We carried out an unannounced comprehensive inspection of Dene Park House on 24 and 25 July 2018. The first day of inspection was unannounced. This meant the provider and staff did not know we would be coming.

At the last comprehensive inspection of the service on 15, 16 and 20 June 2017 we identified breaches of regulation 12, safe care and treatment, and regulation 17, good governance. The provider had not fully assessed and mitigated the risks to people who used the service and infection control procedures where not always followed by staff. The provider failed to ensure that there was an effective system in place to monitor the quality and safety of the service and care records were not always accessible or complete. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

At this inspection the service had made the required improvements. We found no breaches of regulation and the service was meeting the legal requirements. Risks to people were clearly identified, assessed and mitigated, infection control procedures were being followed by staff and there was a new robust governance framework in place. People's care plans reflected their individual needs and risks were assessed.

Dene Park House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The home accommodates people in one adapted building over three floors and on the date of this inspection there were 43 people living at the home, some who were receiving personal care, nursing care and some people who had a diagnosis of dementia.

The service had a registered manager in post who had been registered with the Commission since December 2017. A registered manager is a person who has registered with the CQC 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 at the home felt safe living there and relatives agreed with these comments. There were safeguarding policies and procedures in place to keep people safe. Staff had received training and attended supervisions around safeguarding. The registered manager appropriately escalated all safeguarding concerns to the local authority.

Staff were safely recruited and were provided with all the necessary induction training required for their role. The registered manager continued to provide on-going development for staff through refresher training and accessing courses to increase staff knowledge and skill. Accidents and incidents were recorded correctly and if any actions were required, they were acted upon and documented. There were enough staff to meet people’s needs. We saw documentation to show staff received regular supervisions and appraisals.

The premises were safe. Regular checks of the premises, equipment and utilities were carried out and documented. These were also audited regularly by the registered manager and any issues identified were acted upon. On the first day of inspection we found three clinical waste bins which were not secure. The registered manager took immediate action with this and requested the maintenance person to secure the clinical waste bins. Infection control measures were in place and the home was clean. We saw domestic staff cleaning the home regularly during the inspection.

The premises were ‘dementia friendly’ and people had personalised bedrooms. There was pictorial signage throughout the home to help people to orientate themselves. The registered manager was working in partnership with Silverline Memories to create a dementia friendly café in the home.

On both days of inspection, we obs

This inspection took place on 15, 16 and 20 June 2017. The first day of the inspection was unannounced which meant the provider did not know we would be visiting. We last inspected the service in November 2016 where we found two breaches of our regulations relating to complaints and good governance. The provider sent us an action plan following the inspection which we reviewed at this inspection. We carried out this inspection due to concerns we had received about the service and we wanted to make sure people were safe.

Dene Park House is situated in Gosforth and close to the town centre and local amenities. Residential and nursing care is provided for up to 52 people. There were 42 people using the service at the time of our inspection. Accommodation is provided over three floors.

There was no registered manager in post at the time of the inspection, as they had left the service in March 2017. A new manager had been appointed and the service was being supported by a regional manager and an experienced home manager from another Akari 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.

Not all aspects of the service were safe. Staff did not always maintain a safe environment. Doors which should have been locked were found to be left unlocked during our inspection and hazardous substances were not always stored correctly. Boxes of archived care records were stored unsafely, however these were removed before we completed our inspection. Infection control procedures were not always followed. A small number of wardrobes were not secured to the wall which posed a potential risk of tipping. These were secured before we completed our inspection.

Medicines were found to be managed safely, and records were satisfactorily maintained. New improved records of the administration of medicines prescribed ‘as and when required’ had been developed but were not in use on each floor on the first day of our inspection. These were introduced to all floors before we completed our inspection, but this procedure was not fully embedded. We have made a recommendation to monitor compliance with the new procedure.

There were suitable numbers of staff on duty during our inspection. There had been some concerns raised about staffing levels prior to our inspection, and we found there had been an increase in staffing on each shift including at night. There was a shortage of permanent nursing staff, and the service was relying heavily on agency nurses. Four new nurses had been appointed, and were awaiting checks prior to starting employment. Recruitment of additional care staff and a deputy manager was underway. Experienced staff from other services including a manager and senior care staff, had been brought in to the service to help support and stabilise the home. Although some people and their relatives told us they had noticed an improvement in staffing levels, some people remained concerned. We have made a recommendation to continue to monitor staffing levels closely.

We found that there had been an increase in the amount of equipment in use for the safe moving and handling of people, and occupational therapists were involved in assessing risks and ensuring correct handling plans were in place.

We observed people being supported at mealtimes, and found that where people were found to be losing weight that advice had been sought from a GP and dietician. Records of people's weights on each floor contained gaps, and did not always record people’s full details. Weights were recorded in people’s individual care files. The regional manager had recognised a lack of oversight of people’s weights and was collecting this information to monitor people's dietary needs

This inspection took place on 4 and 5 October 2016 and the first day was unannounced. This means the provider did not know we were coming. We last inspected Dene Park House in December 2015. At that inspection we were following up on two breaches of regulations which had been found in our previous inspection in February 2015.

Dene Park House is a care home which provides nursing and residential care for older people, including people living with dementia. The home has 50 bedrooms over three separate floors. There were 38 people living in the home at the time of this inspection. The ground and the first floor were both fully occupied and we were informed the top floor had been re-opened a few weeks prior to the inspection following a number of emergency admissions.

The service had a registered manager. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Systems were in place to keep people safe from harm. Staff were aware of the different types of abuse people might experience and of their responsibility for recognising and reporting any potential signs of abuse.

Possible risks to the health and safety of people using the service were assessed and appropriate actions were taken to minimise any risks identified.

A new electronic system had recently been introduced for the management of medication. Although staff had been trained in the use of this system and daily reports were available to the registered manager to check people were receiving their medication as prescribed we found these were not always effective.

Staff were provided with the training and support in terms of both supervisions and appraisals required to assist them in performing their roles effectively.

People using the service told us they felt staffing levels were not sufficient. However we found staffing levels were appropriate based on people’s dependency levels and expected staffing ratios for the completion of care tasks. Staff felt staffing levels were appropriate and our observations during the inspection were that there were sufficient staff to safely meet people’s needs.

Care plans we viewed were evaluated by staff on a regular basis but people and their family members had not been involved in this process. Regular reviews had also not been taking place and formal consent to care and treatment had not been captured. The registered manager had already recognised that people and their relatives had not been provided with the opportunity to be involved in their care planning and we saw evidence reviews had now started to take place. The registered manager also accepted consent to care and treatment had not been formally captured but gave assurances this would be addressed as part of the on-going work being undertaken to update people’s care records.

People were supported to meet their health needs and access external healthcare services and we received positive feedback from an external healthcare professional about the staff team’s response to advice and guidance.

Staff were described as kind and caring and we found they were knowledgeable about people’s needs and preferences. Staff treated people as individuals and were aware of the importance of respecting people’s privacy and dignity.

Systems were in place to obtain feedback from people using the service, their friends and family members and staff. The service had a complaints policy and procedure and information was on display throughout the service informing people how to complain. However records held in relation to complaints were variable and did not always provide details of whether the complaint had been resolved to the complainant’s satisfaction. People and relatives we spoke with felt although

We carried out an unannounced comprehensive inspection of this service on 16 and 20 February 2015. Two breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches of regulations relating to staffing and safeguarding people from abuse and improper treatment.

We undertook this focused inspection on 14 December 2015 to check that they had followed their plan and to confirm that they now met the legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Dene Park House on our website at www.cqc.org.uk.

We found the provider had met the assurances they had given in their action plan and were no longer in breach of the regulations.

The service had a manager in post. This person had applied to the Care Quality Commission in December 2015 to be registered in respect of Dene Park House. 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.

Action had been taken to ensure there were sufficient staff to meet people’s needs. The manager had introduced a new assessment tool which more accurately identified people’s dependency needs. Changes had been made to the deployment of staff. The home had been reorganised to provide care to people over two floors rather than three, which meant staff were better able to meet people’s needs in a timely way. More staff had been recruited and there was less reliance on the use of agency staff. Where agency staff were used, the manager used a small number of such staff for extended periods, which meant they became familiar to people and were better able to meet individual needs.

Action had been taken to ensure the service acted in compliance with the Mental Capacity Act 2005. We found improvements had been made to the assessment of people’s capacity to consent to being placed in the home. Where it was assessed a person lacked such capacity, a decision was made in their best interest and an application was made to the authorising authority for a Deprivation of Liberty Safeguard to be put in place. This meant that people’s rights were being protected and any deprivation of liberty was lawful and as least restrictive as possible.

We carried out this inspection as a result of anonymous concerns received about the provider's recruitment practices.

We looked at a sample of staff recruitment and selection files and spoke with the manager.

We found a number of deficits in recruitment practices, including a failure to check proof of identity and employment histories properly; a failure to ensure appropriate references were obtained; and a failure to fully check the reasons for the ending of previous employment. This meant we could not be confident that only suitable persons were being employed to work with vulnerable people.

This inspection was to check that concerns identified at our last inspection of the home in July 2013 had been addressed.

We found there had been improvements in the provision of training, supervision and appraisal of the staff team, and that systems were now in place to maintain these improvements. This meant staff were better able to deliver people's care and treatment safely and to an appropriate standard.

We found improvements had been made in the quality of the records kept of people's care, and the frequency with which those records were updated. This meant an accurate record of people's care and treatment was now being kept by the home.

People living in the home spoke highly of the manager and her staff, and said that they were well looked after. They said that they usually received the care they needed promptly.

We were told that the manager goes round the home every day and speaks with the people living in the home, asking their opinions on the care being given and on how the home is run.

Most people we spoke with told us that there were enough staff to meet their needs, and that they normally came reasonably quickly, when called. One person said that they “could do with more staff”, but this person also said that she never had to wait very long for attention. She said she had “no complaints”, and said the manager was very good.

We were told that the staff were kind and attentive, and that they treated the people living in the home with respect at all times. People told us that the staff listen to them and act on what they say.

This inspection was carried out over two days on 16 and 20 February 2015 and was unannounced. We last inspected this service in February 2014, when we found a breach of the regulation regarding the recruitment of workers. We carried out a desk-based inspection (that is, without visiting the service) in October 2015, when we found the service to be no longer in breach of this regulation.

Dene Park House is a care home providing accommodation and general nursing or personal care to older people. It has 50 beds over three floors. There were 35 people living in the home at the time of this inspection.

The service had a registered manager who had been in post for one year. 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 living in the home, and relatives and other visitors we spoke with confirmed this. Appropriate policies and procedures were in place for the safeguarding of people using the service. Staff were knowledgeable about their responsibilities to recognise and report any abusive situation. Risks to people had been assessed and managed.

Staffing shortages and the regular use of agency nurse and care staff meant the needs of people who needed two staff to provide their care safely were not always receiving that care in a timely manner.

Staff used appropriate aids and equipment to provide people’s care in a safe way. Accidents and other issues affecting people’s safety were monitored carefully and appropriate actions were taken. Fire systems were checked regularly.

People’s medicines were managed safely.

As Dene Park House Nursing Home is registered as a care home, CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found appropriate policies and procedures were in place and the registered manager was familiar with the processes involved in the application for a DoLS. However, we found applications to deprive people of their liberty had not been submitted in a timely fashion. At the time of the inspection no-one living in the home was subject to a deprivation of liberty safeguard.

People said they felt their needs were met effectively by the staff team, and this was confirmed by relatives and other visitors. Staff were given appropriate induction to their work and received appropriate ongoing training to enable them to meet people’s needs. We noted effective communication between people and the staff team. Where appropriate, checks had been carried out of the competency of individual staff members, for example, in the management of medicines.

Staff received regular supervision of their performance, and a programme of annual appraisals was arranged.

People received a varied and nutritious diet, and told us they were very happy with the quality and quantity of their meals. Any special dietary needs were met.

People told us they were always asked for their consent before any care was carried out.

We found the service to be very caring. People gave us many examples of the kindness, courtesy and caring approach by all staff. Their comments included, “I’m happy with the care. I am treated with kindness and respect”; and, “The staff are very nice. They are lovely.” Relatives were also very complimentary regarding the quality of the care. They spoke of the home being a “warm and welcoming place.”

People told us the staff were good at keeping them informed and giving them any information they might need.

People were involved in the assessment of their needs and the planning of their care. They told us staff responded positively to any changes in their needs and wishes, and were alert to any changes in their health or well-being. Care records showed that staff took a person-centred approach to people’s care.

People told us they were given choices about their daily living routines. They told us, however, that the levels of social activities in the service had decreased from their usual frequency due to the recent unavailability of the home’s activities co-ordinator.

The service worked in conjunction with other health and social care professionals to meet people’s needs.

We found the service lacked a cohesive staff team. The registered manager was robust in driving up standards in the home, but we noted that a significant number of staff did not feel their contribution was always valued and acknowledged. These factors were hampering the development of the service.

Systems were in place for checking the quality of the service, and issues identified were included in the service’s development plan. The registered manager received regular support from his line manager.

We found breaches of the Health and Social Care Act (Regulated Activities) Regulations 2010 in relation to staffing and the protection of people against the risk of unlawful deprivation of their liberty. You can see what action we told the provider to take at the back of the full version of this report.