Oake Meadows Care Home

Oake Meadows Care Home is a residential care home providing personal and nursing care. It is registered to provide care and accommodation to up to 105 people. The home specialises in the care of older people including people living with dementia.

The home is divided into 5 different areas. One area provides general nursing care, 1 provides nursing care for people living with dementia and another provides care to people who have personal care needs. There is also a rehabilitation unit which is run in partnership with the local NHS and a small unit for people who are experiencing a mental health crisis. At the time of the inspection there were 69 people living at the care home.

People’s experience of using this service and what we found

People told us they were happy with the care and support they received. People who were unable to express their views appeared comfortable and relaxed with the staff who supported them.

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

Each person had a care plan which was personal to them. It set out their likes and dislikes as well as their needs. This helped to make sure staff had the information they required to provide person-centred care.

The staff worked in partnership with other healthcare professionals to ensure people’s physical and mental health needs were monitored and met. This included working with therapists from the NHS to provide rehabilitation to people who had been discharged from hospital.

People were supported by staff who had the skills and experience to meet their needs. Staff had opportunities to complete training appropriate to their role and undertake vocational qualifications. People told us staff were patient and attentive.

The majority of people were happy with the food provided. During the inspection we saw people received the support and encouragement they needed to eat a good meal. Drinks and snacks were available throughout the day.

People could follow their own interests or take part in organised activities. Activity workers provided ad hoc social stimulation for people living with dementia. This resulted in people being engaged and animated.

People lived in a home where the registered manager was passionate about making sure people received good quality care which was inclusive and empowering. People told us they felt ‘at home.’

The provider had effective systems to monitor the standard of care provided to people and plan ongoing improvements. Regular audits showed that when shortfalls were identified, action was taken to make improvements.

There were meetings for people who lived at the home to enable them to hear about any changes and make suggestions about the running of the home.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for the service was good (published 13 October 2018)

Why we inspected This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

This was a focused inspection to review the key questions of effective, responsive and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has not changed from good based on the findings of this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The home specialises in the care of older people, including people living with dementia. At the time of the inspection there were 70 people at the home.

The building is divided into four separate areas. Two areas provide care to people who have nursing needs, one area cares for people with personal care needs and the fourth area provides short stay rehabilitation care for people.

We found the following examples of good practice.

Throughout our visit we observed staff following good infection prevention and control practices. Staff wore Personal Protective Equipment (PPE) appropriately and were able to tell us the level of PPE needed for different tasks.

Observational audits, such as hand washing and the safe putting on and removal of PPE, were being carried out. This helped to make sure all staff were following safe practice.

There were systems to make sure people could keep in touch with friends and family. This included visits in accordance with government guidance and phone and video calls. Some people had nominated essential carers and these visitors continued to visit during the current outbreak in accordance with guidelines.

People appeared relaxed and comfortable with the staff who supported them. Activities were continuing which helped to ensure people received ongoing social stimulation. People told us they were content at the home. One person said, "It's a nice place to be."

Staff felt well supported by the management team, the provider and their colleagues. Staff said they were kept up to date with current company guidance and there was good teamwork.

The registered manager praised the staff team for their hard work and commitment to keeping people safe.

The last inspection of the home was carried out in July 2017. At that inspection the home was rated requires improvement but no breaches of regulations were found. We found that the home had made considerable improvements in the quality of care provided to people but these improvements had not been in place long enough to demonstrate they were able to maintain them. At this inspection we found improvements had been sustained and we have rated the service good.

Since the last inspection the provider has changed the name of the home from Sherford Manor to Oake Meadows Care Home. All other parts of the registration remain the same.

Oake Meadows 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.

Oake Meadows is registered to accommodate up to 105 people. However, the provider has informed us they are not able to accommodate more than 80 people as some rooms previously designed as double rooms are now for single occupancy.

Oake Meadows Care Home specialises in the care of older people living with dementia. The home is divided into three separate units - Rose provided care to people who had personal care needs, Redwood and Sutherland cared for people who had nursing care needs. At the time of the inspection an upstairs area of the building was closed off and there were 54 people living at the home.

There is a registered manager in post who had been at the home for approximately 17 months. 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 part of a management team who had worked with the provider to plan and action continual improvements to the care and support people received. They involved people, visitors and staff to make sure improvements made were in accordance with people’s wishes and needs. One visitor told us, “I see improvements every week. I would recommend this home to anyone now.”

Improvements had been made to make sure care provided was person centred and respected people’s lifestyle choices. People made choices about their daily routines as far as they were able. One member of staff said, “It’s much better than when I started here. There’s a nicer atmosphere and we try to give people choices about everything.”

Improvements had been made to the environment to make sure it was comfortable and safe for people. Specific colours had been used to provide an environment which supported people living with dementia and there was some signage to help people to orientate themselves and move around independently. Further improvements were planned to make sure the environment was interactive and supported people living with dementia.

People received safe care and looked relaxed and happy with the staff who supported them. Where individual risks were identified, action was taken to minimise these risks whilst encouraging people to maintain their independence.

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. Staff worked in accordance with up to date guidance to make sure people’s legal rights were protected.

People were cared for by staff who were kind and patient. One person said, “They are all kind and caring.” Another person told us, “Staff are smiley.” Throughout the inspection we saw staff showed consideration and affection for the people who lived at the home.

Assessments of people’s care needs took account of their individual beliefs, culture and lifestyle choices. People, or their representatives, were involved in decisions about their care and staff worked in accordance with the care plans to make sure people received effective and responsive care.

People’s health and well-being was monitored and staff worked with other professionals to make sure people’s individual needs were met. People received their medicines safely from staff who were competent to carry out this task.

People’s nutritional needs were assessed and met. People received meals in accordance with their dietary needs and preferences. People’s views on food were mostly positive. One person said, “Glorious food and you can choose between two.” Another person said when asked about the food, “Good for a place like this. They seem to cater for everyone’s likes.”

People could be confident that any complaints or concerns raised would be fully investigated and responded to. People and staff told us they felt able to share their concerns because the management of the home was very approachable. Where concerns had been raised the registered manager had responded appropriately.

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.

Sherford Manor Care Home specialises in providing care to people who are living with dementia and/or who have mental health needs. The home is registered to provide accommodation with nursing care to up to 105 people. Because of the configuration of the home, the maximum number of people they accommodated was 77. At the time of this inspection there were 50 people living at the home.

Sherford Manor Care Home consists of four separate units. The Rose and Sunflower units provided care and support for people who required assistance with personal care needs. Redwood and the Sutherland Unit provided nursing care. People were living with dementia which meant some people were unable to tell us about their experiences of life at the home. We therefore used our observations of care and our discussions with staff to help form our judgements. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We looked at seven care plans and spoke to 14 people and three visitors. We also spoke to 15 members of staff. The new manager and a peripatetic manager were available throughout the inspection. The nominated individual and provider's regional manager were available on the second day of the inspection.

We carried out a comprehensive inspection of this service on 7 and 8 December 2016. Breaches of legal requirements were found as people were not protected from receiving unsafe care and treatment and were not protected from avoidable harm. People did not receive care and treatment which met their individual needs and preferences and the service failed to ensure people were provided with opportunities to make choices in their day to day lives. There were ineffective quality assurance systems in place to make sure any areas for improvement were identified and addressed.

After the comprehensive inspection, we used our enforcement powers and served three Warning Notices on the provider on 22 December 2016. These are formal notices which confirmed the provider had to meet the legal requirement in respect of safe care and treatment and person centred care by 30 January 2017. They had to meet the legal requirement in respect of effective quality assurance systems/good governance by 20 June 2017.

We undertook a focused inspection in February 2017 to check the provider had taken action to meet the legal requirements relating to the two warning notices we issued for safe care and treatment and person centred care. Although we found some improvements had been made the provider still failed to fully meet the requirement of the warning notice to become compliant by 30 January 2017. This meant the legal requirements had not been fully met; the provider had therefore not fully complied with our Warning Notices.

Following our last inspection in December 2016 we placed the service in special measures because the overall rating for the service was inadequate. Following the focused inspection in February we did not change the rating for the service because some parts of the warning notices were not met and because further time was needed to demonstrate the improvements made could be sustained.

At this inspection we found the issues in the three Warning Notices had been met; the provider has therefore fully complied with our Warning Notices.

There was no registered manager in post, however a new manager had been employed and was in the process of submitting their application to register with CQC. 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 new manager was supported by a peripatetic manager, the organisations regional operations manager and the nominated individual. A nominated individual is a requirement of our (The Care Quality Commission's) registration process where a provider is represented by an appropriate person nominated by the organisation to carry out this role on their behalf. The nominated individual is responsible for supervising the management of the regulated activity provided.

People told us they felt safe living in the home and with the care and support provided. Staff had all attended training in recognising abuse and they all felt they could talk with the management team if they had any concerns.

People were further protected from the risk of harm by the provider’s robust recruitment procedures. All prospective staff underwent checks to check their suitability to work with vulnerable people.

At the last inspection the people in the home were supported by a high number of agency staff. At this inspection we found a recruitment programme had been in place and there were sufficient staff to support the people in the home. The new manager explained that they had employed a new unit manager two registered nurses and care workers. They also had two activities co-ordinators two handy men and a new chef in the kitchen. When agency staff were used they managed to use the same staff maintaining continuity of care for people in the home.

All staff including ancillary and maintenance staff had received training in dementia awareness this meant people were supported by staff who understood their needs and could provide a homely inclusive atmosphere. Staff confirmed they had received training in areas relevant to their role and that the provision of training in the home had improved. One staff member said, “The training is really good now and we can ask for extra training and they listen.”

Two activities co-ordinators had been employed and were working with people to learn their life histories so staff had information to support meaningful conversations. One activities co-ordinator was creating meaningful memory boards with people to put outside their room. This meant it would be easier for them to recognise their room and provided staff with the information to strike up a conversation. We found people were engaged in activities meaningful to them and staff supported them in their chosen activity. For example one person was reading a book with a staff member whilst another person was helping the activity co-ordinator put together a memory board.

At our last inspection the home was in poor repair and people had been moved from the Rose Unit to an upper floor that was cramped and lacked space to walk freely. At this inspection we found improvements had been made and the Rose unit had been re-instated. The unit was bright airy and clean with people engaged in painting pictures to decorate the communal area. We saw other units in the home were all being refurbished and redecorated and the garden areas tidied. Visitors told us the general décor of the home had been improved and was more homely and welcoming.

Throughout the inspection we observed staff talk to people in a kind a caring way. They took time to sit and talk with people and help them engage in an activity of their choice. People on Redwood were supported to choose an activity and staff supported their choice to watch a film. People told us they felt respected and dignified interactions between staff and people were observed.

We found the mealtime experience for people had improved with people being supported to make an informed choice of the meal they wanted. A residents meeting had been held with the new chef and people had been supported to make suggestions about meals they would like. People said they would like traditional meals and more home-made snacks such as cakes. Consideration was being taken when preparing pureed meals and the pureed meal provided during the inspection appeared appetising.

We found care plans had been reviewed and re-written and they contained sufficient information for staff to meet the assessed needs of people living with dementia. Specific care plans for people with extra needs such as diabetes were very clear about the protocols in place to support that person safely.

At this inspection we saw the governance systems in place were being used to drive improvement. We saw audits were carried out by staff on the floor, then by the new manager and included weekly visits from the regional operations manager. An action plan was maintained and regular checks to assess and record progress against the action plan were in place. We saw improvements had been put into place following conversations with people living in the home, staff and relatives.

We discussed how the improvements and governance needed to be sustained over time and embedded in the day to day running of the home. Therefore we will continue to review the progress being made to ensure it is sustainable.

Sherford Manor specialises in providing care to people who are living with dementia and/or who have mental health needs. The home is registered to provide accommodation with nursing care to up to 105 people. Given the configuration of the home, the maximum number of people they accommodated was 77. At the time of this inspection there were 63 people living at the home. Sherford Manor consists of four separate units. The Rose and Sunflower units provided care and support for people who required assistance with personal care needs. Redwood and the Sutherland Unit provided nursing care.

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 and associated Regulations about how the service is run. The registered manager was on long term leave so was not available for this inspection or the previous inspection. The home was being managed by the provider’s regional manager and three of the provider’s peripatetic managers.

We carried out a comprehensive inspection of this service on 7 and 8 December 2016. ¿Breaches of legal requirements were found as people were not protected from receiving unsafe care and treatment and were not protected from avoidable harm. People did not receive care and treatment which met their individual needs and preferences and the service failed to ensure people were provided with opportunities to make choices in their day to day lives. There were ineffective quality assurance systems in place to make sure ¿any areas for improvement were identified and addressed.¿

After the comprehensive inspection, we used our enforcement powers and served three Warning ¿Notices on the provider on 22 December 2016. These are formal notices which confirmed the ¿provider had to meet the legal requirement in respect of safe care and treatment and person centred care by 30 January 2017. They had to meet the legal requirement in respect of effective ¿quality assurance systems/good governance by 20 June 2017.¿

We undertook this focused inspection to check the provider had taken action to meet the legal requirements relating to the two warning notices we issued for safe care and treatment and person centred care. Therefore this ¿report only covers parts of three of the five key questions we report on; Is the service safe? Is the service effective? And Is the service responsive? The ratings for the three questions and the overall rating for the service therefore remains unchanged. The requirement notices issued at the last inspection will be followed up at our next inspection, so are not included in this report. You can read the report from our ¿last comprehensive inspection, by selecting the 'all reports' link for on our website at ¿www.cqc.org.uk.

We found some action had been taken to improve the safety of the people who lived at the home. Care plans for people who had diabetes, those who were at risk of choking and those who were at high risk of falls had be reviewed and re-written so they provided more detailed information about how to minimise risks. We observed people were supported by staff in accordance with their plan of care. People had access to the specialised equipment they required.

Some action had been taken to ensure people received care which met their assessed needs and preferences. The majority of the care plans we read now contained information about a person’s life history and preferred daily routine. This meant staff had information which helped them support people This helped staff to understand what was important to people and of the things they liked to do. For example one person had certain preferences about their appearance and we observed staff had supported them in accordance with their preferences.

At our two previous inspections; March 2016 and December 2016 we found care plans were bulky and contained a lot of historical information which made it difficult to locate the current needs and preferences of the people who lived at the home. At this inspection we found that no progress had been made. We were not provided with a timescale for completion. This meant the provider had failed to meet the requirement of the warning notice to become compliant by 30 January 2017.

Staff had received training in how to care for people who were living with dementia and the provider had employed the services of an external trainer to improve the skills and knowledge of staff. However we met with the trainer who explained they had gone back to the basics of dementia care with staff and whilst they acknowledged some improvements in the knowledge and understanding of staff, further improvements were needed to ensure a change in culture throughout the staff team. We saw staff did not always recognise opportunities for engaging/involving people who were living with dementia. For example we observed a staff member laying a table for lunch. There was a person sat at the table but they did not involve them until prompted by us.

At our last inspection we found activity staff had not received training about supporting people who were living with dementia this inspection the provider’s regional manager told us since the last inspection one of the activity workers had left and they were in the process of recruiting a replacement. The remaining activity worker had received training in caring for people who were living with dementia. The activity worker was not present for this inspection and no planned activities took place. We were therefore unable to establish that the provider had complied with this part of the warning notice.

At our last inspection one of the care plans we read told us the person was “at low risk of social isolation” because they “liked to interact with other residents and staff.” However, the daily records for the person showed they had spent the majority of their time with no social interaction. We followed this up at this inspection and again found staff recorded entries as before and there was no evidence that the person had engaged in any social interaction or activities. We observed the person throughout the day and saw they spent the majority of their time sat in the lounge area on Rose unit. The television was on but they were not watching it. This meant the provider had failed to meet the requirement of the warning notice to become compliant by 30 January 2017.

People had not yet been provided with opportunities to express a view about the care and support they received however the provider’s regional manager told us letters had been sent to people’s relatives inviting them to attend a person centred review with their relative however we were not provided with a timescale for completion. This meant the provider had failed to meet the requirement of the warning notice to become compliant by 30 January 2017 .

Pictorial menus had been introduced which meant people could make an informed decision about the meals they wanted. Tables were nicely laid for lunch however we noticed on Rose and Redwood units, tables had been laid for lunch following breakfast . This could be confusing for people who lived with dementia. People were provided with drinks and snacks throughout the day. Improvements were needed to improve the appearance of pureed diets as those we saw did not appear appetising. This meant the provider had failed to fully meet the requirement of the warning notice to become compliant by 30 January 2017.

The legal requirements had not been fully met; the provider had therefore not fully complied with our Warning ¿Notices.¿

Following our last inspection in December 2016 we placed the service in special measures because the overall rating for the service was inadequate. Following this focused inspection we have not changed the rating for the service because some parts of the warning notices were not met and because further time is needed to demonstrate the improvements made can be sustained. Also we only focused on the issues within the warning notices and only looked at parts of three of the five domains; Is the service safe? Is the service effective? And is the service responsive?

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 long

At the last inspection carried out over three days in March 2016 we rated the service as requiring improvements and there were two breaches of our regulations which related to the failure to notify us of significant incidents and good governance. At this inspection we found that some action had been taken to improve the service and meet the actions set at the previous inspection. However; we found further improvements were needed.

Sine our last inspection we received a number of concerns from whistle-blowers and the local authority safeguarding team. Since then the provider has been meeting with the local authority and the clinical commissioning group and concerns were being investigated by the local authority. Investigations are on-going.

Sherford Manor specialises in providing care to people who are living with dementia and/or who have mental health needs. The home is registered to provide accommodation with nursing care to up to 105 people. The manager informed us that, given the configuration of the home, the maximum number of people they accommodated was 77. At the time of this inspection there were 63 people living at the home. Sherford Manor consists of four separate units. The Rose and Sunflower units provided care and support for people who required assistance with personal care needs. Redwood and the Sutherland Unit provided nursing care. People were living with dementia which meant some people were unable to tell us about their experiences of life at the home. We therefore used our observations of care and our discussions with staff and visitors to help form our judgements. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

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 and associated Regulations about how the service is run. The registered manager was not available for this inspection. The home was being managed by two of the provider’s peripatetic managers who were supported by one of the provider’s regional managers.

Prior to our inspection we received concerns about staffing levels at the home being insufficient to meet the needs of the people living there or to keep people safe. The peripatetic manager (the manager) told us staffing levels had been reviewed and increased and were now sufficient to meet people’s needs and keep people safe. The home used a high level of agency staff to cover vacancies and we were informed the home was actively recruiting permanent staff to reduce agency usage. No concerns were raised with us at this inspection about staffing levels or of the ability of staff to meet people’s needs with the number of staff available.

People who were able told us they felt safe living at the home however; individual risk assessments and care plans did not fully protect people from the risk of receiving unsafe or inappropriate care. For example one person’s care plan told us they were diabetic and they should not receive a diet containing high levels of sugar. Daily records and our observations showed the person had been given foods which were very high in sugar. Another person had been assessed as being at high risk of choking and required oral suction to be available when eating. We observed the person being assisted with their meal however the suction machine was unassembled in a box in the nursing office meaning it was not readily available. We read the care plan for one person who had been assessed as being at high risk of falls. We observed the person mobilising with a wheeled Zimmer frame however staff placed this out of reach when the person sat down and the person’s care plan made no reference to the fact they used a Zimmer frame.

Staff had received training and were confident in reporting any issues of abuse. People received their medicines in a safe way by staff who had been trained and deemed competent.

The home specialised in providing a service to older people who were living with dementia. However the environment did not promote a welcoming or suitable environment. There was no clear signage, the standard of décor was poor and the people on Rose unit were living in cramped conditions which made it difficult to wander. The lunch time experience did not promote a sociable experience for people and people were unable to make an informed choice about what they wanted for lunch. On the first day of our visit soft/pureed diets had not been presented in an appetising way.

Not all staff were provided with sufficient training to enable them to effectively meet the needs of people who were living with dementia. For example, people were left for long periods without any interactions from staff or any form of stimulation. On Redwood Unit lounge chairs were arranged in a circle with little room to move around or for staff to sit and chat to people. Many people were able to interact with us and with other people however we did not observe staff assisting or offering people to sit together so they could chat. Activity co-ordinators had not received training in providing suitable and meaningful activities for people living with dementia.

Staff spoke to people in a kind way when they assisted them with a task. However; we noticed opportunities for social stimulation were not always recognised or responded to by staff meaning that people sat for long periods with little or no interactions. For example we observed staff walk through a communal area where people were sat without acknowledging them. Some people were able to tell us about the staff who supported them. One person said “They [the staff] are very acceptable. I get up when I want and I go to bed when I want.” A visitor described the staff as “lovely.”

People were not always treated with respect. For example we observed a member of staff standing over a person whilst they assisted them with their meal. We also found the standard of bedding and pillows on two of the units to be poor and some bedrooms were sparse with no rationale for this detailed in the plan of care. Some care plans contained personalised information however; this was not always followed by staff. For example one care plan detailed how the person liked to look and what was important to them. We observed the person was not presented as they chose and staff had no knowledge of the importance of a cuddly toy. Another person’s care plan did not contain sufficient information about the management of their diabetes. Another care plan told us the person was not at risk of social isolation as they liked to interact with other people who live at the home and staff. When we read their daily records we saw they had experienced very limited interactions over a seven day period.

At this inspection we found the provider had not taken action to ensure people’s care plans contained important information which would enable staff to provide person centred care. The majority of the care plans we read contained no information about people’s life history and when we spoke to staff, they had no knowledge about peoples past history. As noted at our last inspection, care plans remained bulky and contained a lot of historical information which meant it would be difficult for staff to easily locate current information.

The home was not always well led. Although the provider had supplied additional management staff to oversee the running of the home, systems had not always been effective in ensuring people received an improved quality of care. This mainly related to the standard of the environment, the skills and knowledge of the staff team, the lack of improvement in care planning systems and the effectiveness of internal audits.

The overall rating for this service is Inadequate and the service is now 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.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Sherford Manor Care Home is registered to provide care and accommodation for up to 105 people. However, the registered manager confirmed they only accommodated 77 people when full. The home specialised in the care of older people living with dementia. At the time of the inspection there were three units, with a fourth planned for people who were more mobile and independent. Rose unit provides residential and not nursing care. Redwood and Sutherland units both provide nursing care; registered nurses on these two units provide support and advice for the care staff on Rose.

At the last inspection carried out in April 2015 we identified concerns with some aspects of the service and care provided to people. The service was found to be in breach of two of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following the inspection the provider sent an action plan to the Care Quality Commission (CQC) stating how and when improvements would be made. At this inspection we found that action had been taken to improve the service and meet all the compliance actions set at the previous inspection. However; we found further improvements were needed.

At the last inspection we found people were not always protected against risks to their health and safety because some risks had not been considered or recorded. People’s care plans did not always reflect the care they received. At this inspection we found people’s care plans contained risk assessments and clearly reflected the care and support they needed.

There is 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.

Before this inspection concerns had been received about some areas of care provided in the home. These concerns included safeguarding concerns around the undignified treatment of people living in the home. They also involved people’s wishes and preferences not being recognised. People were got out of bed very early in the morning, whether they wished to or not. On receiving these concerns the registered manager had acted immediately and with the support of senior staff had carried out spot checks in the home throughout the day and night. The concerns and how they could improve had been discussed with staff at team meetings and supervision. The registered manager had taken further action and worked in partnership with relevant authorities to make sure people were protected.

Registered managers and providers are required to send statutory notifications to the Care Quality Commission (CQC) when a significant event occurs. One type of significant event is when a person living in the home experiences an accident that results in a visit to the accident and emergency department or requires medical intervention. Another is when a safeguarding incident occurs. We found the registered manager and person delegated by the registered manager to send notifications to CQC had not carried out the role correctly. They had failed to inform CQC of two falls and one safeguarding incident. The content of a safeguarding incident that was sent was not recorded correctly.

We found although there were quality audit systems in place they had failed to identify some shortfalls. For example the registered manager had failed to pick up issues such as an out of date list of staff and people living in the home provided in the emergency grab file. The lack of a dementia friendly environment in the new unit. They had also failed to identify the failure to send notifications to CQC and the incorrect monitoring of accidents/incidents by a delegated member of staff. However we found the audits for care related issues were being followed up appropriately and action was being taken to improve, review and update records and equipment in the home.

The minutes of team meetings showed the concerns raised by the local authority had been discussed. However the minutes for one unit meeting showed how a culture of task orientated working had developed on that unit. This culture did not always take into consideration the wishes and preferences of the people. However, throughout the inspection we did observe people being supported to make choices about their day to day life. People were supported to follow activities meaningful to them, for example, one person enjoyed sweeping leaves in the garden.

People were supported by sufficient numbers of staff who had a clear understanding of their personal needs. We observed staff took time to talk with people during the day. One person said, “There seems to be plenty staff about, I never have to wait long for someone to help me.” A relative said, “I am impressed there always seems to be enough staff around, never have to look for someone.”

People received effective care and support from staff with the skills and knowledge to meet their needs. One person said, “They are excellent they do everything exactly how I need it done.” One relative said, “I’m really impressed by them, it’s the whole team, the care is spot on, I cannot fault them and I cannot praise them enough.” All staff had access to training specific to their roles and the needs of people, for example some staff had received training in diabetes care. A visiting healthcare professional said the training had been successful and people’s diabetes was more stable.

The provider had a robust recruitment procedure which minimised the risks of abuse to people. Staff said they knew how to report any concerns, and people who lived at the home said they would be comfortable to discuss any worries or concerns with staff.

People saw healthcare professionals such as the GP, district nurse, chiropodist and dentist. Staff supported people to attend appointments with specialist healthcare professionals in hospitals and clinics. Staff made sure when there were changes to people’s physical wellbeing, such as changes in weight or mobility, effective measures were put in place to address any issues.

The service had a complaints policy and procedure which was available for people and visitors to view in the home. People said they were aware of the procedure and knew who they could talk with. People and staff said they felt confident they could raise concerns with the registered manager and they would be dealt with appropriately.

The registered manager had a clear vision for the home, on their website they said, “Our philosophy is simple; we want everyone to enjoy life to the full. We never forget that all our residents are individuals and we treat them with dignity, privacy and respect while offering freedom of choice and as much independence as possible.” We could see through staff meeting minutes this philosophy had been shared with staff, and staff we spoke with said they aimed to provide care and support in a dignified manner. Observations throughout the inspection supported the aim to provide an environment where people could maintain some independence when able and enjoy themselves with meaningful activities.

We found the service was in breach of two of the Regulations of the Care Quality Commission (Registration) Regulations 2009 (part4). You can see what action we told the provider to take at the back of the full version of this report.

We visited Redwood, one of the three units in the home. Redwood provided nursing care for people, most of whom had a dementia. Most people were not able to tell us about their experiences in the unit. We met one person's relative who told us they were very pleased with the care given and the support they received themselves.

We spoke with a doctor who visited regularly who said they found staff to be caring and concerned about the people who lived in the home. We observed care for a short period at lunch time. We saw people looked relaxed and cared for. We saw staff assisted people with their meals in a patient and kind manner.

We had asked the home to improve the way in which it recorded people's care needs and to monitor people's weights more carefully. Action had been taken and it was now clear how much people weighed. We could see any possible reasons for weight loss and any actions that had been taken by staff.

We looked at four people's care records in detail and checked other fluid and food charts. We spoke with three members of staff.

We spent most of the inspection observing care and talking to people who lived there. We saw that most people looked relaxed and cared for. We saw that staff provided care in a patient and kind manner. People who were able to talk to us about the care they received told us they were satisfied. We spoke with people on Rose unit where people received residential care. One person said 'I have been here for just over a year now. I wouldn't like to be anywhere else.' Another person told us 'We are fine here. It is very nice, the staff are kind.'

We inspected the infection control in the home. We saw the home was clean and well maintained. We found there were safe systems in place to administer medication to people.

We have asked the home to improve the way in which it records people's care needs and to monitor people's weights more carefully. The manager has increased the number of care plans being monitored since the inspection.