The inspection took place on 22 and 23 January 2019. The first day of our inspection was unannounced, the second day was announced.

Deer Park Care Centre 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. People received nursing and personal care.

Deer Park Care Centre accommodates up to 38 people with mental health issues in one two storey building. There were 35 people living at the service when we inspected. Two people received their care in bed. Some people lived with dementia, most people had a diagnosed mental illness.

At the last inspection on 22 January 2018, we rated the service Requires Improvement overall. The provider had failed to ensure water temperatures did not pose a risk to people. This was a continued breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also recommended that the provider and registered manager continued to embed auditing processes and improvements in the culture.

We requested the provider to send an action plan to detail how they planned to meet the breach of Regulation 12 by the 12 April 2018. The registered manager sent an action plan to CQC on 10 April 2018. They said they would meet Regulation 12 by 10 August 2018.

At this inspection, there continued to be a breach of Regulation 12. We also found two other breaches of Regulation. The service has been rated Requires Improvement overall. This is the fourth consecutive time the service has been rated Requires Improvement.

There was a registered manager in place. 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.

Medicines were not always well managed. The provider was not following their medicines policies and procedures. Stock medicines were not recorded on the medicines administration records (MAR sheets). Some medicines had not been kept securely locked away. People were not always supported with their medicines at the appropriate times.

Risks to people’s health and safety were not always well managed. People that required moving and handling equipment such as hoists and slings did not have robust risk assessments to evidence to staff the safest way of working with the person. Accidents and incidents involving people were recorded. Action taken by the registered manager following the incident/accident was not always clear or recorded, so it was unclear how lessons were learnt from the incidents.

The provider had carried out sufficient checks on all staff to ensure they were suitable to work around people who needed safeguarding from harm. However, the provider had not asked applicants for a full employment history and documented reasons for gaps in interview records. We made a recommendation about this.

People had access to food and drink which met their needs and to maintain good health and were supported to be as independent as possible at meal times. People were supported to put together a pictorial menu plan for the week. People were able to choose different foods from the menu plan when they wanted. Some people experienced delays to their meals. This is an area for improvement.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, the policies and systems in the service did not always support this practice. This is an area for improvement.

Records showed that the premises and equipment received regular servicing. Some actions identified by contractors had not always been dealt with in a timely manner. Some hot

Deer Park Care Centre is a privately owned residential care home supporting up to 38 people with mental health issues. At the time of our inspection there were 32 people living at the service. Accommodation is arranged over two floors and not all of the rooms had en-suite facilities. Deer Park Care Centre 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.

There was a registered manager at the service who was supported by a deputy manager, both of whom had worked at the service for a number of years. 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 the last inspection on 30 May 2017, we asked the provider to take action to make improvements related to, concerns about a lack of oversight and auditing of the service. Feedback from people had not been analysed and there was a lack of action to minimise risks and prevent incidents reoccurring. Risks related to the environment had not been minimised effectively and staff had not received the training and support required to carry out their roles. People were not always involved in planning their care and were not always treated with dignity and respect by staff. People were also being restricted and no consideration had been given to less restrictive options.

At this inspection, improvements had been made, however there remained a small number of ongoing concerns. Water temperatures continued to be inconsistent, sometimes at a temperature which put people at risk of scalding. A variety of solutions had been tried unsuccessfully, a plan was in place to fit valves which control temperatures but this had not yet been carried out. Auditing had improved and an action plan was in place which identified improvements. However this was an ongoing piece of work and had not yet been fully embedded in to practice. We made a recommendation about this.

People were supported by staff who understood their role in keeping people safe. Staff encouraged people to be respectful of each other and appropriately challenged people when their behaviours impacted on others. Risks relating to people had been assessed and staff had the guidance required to minimise risks. Staff treated people with kindness and respect. People were offered reassurance when they were distressed. Staff communicated with each other effectively to ensure people’s needs were met.

People were supported to have maximum choice and control of their lives and staff supported people in the least restrictive way possible; the policies and systems in the service supported this. People were encouraged to be involved in planning their support and activities they wished to take part in. People enjoyed a range of meals which they chose from a menu which was displayed in the dining room. People were encouraged to have a diet which supported them in remaining healthy. Staff supported people to access health professionals when required and to understand any information given to them. Staff worked closely with local mental health professionals to ensure people had access to support swiftly when required. People were supported to have their medicines by trained staff, in the way they preferred.

Adaptations had been made to the premises when required, with grab rails being fitted to support people to move around the service independently. Staff were aware of infection control measures and used these appropriately. People could choose to stay at the service for as long as they liked. When people were having end of life care this was given based on the wishes of the p

This unannounced inspection took place on 30 May 2017.

Deer Park Care Centre is a privately owned residential care home supporting up to 38 people with mental health issues. At the time of our inspection there were 32 people living at the service, however one person was in hospital. Accommodation is arranged over two floors and not all of the rooms had en-suite facilities. One part of the service supported people living with dementia and the main part of the home, supported people who had a diagnosed mental health condition.

There was registered manager working at the service. The registered manager was supported by a deputy manager, business manager and team of staff. 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.

On the day of the inspection the registered manager was not available but they did come to the service briefly and introduce themselves. The deputy manager, business manager and a senior care worker supported the inspectors throughout the visit. We spoke with the registered manager after the inspection.

We previously carried out an unannounced comprehensive inspection of this service on 19 and 20 October 2016. Breaches of regulations were found. We issued requirement notices relating to staffing levels, safe care and treatment, medicines management, consent and good governance. We asked the provider to take action. The registered manager sent us an action plan telling us what action they would take to meet legal requirements in relation to the breaches. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. We found some improvements had been made but there were continued breaches of the regulations.

At the previous inspection there was a lack of management oversight by the provider to check delegated duties had been carried out effectively. The quality monitoring systems included reviews of people's care plans, health and safety checks and checks on medicines management. These checks and systems were not regularly reviewed and completed so it was difficult for the provider to be confident people received a safe service. At this inspection improvements had been made in some of these areas but shortfalls were still found. Some checks and audits had not been completed and some were not effective as they had not identified the shortfalls found at this inspection. Records were not always detailed to ensure that staff had the guidance to provide safe care. This was a continued breach of the regulations.

There were systems in place to receive feedback from people, relatives and staff. Feedback received had not been analysed and acted on to improve the service. Accidents and incidents were recorded and were reviewed to identify if there were any patterns or if lessons could be learned to support people more effectively. However, when patterns had been identified the required action to reduce re-occurrence had not been implemented.

The culture at the service was outdated and not in line with current good practice guidelines which did not support people's individual development.

There was open communication between staff and the management team. Staff told us they were able to give honest views and had regular staff meetings to discuss any concerns. People said they could go to the management team and said they would be listened to and get the support that they needed. They thought the service was well-led.

The registered manager and staff had knowledge of their responsibilities in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). When people lacked capacity, they received support in making more complex decisions, such as

The inspection took place on 19 October and 20 October 2016. The visit was unannounced on 19 October 2016 and we informed the registered manager we would return on 20 October 2016.

Deer Park Care Home is a residential home which provides care to older people including people who have a diagnosed mental health illness. Deer Park Care Home is registered to provide care for up to 38 people. At the time of our inspection there were 36 people living at the home, however two people were in hospital. Accommodation is arranged over two floors and not all of the rooms had en-suite facilities. One part of the home supported people living with dementia and the main part of the home, supported people who had a diagnosed mental health condition.

This service was last inspected on 5 June 2014 when we found the provider was compliant with the essential standards described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

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.

There was a lack of management oversight by the provider to check delegated duties had been carried out effectively. The quality monitoring systems included reviews of people’s care plans, health and safety checks and checks on medicines management. These checks and systems were not regularly reviewed and completed so it was difficult for the provider to be confident people received a safe service. Accidents and incident analysis was completed but it did not provide an overall picture to prevent further incidents from happening.

There were not enough staff on duty to respond to people’s health needs and to keep people safe and protected from risk. The registered manager could not be confident there were sufficient numbers of staff to keep people safe because there was no effective formula that calculated what safe staffing levels should be. The registered manager and deputy manager regularly supported staff on shift which meant some quality checks and improvement actions were not always identified and resolved. This affected the quality of service people received.

Risks to people’s health and welfare were identified but not always effectively managed. Where people were at risk of harm, actions had not always been taken to keep people safe. Care plans provided information for staff that identified people’s support needs and associated risks.

People said staff provided the care they needed. Care was planned to meet people’s individual needs and abilities. Care plans were reviewed although some information about people’s mental capacity required updating to ensure staff had the necessary information to support people as their needs changed. Some people’s physical and mental stimulation was limited because they were not proactively supported to pursue their own hobbies and interests because staffing levels did not always allow time for this.

The registered manager and staff had limited knowledge of their responsibilities in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity, staff’s knowledge and people’s records did not always ensure people received consistent support when they were involved in making more complex decisions, such as decisions around medical procedures, finances or where they wanted to live.

Before providing care, staff sought consent from people and gave them time to respond. They respected people as individuals and supported them to make their own choices as far as possible.

Staff were trained and knew how to keep people safe from the risk of abuse although staffing levels made it difficult to prevent people becoming agitated

One inspector visited the home, during this visit we were able to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service and a visiting relative, the staff and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

The service was safe?

Practices in the service generally protected people, staff and visitors from the risk of harm.

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

Appropriate arrangements were in place in relation to obtaining medicine. The system was straightforward and all medicine was checked into the service and recorded appropriately to ensure people's safety.

Each person had a care plan detailing their support and care needs. We saw that there was guidance for staff to follow to reduce risks and strategies implemented to make sure people were as safe as possible.

CQC monitors the operation of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLs) which applies to care homes. The provider may wish to note that care documentation viewed did not show that mental capacity had been considered. Where people lacked capacity and decisions were made on people’s behalf the documentation did not show that the service had consulted with relatives / friends or advocates. This was needed to show that the service had acted in people’s best interest and that people’s human rights and rights of choice were not compromised. DOL's (Depravation of liberty safeguards) assessments had not been considered for any of the people using the service. This was needed as locks were fitted to external doors. This meant that people’s human rights may not be fully protected.

Is the service effective?

The service was effective overall. People told us that they were happy with the care that they received and that their care needs were met. One person we spoke with told us, “I am very happy here I have no concerns”. A relative said " Staff treat my Father well. I am happy he is here". We saw that staff were attentive to people using the service and responded promptly when needed.

People’s health and care needs were assessed with them and /or their representatives where possible. However we found that care plans were not always regularly reviewed to reflect any changes in a person’s needs.

Is the service caring?

The service was caring. People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people. People we spoke with said they felt staff respected their privacy and dignity and staff were polite and caring.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We reviewed and discussed with staff the care records of five people who lived within the service. These had sufficient detail and guidelines about the support needed to meet the people's needs.

Is the service responsive?

The service was responsive. People told us that they were happy with the service. It was clear from observations and from speaking with staff that they had a good understanding of people's care and support needs.

We found that the manager and staff were approachable and encouraged people to voice any concerns or ideas for change. People were consulted and were given the opportunity to contribute towards the running of the service. We noted evidence of regular meetings which enabled people to air their views.

We found that people were supported to attend health appointments, such as, doctors or dentists. We saw records to show that the service worked closely with health and social care professionals to maintain and improve people's health and well-being.

Is the service well-led?

Staff we spoke with had a good understanding of the different policies and procedures. They knew where to access them and where they get further advice from. Staff told us that they felt well supported and were given the information they needed to support the people who lived in the service.

The manager took an active role in the running of the home and met with staff and people who lived in the service to listen to what they had to say. We saw minutes of regular staff meetings where changes or issues with peoples’ care were discussed. In addition, we saw evidence of meetings with people who used the service to ensure they were consulted and encouraged to contribute their ideas about running the service.

People spoken with and observations made, did not raise any concerns with regard to the quality of care received. All staff spoken with demonstrated an appropriate level of experience and knowledge that enabled them to support the people who lived at the service.

We saw that the people who used the service were making choices about their lives and were part of the decision making process. People had their own individual routines which were respected. One person who used the service said "Staff are very good. I have no concerns". Another person said “Food is great, lovely choices and plenty of it”. Another person said "If I was unhappy I would talk to the manager. Staff look after me well. I have no concerns".

We had the opportunity to speak with a visiting Mental Health Nurse and discuss the care and treatment provided at the service. She was very complimentary of the staff and manager and said that the level of communication was good and the manager and staff were proactive in following through her practice recommendations. She had no concerns about the quality of care.

During the inspection process we identified that training had lapsed and that staff did not have the required mandatory training to fully meet people’s needs. We have made a compliance action and will consider enforcement action in future should this outcome continue not to be met.

We had already visited Deer Park within 12 months and found the service to be compliant with Outcome 4 Personal care, Outcome 7 Safeguarding people who use services from abuse and outcome 16 assessing and monitoring the quality of service provision.

This inspection focused on Outcome 8 Cleanliness and infection control and Outcome 10 Safety and suitability of premises. We spoke with several people who use the service about these outcomes. All those spoken with did not have any concerns in these areas and did not pass comment.

We found the service to be none compliant with regard to cleanliness and infection control and safety and suitability of premises as the provider had failed to ensure that it was meeting the regulations as detailed within this report.

Whilst bedrooms were generally well maintained with fresh paint other parts of the service were not so well maintained. The flooring in some areas was worn and dirty. General paintwork within parts of the service were faded and chipped posing a possible infection control risk as it prevented effective cleaning.

The outside fabric of the building was in need of general maintenance in that many wooden windows were rotting and falling into disrepair. Paint was peeling with broken roof tiles and broken plastic down pipes needing attention.

People told us that they felt settled at the service. They told us that they were able to have their personal belongings in their rooms which made it feel more like home.

People told us that they felt well cared for and that they liked the staff. They told us that they had confidence in the staff and that they understood their needs.

People said that they were asked what they thought of the service and could make suggestions and raise concerns with the manager whenever they wanted to.

People told us that they were involved in choices about their care and kept informed of any changes to the service.

People felt safe and well looked after and liked the staff that worked there.

People told us that they felt able to raise any comments that they had with the manager and that they were responded to.

We observed people being treated with dignity and respect. Staff acknowledged people when they entered a room and stopped to chat with people as they met them in the corridor.

People appeared calm and relaxed and were able to choose what activities they wanted to get involved in.