This inspection took place on 2 and 3 May 2017 and was unannounced.

The provider is registered to provide accommodation for up to 68 older people living with or without dementia in the home over two floors. There were 59 people using the service at the time of our inspection. The home provides nursing care for older people.

A registered manager was in post and was available throughout the inspection. 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.

Staff knew how to keep people safe and understood their responsibility to protect people from the risk of abuse. Risks were managed so that people were protected from avoidable harm and not unnecessarily restricted.

Sufficient staff were on duty to meet people’s needs and staff were recruited through safe recruitment practices. Safe medicines and infection control practices were followed by staff.

Staff received appropriate induction, training and supervision. People’s rights were protected under the Mental Capacity Act 2005.

People received sufficient to eat and drink. External professionals were involved in people’s care as appropriate and adaptations had been made to the design of the home to support people living with dementia.

People and their relatives were involved in decisions about their care. Advocacy information was made available to people.

People received care that respected their privacy and dignity and promoted their independence.

People received personalised care that was responsive to their needs. Care records contained information to support staff to meet people’s individual needs, though activities could be further improved so that more people could access activities outside the home.

Complaints were handled appropriately. A complaints process was in place and staff knew how to respond to complaints.

People and their relatives were involved or had opportunities to be involved in the development of the service. Staff told us they would be confident to raise any concerns with the management team and appropriate action would be taken.

The registered manager and provider were meeting their regulatory responsibilities. There were effective systems in place to monitor and improve the quality of the service provided.

This inspection took place on 4 and 5 May 2016 and was unannounced.

Accommodation for up to 68 people is provided in the home over two floors. The service is designed to meet the needs of older people and has a separate unit for people living with dementia. There were 57 people using the service at the time of our inspection.

At the previous inspection on 3 and 4 June 2015, we asked the provider to take action to make improvements to the area of safe care and treatment, specifically medicines management. At this inspection we found that improvements had been made in this area.

A manager was in post but had not started the application process to become registered with the CQC. The service had not had a registered manager for over a 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 felt safe in the home and staff knew how to identify potential signs of abuse. Systems were in place for staff to identify and manage risks and respond to accidents and incidents. The premises were well maintained. Sufficient numbers of staff were on duty to meet people’s needs. Staff were recruited through safe recruitment practices. Safe infection control and medicines practices were followed.

People’s rights were not fully protected under the Mental Capacity Act 2005. People received sufficient to eat and drink, but action had not been taken to ensure that a request for a dietician referral had been progressed for a person who had significant weight loss. Staff received appropriate induction, training, supervision and appraisal. External professionals were generally involved in people’s care as appropriate. People’s needs were met by the adaptation, design and decoration of the service; however, not all people could use the bath as equipment was not in place to support them to do this.

Staff were caring and treated people with dignity and respect. People and their relatives were involved in decisions about their care. Advocacy information was made available to people. People’s privacy was protected and they were encouraged to be as independent as they could be.

People’s needs were promptly responded to. Care records provided sufficient information for staff to provide personalised care. Activities were available in the home and plans were in place to improve them further. A complaints process was in place and staff knew how to respond to complaints.

People and their relatives were involved or had opportunity to be involved in the development of the service. Staff told us they would be confident raising any concerns with the management and that the management would take action. There were systems in place to monitor and improve the quality of the service provided.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service. This was an unannounced inspection.

In October 2013, our inspection found that the care home provider had breached regulations relating to records. Following the inspection the provider sent us an action plan to tell us the improvements they were going to make. During this inspection we looked to see if these improvements had been made. We saw that issues remained regarding records.

Park House is a care home providing accommodation and nursing care for up to 68 adults. There were 61 people living there when we visited, however three of the people were in hospital. The care home provides a service for people with physical nursing needs and for people living with dementia. The registered manager was no longer in post, however, a new manager had been appointed and they told us they would be applying to be the registered manager of the home. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

The Mental Capacity Act 2005 was not being adhered to. The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS), and to report on what we find. The DoLS are a code of practice to supplement the main Mental Capacity Act 2005 Code of Practice. We looked at whether the service was applying the DoLS appropriately. These safeguards protect the rights of adults using services by ensuring that if there are restrictions on their freedom and liberty these are assessed by professionals who are trained to assess whether the restriction is needed. A staff member told us that a DoLS application had been made for one person who used the service. However, we saw some people on the dementia unit trying to access the garden but the door was locked and DoLS advice had not been obtained for these people. The service was not meeting the requirements of the DoLS.

Safe staffing levels were not in place and safe medicines management and infection control procedures were not being followed. This meant that people who used the service were not always protected from the risk of harm. However, staff were recruited through safe recruitment practices and people told us they felt safe.

Staff told us they received supervision, appraisal and appropriate training as required. However, we saw that there were some training courses that had not been attended by all staff. This meant that there was a greater risk that staff would not have the knowledge and skills to meet people’s needs.

Records and observations showed that people who used the service were not always protected from the risks of inadequate nutrition and dehydration and we saw that limited adaptations had been made to the design of the home to support people with dementia. However, the home did involve outside professionals in people’s care as appropriate and some people told us that staff knew what they were doing.

People were not always involved in their care where appropriate and end of life care arrangements required improvements.

The service did not respond promptly and appropriately to people’s needs and we made a safeguarding referral regarding the care that had been provided to one person. Activities were limited and care plans were not in place for all identified needs. People who used the service told us they were not comfortable making a complaint, however, complaints were responded to appropriately.

There were systems in place to monitor and improve the quality of the service provided, however, these were limited and were not always effective. The provider had not identified the concerns that we found during this inspection. However, staff told us they would be confident raising any concerns with the management and that the manager would take action.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

We carried out this inspection as we had received information that staff were living in the care home and people who used the service were being affected by noise from those staff. We spoke with one person who used the service. They told us that they had no concerns regarding noise.

We did not find any evidence that staff living in a part of the building (separated from the rest of the care home) were causing disruption to people who used the service.

We carried out the inspection to check that the provider had met the warning notices and compliance actions that we set at our previous inspection on 10 and 11 October 2013.

We spoke with five people using the service. All of them told us they were happy with the care provided by the service. We spoke with two people specifically about the pressure area care they received. One person said, "They turn me now and again, I am comfortable resting in bed." Another person said, "They turn me over every two hours. I am kept comfortable.”

We spoke with two people who were using the service and asked about the quality and quantity of food and fluids they received. Both of them were satisfied with the food on offer and the amount they received. One person said, "I enjoyed my dinner it was very nice." Another person said, “The food is good, there is plenty to eat."

We found that people experienced care, treatment and support that met their needs and were supported to be able to eat and drink sufficient amounts to meet their needs. We found that effective infection control practices were being followed and medicines were appropriately managed.

We found that the provider had an effective system to regularly assess and monitor the quality of service that people receive. We found that records were kept securely; however, records were not always accurate.

We asked people about their involvement in the care and support they received. People told us they were encouraged to remain as independent as possible, and care workers provided support and assistance where required. They said the routine was relaxed and flexible, and they were able to make decisions about their daily routine, such as the time they got up and went to bed. People told us care workers were always respectful when dealing with them, and knocked on their bedroom doors prior to entering.

We asked people whether they were involved in the development and reviewing of their care plan. People were unsure whether they had seen their care plans but they thought they had been discussed with them. We also asked people for their views about the care and support they received. People told us that the care workers were good, and knew about their individual care needs.

We asked people about the meals and people commented that the meals were good and they enjoyed them. People told us they were offered a choice of meal, and we saw records to support this.

We asked people about organised activities. People told us activities were organised but these had been less frequent recently. This was due to the activity co-ordinator not being at work. People told us they enjoyed the visiting musicians.

We asked people about whether they thought there were enough care workers on duty to meet their needs. People told us generally they thought they were enough care workers on duty and they did not have to wait too long for assistance. However, several people commented that they sometimes have to wait for assistance at handover time between shifts.

People told us that ‘residents meetings’ took place. These meetings offer people the opportunity to make suggestions about how the service was run. People told us that they felt about the raise any issues they might have with a member of staff. They felt their concerns would be listened to and acted up.

This inspection took place on 3 and 4 June 2015 and was unannounced.

Accommodation for up to 68 people is provided in the home over two floors. The service is designed to meet the needs of older people and has a separate unit for people living with dementia.

At the previous inspection on 17 and 18 March 2015, we asked the provider to take action to make improvements to the areas of dignity and respect, safe care and treatment, safeguarding service users from abuse and improper treatment, premises and equipment, person-centred care, staffing and good governance. A warning notice was served regarding person-centred care, staffing and good governance. The provider had not received a copy of the report from that inspection before we carried out this inspection. As a result, we had not received an action plan in which the provider told us the actions they had taken to meet the relevant legal requirements. At this inspection we found that improvements had been made in all of these areas, but some further work was needed.

There is no registered manager in place. There was a new manager, but she had not yet completed the process to register with CQC. 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 safely managed. People felt safe in the home and staff knew how to identify potential signs of abuse. Systems were in place for staff to identify and manage risks and respond to accidents and incidents. Sufficient staff were on duty to meet people’s needs and they were recruited through safe recruitment practices.

People’s rights were not consistently protected under the Mental Capacity Act 2005. Staff received appropriate induction, training and supervision. People received sufficient to eat and drink and external professionals were involved in people’s care as appropriate. Adaptations had been made to the design of the home to support people living with dementia.

Staff were caring and treated people with dignity and respect. There was some evidence of involvement of people in the development or review of their care plans.

People’s needs were promptly responded to. Activities were available in the home though more work was required to support people to follow their own interests or hobbies. Care records did not always contain sufficient information to provide personalised care. Complaints were handled appropriately.

There were systems in place to monitor and improve the quality of the service provided; however, these were not fully effective. While systems had improved considerably since our last inspection, the provider had not identified the concern that we found during this inspection. People and their relatives were involved or had opportunity to be involved in the development of the service. Staff told us they would be confident raising any concerns with the management and that the manager would take action.

We found a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 related to the management of medicines. You can see what action we told the provider to take at the back of the full version of this report.