This inspection took place on 24 May 2018 and was unannounced. When we last inspected the service in October 2017 we found improvements were required in all key questions. There were four breaches of the Regulations and the provider was rated as 'Inadequate'. They were placed in special measures and served with a warning notice for a breach of Regulation 17, good governance. Following the last inspection, we asked the provider to complete an action plan to show what they would do, and by when, to improve the key questions Safe, Effective, Caring, Responsive and Well-led.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

During this inspection, we found sufficient action had been taken to address the previous breaches of the Regulations around staffing levels, recruitment and assessment and mitigation of risk to improve so that the service was no longer rated inadequate. However, we identified further areas of concern at this inspection, which the provider had not identified. There continued to be areas needing improvement and the provider needed to ensure improvements were sustained and fully embedded within the culture of the service. Therefore the provider remains in breach of Regulation 17, Good Governance.

The Oaks Care 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 Oaks Care Home provides personal care and accommodation for up to 16 older people, some of whom may be living with dementia. There were 15 people who were living at the home on the day of our visit.

There was a registered manager in place at the time of our inspection visit. A registered manager from the providers other service came to support 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 2008 and associated Regulations about how the service is run.

Some risks to people were not consistently assessed when people first moved into the home, which meant that some people were placed at potential risk of harm. However, we found that improvements were being made and staff and management were learning and therefore improving the safety of people’s care. Staffing levels reflected the needs of the people who lived there. Staff were able to meet people’s needs and keep them safe from harm. The management of people’s medicines had improved, however further work was required to ensure this was following best practice. The environment of the home did not always promote people’s safety and we raised concerns with the provider regarding the security of the building.

The registered manager had put in place checks to ensure staff were competent in their roles and supporting people in line with best practice. New staff were beginning to receive training prior to starting work for the provider in line with the Care Certificate. The Care Certificate is an agreed set of standards that sets out the knowledge, skills and behaviours expected of those who work in Health and Social Care. Staff sought people’s consent before supporting them, staff understood and recognised the importance of this. We found people were supported to eat a healthy balanced diet and drink enough. We found that people had access to healthcare professionals, such as their doc

This inspection took place on 05, 06 and 24 October 2017 and was unannounced. We found the service required improvement with four breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 and one breach of the Registration Regulation Health and Social Care Act 2009. You can see what action we told the provider to take at the back of the full version of the report.

At this inspection we found the service was inadequate overall, and in the key questions safe and well-led. The inspection identified five breaches of regulation.

Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The Oaks Care Home provides personal care and accommodation for up to 16 older people, some of whom may be living with dementia. There were 16 people who were living at the home on the day of our visit.

There was a registered manager in place at the time of our inspection visit. A registered manager from the providers other service came to support 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 2008 and associated Regulations about how the service is run.

Risk's to people were not adequately assessed when people’s care needs changed, which meant that staff took actions that put people at potential risk of harm. There were not sufficient staffing levels in place to keep people safe from harm, staff had raised this as an on-going concern, however the registered manager and provider could not demonstrate that staffing levels reflected people's care needs. Staff did not have clear direction for some prescribed medicines, for example, where people who had swallowing difficulties required fluid thickener staff did not know how thick the fluid should be. The storage of controlled drugs and was not locked or secure.

The registered manager did not have checks in place to ensure staff were competent in their roles and in line with best practice. New staff had not received training prior to working and relied on their past experience. Staff supported people with thei

We carried out an unannounced comprehensive inspection of this service on 12 and 13 January 2016. Three breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment, Regulation 10 HSCA (RA) Regulations 2014 dignity and respect and Regulation 17 HSCA (RA) Regulations 2014, Good governance.

We undertook a further comprehensive inspection on 4 and 5 October 2016 which was unannounced. This was to check the provider had followed their plan and to confirm that they now met legal requirements and to review the ratings of the service. We found that the provider was now meeting the legal requirements in relation to three breaches. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (The Oaks Care Home) on our website at www.cqc.org.uk.

The Oaks Care Home provides accommodation and care for up to 13 older people. There were 13 people who were living at the home on the day of our inspection.

At the time of our inspection 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 lived in a safe environment as staff knew how to protect people from harm. We found staff recognised signs of abuse and knew how to report this. Staff made sure risk assessments were in place and took actions to minimise risks. There were sufficient staff on duty to keep people safe. People’s medicines were administered and managed in a safe way.

People and relatives felt that staff had the knowledge and skill to care for people in the right way. We found people were supported to eat a healthy balanced diet and with enough fluids to keep them healthy. People had access to healthcare professionals, such as the chiropodist and their doctor when they required them and where supported to attend hospital appointments.

People told us that staff treated them kindly, with dignity and their privacy was respected. People and relatives views and decisions they had made about their care were listened and acted upon.

People did not always receive personal care in a timely way during busier periods. The provider told us they would address this, however staff had not expressed this view to the provider for them to be able to rectify this. Staff continued to be task-led in their approach to care. We found there was very little stimulation for people who expressed their frustration of boredom with staff.

People and relatives knew how to complain and felt comfortable to do this should they feel they needed to. We looked at the providers complaints over the last nine months, since our last inspection. We found two complaints had been received, both of which had been responded to with satisfactory outcomes for the complainants.

While people and relatives felt the registered manager was approachable and listened to their concerns and made changes were they were able. We found that, while people received good healthcare, people’s social well-being was not addressed. We continued to see that the registered manager had not made changes to improve this aspect of people’s care.

The Oaks provides accommodation and personal care for up to 16 people who may be living with dementia. This inspection took place on 12 and 13 January 2016. The inspection on the 12 January 2016 was unannounced. We visited the service again on the 13 January 2016 to conclude our findings. There were 13 people living at the home on the day of our visit.

At the time of our inspection 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 kept safe as the provider did not have adequate checks in place to ensure the equipment used within the home was safe and fit for purpose. Lack of regular safety checks and servicing of equipment placed people at unnecessary risk of potential harm.

People did not always live in a clean and hygienic home because there was were no systems in place to ensure the cleaning that took place was effective and happened in a timely way.

People told us they felt safe. Staff recognised signs of abuse and knew how to report this. Relatives and staff told us there were enough staff to provide care and support to people. People and relatives did not raise any concerns around the management of their medicines. People’s medicines were stored and managed in a way that kept people safe.

People and relatives felt that staff had the knowledge and skill to care for people in the right way. Care and support was provided to people with their consent and agreement. Where it had been deemed that the person did not have the capacity to make decisions on their own behalf the registered manager had taken steps to ensure the Mental Capacity Act (MCA) had been followed. People were supported to eat a healthy balanced diet and were supported with enough fluids to keep them healthy. We found that people had access to healthcare professionals, such as their doctor when they required them.

People and their relatives were involved in planning their care. However, people’s views and decisions they had made about their care not always acted upon. We found that staff treated people kindly; however their dignity was not always considered. We saw that people were not always supported to continue their hobbies and interests that was individual to them.

Relatives told us that they would know how to make a complaint and felt comfortable to do this. The provider had not received any written complaints. The registered manager confirmed that verbal complaints had been received but had not been recorded. The provider was unable to demonstrate that verbal complaints had been responded to and that the complainant was satisfied with the provider’s response.

The provider was not meeting the requirements of the law. We found three breaches of regulations, in premises and equipment, dignity and respect and good governance. You can see what action we told the provider to take at the back of the full version of the report.

At the previous inspection on 10 June 2013 we identified areas of concern with infection control, medicine management and quality assurance in the home. This resulted in the provider receiving a warning notice for medicines and compliance actions. This inspection was made in order to follow up on the warning notice and compliance actions.

We found that the provider had made improvements in order to manage the risks associated with the unsafe use and management of medicines.

The provider had made improvements. The provider had used information from audits or complaints to improve the service.

We found that people lived in a clean environment and the provider had reduced the risk of the spread of infection.

When we visited The Oaks we spoke with three people who lived there. We also spoke with four staff, the manager and the provider. One person living there told us: "I like the care here".

The provider treated people with respect and dignity. One person told us: "They (staff) are very polite and helpful".

Appropriate standards of cleanliness and hygiene were not being maintained. This placed people at risk of getting an infection.

We found that the provider was not using information from audits or complaints to improve the service.

When we visited we found people were not receiving their medicines as prescribed. We found that appropriate arrangements were not in place to manage the risks associated with medicine management.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

When we visited The Oaks we spoke with eight people who used the service. Not all of the people living there were able to speak with us due to their level of health needs. People told us that the, "Care is good", and the staff do, "The best they can".

The provider was not always respecting what was important to people regarding their care and treatment.

Appropriate standards of cleanliness and hygiene were not being maintained. This placed people at risk of acquiring an infection.

Staff told us that they had support and training to help them with their work.

Staff told us that they had knowledge of safeguarding and prevention of abuse.

We found that the provider was not using information from audits or complaints to improve the service.

We found that people did not always have the correct amounts of medicines left. We also found medicines not being stored appropriately.

We spoke with seven people who lived at the home. They told us that “I like it here” and “I can move around and go for a walk”. One person told us “I like to sit here as it’s quiet with no television” and “I get my newspaper everyday”.

We saw that the service used a bathing rota for people. This meant that each person had a specified day and time for a bath. The rota showed that each person had one bath per week. There was no evidence to show that people’s preferences had been considered or that people could request a bath at any other time.

We observed a lunchtime and saw that people were supported to make choices about where and who they sat with. Care workers offered support to people so they could enjoy their meal. We did not see that people were prompted or supported to wash their hands before or after their meal to help prevent the spread of infection. We saw that three people had a brown substance under their nails.

People told us they were able to go to bed when they wanted and get up when they wanted. They told us there were some things to do and we saw that there were some activity items available. One person told us “the library comes here” and they told us there “were plenty of books”. Whilst we were in the lounge the television and the radio were on at the same time and it appeared that no one was watching the television.

People that we spoke with were complimentary about the care workers and the help and support they provided. Two people told us that the care workers are sometime busy and often say “just give me a minute”. We saw that care workers spoke with people in a polite and positive manner. They recognised people’s personalities and this reflected the way they interacted with people and their responses. We saw that when care workers had time they were able to spend time with people socialising.