Park Lane 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 Lane can accommodate up to 40 older people who have nursing and or personal care needs. At the time of the inspection there were 36 people living at the service.

The home is divided into two separate units, with people who require nursing care living in one and those who did not require 24-hour nursing care living in the other. Both units had communal rooms on the ground floor and bedrooms on three floors with access via passenger lifts.

Rating at last inspection

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good, in all areas except safe, which we have now rated as requires improvement. This was because improvements were needs to the way risks were documented and in medicine records. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns, the areas for improvement were already being mitigated following our feedback. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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Why the service is rated Good

People enjoyed living at Park lane. They felt safe and well cared for. Comments included, “If you only want a tissue they will get it for you, they do anything and everything for you, I can’t think of a better place.” Another said, “I feel well care for, they make us feel special, when it was my birthday they made me a cake, big enough for us all to share, I feel they are here for us and our needs come first.” One relative said “They wake mum up with a kiss, she is given hugs when required. There is a person employed to carry out individual pamper sessions, she comes every week she is such a lovely lady.” Healthcare professionals said staff were caring. One said, “The have observed the staff during my visits to be polite caring and helpful.”

Some improvements were needed in the way in which risks were documented. This was being addressed.

Improvements were needed to records in relation to when staff were applying topical creams. We have made a recommendation in relation to this and to ensure staff administer in line with the prescribed medicines.

Staff knew people well, understood their needs and wishes and worked in a way which showed they were respecting people’s dignity and privacy. There were sufficient staff with the right skills to meet people’s needs.

Staff had training and support to do their job effectively. Further training was planned to look at enhancing skills in understanding complex conditions such as diabetes and Parkinson’s.

People were supported to have 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 were protected because recruitment was robust and staff understood about abuse and who they should report any concern to.

People’s healthcare was monitored and actioned when needed. Their nutritional and hydration needs were met to ensure they maintained weight a balanced diet.

The service was clean and adapted to suit people’s needs. Audits and checks ensured quality monitoring of the records, environment and care and support being delivered.

The management approach was open and inclusive. There were and a range of ways used to gain the views of people, relatives and staff.

Further information is in the detailed findings below

This unannounced inspection took place on 5 and 11 April 2016.

Park Lane Care home is registered to take up to 40 people with nursing needs; some people were living with dementia. At the time of the inspection there were 37 people living at the service. The service is situated in Barnstaple, North Devon. The service has two units Caburn and Park Lane. The Park Lane unit provided nursing care and support to people living with dementia and other complex needs. Caburn provided residential care and support for people who did not require nursing care.

The service was last inspected in January 2015 when we found the provider was not meeting all of the standards we inspected. The overall rating for the service was ‘requires improvement’. We found improvements were needed in relation to the management of medicines and the governance and monitoring of the quality of the service. The provision of activities did meet people’s needs or preferences. There was limited information about people’s interests, past hobbies or activities to help ensure suitable activities were offered. At this inspection we found improvements had been made in these areas.

There was a manager at the service who was registered with the Care Quality Commission (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 using the service, their relatives and professionals said they felt the service was safe. They said the environment was safe and well maintained. People liked the décor, layout and equipment available at the service. One person said, “…it is like a five star hotel…”

Medicines were managed and stored safely and people received their medicines as prescribed. The service had systems in place to protect people from harm and abuse. Staff understood their responsibilities relating to safeguarding. The registered manager had responded appropriately to safeguarding concerns and the necessary alerts had been made to the local authority to ensure any concerns were dealt with.

There were enough staff on duty to support people safely and ensure their needs were met. We observed the general atmosphere between people and staff was friendly, calm and relaxed. Recruitment practices were robust and helped to ensure people were protected from staff who were unsuitable to work in care.

People using the service, their relatives and professionals were confident about the approach, skills and abilities of staff. Staff received training and refresher updates relevant to their roles and had regular supervision meetings to discuss and review their development and performance.

People were protected by the practice in place in relation to decision making. The registered manager and staff had an understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). DoLS applications had been appropriately made when needed.

People were supported to maintain good health and had access to health and social care professionals when necessary. They were provided with a healthy balanced diet that met their individual needs and preferences.

Care was provided in a way that promoted people's dignity and respected their privacy. People received care and support from a staff team who treated them in a friendly, compassionate and understanding way. People and their relatives spoke highly about the staff’s approach.

There was an activities programme in place and people participated in activities of their choosing. Family and friends were made welcome and people were able to receive their visitors at any time.

Care plans and risk assessments had been developed with people and/or their relative. Care plans provided detailed information to help staff deliver the

We carried out an unannounced inspection of this service on 18 September 2014. A breach of legal requirements was found. We issued warning notices in order to ensure the necessary improvements were made in relation to safeguarding people who use services from abuse and staffing levels.

We carried out this inspection to check whether Park Lane Care Home had taken action to deal with the breaches.

We have received an action plan from the provider about the improvements underway in relation to the other areas of non-compliance found at the last inspection. We will carry out a further inspection to check these improvements have been made.

Devon County Council implemented a safeguarding process in September 2014 following the last inspection and concerns raised with them. Placements to the home have been suspended as a result of the safeguarding concerns. During the safeguarding process the service had been monitored through a combination of visits by social services staff, the community nurse team, the local mental health team, as well as multidisciplinary safeguarding strategy meetings, which are on-going.

Two CQC inspectors carried out this inspection over the course of one day. The home was providing nursing care for older people with physical disabilities, for some people living with dementia and with a learning disability. At the time of the inspection there were 33 people living there.

Based on our discussions with people living at the home, staff, and relatives, as well as on our observations and review of records, we judged the provider had complied with the staffing warning notice served.

Some improvements had been made in relation to safeguarding people by providing staff with relevant training. However, we found people were not fully protected from the potential abuse of others. This was because the incident reporting system was not effective. Three incidents had not been reported to the registered manager or to the local authority safeguarding team or to the Care Quality Commission. This meant opportunities to review and change people's care to reduce risks in response to incidents were being missed. We raised our concerns about these incidents with the local authority safeguarding team and with commissioners.

Therefore the enforcement action remains in place in relation to safeguarding people who use the service from potential abuse. We will be inspecting the service again to check on compliance.

We spoke with four people living at the home who could give us feedback about the care and support they received. We also spoke with four relatives and 15 members of staff, including the registered manager, deputy manager, nursing staff, care staff and ancillary staff, including the administrator.

People living at the service told us the staff were kind and friendly and available to help them when needed. All relatives said they were happy with the care and support their family member received. One said, “I am most impressed with the care and staff”; another said, “You can’t fault the staff”. Relatives noted the improvements to staffing levels and commented on the positive impact. One said, “Staff are always around now. It makes a difference”.

We found people were supported by staff in a caring and gentle manner. Staff were attentive and responsive to people’s needs. Staff had time to stop and sit and talk with people throughout the day. Staff and people appeared to know each other well and to have warm, engaging relationships.

Improvements to staffing levels ensured people received care in a timely way. Care and support was unrushed and the atmosphere in the communal areas was relaxed and calm.

Staff had received training since the last inspection which had increased their confidence, competence and knowledge in relation to the Mental Capacity Act (2005), Deprivation of Liberty Safeguards (DoLS); safeguarding and managing challenging behaviour. Staff said the recent training had been useful and enjoyable.

The questions we asked on this visit were:

Is the service safe?

Is the service caring?

Is the service effective?

Is the service responsive?

Is the service well led?

The inspection was unannounced and was carried out in response to a number of concerns raised with the Care Quality Commission which included low staffing levels and lack of staff training affecting the care and support of people who lived there.

Park Lane Care Home is a 40 bed nursing home that provides nursing care for older people with physical disabilities, for some people living with dementia and with a learning disability. At the time of our inspection there were 39 people living there. We visited the home on 18 September 2014. We arrived at 06.50 am and left at 2030 which enabled us to see people’s care at different times of the day. The service was last inspected in December 2013 and was compliant.

We spoke with seven people who could give us feedback about the care and support they received and with seven relatives. Some people we met were living with dementia and were not able to give us feedback. We observed their care using the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people, who could not talk with us. We saw all of the people living at the home either in their bedrooms or in communal spaces. We spoke with 16 members of staff including the nominated individual, the registered manager, nursing staff, care workers and other support staff. We looked at nine people’s care records and at staff records. We spoke with seven visiting professionals.

This is a summary of what we found.

Is the service safe?

People who used the service were not protected from the risk of abuse because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Some staff had not been trained to identify signs of abuse. Staff had not received training to help them understand the support people needed to help them feel safe and supported when behaviours challenged the service.

Some people at the home had periods of challenging behaviour and when staff told us how they managed this, they described to us some support holds they used which could be considered as use of restraint. These methods were not in people’s care plans, and staff had not been trained in their use. Also, there was no evidence these decisions had been agreed by other professionals or relatives in the person’s best interest.

People were not safe because low staffing levels meant staff were not able to provide the support and supervision people needed at all times. People said they felt safe and well cared for at the home and their relatives agreed. Several relatives said they would like to see more staff available in the communal and corridor areas. The home often did not have the required numbers of staff on duty because of difficulties covering staff absence. This meant some people’s care was delayed, and staff were not always available when people needed help and reassurance.

People were at risk because the accident/incident reporting system was not being used effectively, which meant opportunities to reduce risks and learn from incidents were being missed.

The service was not safe because people were not always protected against the risks associated with medicines. The provider did not have appropriate arrangements in place to manage medicines safely. Incidents observed suggested the level of support and supervision given to people to take their medication was insufficient. This resulted in some people not receiving their prescribed medication.

We immediately raised our concerns with the provider and manager about the lack of support for people and gave clear feedback about the areas for improvement. The concerns about care and practice were promptly shared under a safeguarding process. A multi-disciplinary plan was drawn up by health and social care professionals to protect people's safety and well-being. This resulted in health professionals visiting the home as part of a safeguarding investigation and in a protection role.

Is the service caring?

The service was caring because people and relatives told us they were happy with the care and support they received and staff treated them with dignity and respect. We received many positive comments from people using the service, their relatives and visiting professionals about the staff team. People using the service told us, “All the staff are lovely.”; “The staff are kind and gentle with me”, “They have very good people working here. They help me” and “Staff are very pleasant and friendly”.

We found staff were caring and compassionate towards people, and most interactions between people living at the home and staff were respectful and friendly. However, the majority of contact between staff with people was brief, particularly in the morning, as staff were so busy.

Is the service effective?

The service was not effective because staff lacked knowledge and understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty safeguards and codes of practice and had not had training in these area. Many people who lived at the home were living with dementia and lacked capacity. We had concerns about whether the Deprivation of Liberty Safeguards were only being used when it was considered in a person’s best interest. On the day we visited, one person was distressed on several occasions and was trying to get out of the home. The registered manager told us they had made applications to the local authority Deprivation of Liberty team for that person and others and were awaiting an assessment.

The service was not effective because staff had not received all the training they needed to meet people’s care needs. We found the care provided was more focused on completing tasks than centred on the individual needs of each person. This was because staff worked to daily routines, to ensure people had regular care.

People’s nutritional needs were not always identified and monitored. Nutritional care plans lacked detail or clear instructions for staff about how to support people in relation to eating and drinking. Records relating to people’s daily dietary intake were poor. This meant we could not tell in any detail what people had to eat each day, or whether they were being offered alternative snack or food supplements, when they declined meals.

People were supported to access health care services. Health professionals told us communication with the home was good and referrals to their services were appropriate. However, the ineffective management of wound care and pressure area care posed a risk to two people’s health and welfare.

Is the service responsive?

The service was not responsive because the care planned and delivered was not personalised to reflect people’s likes, dislikes and preferences. There was a risk that workload considerations may impact on people’s individual preferences and wishes.

Although the service had a full activities programme, it was not always suited to the needs of people with dementia and some people said they were bored.

Staff showed concern for people’s well-being however, they were unable to respond to their needs and requests quickly enough. This meant people became distressed and agitated at times.

Is the service well led?

The service was not well led. This was because people were at increased risk as there was a lack of quality monitoring systems at the home, which meant some risks were not being identified or responded to. Staff told us the concerns about staffing levels were not being adequately responded to.

We found the home was not compliant with any of the standards we looked at. We will follow this up further with the provider and report on any action we take.

During this inspection we spoke with four people who lived at the service and with six visiting relatives. Most people were unable to give an informed view of their experiences so we spent time observing how care and support was being delivered. We also spoke with six staff and the manager who was in the process of registering with CQC.

People told us they were well cared for. Comments included ''It's very nice here, We have good staff.'' Visiting relatives were also complimentary about the care and support offered by staff. One person told us ''I have no complaints, care is second to none here. Since the new build they have put more staff on which is good. They can always do with extra staff, but they are very good.'' Another relative told us ''It's very nice here, we live locally so we are very happy, the care staff do a brilliant job.''

We had received an anonymous concern about staff not feeling supported or being able to take their breaks because they were too busy. All the staff we spoke with during this inspection said they were supported to do their job via training and supervisions. They all expressed confidence in the new manager and said the home was a good place to work. One staff member told us ''I am proud to work here, we work well as a team and people get good care.''

We found the service was compliant with all five outcomes we inspected.

We brought the scheduled inspection forward because we received concerning information about the health and welfare of people at the home. This information suggested that people were not being treated at they should be; food safety was not being maintained; people’s health needs were not being managed appropriately; manual handling, medicine and wound care procedures were not being followed which could have put people at risk.

We carried out an inspection of Park Lane Nursing Home on 20 July 2012. We focussed on the outcomes for people with regard to health and welfare, nutrition, management of medicines, recruitment and quality assurance. We found that the service was fully compliant with these outcomes.

We looked at the records of four people in detail; and spoke with five people about their experiences at the service. However, most people were not able to comment directly on their care so we spent time with them to help us understand what life was like at the home. This meant we spent time observing care and people's interactions with staff to see whether they had positive experiences. To do this we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us about their experiences of care. We used SOFI for one and half hours in the lounge and dining room. We spoke with six staff, three relatives, the deputy manager and provider.

People told us that they were involved in all aspects of their care, treatment and lives at the home. For example, we were told “I trust them. They know what they’re doing”. We saw that health care professionals worked closely with the home to ensure that people’s health was maintained.

People said that they felt safe. For example, they told us they were looked after by “Kind and caring” care workers. We also saw this when we spent time observing people’s experiences. We saw that people were regularly prompted to eat and drink. When help was needed, we saw that this was given in a discreet and safe way that followed best practice.

We saw that people were stimulated and this had a positive effect on their wellbeing. For example, a person told care workers they wanted to go out for an ice cream to Fremington Quay and arrangements were put in place for this to happen.

People said that Park Lane was “Homely and a good place to be”. Three relatives we met on the day told us that they “Communication is excellent” and “They always keep us up to date with developments” about their relations wellbeing.

At this inspection, we did not make any compliance actions although we made the provider aware of areas that they might improve. These areas related to lockable storage for people self medicating and laundry procedures.

People told us that they liked living at Park Lane Care Home and were very satisfied with the service they had received. We were told that care workers are liked and do their work well. We saw that people are assisted at their pace and care workers have time to engage with people in a kind and respectful way. Health and care needs are well met.

Staff offer people choice and people make decisions about how they spend their day. There is a regular program of activities available or people choose to spend their time alone, as is their choice.

People live in a very clean, fresh, well maintained, well equipped, decorated and furnished home. Where a need is identified it is dealt with speedily and the manager and provider work hard to find ways in which to make improvements.

People are protected through the culture of respect at the home, a strong management/provider team, staff knowledge of safeguarding, health and safety and the systems in place to ensure the home is run well.

This inspection was undertaken on 20 and 23 January 2015 and was unannounced. This meant that the staff and provider did not have notice that we would be visiting.

At the inspection in September 2014 we identified breaches of regulations relating to consent to care and treatment; care and welfare, safeguarding; the management of medicines, requirements relating to workers, staffing levels, supporting workers, assessing and monitoring the quality of service provision and records. As a result of that inspection warning notices were issued to the provider in relation to safeguarding and staffing levels. Compliance actions were issued in relation to the other breaches of regulations.

We inspected the home again in December 2014 to see if the warning notices had been met within the timescale set by the Care Quality Commission (CQC). At the December 2014 inspection the provider was meeting the warning notice in relation staffing. However, they were not fully meeting the warning notice relating to safeguarding. Therefore the breach remained. Following the September 2014 inspection the provider sent us an action plan telling us about the improvements they intended to make in respect of the other breaches identified. During this inspection we looked at whether or not those improvements had been made.

Devon County Council implemented a safeguarding process in September 2014 following the September CQC inspection and concerns raised with them. Placements to the home had been suspended as a result of the safeguarding concerns. During the safeguarding process the service had been monitored through a combination of visits by social services staff, the community nurse team, the local mental health team, as well as multidisciplinary safeguarding strategy meetings. The suspension of placements was lifted by the local authority in January 2015. The safeguarding process was closed in February 2015 as the multidisciplinary safeguarding meeting concluded that improvements had been made at the service to keep people safe.

Park Lane Care Home is a 40 bed nursing home that provides nursing care for older people with physical disabilities, for people living with dementia and/or with a learning disability. At the time of our inspection there were 31 people living there, one person was in hospital.

There was a registered manager 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Appropriate arrangements were not in place for the safe administration of all medicines. One person had not received their prescribed medicine which resulted in them experiencing discomfort. Some medicine administration records relating to creams and lotions were no accurate. This meant we could not confirm people had received these medicines as prescribed.

We received mixed responses about people’s experiences in relation to activities. Several people felt there were not enough activities provided to stimulate people.

Mealtimes were a sociable occasion for most people, although two people who required help did not have a positive mealtime on the first day of this inspection. The registered manager had addressed this by the second day of the inspection. People commented positively about the food. People were offered a varied and healthy diet, with daily choices available. Comments included, “Its good proper food” and “I enjoy the food. It is home cooked.”

People’s care plans had improved since our inspection in September 2014 and included clearer information about how to support people and reduce risks for them. However, there was limited information about people’s interests, past hobbies or activities they may enjoy. People’s personal preferences and likes and dislikes were not always recorded in care plans. This meant people may not always receive support in the way they prefer.

Quality assurance processes were being embedded within the service. The registered manager obtained informal feedback from people when she spoke with them. A system to obtain, record and analyse feedback, in order to drive forward improvements at the service was being introduced. A range of audits had been introduced to help the registered manager and provider monitor the quality of the service. However, some audits did not always identify shortfalls. The registered manager recognised this and was keen to continue to improve the implementation of quality audits.

Improvements were being made in relation to the training and support provided for staff. A training plan had been developed for 2015 and a new staff induction training programme had been introduced. Regular staff support meetings were being planned but had not been fully introduced.

People said they felt safe and well cared for at Park Lane. Relatives and visitors confirmed this. Comments included, “People here understand your needs. They look after us so well. I feel safe”, “We are definitely safe here. I just have to call them (staff). They are tip top!”; “I go away from here happy that Mum has all the care and attention she needs” and “This home is absolutely first class. All the carers treat my husband beautifully. They are caring and careful with him…I see how he is treated. I couldn’t ask for anyone to be cared for any better.” People were treated with kindness, compassion and respect.

There had been improvements in the safeguarding arrangements at the service. Staff received training relating to safeguarding and were aware of how to identify abuse and the procedures in place to report this. Any concerns were reported to the local authority safeguarding team.

People were protected against risks. Risk assessments were in place and updated as required to help staff manage identified risks in a safe way. Improvements had been made in relation to the management of wound care; pressure area care and issues relating to nutrition. Health and social care professionals said they were contacted appropriately and the service implemented their advice and suggestions. Comments included, “The manager and staff are willing to learn and take on board suggestions” and “I am always impressed by the staff’s patient friendly manner.”

Staffing levels were sufficient to meet people’s needs and staff had gone through appropriate recruitment checks to ensure they were suitable and safe to work at the home.

The service followed the requirements of the Mental Capacity Act 2005 Code of practice and Deprivation of Liberty Safeguards. This helped to protect the rights of people who were not able to make important decisions themselves.

We found two 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 the report.