This unannounced inspection took place on 13 September 2017. Parker House Nursing Home provides accommodation for up to 25 older people, with or without dementia, who require nursing care or support with personal care. On the day of our inspection 25 people were using the service.

The service had a registered manager in place at the time of our 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.

People felt safe in the service and staff understood their responsibility to protect people from the risk of harm or abuse. The risks to people’s health and safety had been assessed and were kept under review to ensure that action taken to reduce risks was effective. There were sufficient numbers of staff to meet people’s needs in a timely manner and systems were in place to support people to take their medicines.

Staff received relevant training and felt supported. People were asked for their consent before support was provided and people who lacked capacity to make certain decisions were supported appropriately. Although information about the choice of food available to people was not always communicated clearly, people were supported to eat and drink enough. People were supported to maintain good health and referrals were made to health care professionals for support and guidance if people’s health changed.

People were supported by a caring staff team who interacted warmly and with compassion. Staff offered people explanations and provided them with information in order to promote choice and independence. Staff supported people to maintain their privacy and dignity.

People’s needs were responded to by staff who knew people well and respected their choices and preferences. Care plans were in place which provided detailed information about the care people required. The care that people received was recorded and some improvements were required to ensure this reflected the support provided. People felt confident to raise concerns and felt these would be acted on.

People and their relatives felt that management team were approachable and responsive. People’s views about the quality of the service they received were sought and records showed that suggestions about improvements had been acted upon. Effective systems were in place to monitor the quality and safety of the service.

This unannounced inspection took place on 29 June and 8 July 2016. Parker House Nursing Home provides accommodation for up to 25 older people, with or without dementia, who require nursing care or support with personal care. On the day of our inspection 24 people were using the service.

The service had a registered manager in place at the time of our 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.

Although risks to people were identified and assessed and people were supported by sufficient numbers of staff, risks were not always minimised by staff following good practice in relation to equipment and moving and handling.

People received their medicines when they needed them but the management of medicines required further improvement.

People felt safe in the service and staff understood their responsibility to protect people from the risk of abuse. We found that the registered manager had shared information with the local authority when needed.

People were not consistently asked for their consent before support was provided. Where people lacked capacity to do so they were protected under the Mental Capacity Act 2005. People were not deprived of their liberty without the required authorisation being applied for.

People were not always provided with timely support in relation to eating and drinking. Referrals were made to health care professionals for additional support or guidance if people’s health changed.

People were cared for by staff who received training and support. We observed that staff were compassionate in their care and interactions with people who used the service.

People were encouraged to make choices about the care they received and people’s privacy and dignity were respected by staff.

People told us that they felt that activities at the service were limited and we observed this to be the case during our visit. Records did not always show that people received care when they needed it.

People, and their relatives, told us they would feel comfortable making a complaint to staff or the registered manager. Records showed that complaints were responded to appropriately.

There were systems in place to monitor the quality of the service however these were not always effective in identifying issues within the service and the appropriate action being taken.

People felt that the management team were approachable and responsive to any concerns. People’s views about the quality of the service they received were sought and staff felt they received a good level of support from the registered manager.

We found that people’s care and support plans included detailed assessments of identified health needs and associated risks. We saw that people were able to freely move around the home and that staff knew how to meet their individual needs.

During our previous inspection visit on 18 and 19 April 2013, we found that people were not protected from the risk of infection because appropriate guidance had not been followed. During our inspection visit on 28 November 2013, we found that there were effective systems in place to reduce the risk and spread of infection.

On 18 and 19 April 2013, we found that the provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others. During our inspection visit on 28 November 2013, we found that the provider had taken appropriate steps to ensure they identified risks and took appropriate action to minimise potential risks to people who used the service and others.

We spoke with three of the 21 people who used the service when we visited. We also spoke with one visitor, four staff and the manager. We spent time in the lounge and dining room observing the care and support people received.

People told us they were treated with respect and dignity. One relative explained they were very pleased with the home and that care was delivered to a high standard. We were told, "They're lovely, you can't fault them."

One person said, "I am happy here."

People told us they were treated with dignity and respect. One person told us they were able to talk to both the manager and the staff about their concerns or worries. We were told, "Some [staff] are angels and the people in charge are respectful to me."

One person said, "They ask how I like to be cared for but it sometimes doesn't work." Some people were unhappy about some of the personal care arrangements.

One relative commented “the staff are very nice and they have asked me about (their relative’s) likes and dislikes”.

A person told us the staff were able to meet their needs and they, "Did their best." They told us they were, "As happy here as I would be anywhere.”

People also told us staff answered the buzzer quickly and they received their medication when they needed it.

People told us they felt safe. A person told us they were happy with the home. They said, “I have a really nice room.” Another person said there was a shortage of some facilities.

We were told the staff were helpful and knew how to support people's needs.

One person told us staff listened to them and they knew who to speak to if they were unhappy.

We spoke with two people who used services. They told us they were satisfied with the service provided and that they were given choices. They were provided with a weekly bath or more frequently if required. They chose who to sit with at meal times.

Two people who used services told us they did not have to wait an unreasonable time to attract staff attention.

People who used services told us they felt safe at the home and would tell the person in charge if they ever felt unsafe.

People told us that they liked their bedrooms and were satisfied with the facilities at the home.

People's views were taken into account in the way the service was provided on a daily basis. We spoke with six people using the service and they told us they were consulted and able to make choices as far as they were able.

We found people's needs were planned for and delivered appropriately. The people we spoke with said they were happy with the care they received and knew who to speak with if they wanted to raise a concern. People using the service spoke positively about the staff working in the home saying they were, “Caring and kind” to them.

We were concerned about hygiene standards at the home and that quality monitoring systems had not identified this as a problem. Although quality monitoring systems have improved, they are not effective enough to identify, monitor and manage risks to people who use the service.