We carried out an unannounced inspection of Addison Park 25 June 2018. Addison Park is a ‘care home’ that provides care for a maximum of 42 adults. 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 time of the inspection there were 28 people living at the service.

The service is all on the ground floor. Bedrooms are located in different ‘wings’ all with easy level access to the shared living areas. Shared living areas include an open plan lounge, two conservatories, a dining room, garden and patio seating area.

There was a registered manager in post who was responsible for the day-to-day running of the service. 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.

As part of this comprehensive inspection we checked to see if the provider had made the improvements recommended at the inspection of 13 June 2017. In June 2017 we found records to evidence when staff monitored certain aspects of people’s care were not consistently completed. Daily handover sheets were not always updated to reflect people’s needs. Quality assurance and audit processes had just been started and there had been insufficient time to test if these systems would be effective in monitoring the quality of the service provided.

At this inspection we found monitoring records to evidence the care people received were still not always consistently completed. There were discrepancies and gaps between different documentation used to record important information about people’s needs. Information in people’s care files was difficult to locate and therefore not easily accessible for staff. We asked if the service could find specific documents and most of these were not found on the day but given to us after the inspection. However, we judged that the gaps in records and missing documents had not impacted on the care people received.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, there was a lack of clear overview and accurate information in relation to Mental Capacity Act 2005 (MCA) assessments, Deprivation of Liberty (DoLS) records and Lasting Power of Attorney (LPA) records. Where people lacked mental capacity to consent to their care and treatment the service had asked relatives to sign who did not have the legal authority to do so.

There were quality assurance systems in place and audits were routinely completed. These included audits of care plans, risk assessments and medicines. However, actions identified from care plan and medicines audits, in relation to missing records, had not been completed. The specific records identified as missing, from these audits, were given to us after the inspection. We therefore concluded that the difficulty of locating documents at the service had not been identified by the provider or the registered manager.

On the day of the inspection there was a relaxed and friendly atmosphere in the service. People told us they were happy with the care they received and believed it was a safe environment. Comments included, “I feel quite safe here, they look after that for me”, “This really feels like a home to me. I was having too many falls to continue living alone. Now I feel very safe” and “I am made to feel like I matter, despite my age and frailty.”

Arrangements for the storing and administration of people’s medicines were robust. Medicine Administration Records (MARS) were completed appropriately and there were no gaps in the records.

There was a system of induction,

We carried out this unannounced inspection on 13 June 2017. This was the first inspection for the service since registering under a new provider in late December 2016. Addison Park is a care home which is registered to provide nursing care for up to a maximum of 45 older people, some of whom had a diagnosis of dementia. On the day of the inspection there were 24 people living at the service.

There was a registered manager in post who was responsible for the day-to-day running of the service. 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. There was also a manager in charge of the day-to-day running of the service and they were supported by the registered manager, who was also the registered manager for another of the provider’s services.

The service had been operating under new ownership for nearly six months, since December 2016. In that time many vital repairs to the structure of the building had been completed. This included a new roof, which had resolved problems the new owners inherited in relation to several leaks from the roof into the premises. Some internal re-decorating had started and new equipment had been purchased such as hoists, hospital beds and kitchen appliances. A programme was in place to decorate every bedroom replacing carpets and furniture and some bedrooms had already been decorated and had new furniture. Four bedrooms with internal windows, that were no longer being used, and an adjoining conservatory were soon to be converted into another lounge. There were other plans in place to upgrade all areas of the premises, including landscaping an enclosed garden area and changing the structure of two other conservatories. Any disruption to people’s lives, while the refurbishment was being completed, had been well managed.

Where people needed to have specific aspects of their care monitored staff completed records to show when people were re-positioned, their skin was checked or their food and fluid intake was measured. While there was no evidence to suggest that checks were not being completed appropriately, records to evidence the care people received were not always consistently completed. Daily handover sheets had not been updated to reflect everyone’s current needs. We judged that staff were knowledgeable about people’s needs and the gaps in some records had not impacted on the care provided for people. We have made a recommendation about care records.

At the time of the inspection the service manager had been in post for six weeks. During this time they had made many positive changes to the service and updated some systems that had fallen behind. Care plans inherited from the previous provider had been updated and accurately reflected people’s needs. There was a clear programme in place to rewrite each person’s care plan using the new provider’s documentation. People with the highest needs had had their care plans updated into a new format as a priority. Quality assurance and audit processes had just started to be implemented by the new manager. However, there had been insufficient time to test if these systems would be effective in monitoring the quality of the service provided.

Staff told us the provider and new manager gave them appropriate support. Staff were positive about the management of the service. Comments from staff included, “Change for the better”, “Lots more equipment in. All hoists and beds are new”, “We were asked what we wanted and we got it”, “The new manager listens”, “We are much more settled now. Cornwallis seems to know where they are going”, “Things are better with the new manager.”

People, visitors and healthcare professionals were all positive about how the service was managed. Commen