Oaklands (Essex)

Oaklands [Essex] is a residential care home providing personal and nursing care for up to 55 older people aged 65 and over; and people living with dementia. At the time of the inspection, 15 people were living at the service. The care home accommodates people in one adapted building.

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

People told us they were safe and liked living at Oaklands [Essex]. Observations demonstrated staff had a good relationship and rapport with the people they supported. Staff had a good understanding and knowledge of people’s needs and the care to be delivered. People told us they were safe and suitable arrangements were in place to protect people from harm and abuse. Risks were identified and recorded to ensure peoples safety and wellbeing. Recruitment practices were robust to ensure the right staff were recruited. People were protected by the services prevention and control of infection practices and from the risk of transmission of COVID-19 and other infectious diseases. The environment was clean and well maintained. Lessons were learned and improvements made when things went wrong.

Effective systems were in place to monitor and improve the quality of the service provided through a range of internal checks and audits. Relatives and staff told us the service was well-led and managed and were positive about the improvements made since our last inspection to the service in December 2020. Staff felt valued and supported.

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

Rating at last inspection and update

The last rating for this service was Inadequate [published March 2021] and there were two breaches of regulation. A Warning Notice was served and conditions were imposed on the providers registration.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of these regulations. However, we could not improve the rating for 'Well-Led' because to do this requires consistent good practice over time. We will check this during our next inspection.

This service has been in Special Measures since December 2020. During this inspection the provider demonstrated improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We checked whether the provider had met the requirements of the Warning Notice in relation to Regulation 12 [Safe care and treatment] of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and conditions imposed on the provider's registration.

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.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Oaklands (Essex) on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Oaklands [Essex] is a residential care home providing personal and nursing care for up to 55 older people aged 65 and over; and people living with dementia. At the time of the inspection, 19 people were living at the service.

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

Effective arrangements were not in place to ensure the safe management of medicines and this placed people at risk of harm. Suitable arrangements were not in place to mitigate risks for people using the service. Not all appropriate measures were in place or being followed to prevent and control the spread of infections.

The leadership, management and governance arrangements did not provide assurance the service was well-led. Quality assurance and governance arrangements at the service were not reliable or effective in identifying shortfalls. Lessons were not consistently learned to make improvements for people using the service. Though the arrangements for staff inductions, training and supervision and some elements of record keeping had improved, further improvements were still required in these areas.

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. There were enough staff available to meet people's needs and staff were recruited safely. Suitable arrangements were in place to ensure the dining experience for people using the service was positive.

Care plans covered most people's individual care and support needs. Nevertheless, information showed further improvements were still required to ensure each person's care plan was reviewed, updated and accurate. People were supported and encouraged to take part in social activities.

We have made a recommendation about staff induction, training and supervision.

At this inspection we found improvements had been made relating to the dining experience for people using the service, some aspects of record keeping, staffing levels and the deployment of staff. The provider was no longer in breach of Regulations 9, 14 and 18 of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2014. However, not enough improvement had been made relating to risk [including medicines management and infection, prevention and control], governance and quality assurance. The provider was still in breach of Regulations 12 and 17 of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2014.

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

Rating at last inspection (and update)

The last rating for this service was Inadequate (published March 2020).

Why we inspected

We carried out an unannounced focused of this service on 1 and 11 December 2020 which was based on the previous rating. Breaches of legal requirements were found.

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 coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained rated Inadequate. This service has been rated Inadequate for the last two consecutive inspections. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Oaklands (Essex) on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

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

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Oaklands [Essex] is a residential care home providing personal and nursing care for people aged 65 and over. Some people were living with dementia. The service can support up to 55 people and at the time of our inspection there were 49 people living at the service.

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

Information relating to people’s individual risks was not always recorded or did not provide enough assurance that people were safe. Suitable arrangements were not in place to ensure the proper and safe use of medicines. The deployment of staff was not always suitable to meet people’s care and support needs and concerns were raised about agency usage. Lessons were not learned, and improvements were not made when things went wrong. People were protected by the prevention and control of infection, but stale odours were observed on the first floor. Recruitment checks were generally satisfactory.

Not all staff employed at the service had completed their mandatory training. Though staff had completed an orientation induction, not all staff had completed a more robust induction. Some staff had not received regular formal supervision or an annual appraisal of their overall performance. Not all staff spoken with felt supported or valued by the management team. Best interest decisions were not always recorded where people had bedrails in place or a sensor alarm fitted to alert staff if they got out of bed and mobilised within their room. People at risk of poor nutrition and hydration were not properly and accurately assessed. Although the service worked with other organisations to ensure they delivered joined-up care and support, records suggested people did not always have access to healthcare services when needed. We have made a recommendation about this. People’s comments about the food they received was positive.

People told us they were treated with care and kindness. Relative’s comments about the level of care their loved one received was variable. This was attributed to agency staff usage and the impact on the quality of care people received. Concern was expressed regarding the amount of time staff spent completing paperwork and not interacting and talking with people. Many interactions by staff remained task and routine led. No-one spoken with had seen their own or their family member’s care plan.

Not all care plans contained enough information to ensure staff knew how to deliver appropriate person-centred care and treatment based on people’s needs and preferences. Where information was recorded this was not always accurate or up-to-date and evidence of staff interventions to demonstrate the support provided was not always recorded. End of life care plans were in place but provided limited information to guide staff on how to provide care to a person who was at the end stages of their life. People were not supported or enabled to take part in regular social activities that met their needs. Arrangements were in place to record, investigate and respond to any complaints raised with the service.

The leadership, management and governance arrangements did not provide assurance the service was well-led, that people were safe, and their care and support needs could be met. Quality assurance and governance arrangements at the service were not reliable or effective in identifying shortfalls in the service. There was a lack of understanding of the risks and issues and the potential impact on people using the service. We were not notified of all incidents as required by regulation. The Provider Information Return [PIR] which was submitted to us, portrayed an inaccurate picture of the service.

Rating at last inspection

The inspection was prompted by ongoing concerns raised by the Local Authority. A decision was made for us to inspect and examine those risks and concerns. We found significant improvements were required.

The rating at last inspection was good (published July 2018).

Full information about CQC’s regulatory response to the more serious 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’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions 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.

Follow up

We will meet with the provider and request an action plan to understand what they will do to improve the standards of quality and safety. We will work alongside the provider, Local Authority and CCG to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

Oaklands is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection

At the last inspection, the service was rated Requires Improvement. At this inspection we found improvements had been made and the service is rated as Good. However, Well Led remains requires improvement, there had been significant instability in the management of the service and although the new manager has made significant improvements, they are not yet registered and will need to evidence consistent compliance over time to ensure continued safe delivery of care.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. There were systems in place to minimise the risk of infection. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. People’s needs were met by sufficient numbers of staff. Medication was dispensed safely by staff who had received training to do so.

People were safeguarded from the potential of harm and their freedoms protected. Staff were provided with training in Safeguarding Adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People had sufficient amounts to eat and drink to ensure that their dietary and nutritional needs were met. The service worked well with other professionals to ensure that people's health needs were met. People's care records showed that, where appropriate, support and guidance was sought from health care professionals, including a doctor, district nurse and palliative care nurse. The environment was appropriately designed and adapted to meet people’s needs.

Staff were well trained and attentive to people's needs. Staff could demonstrate that they knew people well. Staff treated people with dignity and respect.

People were provided with the opportunity to participate in activities which interested them at the service. These activities were diverse to meet people’s social needs. People knew how to make a complaint should they need to. People were provided with the appropriate care and support at the end of their life.

The manager had several ways of gathering people’s views and held regular meetings with people and their relatives. The manager carried out quality monitoring to help ensure the service was running effectively and to make continual improvements.

We carried out an unannounced comprehensive inspection of the service on the 2, 3, 10 and 13 October. Previously the service had been inspected in February 2017 and received an overall rating of requires improvement with the domain ‘well led’ being rated as inadequate. At this inspection whilst improvements had been made, improvements were still required to ensure the safety, health and well-being needs of people were met.

At our previous inspection carried out on the 20, 21 and 28 February 2017 we found breaches of Regulations 9 [Person centred care],12 [Safe care and treatment], 13 [Safeguarding service users from abuse and improper treatment], 14 [Meeting nutritional and hydration needs], 17 [Good governance] and 18 [Staffing]. Two Warning Notices were served on the registered provider in respect of Regulations 12 and 17 requiring the registered provider to ensure they met with legal requirements by 24 April 2017. We carried out an unannounced comprehensive inspection on 2, 3, 10 and 13 October 2017 to confirm whether they now met those legal requirements .

The service has been placed in special measures as there have been continued breaches of regulation and a continuation of a key question rated ‘inadequate’. 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 being the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of this registration.

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.

Since our last inspection in February 2017 a manager had been recruited. They were registered with the Commission as registered manager for the service on 25 September 2017. 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 previous inspection in February 2017 we found improvements were needed to ensure quality assurance systems were effective. Whilst we found improvements had been made at this inspection, further improvements were required to ensure the service was well led and the systems available for the monitoring and on-going improvements regarding the quality of the service were embedded and used effectively to ensure people’s care and support needs were met safely.

At our last inspection we found improvements were needed to ensure the safe management of medicines. At this inspection we found although significant improvements had been made, further improvements were required to ensure medicines were administered safely and as prescribed.

Risks associated with people’s health care needs were not always being managed safely as not all risks to people had been identified and suitable control measures in place to mitigate these. Furthermore, where risks had been identified people’s care records had not always been reviewed and, where appropriate, updated. Improvements were required to ensure accurate and contemporaneous records were kept. For example, people’s dietary needs were not always accurately recorded and their food and fluid intakes effectively monitored. Additionally, where people were supported to access healthcare services, their care records were not always updated to reflect the actions taken by the service and the outcomes of healthcare interventions.

The registered manager was unable to demonstrate how staffing numbers were calculated. Improvements were required to ensure sufficient staffing levels and deployment of staff to ensure people’s individual care and support needs were effectively met.

People and relatives had mixed views about the caring attitude of staff. Whilst some people thought staff were kind and caring others felt staff were not always caring and did not know about people living at the service. People were encouraged to retain their independence and their privacy and dignity was respected.

The registered manager understood and complied with the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Staff were aware of their role in relation to MCA and DoLS and how to support people so as to ensure their rights were respected and met.

Staff treated people with dignity and respect and promoted people’s independence. People were encouraged to maintain relationships with family and friends and there were no restrictions on visiting times. When required, people were supported to access their faith and cultural needs.

There were thorough recruitment procedures in place to ensure staff were suitable to work with vulnerable adults. Staff received appropriate training and supervision. Staff told us they were supported and that staff morale had improved since our last inspection.

There were effective systems in place for receiving and acting on concerns and complaints.

The service had a number of ways of gathering people’s views including using surveys and by talking with people, staff and relatives. The registered manager was open and transparent throughout our inspection and was committed to driving improvements.

At this inspection we found three continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of this report.

Oaklands (Essex) provides accommodation and personal care for up to 55 older people who may have care needs associated with living with dementia. There were 37 people living at the service at the time of our inspection. The service does not provide personal care.

The service is required to have a registered manager however there was no registered manager at the time of 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.

Overall we found that the quality assurance systems and processes in place were not effectively robust to ensure the health, safety and well-being of people using the service and to drive improvements. The registered provider lacked oversight of the service and there was poor quality monitoring. Some of the concerns found at our previous inspection on 27 and 30 September 2016 continued to be areas of concern at this inspection.

Improvements were required to ensure the management of medicines was safe. Improvements were also required to ensure that all care records were accurate and reflected people’s current care and support needs; and that any associated risks were clearly identified, monitored and mitigated.

Although staff were recruited safely upon completion of appropriate checks improvements were required to ensure the on-going monitoring to check staff’s criminal histories had not changed. There were sufficient numbers of staff to meet people’s care and support needs.

Improvements were required to ensure the registered provider learnt from safeguarding incidents. Staff received training regarding how to keep people safe from harm and abuse and were aware of how to report any concerns.

Staff had an understanding of the requirements of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards applications had been made where appropriate.

Generally people received sufficient amounts to eat and drink however we found sufficient action was not always being taken where people were at risk of malnutrition and dehydration.

People were supported to access healthcare services. However, where healthcare professionals were involved in people’s care their guidance was not always followed.

People had mixed views about the caring attitude of staff. Whilst most interactions between staff and people were kind and caring, some were task focussed. People’s privacy and dignity was respected.

Care plans and assessments did not always include sufficient information of how people’s care and support needs were to be met. Activities required improvement to ensure people living with dementia were encouraged and supported in taking part in meaningful activities.

There was an effective system in place for complaints.

At this inspection we found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 including continued breaches from our last inspection. You can see what action we have told the provider to take at the back of this report.

Oaklands (Essex) provides accommodation and personal care for up to 55 older people who may have care needs associated with living with dementia. There were 48 people living at the service at the time of our inspection. The service does not provide nursing care.

A registered manager was 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.

Although people told us they felt safe, we found that the systems and processes in place to help keep people who lived at the service safe required improvement. People were not protected from the risks associated with the unsafe use and management of medicines.

There were quality assurance processes in place to monitor the quality of the service and to make improvements, however the manager had not undertaken regular audits since they had been managing the service as they had been working to an action plan agreed with the registered provider.

There were processes in place to seek the views of people who used the service and those acting on their behalf but it was unclear how this feedback was used to improve the quality of the service. Improvements were required to ensure people’s concerns and complaints were acted upon.

Care plans were in the process of being updated and reviewed however some of the information in people’s care records was contradictory. People’s healthcare needs were monitored and advice and guidance was sought from healthcare professionals when needed.

Although the manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS), some staff had a limited understanding of the MCA and DoLS.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns.

People were supported to eat and drink sufficient amounts to meet their nutritional needs. People were able to choose alternative meal options if they did not like the choices offered on the daily menus.

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

Oaklands (Essex) is registered to provide care and accommodation for up to 55 older people. There were 52 people living at the service at the time of our inspection. The home does not provide 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 2008 and associated Regulations about how the service is run.

People told us they felt safe. There were systems in place to assess and manage risks and to provide safe and effective care.

We received mixed views about staffing levels. People told us that sometimes there were insufficient staffing levels particularly at weekends.

People were protected from the risks associated with nutrition and dehydration. People spoke positively about the choice and quality of the food. Where people were at risk of malnutrition referrals had been made to healthcare professionals.

People received support from trained staff who were well supervised. Staff knew people well and they were kind, caring and compassionate and they ensured that people’s privacy and dignity was maintained at all times.

The registered manager and staff were aware of their responsibilities under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS).

People’s care and support needs were assessed before they moved into the service. The care and support provided was personalised and based on the identified needs of each individual.

There were quality assurance systems in place which continuously assessed and monitored the quality of the service. This included feedback from people who used the service and their families.

The service had a visible and approachable manager who knew people and their families well. The registered manager told us they operated an ‘open door’ policy so people living at the service, their families, staff and visitors could discuss any issues they have.

This is a summary of what we found;

Is the service safe?

When we arrived at the service a staff member looked at our identification and the registered manager asked us to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the registered manager understood when an application should be made, and how to submit one. They confirmed that they had received training in this subject and explained when they had made referrals which further demonstrated their knowledge.

Staff were provided with training in safeguarding vulnerable adults from abuse. This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

The service was safe. Records and discussions with staff showed that there were regular health and safety checks carried out to make sure the service was well-maintained and met people's needs.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

Is the service effective?

People told us that they were happy living in the service. One person said, "I get everything I need, I am very happy." Another person said, "I am happy with the care I get, I have no problems."

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 reviewed every month and updated which meant that staff were provided with up to date information about how people's needs were to be met.

Is the service caring?

The staff interacted with people living in the service in a caring, respectful and professional manner. People told us that the staff treated them with kindness and respect. One person said, “There is not one of them (staff) that I don't get on with. They are very loving, you can hear in their voice that they mean it.”

People’s preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People who used the service were provided with the opportunity to participate in activities which interested them. People's choices were taken in to account and listened to.

People's care records showed that where concerns about their wellbeing had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health care professionals, including a doctor and mental health professionals.

Is the service well-led?

Staff told us they were clear about their roles and responsibilities. We reviewed the minutes from staff meetings which showed that the management team had consulted with staff before implementing changes in the service. This helped to ensure that people were provided with a good quality service.

The service had an effective quality assurance system and records reviewed by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

We found that whilst the service provided was safe sometimes staff were task orientated instead of person orientated.

During our inspection we spoke with five people, two relatives, three members of staff and one visiting healthcare professional.

People were generally happy with the care that they received. One person commented, "They look after me." Relatives told us if they had any issues they were dealt with as quickly as possible.

The healthcare professional told us that, "Since this manager's been on board I've seen improvements," and, "In general they are quite good."

Whilst there had been a recent turnover of staff, at the time of our inspection the provider was fully staffed and appropriate recruitment processes had taken place.

Staff were observed speaking with people with dignity and respect and involving them in their care. People appeared relaxed and staff were viewed helping them to make choices on how they wanted their care provided. During our visit at no time were people seen waiting for staff to support them.

People we spoke with were complimentary about the care they received at Oaklands (Essex) and the staff. Comments received during our visit included, “I am happy with the care,” “The staff are really friendly,” and “They are all really nice.”

During our visit relatives and visitors were seen coming and going. One relative spoken with stated the staff always made them welcome and there was “Always a cup of tea” when they visited.

People spoken with stated that they felt ‘safe’ at the home. A relative spoken with added that they could leave the home and know their relative could gain help if they needed.

People told us they knew how to raise any concerns they may have. They added that they had found the manager to be approachable and felt they could take any concerns they may have to him. Staff spoken with also added that they felt that they could raise any concerns they may have with the manager.