About the service: Clarence Park Nursing Home is in Weston Super Mare and was providing personal and nursing care to 28 people aged 65 and over at the time of the inspection.

People’s experience of using this service:

People received personalised care that considered their individual needs. The registered manager was aware of the needs of people and knew them well.

Recruitment procedures were safe and staff members received training relevant to their roles.

At the time of our inspection, the service had recently recruited an Activities Coordinator and activities were in the process of being developed. However, we saw people had been provided with access to meaningful activities.

Improvements had been made to how people’s medicines were managed and administered.

Governance systems were not always used effectively to identify gaps in records or areas that required further investigation.

We have made a recommendation about the service’s audit systems.

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

Rating at last inspection: Requires Improvement (report published February 2018). This service has been rated Requires Improvement at the last two inspections.

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor the service through the information we receive. We will inspect in line with our inspection programme or sooner if required.

We carried out a comprehensive inspection on 1 December 2017. The previous comprehensive inspection was undertaken in November 2016. At this inspection the provider had breached two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations. These breaches related to staffing and good governance. The service was rated as ‘Requires Improvement’. At this inspection we checked whether improvements had been made and the service was no longer in breach of the regulations.

You can read the report from our last comprehensive inspection, by selecting the 'All reports' link for Clarence Park, on our website at www.cqc.org.uk.

Clarence Park is registered to provide accommodation for persons who require personal or nursing care for up to 43 people. The service cares for older people, some of whom are living with dementia. At the time of our inspection there were 39 people living in the service.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last inspection in November 2016 we found there were insufficient numbers of suitably qualified, competent, skilled and experienced staff deployed to meet the needs of people using the service. During this inspection we found some improvements had been made but this is an area that is still work in progress. The service is undertaking a recruitment drive.

At our previous inspection we found inconsistencies in people’s care records and in the frequency of care plan reviews. Although improvements had been made, this area still required further development. Some of the care plans we looked at did not provide enough detail for staff on how to meet people’s physical needs. Despite the lack of some detail within the plans, staff knew people well. They were able to discuss at length with us people’s life histories and their physical, mental and social needs and preferences.

At our previous inspection the provider did not have effective systems and processes for identifying and assessing risks to the health, safety and welfare of people who use the service. Although sufficient improvements had been made, this area required further development. Some shortfalls identified during this inspection had not been identified. In most cases the quality assurance process was more detailed and actions were taken in a timely manner. The service had an action plan in place which identified issues that needed to be taken forward within stated timelines.

Medicines were in the main managed safely but there were areas which required improvement, such as the need to update each person’s ‘as required’ medicines records.

Care plans contained risk assessments for areas such as falls, mobility, skin integrity and malnutrition. In most cases these were detailed and included guidance for staff on how to manage the risks of harm to people.

Regular maintenance and equipment audits relating to fire safety records, maintenance of safety equipment, gas safety, call systems, portable appliance testing (PAT) were undertaken.

People's rights were upheld in line with the Mental Capacity Act (MCA) 2005. This is a legal framework to protect people who are unable to make certain decisions themselves.

People received effective support from staff that had the skills and knowledge to meet their needs. We saw that the service’s induction was aligned with the Care Certificate. The Care Certificate is a modular induction which introduces new starters to a set of minimum working standards. Staff received on-going training to enable them to fulfil the requirements of the role.

People were supported to have enough to eat and drink. People were assessed for the risk of malnutri

The inspection took place on 9 November 2016 and was unannounced. The service was last inspected on 13 January 2014 and no concerns were identified.

Clarence Park provides accommodation for up to 43 older people who need nursing and/or personal care. At the time of the inspection there were 36 people living at the home. Many of the people had mobility needs and needed staff assistance to move around the home in wheelchairs, or they used mobility aids to assist them with walking. People also had a range of other needs, including; sensory disabilities, early stage dementia, and other nursing or support needs.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The registered manager had worked at the home, in the capacity of deputy manager, but had recently been appointed as the permanent replacement for the previous manager of the service. The new manager was highly regarded by the people who lived in the home and by the staff. It was evident from our discussions that they had started to make improvements to the way the service was run. However, we found there were other areas that required improvement.

People told us they felt safe, but we found people’s needs were not always consistently met in a timely manner when they pressed their call bells for assistance. This meant there could be a risk of delay in responding to an accident or other health incident. Either there were not enough staff on duty or they were not deployed in an effective way. Staffing was particularly stretched during the busy morning period.

We found inconsistencies in people’s care records and in the frequency of care plan reviews. We did not see evidence of inappropriate care; but the failure to keep up to date records meant there was a risk people may not have received care in line with their current needs.

The service adopted a person centred approach to care planning but more could be done to ensure a consistently good person centred approach by all of the staff. Some of the staff were better at engaging with people than others.

The provider had a quality assurance system which had previously identified some of the above issues; but it had not operated effectively in terms of resolving and sustaining the identified areas for improvement.

People’s nutritional needs were met and, once everyone was seated, people’s lunchtime experience was good. However, there were delays in getting everyone seated before staff started serving their meals. We have made a recommendation about improving this aspect of people’s lunchtime experience.

People told us staff were good at providing the care and support they needed. One person said “They are very good with me. I need two staff and a stand aid to help me get into my wheelchair. They seem to have everything I need here. The chef is wonderful, I’m on a diet but I’m never hungry”. Another person said “Everyone’s lovely and they all muck in. I’d recommend this home to anybody. The manager is brilliant, she loves us all”.

Overall, staff displayed a friendly, kind and caring approach toward the people in the home. Apart from the delays referred to above, staff cared for people in a supportive and considerate way; such as when they were supporting people to move around the home and when assisting people at mealtime.

People were protected from abuse and risks were identified and managed in a way that helped people to remain safe. The premises were adapted for wheelchair use and there was a wheelchair accessible lift to the first floor. People received their medicines safely from registered nurses and were protected from the risk of infection through appropriate staf

We spoke with three people who use the service, one relative of a person that had previously used the service, two members of staff, the manager and the Operations and Training manager. We also reviewed the records of four people who use the service.

We saw that people were asked for their consent prior to receiving care and treatment.

We saw that people had their care planned and delivered in a person centred way. One person told us "I prefer to stay in my room and watch television, and I choose what time I get up and what time I go to bed". Another person told us "I like to potter in the garden when the weather is better" and another told us "I get my hair done every week, and there are trips that we can go on if we want, and activities every day".

We saw that training was planned and delivered for staff to ensure that staff had the relevant skills and knowledge to perform their roles, including safeguarding.

We saw that on the day of our inspection there were sufficient staff on duty to meet people's needs.

The provider had a comprehensive audit system in place to monitor the quality of service provision and a recent internal quality review had highlighted some areas for improvement.

At the time of our inspection the manager had been in post for four weeks and was not registered with the Care Quality Commission. They told us that they would register once they had completed their probation period (three months).

This inspection was carried out as part of our planned schedule of inspections.

We spoke with six people that lived in the home. Everybody spoken with agreed that Clarence Park was a nice home and that staff were helpful. They said they felt included in the running of the home and that they had freedom to choose activities and meals.

We spoke to seven members of staff. Everyone spoken with said it was a nice place to work with training opportunities and that they felt supported by the management team.

During our visit we observed the way staff provided care and support. Staff spoke with people in a calm, respectful and dignified manner, whilst keeping a friendly approach. Requests for assistance were responded to in a timely manner.

People had coffee and lunch during our inspection. Some people choose to eat in the lounge either together or separately and others chose to stay in their rooms. They were able to choose from three meals on the menu and a selection of drinks was available.