We carried out an unannounced inspection of this service in June 2016 and we found breaches of legal requirements in relation to regulations 12, 17 and 18. The provider submitted an action plan about how they would make improvements to the service and ensure compliance with the regulations. At a comprehensive inspection in August and September 2017, we found continued breaches of regulations 12, 17 and 18 and further breaches of regulations 9, 10, 11 and 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3). The service was rated ‘Inadequate’ and placed into special measures. We took immediate enforcement action to restrict admissions to the service. We placed conditions on the provider’s registration requiring them to demonstrate that the numbers, skill mix and competency of all staff was appropriate for the care and support needs of people living at the service.

We carried out a focused inspection within the six months timescale because we received further information of concern from the local authority and whistle blowers, which related to poor staffing levels and poor care. We inspected the key questions of ‘Safe’ and ‘Well-led’ and found that sufficient improvements had not been made since our last inspection in August and September 2017 and the provider was continuing to fail to meet the requirements of the regulations, commonly referred to as The Fundamental Standards of Quality and Safety.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Oaks Residential Home on our website at www.cqc.org.uk

We undertook this comprehensive inspection on 19 June 2018 to check that the registered provider had made the required improvements and to confirm they now met legal requirements.

The Oaks is a residential care home that provides personal care for up to 30 older people, including people living with dementia. There were 12 people living in the service when we inspected on 19 June 2018. This was an unannounced 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.

Since our last inspection of the service, while improvements had been made and we found no breaches of legal requirements, further improvements were still required. We viewed the steps taken to strengthen the management team of The Oaks to be a very positive step, however further improvements were still required. This to ensure that quality assurance arrangements were robust and effective to drive, sustain and embed improvements, to rebuild confidence in the service and to achieve continued compliance with regulatory requirements. We made a recommendation regarding information sharing between services and the development of a dementia friendly environment.

There were systems in place to safeguard people from abuse and the recruitment of staff was safely completed to make sure that they were suitable to work in the service. Staff were aware of their responsibilities and knew how to report any concerns.

There were procedures and processes in place to ensure the safety of the people who used the service. However, not all environmental risks had been identified and managed and improvements were required around cleanliness and decoration.

There were sufficient numbers of staff on duty to support people and meet their needs and people were provided with adequate supervision, stimulation and meaningful activity. Staff were deployed effectively to meet people’s needs.

Training for staff was managed effectively and staff had received training to equip them with the skills and knowledge required to carry out their role. Staff demonstrated an u

This was an unannounced and focused inspection carried out on 25 and 31 January 2018

The Oaks is a residential care home that provides personal care for up to 30 older people, including people living with dementia. On the day of our inspection there were 17 people using the service.

We carried out an unannounced comprehensive inspection of The Oaks Residential Home on 24 and 31 August and 26 September 2017, and we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was given an overall judgement rating of 'inadequate' and is therefore in Special Measures.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Oaks Residential Home on our website at www.cqc.org.uk

The service had no registered manager in post. However, a new manager who intended to apply for registration had started work at the service the day before our inspection. 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.

Following our inspection in August and September 2017, we took immediate enforcement action to restrict admissions to the service. We placed conditions on the provider’s registration requiring them to demonstrate that the numbers, skill mix and competency of all staff was appropriate for the care and support needs of people living at the service. This inspection was undertaken within the six months timescale because we received further information of concern from the local authority and whistle blowers, which related to poor staffing levels and poor care. Because of this, we wanted to check that the enforcement action, which had been taken, was resulting in improvement.

This inspection focused on the areas of safe and well-led. We found that sufficient improvements had not been made since our last inspection in August and September 2017 and the provider was continuing to fail to meet the requirements of the regulations, commonly referred to as The Fundamental Standards of Quality and Safety.

There were insufficient numbers of staff on duty to meet people’s care and support needs. People’s care had not been co-ordinated or managed to ensure their specific needs were being met safely. People were not protected from the unsafe management of medicines.

Robust and sustainable audit and monitoring systems were not in place to ensure that the quality and safety of care was consistently assessed, monitored and improved. Failures in the service continued to be widespread and demonstrated the provider’s inability to make and sustain improvements.

The Commission is currently considering its enforcement powers. This includes taking action in line with our enforcement procedures to begin the process of cancelling the provider’s registration.

The Oaks is a residential care home that provides personal care for up to 30 older people, including people living with dementia. There were 24 people in the service when we inspected on 24 and 31 August 2017 and 23 people on 26 September 2017. This was an unannounced 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.

At our last inspection in June 2016 we found that the registered provider was in breach of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to submit an action plan to tell us how they intended to make the required improvements. At this inspection we checked whether these improvements had been made and found that the provider continued to be in breach of these regulations. Additional multiple breaches of the regulations were also found.

There was a lack of managerial oversight at all levels and leadership was not pro-active. The culture within the service did not promote a holistic approach to people's care to ensure that their physical, mental and emotional needs were being met. Robust and sustainable audit and monitoring systems were not in place to ensure that the quality of care was consistently assessed, monitored and improved. Quality assurance systems had failed to identify the issues we found during our inspection.

There was not an effective system in place to ensure there were sufficient numbers of staff on duty to support people and meet their needs. There were not enough staff to provide people with adequate supervision, nutritional support, stimulation and meaningful activity. This had a direct impact on people’s safety and welfare.

People’s care had not been co-ordinated or managed to ensure their specific needs were being met. Risks to people injuring themselves or others were not appropriately managed. People's medicines were not being managed effectively to protect them from the risks of not receiving prescribed medicines.

The provider had not ensured the service was being run in a manner that promoted a caring and respectful culture. Although most staff were attentive and caring in their interactions with people, they were not supporting people in a consistent and planned way. They did not always respond appropriately and in a timely manner to all of people's needs.

Care plans were incomplete, inconsistent and task led. They had not been updated to reflect people’s current care needs. Opportunities to participate in activities were limited and activities provided were not personalised or tailored to meet people’s level of ability, choice or preference.

Training for staff was not managed effectively. Training records did not accurately identify gaps in training and not all staff had received training in subject areas relevant to their role. Staff demonstrated an understanding of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS.) However, this wasn’t always seen in practice. People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible.

Staff were aware of their responsibilities with regard to safeguarding people from abuse. However they were concerned that they would not be supported in raising concerns and that this could have negative repercussions for them.

We identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following this inspection we took immediate enforcement action to restrict admissions and force improvement.

The overall rating for this service is 'Inadequate' and the service is therefore in '

The Oaks is a residential care home that provides personal care for up to 30 older people, including people living with dementia. There were 19 people in the service when we inspected on 9 June 2016. This was an unannounced 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.

Risks to people injuring themselves or others were not always appropriately managed. People felt that there were not always enough staff on duty. We observed that although staff were caring in their interactions with people there was a lack of attention to detail in ensuring all of people’s needs were met.

The provider had quality assurance systems in place which were used to identify shortfalls and to drive continuous improvement. However, these systems had failed to identify the concerns relating to the safety of some parts of the premises or poor staffing levels. Staff were not always clear on their roles and responsibilities and how they contributed towards the provider’s vision and values.

People presented as relaxed and at ease in their surroundings and with the staff. Systems were in place to reduce people being at risk of harm and potential abuse. Staff understood the various types of abuse and knew who to report any concerns to. People were provided with their medicines when they needed them and in a safe manner.

Staff were trained. However, they had not received regular supervisions to ensure they were meeting people’s needs effectively. The service was up to date with the Deprivation of Liberty Safeguards (DoLS). People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment.

People’s nutritional needs were assessed and met. However, the mealtime experience was not a positive one for many. People, or their representatives, were involved in making decisions about their care and support which was planned to meet their individual needs. However, there was a lack of resources, time, staff knowledge and motivation to provide people with a range of appropriate activities throughout the day.

People told us that they felt that their choices, independence, privacy and dignity was promoted and respected. However, we were concerned that people’s dignity was not always upheld in the way that they were assisted with their appearance.

Staff were compassionate, attentive and caring in their interactions with people. They listened to people and acted on what they said. Feedback from people and relatives about the staff and management team was positive.

A complaints procedure was in place. People’s comments, concerns and complaints were listened to and addressed in a timely manner. Family and visitors to the home felt that they were made to feel welcome and that management and staff were open and transparent.

You can see what actions we told the provider to take at the back of the full version of the report.

We inspected this service on 20 January 2015 and this was an unannounced inspection. The Oaks Residential care Home provides accommodation and personal care for up to 30 older people. Some People are living with dementia. There were 24 People in the service when we inspected.

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 provider had systems in place which guided staff on how to safeguard people who used the service from abuse. Staff spoken with understood the various types of abuse and knew who to report any concerns to. However, we identified an instance where alleged abuse had taken place, but the matter had not been reported to the local authority’s safeguarding investigating body or reported to us. This was a breach of the Regulation 11 of the Health and Social care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

At our last inspection on 12 June 2014, we asked the provider to take action to make improvements in consent to care and treatment, medication, infection control and staff competency The provider wrote to us to tell us how they had implemented these improvements. During this inspection we checked on their improvement plan and found that the required improvements had been made.

Procedures and processes were in place to guide staff on how to ensure the safety of the people who used the service. These included checks on the environment and risk assessments which identified how the risks to People were minimised. There were systems in place to provide People with a clean and hygienic environment to live in.

Appropriate arrangements were in place to provide People with their medication at the prescribed times. Medication was obtained and stored safely.

There were sufficient numbers of staff who were trained and supported to meet the needs of the People . Staff respected people’s privacy and dignity and interacted with People in a caring, respectful and professional manner.

People who used the service or their representatives, where appropriate, were involved in making decisions about their care and support. The service was up to date with recent changes to the law regarding the Deprivation of Liberty Safeguards and at the time of our inspection they were working with the local authority to make sure People’s legal rights were protected.

Staff were trained and knowledgeable about the Mental Capacity Act (MCA) 2005. The MCA sets out what must be done to make sure that the human rights of people who may lack mental capacity to make decisions are protected, including when balancing autonomy and protection in relation to consent or refusal of care or treatment.

People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment. People were supported to have sufficient to eat, drink and maintain a balanced diet. Their nutritional needs were being assessed and met.

Staff understood their roles and responsibilities in providing safe and good quality care to the People. The provider had an annual quality assurance system, and had recently enhanced this by introducing a system of incorporating quality assurance questionnaires as part of monthly care reviews. The manager told us that they felt that as a result, the quality of the service continued to improve

During our inspection, we spoke with four of the 22 people who used the service. We also spoke with two visitors, three staff members and a visiting healthcare professional. We looked at four people's care records. We also looked at staff records, health and safety checks, and records of the checks the provider completed to monitor the quality of the service.

We considered our inspection findings to answer 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?

This is a summary of what we found;

Is the service safe?

We saw that the staff support given to people during moving and handling transfers was safe and supportive to people who used the service.

Where people did not have the capacity to consent, the provider had not acted in accordance with legal requirements. We found that not everyone had had their capacity to make day-to-day decisions assessed and that decisions made on their behalf were not always clearly explained. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to consent to care and treatment.

People were not protected from the risk of infection. The laundry was not clean and hygienic in line with appropriate guidance. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the safe management of infection and cleanliness.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines safely. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the safe management of medicines.

We saw records which showed that aspects of health and safety in the service was regularly checked.

Is the service effective?

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated. This meant that staff had been provided with up to date information about how people's needs were to be met safely and effectively.

We saw that the service had effective systems in place to ensure that people's nutritional well-being was monitored and supported.

Is the service caring?

People told us that they received the care they needed. One person said, "I know they are called carers and they really are caring.”

We noted that most staff were attentive and caring towards people who used the service. Staff spoke with people by name and interacted with them in a friendly and respectful way. People who used the service also knew the staff by name.

Another person said, “Staff are very caring and concerned. They talk to people nicely. Some people are impatient, but there is never an unreasonable wait for anything or anyone."

Is the service responsive?

People’s preferences, interests and diverse needs had been recorded and care and support had been planned and provided in accordance with people’s wishes. This included noting people’s religious preferences and their end of life care wishes.

The service recognised when people needed support from other professionals and took appropriate action to access services to meet their needs. A visiting professional told us that staff monitored people's well-being effectively, responded to their changing needs and provided people with safe care that met their needs.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

Is the service well-led?

The provider was able to demonstrate that some systems were in place to assess and monitor the quality of the service provided. The views of the people who used the service and staff had been sought. People's views about the service were noted to be positive. However, whilst the provider did have some systems in place to monitor the quality of the service provided, it was apparent from our inspection that the absence of robust quality monitoring maybe a contributory factor to the failure of the provider to identify non-compliance or any risk of non-compliance sooner.

We found that, while there were sufficient numbers of staff on duty, the skills mix, competence and deployment of staff at times during the inspection was not well organised. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the provision of having suitably numbers of skilled and experienced staff employed.

One person we spoke with told us, "The home is run very well. The care you get is very good and one is always listened to. The manager will listen and address any issues you speak with them about. The manager is very vigilant with the care and oversees what goes on".

As part of the inspection we checked on standards that were not met at our last inspection in February 2013. These related to care and welfare, assessing and monitoring the quality of the service and safety and suitability of the premises. At this inspection we found that the provider had made considerable improvements in these standards and we found that they were now met.

During our inspection we spoke with six people living in the home. One person told us: “I count myself lucky to be here, I can’t fault them.” People were very complimentary about the staff. One person said: “The carers are without exception really caring.” All the people we spoke with told us that they were happy with the food. One person described it as “excellent” and another person told us: “They have really good cooks here and the meals are wonderful.” People looked well cared for and there was a happy and relaxed atmosphere in the home.

The Oaks had recently gone through a period of change during which time standards had fallen. Staff had received additional support from Essex County Council during this time. The new manager was only appointed one month prior to our inspection but had already made a number of improvements in the home.

We spoke with the majority of people living in the home and with two relatives who were visiting at the time of our inspection. People living in the home were very complimentary about the staff. One person commented, “The staff are wonderful. Nothing’s too much trouble for them.” The relatives were full of praise for the standards of care and support that people received in the home. They told us, “Staff are very caring, there’s good interaction with residents and there’s a good atmosphere in the home. The only thing that could be better would be more activities.” The manager was taking steps to improve the frequency and variety of activities by involving all the staff.

Parts of the premises were in need of repainting and refurbishment and carpets needed to be cleaned. The manager confirmed that all the issues raised during our inspection would be addressed. The manager was aware that the care records needed to be improved and that the systems for quality assurance needed further development.

People who use the service told us that they were happy with the way staff manage their medicines and that they are given a choice of when to take them. We did not find anyone who takes care of their own medicines but no-one had expressed the wish to do so. We watched medicines being given to some people at lunchtime and this was undertaken with regard to people's dignity and personal choice. On some occasions, medicines were left unattended on top of the medication trolley and could be accessible to people they were not prescribed for.