This inspection took place on 24 October 2016 and was unannounced. The home provides accommodation for up to 35 people with nursing care needs. There were 33 people living at the home when we visited, all of whom were living with dementia and had additional nursing needs. All areas of the home were accessible via a lift and there were three lounge/dining rooms on ground of the home. There was accessible outdoor space from the ground floor. Bedrooms were a mix between single and shared occupancy.

There was a registered manager at the home. 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 July 2015, we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to make improvements in the areas of: ensuring peoples care plans reflected their most current needs, ensuring guidance for staff was clear to support people with their medicines, and taking steps to minimise risk to ensure a safe environment for people to live in. At this inspection we found that improvements had been made and provider had taken steps to meet the requirements of the regulations.

People received personalised care which was tailored to their needs. This included care plans that reflected peoples; dietary needs and preferences, personal care routines, people’s life history and medical conditions. People and their relatives were involved in the planning and reviewing of their care and told us the provider worked in partnership with them.

People’s care records were updated regularly to reflect their changing needs. The staff responded quickly to changes in people’s health and wellbeing. Staff were able to identify when people’s conditions changed and took appropriate action to ensure they were seen by healthcare professionals.

The provider had made adjustments to the environment to make it more suitable for people living with dementia or visual impairment. Environmental and individual risks to people were monitored and managed to ensure the risk to people coming to harm was minimised. The registered manager undertook regular checks and audits of the home environment to ensure it provided a safe and comfortable place for people to live in. Incidents were analysed to identify causes with measures put in place to reduce the risk and likelihood of reoccurrence.

People were cared for with kindness and compassion. Staff followed legislation designed to protect people’s rights and freedoms.

Staff knew people well and interacted with them positively when supporting them. They actively sought to uphold people’s choice, privacy and dignity. People had a range of activities available for them to participate in and were supported to maintain contact with people who were important to them.

People’s medicines were managed safely and people received their medicines as prescribed.

There was a clear management structure in place and sufficient staff that were suitably skilled and qualified to meet people’s needs. Staff felt supported in their role by the registered manager and received regular supervision and guidance. Staff were confident in identifying and acting upon safeguarding concerns about people.

The service had an open and transparent culture. The provider encouraged feedback from people, relatives and professionals and looked to make improvements from suggestions made. Complaints were dealt openly with the registered manager responding feeding back to people in a timely manner. The provider notified CQC about significant events that happened in the home.

We used a number of different methods to help us understand the experiences of people using the service because the people had complex needs which meant they were not able to tell us their experiences. During our inspection we spoke with two people who used the service, the relatives of two people, two members of staff and observed interactions between staff and people living at the home.

During our previous inspection on 1 May 2013, we found that the provider had not completed a mental capacity act assessment for all the people using the service, who required one. During our follow up inspection on 9 September we found that this had changed. Where people did not have the capacity to consent, the provider had acted in accordance with legal requirements. The deputy manager explained that most people who used the service did not have the capacity to consent. She told us that everyone using the service had a mental capacity act assessment included within their care plan.

Staff received appropriate training and support. We saw records which showed that all staff had had a supervision meeting during May, June or July 2013. The deputy manager told us that staff had a supervision meeting every three months or more often if the need arose. We saw supervision responsibilities displayed in the manager’s office.

We used various methods to help us understand the experiences of people using the service, as they had complex needs they were not able to tell us their experiences. We spoke with one person who used the service, the relatives of four people, three members of staff and observed interactions between staff and people living at the home.

We observed people being spoken to kindly and staff responding to people’s needs, offering support to make sure they were comfortable. Staff told us that they respected people’s wishes if they did not want care. One relative told us they had overheard staff providing personal care for their relative, speaking to them kindly and with respect, explaining what they were doing and asking for consent to provide care. But we found that the requirements of the Mental Capacity Act 2005 were not always met, where people lacked capacity to consent.

We spoke with staff who demonstrated a good understanding of safeguarding vulnerable adults, so people were protected from the risk of abuse.

Current training records showed that the only fire safety and moving and handling training had been kept up to date. This meant that most staff had not received all the training they needed to provide a safe and efficient service.

Regular inspections of the quality of care were carried out by an independent consultant. Various aspects of care including privacy and dignity were reviewed and action points were raised.

We saw that care records contained details of people’s family and social history. These details in most cases had been supplied by relatives and gave care staff an understanding of the person’s past life and personal values. One person’s relative told us how staff always ensured their family member was dressed appropriately: “She always looks lovely, they coordinate her. A scarf, beads and make up. Just the way she would want.”

We spoke with four members of staff who all demonstrated a good understanding of people’s needs. Relatives we spoke with praised the staff for the care and support they gave to their family member. One person said: “Nothing is too much trouble.” Another told us: “I know they check things like weight and can always let me know if there is any change.”

The service had recently revised and updated both their safeguarding and whistle blowing policies. Local authority and safeguarding team contact details were available on the staff notice board. This meant that should there be an allegation of abuse staff would be able to make an appropriate referral in a timely way.

One member of staff told us: “The use of agency staff has been reduced and the delegation of staff to help people eat is a lot better.” One of the relatives we spoke with commented on the way staff carried out their duties to be able to care for a wide range of needs: “Staff are so well organised.”

Most of the people at this care home were unable to communicate verbally and were not able to tell us about their experiences. Of those who had verbal skills, responses were limited due to individual levels of comprehension.

During our inspection we used the Short Observational Framework for inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of those people who could not talk with us. We observed that not all staff interacted and communicated with people in an appropriate and respectful manner. Some meaningful interaction however was provided by some staff who obviously knew the people well and responded appropriately to people’s needs.

We were able to speak with the relatives of five people who live at Home Park. Three of the five people told us that they thought there were not enough staff available. One person said, “At lunchtime there are not enough staff available to support people.”

One relative was concerned that they had not seen any activities taking place in the home at weekends. “Is there any stimulation?”

Most of the relatives we spoke with praised the staff for their friendliness and said they were very approachable. They felt that their family member was being well cared for and their day to day needs met. Two people commented that their relatives were always dressed nicely and their clothes clean.

One person we spoke with felt the home had not done enough to protect their relative against any risks to their safety.

This was a follow up visit to monitor issues raised at out last compliance review. We did not speak with people using the service on this occasion.

The inspection took place on 14, 16 and 21 July 2015.

The home provides accommodation and care for up to 35 people. There were 34 people living at the home when we visited, all of whom were living with dementia.

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 and associated Regulations about how the home is run.

At the last inspection on 30 and 31 October 2014, we asked the provider to take action to make improvements in the following areas: respecting and involving people; care and welfare; safeguarding people from abuse; cleanliness and infection control; recruitment procedures; staffing; medicines and assessing and monitoring the quality of the service provision. Action had been taken to make improvements in line with the provider’s action plan but during this inspection we found two continuing breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found one new breach. You can see what action we told the provider to take at the back of the full version of this report.

The home was clean but there were were areas of the home where risks had not been identified or action taken to minimise them. Care plans were not up to date and one person did not have a care plan in place. Medicines were stored safely but people did not always have effective care plans in place for medicines prescribed as ‘when needed’.

Staff were aware of risks to people, such as using the hoist to support people to move. They knew about people’s moving and handling care plans which detailed what equipment people needed to ensure they were supported to move safely.

Most people needed staff support to eat and drink and this was done in a patient and caring way. However, we saw two incidents where people were not getting the support they needed and the registered manager dealt with the incidents. Staff formed positive caring relationships with people and spoke about them in a caring and compassionate way. People’s dignity was respected when staff supported them with personal care. The provider employed an activities co-ordinator who used a range of techniques to interact with people.

New staff started work after satisfactory pre-employment checks had been completed. Staff completed a thorough programme of induction training as well as further training, relevant to their work. Staffing levels were calculated based on the number of people living in the home rather than on assessed needs and staff said most people needed support with eating and many needed two staff to support them with moving and personal care. However, staff did meet people’s needs. The registered manager was well thought of and ensured an open and positive culture within the home.