We carried out an unannounced comprehensive inspection on 15 November 2018. This meant that the provider did not know that we would be visiting. We made a further two announced visits to the home on 22 and 27 November 2018 to complete the inspection.

At the last inspection in May 2018 we rated the service overall inadequate. At that time, we identified multiple breaches of the regulations and placed the service into special measures. Services in special measures are kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, we inspect the service again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. This inspection did not change the rating of the service and the overall rating is ‘Inadequate.’ The service remains in ‘special measures.’

Following the last inspection, we met with the provider to discuss the concerns we had about the service. We asked the provider to complete an action plan to show what actions they were going to take to improve. At this inspection, we found that although some action had been taken to address the previous shortfalls; we found ongoing breaches of the regulations and identified new concerns and shortfalls.

This is the second inadequate inspection of Park House and third inspection where the provider has failed to maintain compliance with the legal requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Park House 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. Park House can accommodate up to 50 people. At the time of the inspection there were 37 people living at the service, some of whom were living with a dementia.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. The registered manager was a peripatetic manager employed by the provider. A peripatetic manager is a manager who works across a number of services ran by the provider. We were told a permanent manager had been recruited for the home who would register as the manager once they commenced working at the service.

People told us they felt safe living at the home. There were safeguarding and whistleblowing procedures in place. Training had been provided to staff on safeguarding and whistleblowing procedures. It was also a standard agenda item on staff meetings and daily flash meetings to help ensure staff were given the opportunity to raise any concerns and were aware of how to escalate these if they felt their concerns were not being listened to. Three staff told us however, that they had raised several concerns about staff conduct. It was not clear whether the issues raised were dealt with in line with the provider’s policies and procedures; since records of the concerns raised and action taken were not fully available at the time of the inspection.

There were shortfalls and omissions with the management of risk. Although staff had completed training in moving and handling, we received feedback from several staff, people and a health and social care professional, that moving and handling risk assessments were not always followed. In addition, care plans and risk assessments were not always updated when there was a change in need for people.

The home was clean and there were no strong odours. One staff member told us that timely action had not been taken to replace mattresses that had been repeatedly

We carried out an unannounced comprehensive inspection on 28 May 2018. We made a further two announced visits to the home on 30 May and 31 May 2018 to complete the inspection.

The service was last inspected in September 2017. At that time we identified two breaches of the regulations relating to safe care and treatment and good governance. We rated the service as requires improvement. We asked the provider to complete an action plan to show what actions they were going to take to improve. At this inspection, we found that although action had been taken to address the previous shortfalls; we identified new concerns and shortfalls.

Park House 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. Park House is registered to provide accommodation for persons who require nursing or personal care and for treatment of disease, disorder or injury. Park House can accommodate up to 50 people. At the time of the inspection there were 46 people living at the service, some of whom were living with dementia.

A new manager had been appointed in October 2017. They had applied to register with CQC as a registered manager. However, they were not present during or following our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

During this inspection, concerns were highlighted about how people were treated. Several people raised safeguarding allegations of a physical and psychological nature. Two staff informed us of their concerns about how certain staff spoke with people. We passed this information to the regional manager who notified the local authority safeguarding adults team and the police. We found that the correct actions had not been taken with regards to several safeguarding allegations. They had not all been reported to the necessary authorities including CQC.

There were shortfalls and omissions with the management of risk. Staff did not always follow risk assessments in relation to moving and handling. Documented risk assessments were not always in place for identified risks such as choking.

People received their medicines as prescribed. Records relating to administered medicines were well kept and medicines were stored appropriately.

Timely action had not been taken to resolve the bathing and plumbing issues at the home. At the time of the inspection, there was only one bath in use to bathe all people on both floors because none of the showers or other baths were working. This was resolved by the third day of our inspection. Maintenance records showed that suitable water temperatures were not always maintained in people’s bedrooms. Some water temperatures were recorded at less than 30°C.

We received mixed feedback from people and staff about staff deployment. We considered that more direction from senior staff could help staff deployment. We have made a recommendation that staff deployment is kept under review to ensure sufficient staff are deployed at all times

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The manager had submitted Deprivation of Liberty Safeguards [DoLS] applications in line with legal requirements. We found however, that consent to care and treatment was not always sought in line with the Mental Capacity Act 2005 (MCA).

Training records were not well maintained. The training matrixes contained gaps against certain training courses. It was unclear which training staff had completed or needed

This inspection took place on 27 September 2017 and was unannounced. A second day of inspection took place on 28 September and was announced.

Park House is a residential home which provides nursing and personal care for up to 50 people. At the time of our inspection there were 44 people living at the home, some of whom were living with dementia. 30 people required nursing care and 14 people required residential care.

A registered manager was in place at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (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.

We last inspected this service on 13 May 2015 when it was rated 'good.'

During this inspection we found breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because risks associated with people's care were not always identified and mitigated, and the provider did not have effective quality assurance processes to monitor the quality and safety of the service provided to ensure people received appropriate care and support.

You can see what action we told the provider to take at the back of the full version of the report.

People and most relatives spoke positively about the service and said it was a safe place to live.

Staff had received training in safeguarding and knew how to respond to any allegations of abuse. Safeguarding referrals had been made to the local authority appropriately, in line with set protocols. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who used the service.

The premises were clean and largely well-maintained although some walls and handrails needed repainting. The provider had not responded to repeated requests from the registered manager to address specific maintenance issues.

Medicines that are liable to misuse, called controlled drugs, were stored appropriately. Records relating to controlled drugs had been completed accurately.

Regular planned and preventative maintenance checks and repairs were carried out and other required inspections and services such as gas safety were up to date.

Accidents and incidents were recorded accurately and analysed regularly. Each person had an up to date personal emergency evacuation plan should they need to be evacuated in the event of an emergency.

Staff received regular supervisions and appraisals and told us they felt well supported by the manager.

People had maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People told us staff were kind and caring. People said their choices were respected and their dignity was upheld.

Each person who used the service was given information about how to make a complaint and how to access advocacy services. An advocate is someone who represents and acts on a person's behalf, and helps them make decisions.

People we spoke with knew how to make a complaint. They told us they would speak to a member of staff or the manager if they had any issues. Relatives had mixed views whether complaints they had raised had been dealt with appropriately.

Staff had a good understanding of people’s care preferences but care records did not always contain up to date and relevant information about people’s care needs.

People we spoke with knew who the registered manager was and said they liked them. Staff said the registered manager was approachable and supportive.

People living in the home were asked to give their consent to their care and treatment, and this was recorded. Where people were unable to give or communicate their consent to treatment, the home acted in accordance with legal requirements in making and recording decisions in their best interests.

People's care and treatment needs were assessed before any care was given, and these assessments were reviewed regularly, to make sure they continued to meet people's needs. We spoke with people living in the home, with their relatives and with visiting professionals about the standard of care in the home. All were very positive, and praised the manager and the staff highly for their care and compassion.

Improvements in policies and procedures for keeping people in the home safe had been made since the last inspection, and staff had also been given further training in recognising and responding to any suspicions of abuse. This meant that people's safety had been enhanced.

Staff were also being given better support, supervision and training. This meant they were able to better understand and meet the needs of those people living in the home.

Any complaints received by the home had been taken seriously and had been properly investigated. Where necessary, steps had been taken to either refer the problem to the appropriate authorities or to make changes in the home, to prevent further complaint being necessary.

People living in the home told us they were free to make choices about their daily activities. One person told us, “You can do what you want, here”. They and their families were helped to understand choices regarding their care and treatment. Staff responded to people’s choices and showed respect for their diversity, values and human rights.

People told us they were happy with their care and were very positive about the staff. Their comments included, “We’re well looked after, and the staff are nice”; and, “They [the staff] are very kind”. People's needs and wishes had been properly assessed and their care was carefully planned. Relatives told us they were also satisfied with the quality of care. One relative told us, "The care is generally very good". Visiting health professionals agreed, one person saying the care was "excellent".

Staff were very caring and were aware of their responsibilities for protecting people. However, we found that records for the safeguarding of vulnerable adults were not clear and did not demonstrate that all necessary steps had always been taken to prevent abuse, or to respond appropriately to some allegations of abuse.

The systems in place to support staff in meeting people's needs were not working well. Staff training was not up to date, and staff had not received the necessary formal supervision or appraisal in recent months.

The home had generally effective systems for checking the quality of the service offered.

This inspection took place on 12 and 13 May 2015 and was unannounced.

The last inspection of this service took place in May 2014, when we found the service to be compliant with all the areas inspected.

Park House is a care home providing accommodation for older people requiring nursing or personal care. It has 50 beds.

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.

Systems were in place to protect people living in the home from harm. Staff had been given training in how to recognise and respond appropriately to any suspicion of abuse, and were fully aware of their responsibility to keep people safe. People told us they felt safe and protected in the home.

Staffing levels were sufficiently high to allow staff to meet people’s needs safely and in an unhurried way. Staff told us they had time to talk with people, as well as meet their care needs. New staff had been carefully checked to make sure they were suitable to work with vulnerable people.

People’s prescribed medicines were stored and administered safety, and clear records were kept of all medicines received, administered and disposed of.

Before people came into the home their needs were assessed, to make sure those needs could be fully met by the service. People and their family members were encouraged to be involved in the assessment of their needs, and their wishes about how their care should be given were recorded. Detailed care plans were drawn up to meet all identified needs and personal preferences. These plans were regularly evaluated to make sure they continued to meet people’s care needs. People told us their felt their care was given in the ways they wanted and was effective.

People told us they enjoyed a good, varied diet, with plenty of choice. They said they were happy with the quality and quantity of their meals. Care was taken to monitor people’s diet, and any concerns were shared with dieticians, who advised the service on any special diets or feeding techniques required.

Staff monitored people’s health needs and accessed the full range of community and specialist healthcare services, where necessary, to make sure people received the healthcare they needed. Staff had been trained to pick up any changes in a person’s health or general demeanour and to respond appropriately. There were effective working relationships with NHS and other professionals.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005. These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. Staff had been trained in this important area and were aware of their responsibilities regarding protecting people’s rights. The registered manager submitted appropriate applications to the local authority for authorisation to place restrictions on certain people’s movement, in their best interests.

People and their relatives told us they were happy with their care. They told us they were treated with respect and their privacy and dignity were maintained at all times. People spoke highly of the sensitive and caring approach of the staff team, and said they received personalised care. The interactions between people and staff were positive and affectionate, and staff took an obvious pride in their work.

There was a good range of activities and social stimulation available to people, and staff had time for one-to-one activities as well as group events and trips out. People told us staff encouraged them to be as independent as possible, and they were supported to use local shops and other facilities. People told us they were supported to make as many choices as possible about their care and their daily lives. Relatives told us they felt welcome in the home.

People were able to give their views about their care and the running of the home in residents’ meetings and in their individual care reviews. There were regular surveys of the views of people and their relatives, and the registered manager acted on their feedback. Complaints were taken seriously and responded to appropriately.

Staff and visiting professionals told us all aspects of the service had improved significantly over the previous year. They told us the registered manager provided clear and effective leadership which had led to an increase in the quality of the care people received. The registered manager had an open-door policy and was always available to discuss any concerns.

A range of systems were in place to monitor the quality of the service, and the registered manager took positive action to address any shortfalls. Feedback was welcomed as an opportunity to improve the service.