them by their preferred name. They both told us they would speak with a nurse if they were unhappy about anything.

We spoke with three relatives of people living in the home. One of them told us how their mother moved into the home in a very frail condition from hospital. They said their mother had gained weight, had recovered from ulcerated legs and had an improved quality of life. The home had arranged for a special chair that enabled the person to spend the day in the lounge which they liked to do. The relative said they were happy that their mother lived in the home and that staff responded to all requests. They said they would complain if they were unhappy and felt they would receive a good response.

Other relatives told us they were happy with the service provided at Oaktree House. They said they had no reason to complain but would be listened to if they did.

A visitor who came to the home to see their ex-neighbours said they always found them well dressed and had never seen anything they were not happy about.

The four staff we spoke with were happy in their work. They had worked at the home for varying lengths of time and had different roles. They all said they felt supported by the management of the home. One of the staff spoke about the good team working in the home and the pleasant atmosphere.

We met a visiting medical professional. They told us they had been visiting the home for a number of years and had good relationships with staff who were friendly. They said they usually got all of the information they needed and staff followed instructions well.

We spoke with five people who use the service they told us they enjoy living in the home and that they receive the help and care they need. People said "the carers are nice", "it's a pleasant place to live", "I get the help that I need", "it's very nice and people are very kind", "the food is nice and I get a choice of things" and "they look after me well".

The people we spoke with were unaware that they had a care plan in place which reflected their needs.

People told us that staff come quickly when they press their call bell. One person told us "you can always get hold of somebody".

We asked people about their involvement in activities within the home. One person said "I'm not involved in activities in the home, I don't want to be". They went on to say that the activities coordinators come and see them even though they do not want to be involved in the activities. This resident was aware of the activities occurring within the home because they had been given a newsletter which detailed the activities occurring that month. Other people were aware of the activities going on in the home too and told us that they had been on trips out occasionally, and had been involved in the entertainment within the home. One person told us they had not been involved in any activities which were just for them within the home, although their son takes them out of the home regularly. People told us that they were not bored in the home.

People told us they were unaware that they had a care plan in place and were not involved in the planning of their care. One person told us that they might have been involved but they could not remember having a care plan. Another told us "I don't know about the care plan but they [staff] will help with anything".

People told us they had a choice in the way that care was delivered on a day to day basis. One person said "I usually get up in time for breakfast, but I have stayed in bed until 2pm because I didn't want to get up". Other people told us they are asked when they want to get up too. All of the people that we spoke with told us they were always asked whether they wanted a bath or a shower and that they were given their preference. One person told us they weren't sure if they could have a bath or a shower every day if they wanted one. Another person told us they did not have to wait for a bath or a shower, that they could have one when they got up.

One person told us that when they are taken to the bathroom for a bath or shower the care staff always ensured they took care and covered them up so that their privacy and dignity was maintained.

The people who use the service we spoke with told us that they feel safe in the home. Although most people did not know who to speak with if they felt that they had been put at risk.

No one was able to look after their own medicines so they were all given by staff. People we spoke with said they were happy with how their medicines were looked after. They told us that the times they were given their medicines sometimes varied depending on who was working. One person told us they were sometimes given their night time medicines later than they would have liked.

Two people told us they were always given their creams and ointments although we saw that often care staff had not recorded that they had done so.

We saw some medicines being given after lunch on both floors. These were given in a safe and respectful way.

People we spoke with told us that they felt there were enough staff within the home to care for their needs. People told us that their call bells are responded to in a timely manner by staff.

This inspection took place on 8, 9 and 29 September 2015. We carried out this inspection because we had a number of concerns shared with us. These concerns came from a range of different sources including, relatives, health and social care professionals who had visited the service, South Gloucestershire County Council and a whistle blower. A whistle blower is a member of staff who works for the service and had reported concerns but not been listened to. These concerns were about the care and support people were receiving on the dementia suite. This was a focussed inspection looking at only the Dementia suite, in line with our procedures we have not changed the overall rating of this location.

We visited the service on 24, 26 and 27 February 2015. At that time, we rated the service as inadequate and identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We visited the service again on 8 and 9 June 2015.

We found some improvements had been made and rated the service as requires improvement. However, we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Oaktree Care Home is registered to provide personal and nursing care for up to 78 people. The service is divided over two separate floors. The ground floor is for those who require nursing care and the upper floor is dedicated to those people living with dementia. At the time of our inspection there were 24 people living on the dementia suite.

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.’

People were not always supported by sufficient staff. There was only one permanent qualified nurse employed to work on the dementia suite. The shortfall was being covered by agency and bank nurses who did not always know the people they were caring for. This resulted in communication not always being effective with health and social care professionals and had contributed to inconsistent recording in care documentation.

People were not always safe because where their care needs had changed or an incident had occurred, appropriate action had not always been taken. Incidents were not identified as potential abuse; they were not reported or investigated. This included reporting incidents and accidents to the local safeguarding team and submitting notifications to the Care Quality Commission (CQC).

People could not always be assured they were receiving their medicines as they wished. Staff were not always signing for creams and ointments so it was not clear if people were receiving these as required. There was a surplus supply of medicines that was being returned to the pharmacy. This could be an indicator that people were not receiving their medicines as prescribed by their GP. Medicines were not being stored safely in respect of controlled medicines.

Care records were not accurate or detailed enough and could potentially mean that people were not receiving the care and support they required. People did not always receive medical support and interventions in a timely way to ensure their health and well-being.

People were not always supported to make their own choices and where people had made advanced decisions these were not always taken into account. People’s care was not personalised and did not reflect their individual needs and preferences.

There was a lack of meaningful activities for people on the dementia suite which was leading to some people feeling bored. Most people were disengaged and spent long periods of time with little or no stimulation.

Some staff were caring but this was not always consistent. Our observations throughout our visit, discussions with people using the service, their families and staff and examination of records, all gave the impression the service was task orientated.

The provider did not have effective systems in place to assess, monitor and improve the quality of care. Poor care was not being identified and rectified by the provider.

We found a number of 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.