This comprehensive inspection took place on 30 July, 1, 3, 6 and 16 August 2018. On 30 July and 6 August 2018, the inspection visits were unannounced. On 1 August 2018, we made telephone calls to people who used the service and their relatives. On 3 August 2018, we made telephone calls to staff. On 16 August 2018, the inspection visit was announced.

Park Lodge operates both a care home and domiciliary care service under the registration of this location with the Care Quality Commission (CQC). The care home provides accommodation for persons who require nursing or personal care for up to 40, primarily, older people. The domiciliary care service offers care to people in their own homes. At the time of our inspection, 38 people were using the care home service and 13 were using the domiciliary care service.

Park Lodge 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.

This service is also a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and younger disabled adults.

Park Lodge was last inspected on 10 November 2015 and the service was rated as Good. On this inspection, the service has been rated as Requires Improvement. Providers should be aiming to achieve and sustain a rating of 'Good' or 'Outstanding'. Good care is the minimum that people receiving services should expect and deserve to receive; we found systems in place to ensure improvements were made and sustained were not effective. This is the first time the service has been rated Requires Improvement.

There was a registered manager in post. A registered manager is a person who has registered with 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.

There were systems in place to monitor and improve the quality of the service provided. However, these were not fully effective and had failed to identify the concerns we found with regards to several records in the service.

We found some care plans lacked person-centred detail and contained inconsistent or contradictory information. This could lead to people’s care needs being missed or overlooked.

We identified some improvements were needed to the records of medicines administration. The registered manager acted to ensure the concerns were addressed by the end of the inspection.

Overall, we saw risks were managed, and staff understood how to ensure these risks were minimised. However, records of risk management needed to be strengthened.

The registered manager and staff we spoke with had some understanding of the principles of the Mental Capacity Act (MCA) 2005 and their responsibilities when working in accordance with the legislation. However, where people lacked capacity to make decisions about aspects of their care, records did not show how decisions had been made in people’s best interests.

We recommend the provider reviews the records of capacity assessments and decisions made in people’s best interests to ensure people’s rights are fully upheld.

Staff were seen to be kind and caring in their interactions with people, but some people told us they did not always find all staff to be caring in their approach. Staff showed a good knowledge of the people they supported, and understood how to maintain their privacy and dignity.

People and staff told us the service was safe. Staff could tell us how they would report and recognise signs of abuse and had received training in safeguarding adults. Recruitment was managed safely.

There were enough staff to provide support and ensure people’s needs were met. Staff receive

This was an unannounced inspection carried out on 10 November 2015. Our last inspection took place on 17 April 2013 and we found the provider met the regulations we looked at.

Park Lodge is located in a residential area of Leeds and is near Roundhay Park. The home is in walking distance of local facilities, which include shops and public transport. It is a large adapted building and accommodation is mainly in single rooms, many with en-suite facilities. There are several communal areas including a conservatory. The home has gardens to the front and side of the building and car parking is available.

At the time of this inspection 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.

The care plans we looked at contain mental capacity assessments, although we found these were not decision specific. Applications for the Deprivation of Liberty Safeguards (DoLS) had been made and where the application had been granted and subsequently expired, the provider had submitted a new application. People were given support to access a range of healthcare professionals.

People enjoyed the food on offer although clearer information was required in the documentation concerning dietary requirements.

People told us they felt safe. Staff had a good understanding of safeguarding vulnerable adults and knew what to do to keep people safe. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines safely. There were sufficient numbers of staff on duty to keep people safe. Recruitment processes were safe, although an adjustment to the application form was recommended to make this more robust. We spoke with the registered manager who agreed to review this.

Staff received an induction which included mandatory training. They also received additional training specific to their role. Staff received regular supervisions and appraisals although the recording of supervisions was minimal.

Care plans contained information about people’s life history and their likes/dislikes. Regular reviews took place which included involvement from relatives and other advocates.

There was opportunity for people to be involved in a range of activities within the home or the local community. Complaints were recorded and responded to within stated timescales.

There were effective systems in place to assess and monitor the quality of the service. People in the home and staff felt supported by the registered manager who had a visible presence. People had the opportunity to express their views about the quality of the service they received through surveys and the provider responded with their feedback.

During our visit to Park Lodge we spoke with five people who lived there, three staff members and two visiting relatives. People were generally satisfied with the care and support they received from staff at Park Lodge. One person said "It's so relaxing here, there's no you can't do this and you can't do that." A relative said "There have been no problems, I am happy with the care my mum gets. She would say if she wasn't happy."

We observed the interaction between staff and people living at the home. We saw that people received the care they needed when they needed it and that staff understood the person's needs and how they should be cared for. People were spoken to kindly and responded cheerfully to staff. We saw that no person was ill at ease and people appeared to be relaxed and engaged in their chosen activity. There were enough staff on duty to meet people's needs in a timely way. Staff were unhurried and gave people plenty of time to respond. Staff showed that they understood the needs of people.

We found that the staff we spoke with were appropriately qualified which enabled them to do their job. One staff member said "I like to keep refreshed with training and the organisation supports me to do that."

We saw a copy of the home's complaint procedure displayed by the lift in the entrance hall.

We observed staff treating people with respect, being polite and courteous. People who used the service and their families had contributed their opinions and preferences in relation to how care was delivered. One person told us, “Staff listen to what I want; I can get up and go to bed when I want.”

People had thorough, detailed care plans relating to all aspects of their care needs. They contained a good level of information setting out exactly how each person should be supported to ensure that their needs were met. We spoke with five people and they told us they were happy with the care and treatment they received. One person told us, “I get value for money, I can’t grumble, I am quite happy here.” Another person said, “I’m fine, I am happy here.”

We observed that people were cared for in a clean, hygienic environment. There were effective systems in place to reduce the risk and spread of infection. The people we spoke with told us that they had no concerns with the cleanliness of the home.

We found that people were supported by sufficient numbers of qualified, skilled and experienced staff which met people’s needs. People we spoke with told us there were always enough staff to help them when they needed support.

Complaints people made were responded to appropriately. People told us if they had any concerns or complaints they would discuss them with the manager or members of staff and they were confident of using the complaints system.

We spoke with six people who use the service and they all told us they were happy living at Park Lodge. They said that the standard of care provided was good. One person said, “it’s like your own home; it’s not a nursing home.”

One person told us how they have been supported to regain their independence following a long stay in hospital. They were very pleased that they had regained their independence and said that staff had been very supportive.

People spoke highly of the staff. Two visitors we spoke with said that staff and management were marvellous. We observed staf interacting with people, they did this in a friendly manner and it was obvious that they knew people well.

Staff told us that they knew people's needs and that they tried to offer informed choice.

The people we spoke with told us that they had chosen whether or not they wanted to receive the flu vaccination.