We inspected this service on 11 December 2018. Hall Park Care Home is a ‘care home’ situated in the Nottingham suburb of Bulwell. It provides accommodation for up to 62 older people or people living with dementia. At the time of this inspection, 57 people were living at the service. 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 our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring, that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

A registered manager was 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.

People continued to feel safe and staff ensured that risks to their health and safety were reduced. We found that sufficient staff were deployed to safely meet people’s needs and that staff had received training to ensure they had the knowledge to protect people from the risk of avoidable harm or abuse, whilst providing care.

People were protected from the risk of an acquired health infection, as the service employed dedicated cleaning staff to ensure the environment was clean and had appropriate policies and procedures to monitor and reduce the risk

Systems were in place to support people to take their medicines safely. Staff received relevant training and felt well supported. People were asked for their consent to their care and appropriate steps were taken to support people who lacked capacity to make decisions.

People were supported to eat and drink enough to maintain good health.

There were positive and caring relationships between people using the service and the staff who cared for them. Staff promoted people's right to make their own decisions about their care where possible and respected the choices they made. 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 supported this practice.

People were treated with dignity and respect by staff who understood the importance of this.

People received person-centred and responsive care from staff who had a clear understanding of their current support needs. Care plans were in place, which provided information about the care people required.

People knew how to make a complaint and there was a clear complaints procedure in place.

When people were at the end of their life the service had effective measures in place to support them and ensure their wishes and needs were met.

An open and transparent culture enabled people and staff to speak up if they wished to. The management team provided strong leadership and a clear direction to staff.

There were robust quality monitoring procedures in place. The management structure of the service was clear.

Further information is in the detailed findings below

We carried out an unannounced inspection of the service on 14 and 22 January 2016.

Hall Park Care Home provides accommodation to older people in the Nottingham area. It is registered for a maximum of 62 people. There were 58 people receiving care and support at the home at the time of our visit.

On the day of our inspection 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.

People felt safe and the home offered a safe environment for people to live. They were supported by staff who understood how to report allegations of abuse. Risk assessments were in place to identify and reduce the risk to people’s safety. Staff were in place to keep people safe and medicines were stored and handled safely.

People were supported by staff who received a comprehensive induction and training programme. Staff told us they felt well trained and supported by the registered manager and they were knowledgeable about the people they cared for.

People’s rights were protected under the Mental Capacity Act 2005. People received sufficient to eat and drink and had a good experience at meal times. People had access to other healthcare professionals and received effective care that was relevant to their needs.

People were treated with kindness and compassion and spoke highly of the staff. Staff interacted with people in a friendly and caring way. People’s privacy and dignity was protected and they felt able to contribute to decisions made about their care. Information was available should people wish to receive support from an independent advocate if they needed one.

People’s care records focused on people’s wishes and respected their views. Staff responded to people’s needs promptly. They encouraged people to participate in activities that were available in the home which reflected their needs. A complaints process was in place and staff knew how to respond to complaints.

People, relatives, staff, and healthcare professionals all complimented the registered manager. People were encouraged to contribute to the development of the service. The registered manager actively sought people’s views and acted on them. There were systems in place to monitor and improve the quality of the service provided. The service was led by a registered manager who had a clear understanding of their role and how to improve the lives of all of the people at the service. They had a robust auditing process in place that identified the risks to people and the service as a whole and they were dealt with quickly and effectively.

This service was inspected by a single adult social care inspector. In order to answer the questions below we spoke with the registered manager and five members of staff, twelve people in the service and two relatives. We also reviewed six people’s care records. There were 60 people using the service at the time of our visit.

Due to concerns at the previous inspection, we checked that people in the service were consenting to the support they were offered. We saw the service had now arranged for people or their representatives to sign documents to denote their agreement.

Is the service safe?

People told us they felt safe. Staff were confident to raise safeguarding concerns and were able to describe the steps to take if they were concerned any abuse had taken place. There were sufficient numbers of staff on duty to meet the needs of the people in the service. The premises were secure from anyone entering unannounced, and care records were retained in secure areas and only accessed by authorised staff.

Is the service effective?

People can be reassured their needs will be met at this service. Each person had a detailed care plan that described their support needs. Staff had a good understanding of people’s needs and they knew people in the service well. One relative told us, "They’re all nice staff. I like it here.”

Is the service caring?

People told us they were supported by caring staff. We saw staff showed patience when they were with people. One staff told us, “We like to spend time with people, listen to them.” We saw people were not rushed to make their own decisions. A survey which had been sent to families in 2014 was complimentary and positive.

Is the service responsive?

People’s support needs were assessed before they arrived at the service. Care records reflected people’s individual needs and described staff interventions. People and their relatives were invited to meet with their keyworkers each month to review their care plans where necessary. People had access to hobbies that were important to them. Healthcare professionals were readily available if necessary.

Is the service well-led?

The provider had systems in place to monitor the quality of the service being provided. These included feedback by the use of monthly audits, complaints received and surveys issued. All findings were evaluated and actioned. Staff had a good understanding of the aims of the service. All care records we viewed were current. All risks had been assessed, and safeguards put in place where necessary.

The registered manager indicated in this report is no longer employed by the provider. The current manager has not yet submitted their application to become the registered manager of Hall Park Care Home.

We spoke with nine people who used the service. One person said, “Carers are very nice and helpful. They respect our privacy and dignity.” Another person said, “I have the choice. I can go to bed and get up when I want. I like to be independent. They only help me when I needed it.” A third person said, “It’s a nice home. The carers treat me with kindness and they respect my privacy and dignity.”

We found that the service treated people with dignity and respect. However, we were concerned that consent to care and treatment was not always sought from people who used the service.

We found that people were cared for and their individual needs were being met by the service. However, we were concerned that people’s nutrition and hydration needs were not always met.

We found that people who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. We saw staff interactions with people who use the service were mainly caring and polite. We found there were enough staff available to meet people's individual needs.

We found the service had an effective quality assurance system in place. People told us they were supported in commenting on the service they received. We found a number of shortfalls regarding the record keeping, there were gaps in the information to identify if the person’s needs had been met.

We spoke with four people who were using the service during our visit. The people we spoke with told us that staff sought their consent before delivering any care. We were also told that people’s choices were respected. One person said, “Staff always seek my consent, I get to do the things I like and in the way I like it.” We were also told, “The care I receive is very dignified, staff will ask before doing anything and if I say no, they respect that.”

We spoke with four relatives of people using the service. We were told, “I am happy with the care my relative receives, the staff are very nice.” One relative commented that staff made efforts to keep them informed of their relative’s health, “The staff communicate well and always update me with things.”

During our visit we observed staff to be kind and patient when interacting with people using the service.

We spoke with four people who were using the service during our visit. The people we spoke with felt that there were many different ways they could give their opinion of the quality of service. People also felt that their opinions were listened to and responded to effectively. The provider may find it useful to note that not everybody felt the resident’s meeting forum was as effective as it might be.

We asked two people if they were given their evening medicines at the time they wanted them and both said “Yes.” One person was prescribed a medicine that they had to take at exact times. This person received their medicine at the right times on the evening of our visit.

One person kept her medicines in her room and took them herself. This person explained to us what all the medicines were for and showed us the locked cupboard where they stored them. This person said “Everything is very good here. My medicines are delivered on time.”

We asked people whether they thought enough care workers were provided to care for them in the way they wished to be cared for. One person who used the service said, “The staff are great and they are very caring. They are very busy but they do what I need them to do. This is a much better home than I was in before.” Another person said, “I get help when I need it, I don’t wait very long for them to come to me.” A relative of a person using the service said, “There seems to be plenty of staff around, I am very happy with it here.”

People using the service told us that staff respect their privacy and dignity. People said “The staff always knock on the door before coming into my room” and “the staff knock the door before entering”. People using the service were encouraged and supported to maintain their independence. We observed that the routine in the home was relaxed and this was supported by comments made to us. People were engaged in a range of activities, and also supported to access the local community, either with friends and family or with staff. People told us they felt safe. Comments included “I feel safe here” and “I have never seen anyone behave badly”. Staff spoken with were aware of how to recognise potential abuse, and information received from the service demonstrates that staff do report any issues to the manager.

People told us that they were involved in planning and reviewing their care. The care records were looked at supported this. There was little information recorded in care files relating to people’s capacity to make decisions about their care. This is particularly important given the nature of the people’s needs, and may lead to people having restrictions in place that are not in their best interest. People were positive about how staff cared for them, although they did have some negative comments about the number of staff on duty and how staff spend their time. People told us that “staff are nice” and “staff are good at looking after us”. People also said that “sometimes the staff are standing at the nurses station chatting, when people are in the lounge unattended” and “sometimes there are enough staff and sometimes there aren’t, particularly at lunch”. People told us that the meals had improved. They told us that the food was good and they were offered choices. Meals times were relaxed and staff were available to support people who needed assistance. People were not always receiving their medication as prescribed. The amount of medication signed as given and the amount of medication that had actually been given was not always the same. This means that there is an increased risk of poor health outcomes for people.

People using the service were not always aware of how to make a complaint, or confident their concerns would be listened to. People told us “I would feel I could complain but we personally don’t know how to” and “if you had a serious concern they would listen, but whether any action I am doubtful because we have no results”. A person speaking on behalf of people who use the service informed us prior to this visit that people did not want to raise concerns they had directly with us as they were concerned that it may affect the level of care they receive.