This inspection of Park House Rest Home took place on 2 and 6 July 2018 and was unannounced.

This service was last inspected in October 2017. This was a focussed inspection and was carried out as a result of concerns raised about poor and unsafe care and treatment regarding poor hygiene practices and general lack of cleanliness of the home. The focussed inspection found that risks associated with the environment were not being effectively managed. At this inspection we found that risks associated with the environment had been assessed and were managed effectively.

There had been a history of non–compliance with the regulations at this service since February 2016. Following the inspection in February 2016 we started our enforcement action. The subsequent four inspections and this inspection have helped to inform what action we should take regarding our enforcement pathway. At the previous full comprehensive inspection in March 2017, we found the provider had made some progress with compliance against the regulations. However, at this inspection, we found five new breaches of regulations. These had all been previously

breached in the history of non-compliance for this service.

Park House Rest Home 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 Rest Home is registered to provide accommodation for up to 18 older people. There were 16 people, some living with dementia, at the home at the time of the inspection. It is situated in a residential area of Hayling Island. The home has bedrooms provided over two floors in single and shared double occupancy rooms. Stair lifts provide access between the floors. There is one communal lounge joined with a dining area and appropriate toilet, bathing and shower facilities. Externally there is an enclosed garden with gravel pathways and an area of lawn.

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.

A quality assurance process was in place. However, this had not identified the areas of concern we found during this inspection and ensured that improvements were sustained over time.

Audits to monitor the environmental risks had been carried out and were managed safely. Risks to fire were managed well and each person living at the home had an emergency evacuation plan. Most areas of the home were clean and there were systems in place to protect people from the risk of infection. Staff had access to personal protective equipment to reduce the risks.

Risks to people's safety had been assessed but a lack of detailed guidance for staff about how people should be supported to keep safe, meant that people were placed at risk of unsafe care and treatment.

There were not enough staff to provide person centred care at key times of the day. Staff did not always engage with people respectfully and support them to be involved in meaningful activities.

Recruitment processes were not safe and checks to assess the suitability of staff to work with vulnerable people, had not been completed.

Medicines had not always been managed safely. Temperatures of the room where medicines were stored had not been effectively monitored and medicines that required additional security measures, had not been booked into the medicines record book.

Staff were not always sufficiently trained to safely meet the needs of people living in the home.

We observed some staff support people in a caring manner, but we found this was not always the case. Staff did not always consider people’s communication n

We carried out a focused inspection on 03 October 2017 in response to concerning information about poor and unsafe care and treatment regarding poor hygiene practices and general lack of cleanliness of the home. This report only covers our findings in relation to the key questions, ‘Is the service safe?’ and ‘Is the service well-led?’

Park House Rest Home provides accommodation and care for up to 18 older people some of whom may be living with dementia. At the time of our inspection there were 14 people living at the home.

The Registered manager left shortly before the inspection and there was a new manager in post who was applying 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.

People and their relatives told us they felt safe living at the home.

Risks associated with the environment were not being effectively managed.

People felt the home was clean and staff followed infection control guidelines. The manager had started to take action to replace some of the fixtures and fittings where these were no long fit for purpose.

There were appropriate management arrangements in place. Staff and people were encouraged to talk to the manager about any concerns. Audits were undertaken but these were not being fully effective in driving improvements.

We carried out this comprehensive inspection on 22nd March 2017. This inspection followed three comprehensive inspections in December 2015, 19 & 20 May 2016, 11 and 14 November 2016. These inspections led us to follow our enforcement pathway. At each of the inspections since December 2015 we have noticed improvement in response to following our enforcement pathway and the provider is now in breach of just one regulation of the Health and Social Care Act 2008. We will continue to monitor the provider to ensure that improvements are sustained.

Park House Rest Home is a care home, which accommodates up to 18 older people, some living with dementia. On the day of our inspection 15 people were living at the home and one person was in hospital. We were advised five people were staying at the service on a respite basis.

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

There had been a history of non–compliance with the regulations at this service since we inspected in December 2015. Following the inspection we started our enforcement action. The subsequent two inspections and this inspection have helped to inform what action we should take in regards to our enforcement pathway. At this inspection we found the provider had made further progress with compliance against the regulations. There was one new breach found at this inspection.

Potential risks to people's safety had been identified and specific risk assessments showed how people should be supported to keep safe. Medicine records supported the safe administration of medicines. People received their medicines from trained care workers. Infection control audits were taking place on a regular basis but we identified some areas which had not been picked up these by these audits, which were of a concern. We also found some equipment in the home had been properly maintained.

There was sufficient staff deployed within the home with agency staff being used. The provider completed a range of recruitment checks to help ensure new care workers were suitable to work with the people living at the home. Staff felt supported in their roles and the training they received equipped them with the knowledge they needed to do their jobs.

The provider followed the requirements of the Mental Capacity Act 2005 (MCA), including the Deprivation of Liberty Safeguards (DoLS). People had access to a range of health professionals, such as GPs, opticians, chiropodists and community nurses.

Care records included background information about each person including details of their care

preferences. People's needs had been assessed and personalised care plans written. Care plans were reviewed monthly to keep them up to date.

A complaints policy was in place and there had been two complaint’s since the last inspection, which had been investigated.

We were informed the management were visible and there was a range of quality assurance audits were in place.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We carried out this comprehensive inspection on 11 and 14 November 2016. This inspection followed two comprehensive inspections carried out in December 2015 and May 2016, which had led us to follow our enforcement pathway. We received action plans from the provider informing us of the action they were taking to make improvements and achieve compliance with all the Regulations of the Health and Social Care Act 2008 following the inspections.

Park House Rest Home is a care home, which accommodates up to 18 older people, some living with dementia. On the day of our inspection 12 people were living at the home.

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

There had been a history of non–compliance with the regulations at this service from the last two inspections. At this inspection we found progress had been made. We made two recommendations and there was a continued breach of Regulation 17 regarding record keeping.

Staff understood the principle of keeping people safe. Risk assessments had been completed and staff were aware of the risks facing people and how to minimise these risks. Staffing levels met the needs of people.

Recruitment checks had been completed before all permanent staff started work but records for agency staff were not available.

Medicines were administered and stored safely. We have made a recommendation regarding night staff completing medicines training.

There was a training programme and staff enjoyed the training and felt it equipped them to do their job. Staff had a good knowledge of the Mental Capacity Act (2005) which had been incorporated into people’s records. People enjoyed their meals and there was support for those who needed it. People were supported to access a range of health professionals.

People received personalised care which took into account their choices and preferences. We have made a recommendation regarding personalising activities for people. People felt confident they could make a complaint and it would be responded to. Complaints were logged and there were recordings of investigations into complaints.

People felt the staff were caring, kind and compassionate. The home had an open culture where staff felt if they raised concerns they would be listened to. Staff felt supported by the provider. Records were not always accurately maintained. There was an effective quality audit system.

We found a repeated breach in one of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we found progress had been made in all areas and where the provider remained in breach of one regulation the impact and possible impact on people was low. The service had demonstrated that they were no longer inadequate overall or in one domain and therefore were no longer in special measures. CQC is now considering the appropriate regulatory response to the shortfalls we identified during this and previous inspections. Where providers are not meeting the fundamental standards, we have a range of enforcement powers we can use to protect the health, safety and welfare of people who use this service. When we propose to take enforcement action, our decision is open to challenge by the provider through a variety of internal and external appeal processes. We will publish a further report on any action we take.

We carried out this unannounced comprehensive inspection on the19 and 20 May 2016 to see if the provider had made progress following the last comprehensive inspection. The last comprehensive inspection was carried out in December 2015, led us to follow our enforcement pathway and the provider was placed into special measures by CQC as it was rated “Inadequate” overall. We received an action plan in March 2016 from the provider informing us what action they were taking to make improvements and achieve compliance.

Park House Rest Home is a care home, which accommodates up to eighteen older people, some

living with dementia. On the day of our inspection 15 people were at the home; two of these people were on a short respite stay. On the second day of our inspection another person came in for a short stay.

The home does not have 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The provider had recruited a manager who has submitted an application to us to become the registered manager.

We found the provider had made progress in most areas of non-compliance, but in most breaches there was still room for improvement, and in some breaches the impact on people was lower than before. The management of medicines, mental capacity understanding and the training and supervision of staff had been improved to reach compliance. However, this inspection found that there was not enough improvement to take the provider out of special measures.

Risk assessments had not been completed for all people to ensure staff were aware of the risks facing people.

Staffing levels had improved but they were still not adequate to ensure all people’s needs were met at all times.

The provider had completed an audit of staffing recruitment records but had not taken any action to ensure the gaps found had been actioned to ensure the safety of people.

Peoples’ nutritional and hydration needs were not adequately provided for.

People had their mental capacity assessed and best interest decisions had been made appropriately.

All people were not receiving personalised care.

The recording of complaints had improved but these were still not being investigated.

Quality assurance processes and record keeping had improved but there were still shortfalls in these areas, which had not been identified or addressed.

The overall rating for this provider is still ‘Inadequate’. This means that it remains in ‘Special measures’. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate

care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

We found six repeated breaches and one new breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

CQC is considering the appropriate regulatory response to the shortfalls we found during this and previous inspections. Where providers have not been meeting the fundamental standards, we have a range of enforcement powers we can use to protect the health, safety and welfare of people who use this service (and others, where appropriate). When we propose to take enforcement action, our decision is open to challenge by the provider through a variety of internal and external appeal processes. We will publish a further report o

This unannounced inspection took place on 11 December 2015. Park House Rest Home is a care home, which accommodates up to eighteen older people, some living with dementia. On the day of our inspection 17 people were at the home. During the inspection one person left the home as they had only been there for a respite visit.

The service does not have 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The provider was registered on 26 June 2015 and a condition of their registration was they needed to have a registered manager in post. The service had a manager, who in this report will be referred to as the manager. They have not applied to the Commission to become registered.

Risk assessments had not been consistently competed in all relevant areas of care planning and had not always been updated as people’s needs changed. Staffing levels were not planned and there was not enough staff on duty to meet people’s needs. Recruitment checks on staff were not adequate to ensure the safety of people. Staff had an awareness of how to keep people safe and what action they should take if they had any concerns. Medicines were not administered, stored and recorded safely.

Staff had not received adequate training to ensure they could meet people’s needs. Staff were not receiving formalised support in the form of supervision sessions. Some staff had a basic knowledge of the Mental Capacity Act but people’s capacity to make specific decisions had not been assessed. People enjoyed their meals but records of people’s nutritional intake were not adequate to know a person’s food and fluid intake. People were supported to access a range of health professionals.

People did not always have their individual needs met in a personalised way. People felt confident they could make a complaint and it would be responded to, however no records were made of complaints.

The home did not have good leadership and the registration requirements have not been met. There are not effective procedures in place to ensure a good and safe quality service is provided.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action.

We found breaches in seven of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We are taking further action in relation to this provider and will report on this when it is completed.