The inspection of The Oakes Care Centre took place on 27 September, 4 October 2018 and 1 November 2018. We previously inspected the service on 27 and 31 July 2017; we rated the service requires improvement. The service was not in breach of the Health and Social Care Act 2008 regulations at that time.

The Oakes Care Centre 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. The Oakes Care Centre accommodates a maximum of 60 people; there are accommodation and communal areas located on both the ground and first floor. The home provides care and support to people who are assessed as having personal care and support needs. The first floor provides accommodation specifically for people living with dementia. There were 58 people living at the home at the time of the inspection.

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 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 they felt safe. Risks were assessed and actions taken to reduce the risk of future harm. Regular servicing and internal checks were completed to ensure the premises and equipment were safe and maintained. The home was clean and odour free.

There were systems in place to reduce the risk of employing staff who may not be suitable to work with vulnerable people. People, relatives and staff felt there were sufficient staff on duty to meet people’s needs.

Medicines were stored and administered safely by staff who had received appropriate training. Although we identified some improvements needed to be made to staffs recording of the application of creams.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Staff had the skills and knowledge to enable them to provide effective care. New staff received an induction and there was a programme of on-going training and supervision in place.

Feedback about the food was positive. We saw people were provided with regular drinks and snacks. There was a range of options for people to choose from for breakfast and both the lunch and tea time meal.

There were systems in place to ensure relevant information was communicated within the staff team. Staff supported people to access healthcare services when their needs changed.

The registered manager and each of the staff we spoke with were clearly committed to ensuring each person received a service which was caring and respected their individual values. A culture of treating people with dignity and respect was evident from staff in all roles.

The home had a well-being co-ordinator who ensured people were offered a variety of activities and trips out.

Before people moved into the home, an assessment was completed to ensure the home could meet the person’s needs. Care plans were detailed and person centred although care plans were not always updated to reflect information recorded in the review section.

People and relatives were aware of how to complain. We saw evidence complaints were listened to and responded to.

There were systems in place to ensure people received appropriate support as they neared the end of their life.

Feedback from people, relatives and staff regarding the management of the home was positive. The registered manager was clear in their desire to provide a high quality service to people, ensuring staff felt valued and empowered.

There were systems and processes in place to continually monitor the service people received and to gain feedback from people and the relatives.

The inspection of The Oakes Care Centre took place on 27 and 31 July 2017. We previously inspected the service on 11 April 2016; we rated the service Requires Improvement, at that time we found the registered provider was not meeting the regulations relating to dignity and respect, staffing and good governance. At this inspection we checked to see if improvements had been made and sustained at The Oakes.

The Oakes Care Centre is registered to provide care and support to older people. The home has a maximum occupancy of 60 people. The home has a unit on the ground and first floor. On the day of our inspection 55 people were resident at the home.

The service had a manager in place, they had commenced their application to register with the Care Quality Commission (CQC) but the process had not yet been completed. 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 told us they felt safe. Staff were aware of their responsibilities for keeping people safe and knew how and where to report any concerns. People’s care plans contained a variety of risk assessments although we found some people’s moving and handling documentation lacked relevant information, we spoke with the manager after the first day of our inspection and they took prompt action to rectify these matters prior to our return to the home the following week. There was a system in place to ensure the premises and equipment were safe.

Safe recruitment practices were in place. The manager was taking steps to improve the skill mix of staff in particular on night duty; they had also reviewed staffing numbers at the home following analysis of the accident statistics.

Medicines were not always managed safely. We have made a recommendation about the management of some medicines.

People who lived at the home felt staff had the skills they needed to meet their needs. Staff received regular supervision and there was an on-going programme of training for staff. The new manager was eager to ensure staff had appropriate skills and work was in place to further develop staff knowledge and skills.

Care plans contained evidence of mental capacity assessments and care records referred to acting in people’s best interests but there was not always documentary evidence this process had been followed. Staff supported people to make their own choices and decisions and we heard staff asking peoples consent prior to them supporting people with care and support.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice

People told us they enjoyed their meals. We observed lunchtime and saw people were offered a choice of food and drink. People were also offered drinks and snacks between meals. People’s nutritional risk was regularly monitored and action taken if required.

People told us staff were caring and kind. Throughout the inspection we saw staff spoke with people and supported them in a friendly and appropriate manner. Staff were aware of the need to ensure people’s privacy and dignity were respected and we saw examples of this when we were present at the home. The manager had begun to encourage people to become more involved in the care planning process.

People spoke positively about the activities at the home. During the inspection the atmosphere on both floors was warm and homely. Films on the television and the music being played was appropriate to the listening audience.

People were assessed prior to their moving into The Oakes to ensure their needs could be met. Care plans were in place but they did not all contain a satisfactory level of informa

The inspection took place on 11 April 2016 and was unannounced. The Oakes Care Centre is registered to provide accommodation and personal care for up to 60 people. 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. The registered manager was booked off on annual leave during our inspection; however they were present for the later part of the inspection.

People who used the service told us they felt safe and staff we spoke with recognised the signs of abuse and how to report this. Risk assessments had been undertaken and had been updated to reflect the current needs of people living there.

Medication was administered appropriately and all staff who administered medication had received training and were competent to administer. However we found an issue with administering night time medications in a timely manner. Only one member of night staff was trained to administer medication. This meant that if that person was not on duty night time medication was administered by day staff. If people required medication during the night off duty staff had to be called to come to administer medications. The manager of the home was aware of this and was in the process of training more staff.

On the day of our inspection fire extinguishers on the dementia unit had been locked away. This meant that staff did not have access to extinguishers should they have needed them. This was rectified as soon as it was discussed the with the assistant operations director.

All new staff had undertaken an induction which included both theoretical and competency based elements, which were signed off by a senior carer. Staff received supervision twice a year in line with company policy, and an annual appraisal.

The registered manager demonstrated a good understanding and knowledge of the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) and had made ten requests to the local authority. The care staff had received specific training around capacity and demonstrated good knowledge in this area.

People who used the service and staff told us the food was good and we observed people being offered second helpings. Choice was offered at mealtimes, however on the dementia unit no choice was offered in relation to drinks. Everyone was given orange juice with their lunch.

The home had a monitoring sheet to note the food and drink intake of people at risk of malnutrition and hydration. However, this had not been inputted fully for one person whose care we reviewed, which meant the home had no evidence of exactly what this person had eaten or had to drink.

People told us staff were very caring and kind. We saw people’s privacy and dignity were maintained.Throughout the day we saw staff spoke kindly when supporting people.

Activities were regularly taking place in the home although some people did not like what was on offer We saw a list of varied activities and people talked positively of a future trip.

Complaints were dealt with in line with the policy.The complaints procedure was displayed throughout the building for staff, visitors and people living there to access.

Quality monitoring systems were in place and records were accessible and up to date. Audits were carried out weekly however these audits had not picked up that fire extinguishers had been removed or that people were not dressed appropriately.

This visit was carried out by two inspectors who spoke with the manager and seven members of staff. We also spoke with two people who lived at the home and six people visiting their relatives.

The inspectors also through observation and looking at records used the information they were given to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

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

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

Is the service safe?

People were cared for in an environment that was clean and hygienic.

The member of staff we spoke with was aware of their responsibilities in administering peoples medication.

Is the service effective?

People living at the home were encouraged to make their own choices about their life at the home.

Staff did not concentrate purely on physical tasks. The home was also supporting people’s social needs.

Is the service caring?

People were supported by kind and attentive staff who obviously knew people well.

We saw that care staff were patient and encouraging when supporting people.

Is the service responsive?

People were supported to maintain relationships with their friends and relatives.

The care, treatment and support provided at the home met people's individual needs

Is the service well led?

The registered manager has been in post since September 2013.

The service acted upon comments and suggestions made at service user meetings.

Accurate and appropriate records were not consistently maintained.

We received information of concern telling us there were not always enough staff on duty to meet people’s needs. We visited to check staffing levels within the home. We found there were enough staff on duty to meet people’s needs.

We spoke with nine people who were using the service, one relative and seven members of staff. These were some of the things they told us:

”The staff are alright here, we get a good service and the food is good.”

“It’s smashing here.”

“It’s very pleasant here, the rooms are very nice, like a hotel.”

“The staff are very good, if you need them they are always there.”

“I visit at all different times. The staff are always professional and show personal kindness. I have never, ever heard a member of staff be rude, disrespectful or unkind. The staff have been marvellous and go the extra two miles to respond to the individual’s needs. Staff are always friendly and welcoming and they know the people living here very well.”

“We have a good staff team.”

“There are no set routines on the dementia unit about getting people up or putting them to bed. It changes from day to day. If a member of staff is sick, we try to cover the shift. We are not often short of staff.”

We spoke with six people who lived at the home, six members of staff and two relatives. These are some of the things they told us:

“The staff are very kind and helpful.”

“The meals are, on the whole, very good.”

“I like my room and it is always kept clean and tidy.”

”My relative is well looked after, the staff are on the ball and we get on very well with them. There are several new staff, but they seem to have had good training.”

“I think more activities could be provided to keep people stimulated.”

“I really enjoy working here and the changes that have been made are all for the better.”

We found that staff knew about people’s dietary needs and were checking to make sure they were having enough to eat.

Staff were properly recruited and trained to make sure they were suitable and safe to work with vulnerable people.

We spoke with ten people who lived at the home, four relatives and seven members of staff. These are some of the things they told us:

“The home is always kept clean and tidy. I like my bedroom and have brought lots of personal pictures and ornaments to make it homely.”

“My relative organised the place here for me whilst I was in hospital, I think they made a good choice.”

“There are activities and entertainment organised for us. I really enjoyed the brass band that visited from the university.”

“On the whole staff are very good but some are better than others.”

“The building and facilities are very impressive. Our relative has lived here for about 12 months and we are very satisfied with the care. The staff are very good.”

“It’s a great place to work, I love it here.”

We found that people who were losing weight needed to have their food and fluid intake monitored more closely by staff to make sure they were receiving a suitable and nutritious diet. We saw that there were some staff who interacted well with people and some staff that needed more direction, training and supervision.

On the day of our inspection we spoke with three people who used the service and three visiting relatives. They told us the staff treated them with dignity and respect and encouraged them to make choices and maintain their independence. For example; one person told us that staff asked them whether they would like to have a bath or a shower and when they would like to take it. One person told us they requested to have a female carer and the staff respected their wishes.

People told us they were well looked after and enjoyed living at the home. One person said, “This is my home now and I do not want to leave.”

People told us they knew who to speak with if they were not happy. Two people told us that where they had concerns these had addressed to their satisfaction. In relation to activities one person told us, “It’s up to me. If I want to join in I do but staff respect my wishes if I don’t want to.”

One of the visitors told us they had been concerned in the past about the lack of continuity of staff as some staff had additional non-caring duties. This meant that the staff team providing the care differed and this lack of consistency meant staff were not always familiar with each person’s needs. Their relative confirmed that recently they had seen an improvement in the staffing and were aware a key worker system was soon to be introduced which would mean that people using the services would have a designated member of staff to lead their care and support.