This inspection took place on 11 April 2017 and was an unannounced comprehensive rating inspection. The location was last inspected in April 2016 and was rated as ‘Requires Improvement’, with Breaches of Regulations: 12 HSCA RA Regulations 2014 Safe care and treatment, Regulation 17 HSCA RA Regulations 2014 Good governance and Regulation 18 Registration Regulations 2009 Notifications of other incidents.

Following the last comprehensive inspection on 12 and 14 April 2016 the provider was requested to submit an action plane to demonstrate how they were going to improve their service provision regarding there identified breaches. On 27 July 2016 a focussed inspection took place where we looked specifically at the domains of ‘Safe’ and ‘Well Led’ and saw that satisfactory improvements had been made.

Oakwood Rest Home is a registered care home providing accommodation for up to 30 people who require support with personal care. At the time of our inspection there were 27 people living at the home.

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 did not always receive their medicines safely.

Potential risks to people had been assessed and managed appropriately, ensuring that people were kept safe and secure and the risk of potential harm was minimised.

There were sufficient numbers of staff available to look after people safely. Staff had been recruited appropriately and had received relevant training so that they were able to support people with their individual care and support needs.

Staff sought people’s consent before providing care and support. Staff understood when the legal requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) should be followed.

People’s rights to privacy and confidentiality were respected by the staff that supported them and their dignity was maintained.

People had a variety of food, drinks and snacks available throughout the day. They were able to choose the meals that they preferred to eat.

People were supported to stay healthy and had access to health care professionals as required. They were treated with kindness and compassion and there were positive interactions between staff and the people living at the location.

People’s choices and independence were respected and promoted. Staff responded appropriately to people’s support needs. People received care from staff that knew them well and benefitted from opportunities to take part in activities that they enjoyed.

The provider had management systems in place to audit, assess and monitor the quality of the service provided, to ensure that people were benefitting from a service that was continually developing.

At an unannounced comprehensive inspection of this service on 12 and 14 April 2016 we found there were breaches in the legal requirements and regulations associated with the Health and Social Care Act 2008. We found the provider and the registered manager to be in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because they had failed to effectively assess the risk of, and take actions to prevent, detect and control the spread of infections. We also found the provider and the registered manager to be in breach of Regulation 17 of the Health and Social Care Act 2008 (regulated Activities) Regulations 2014 because systems and processes had not been established and/or operated effectively to assess, monitor and improve the quality and safety of the service, nor to mitigate the risks relating to the health, safety and welfare of people using the service. Furthermore, we also found the provider and the registered manager to be in breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 because information that they were legally required to share with us and other agencies, such as the Health Protection Agency, was not shared.

We asked the provider to send us an action plan to show how they would meet the legal requirements of the regulations and gave them until 1 July 2016 to demonstrate their compliance.

We undertook this focused inspection on 27 July 2016 to check the provider had followed their plan and to monitor their compliance with the legal requirements of the regulations. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Oakwood Rest Home on our website at www.cqc.org.uk.

Oakwood Rest Home provides accommodation and personal care for up to 30 older adults. At the time of our inspection there were 27 people living at the home.

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.

We found that improvements had been made to promote the safety of the service.

People were protected against the spread of infectious illnesses and diseases because the provider had improved their infection prevention and control practices. People were now supported by staff who were familiar with the improved infection control policies and procedures and who had the knowledge and skills they required to minimise the risks associated with the spread of infection.

The provider had also improved their quality monitoring processes to further promote the safety and quality of the service in areas including infection control, medication management and record keeping.

The registered manager had ensured that all relevant information that they are legally required to share with us and other agencies had been sent.

While improvements had been made we have not revised the ratings for these key questions; to improve the ratings to ‘Good’ we would require a longer term track record of consistently good practice.

We will review our rating for ‘safe’ and ‘well-led’ at the next comprehensive inspection to make sure the improvements made continue to be implemented and embedded in to practice.

This inspection took place on 12 and 14 April 2016. This was an unannounced inspection.

On our last inspection in October 2014, we found that the service required improvement in three out of the five areas we inspected against, namely is the service effective? Is the service responsive? And is the service well-led? This was because we found that people’s rights to make decisions and choices were not always protected because their abilities to make such decisions had not been assessed or lawfully protected. We also found that registered manager had not kept us up to date with the relevant legislation relating to providing care with lawful consent. Furthermore, we found that the staff we spoke with had little understanding about dementia care and care plans were not always kept up to date to reflect peoples changing needs.

Oakwood Rest Home provides accommodation and personal care for up to 30 older adults. At the time of our inspection there were 23 people living at the home.

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.

At the time of our inspection we found that the registered manager was not always fulfilling their responsibilities for meeting these requirements because information that they were legally required to share with us and other agencies such as the Health Protection Agency, was not sent. We also found that the service did not consistently implement effective quality monitoring processes to ensure that the risks to people’s health, safety and well-being were identified, monitored or addressed. This included risks relating to effective infection prevention and control. Therefore, we found breaches of the regulations.

People were supported by staff to take their medication but this was not always in the way in which it was prescribed. Protocols were not in place to support staff to know when a person may require their medication, if they were unable to ask for it themselves.

We found that people were not always supported to access the community and whilst staff did attempt to engage people in activity, this was not always person-centred and did not always reflect their hobbies and interests.

People were supported by enough staff who were kind and caring, and who had an adequate knowledge base and skill set to ensure people were cared for and their needs were met. People and/ or their representatives were involved in the planning and review of their care and care was provided with consent. We found that people were treated with respect and their privacy and dignity was protected.

Everyone we spoke with knew how to complain and they were confident that any concerns raised would be addressed by the management team. The provider also sought feedback from people who used, visited or worked at the service and used this information to make improvements where necessary.

The inspection took place on 9 October 2014 and was unannounced. Oakwood residential home provides accommodation for 30 people. There were 27 people in residence when we visited.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

During our inspection we talked with seven people who used the service, two relatives, and five members of staff. Some of the people who lived at the home were not able to give their views due to their complex care needs, some of whom are living with dementia. We spent time with people observing the support they received. We observed staff caring for people and saw that this was done with kindness and respect.

People told us they felt safe living at Oakwood. People knew who they could talk to if they had any concerns. There were sufficient numbers of appropriately trained staff to meet the needs of people and keep them safe.

Risk assessments had been completed so that staff had the information they needed to manage identified risks.

Staff were safely recruited so that only suitable people were employed.

People’s healthcare needs were met because they were supported to see healthcare professionals when needed and they received their medicines as prescribed.

People were supported to have their needs met by staff who had the skills and knowledge and who received support and guidance to provide care. People told us that the staff were very good, kind and respectful. Relatives told us they were kept informed about their relative’s care. We observed that staff involved people in their care giving them choices and explanations. We observed that people were treated with dignity and respect. We observed that peoples care needs were met. However, care plans to support staff to know the different stages of dementia and what this meant in relation to personalised care were not available. Following our inspection the manager told us that amendments to care plans had been implemented.

People were able to raise their concerns or complaints and these were thoroughly investigated and responded to. People were confident they were listened to and their concerns taken seriously.

People told us that if they needed anything they would just ask the staff. Staff meetings were held so staff could discuss the service provided to people. People and relative’s told us that staff and the manager was approachable at all times. We observed that staff gave people choices and asked their opinion. We saw that the provider had recently sent questionnaires to people so they could gain their views about the service provided. Staff told us they were clear about their roles and responsibilities.

There were 28 people living at the home at the time of our inspection. We spoke with three people using the service, four relatives, two staff, the manager and the provider. All the people we spoke with were complimentary about their care and the staff. One relative told us, “Excellent home, care really good and staff so approachable“. One person living there told us, “I am very happy, have no worries and staff are very kind and respectful to me’’.

People told us and we saw that staff respected their privacy and dignity and that they were given choices about their care. One relative told us, “Whenever I go there staff are always cheerful, and supporting people with respect”. This meant people were happy with their care.

People’s care and health care needs were planned and met in a personalised way. Both staff spoken with told us they had the information they needed to care for people safely.

The provider did not have effective infection control procedures in place. This meant people using the service may be at risk from cross infection.

Staff spoken with told us they felt supported by the manager, and had regular training opportunities. This meant staff had the skills to care for people safely.

There were systems in place to monitor how the home was run, and action taken where feedback from the people using the service would improve the service provided to them.

Some of the people who lived at the home had dementia care needs. Because people with dementia are not always able to tell us about their experiences, we used a formal way to observe people during this visit to help us understand. We call this a Short Observational Framework for Inspection (SOFI). We spent 20 minutes in a communal area and observed two people. We recorded their experiences at regular intervals. This included their state of well being, how they interacted with staff members, other people who live at the home and the environment.

This enabled us to be more specific about the positive and negative aspects of the care provided to people. It gave us a clearer picture of the experiences of people living in the home over a period of the day.

We spoke with the manager, deputy manager two people living in the home and three relatives.

We saw that care workers treated people with respect and dignity and understood how to communicate with them. One person told us they treat you with respect they knock on my door before they come in and ask permission before they do things for me.’’

Care workers spoken with were able to tell us about people's needs so that they receive care in a way that they prefer. For example, peoples likes and dislikes and how to ensure they supported them by using peoples individual care plans as a guide One person living at Oakwood told us “I have been here five years very happy, staff are lovely, I have never been healthier.’’

Care worker told us they had a range of training so that they have up to date knowledge and skills in order to support the people who lived there.