This unannounced inspection took place on 14 and 16 January 2019.

Oakwood House Residential and 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.

Oakwood House Residential and Nursing Home accommodates 24 people across three separate units on two floors. On the day of our inspection there were 22 people lived in the service. 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 about how the service is run.

At the last inspection in April 2018 we rated Oakwood House overall as requires improvement. This was because quality assurance systems and processes were not in place to ensure that people received good quality, safe care. Following that inspection, we asked the provider to complete an action plan to show what they would do and by when to improve all of the key questions to at least good. At this inspection in January 2019 we found that the actions plan had not been fully implemented and have identified breaches of three regulations. Quality assurance and monitoring processes put in place by the provider had failed to ensure that the service improved from the previous rating of requires improvement.

There was not an open culture within the service. Communication between the management team was poor with misunderstandings leading to the provision of poor care and support.

People were not supported in a safe environment. We identified trip hazards in the service and some cupboards in the communal areas were chipped with the chipboard under the laminate exposed. The seal in several windows had been removed. Hazard tape had been applied to prevent drafts but this was coming off. When we brought this to the attention of the facilities manager some repairs were made.

The environment had a pleasant homely feel but was not always managed to ensure people were comfortable.

Hand washing facilities did not comply with current guidance. Towelling hand towels were being used in some communal toilets which presented an infection control risk. We brought this to the attention of the registered manager on the first day of the inspection but they were still being used on our return inspection visit.

Not all risks were assessed and managed effectively. Where precautionary measures had been put in place these were not always followed. Care plans were not always up to date with people’s support needs. Care plans did not demonstrate people had been involved in their review. They did contain information regarding people’s likes and dislikes.

Staff provided a range of activities. However, these were limited due to poor communication between the service and the provider as to how these should be financed

Medicines were managed safely.

There were sufficient staff to support people safely. Management did not ensure that staff had the skills and time to recognise when and how to give compassionate support. Staff training was not up to date. Staff had not always been given training to use equipment effectively.

People’s nutritional needs were assessed and monitored. People told us the food was good. We observed the lunch time meal which had a convivial atmosphere.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Relatives told us they felt welcomed into the service.

Oakwood House Residential and 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.

The inspection took place on 8 November and 10 November 2017. The first day of the inspection was unannounced. Oakwood House Residential and Nursing Home accommodates 24 people in one adapted building. At the time of our inspection, there were 24 people living at the service.

There was a registered manager in post. They were registered in June 2017 but had managed the service since December 2016. This was their first post as a manager, although they had worked in the service previously as the deputy 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 about how the service is run.

Oakwood House Residential and Nursing Home is an established care home and was recently registered with the Care Quality Commission on 10 October 2017. However, the change in registration was the result of changes within the provider’s organisation. The only change was to the provider’s name. There were no other changes to the service. The management and staff team remained the same. However, this was the first comprehensive inspection under this registration and as such they had not yet received a CQC rating.

At this inspection, we found systems for monitoring quality and auditing the service had not always been effective. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014: Good governance.

The service was not always safe, the building was poorly maintained and health and safety checks had not been carried out as they should have been, meaning that some safety certificates had been allowed to lapse. Arrangements have been put in place to ensure this is rectified as soon as possible. This was a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014: Premises and equipment.

Mainly because of the poor maintenance of the building and some of the equipment, there were some infection control issues that needed attention. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014: Safe care and treatment.

People did not always receive person centred care. People’s individual needs were not always identified. People's privacy was not always respected. Personal information was not always stored securely and staff discussed people’s personal needs within hearing of other people. This was a breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014: Dignity and respect.

People told us that they enjoyed their food; it was well cooked and plentiful. However, their mealtime experience would have benefited from staff being more attentive and concentrating on supporting people to eat their meals without talking over people to other staff members. This is an area requiring improvement.

Not all the staff were sufficiently trained to support people and keep them safe. There was a low percentage of staff training in some areas and some essential training had not been put in place. This is an area requiring improvement.

People were not always supported by staff who were kind and caring towards people and upheld their privacy and dignity at all times. We saw some examples of poor practice in this area. This is an area requiring improvement.

Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk of harm or if they needed to report any suspected abuse.

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