Parkgate Manor provides residential care for up to 40 people with learning disabilities. The majority of people were under 65 years of age. There were 33 people living at Parkgate Manor at the time of our inspection. The service provides care and support to people living with a wide range of learning disabilities, for example downs syndrome. Some people have dementia, some have epilepsy and a number have a variety of long term healthcare needs associated with an aging client group. Some people displayed behaviours that challenged others.

Whilst a number of people had good communication skills, others needed support with communication and were not able to tell us their experiences, so we observed that they were happy and relaxed with staff.

There was a registered manager in post. 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.

We carried out an unannounced inspection on 18 and 24 March 2015 where we rated the home as ‘Requires Improvement’ in all areas. We issued specific requirement notices in relation to dignity and respect, the need to supply notifications where appropriate and quality assurance systems. We received an action plan from the provider that told us how they would make improvements. We carried out this comprehensive unannounced inspection 13 and 14 July 2016 to check the provider had made improvements and to confirm that legal requirements had been met. We found that overall significant improvements had been made in the running of the home.

There were some areas where more clear record keeping could have demonstrated the work carried out in a person centred way. For example, documentation that related to complaints, service user surveys and keyworker meetings. However, following the inspection the manager sent us copies of new formats that would be introduced that, completed well, would address this area.

There were enough staff who had been appropriately recruited, to meet the needs of people. Staff had a good understanding of the risks associated with supporting people. They knew what actions to take to mitigate these risks and provide a safe environment for people to live. Staff understood what they needed to do to protect people from the risk of abuse. Appropriate checks had taken place before staff were employed to ensure they were able to work safely with people at the home.

The manager and staff had received training on the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. They had assessed that restrictions were required to keep people safe. This related to the need to have electric gates preventing access onto a very busy road where visibility was limited. Appropriate referrals had been made to the local authority for authorisation.

Staff had a good understanding of people as individuals, their needs and interests. Some people attended day centres, activities were provided within the home daily, external entertainment was provided and people were supported individually to have their needs met. People’s spiritual needs were met.

People had access to healthcare professionals when they needed specific support. This included GP’s, dentists and opticians. Where specialist healthcare was required, for example, from a physiotherapist or speech and language therapist, arrangements were made for this to happen.

People were asked for their permission before staff assisted them with care or support. Staff had the skills and knowledge necessary to provide people with safe and effective care. Regular training was provided which was specific to meeting people’s needs. If staff identified additional training they would like to receive, arrangements were made for this to happen. Staff received regular super

This inspection was carried out by three inspectors between 5pm and 9.30pm. Some people at the home had complex needs and were not all able to tell us about their experiences. In order to get a better understanding we observed care practices, looked at records and spoke with staff. During the inspection we spoke with the manager, three members of staff and six people who used the service

This was a responsive inspection following concerning information received by the CQC about the safety of people who used the service. Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We judged there was an insufficient number of qualified, skilled and experienced staff to meet peoples' assessed needs. The service did not use a dependency tool for calculating staffing levels and we observed that some people were potentially at risk due to staff being unable to observe them. There were a number of unwitnessed falls and incidents between people who used the service. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

We found that incidents which should have been reported to CQC and the local authority had not been referred as safeguarding alerts. The lack of safeguarding referrals meant that the service had not taken appropriate action to protect people who used the service. A compliance action has been set in relation to this and the provider must tell us how they plan to improve. Staff had received training in safeguarding and there were appropriate policies and procedures in place. The staff we spoke with however were unsure of their roles and responsibilities in this area.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that there was at least one person who used the service who required an application to be submitted under DoLS. This had not been done. Some people's movements had been restricted by the practice of locking their room doors when they were not in use. It was unclear why some people had not been offered a key to their rooms. Although care staff were trained in the Mental Capacity Act they had not been trained in the use of DoLS and they demonstrated a lack of understanding and awareness about these safeguards.

We spoke with four people and six staff. Some people were unable to communicate with us due to their complex medical needs.

We found that staff treated people with dignity and respect. We observed positive interaction between staff and people. One person told us, “I like living here.”

We looked at four care plans and found they were comprehensive. They reflected the care that we saw delivered.

We found the building was suitable for people and there were systems in place to ensure the building was maintained.

We looked at four staff files and found there were effective recruitment and selection procedures in place.

We found the home had effective systems to assess and monitor the quality of service that people received.

We undertook a walk around of the home to review cleanliness. We found it to be mostly clean and tidy. We looked at cleaning schedules and audits relating to domestic cleaning and room inspections. These informed us how often areas of the home had been cleaned and when people rooms had been inspected by a senior care worker. We looked at the home's infection control policy and staff training records, all staff had received training on infection control. We spoke with one person who lived at the home and three staff members. The person we spoke to told us that their room had been cleaned that day and their laundry had been taken to be washed. All staff we spoke to showed a good understanding of infection control principles.

We used a number of different methods to help us understand the experiences of people who used the service. Some people had complex needs, which meant they were not able to tell us their experiences. Others were able to tell us of their experiences. One person told us, “I like it here at Parkgate Manor.” Another person told us what they had been doing during the day, they told us, “I really enjoy the art group.” One person said that they particularly enjoyed going to a lunch club in the local village once a week.

We observed staff interacting positively with people. Care plans were bulky but contained very detailed advice and guidance for staff. Where appropriate, specialist advice and support was obtained to meet people’s needs.

There were sufficient numbers of staff on duty and staff felt well supported. Staff were clear about what they should do if they suspected abuse. They were also clear about the home’s complaint procedure. Some infection control issues were identified during the inspection. There was no effective system in place to ensure that this area was monitored regularly.

People spoken with said that the food was lovely. They said that they enjoyed the activities. One person said that they particularly like going to college and the Friday lunch club. One person raised some issues regarding their bedroom and the home had made progress in addressing them by the end of the inspection.

We inspected Parkgate Manor on the 18 and 24 March 2015. Parkgate Manor provides accommodation and support for up to 40 people. 36 people were living at the service on the day of our inspection. All people are accommodated within one large house. The service provides care and support to people living with a wide range of learning disabilities, for example downs syndrome and a variety of longer term healthcare needs.

We last inspected the service on 25 September 2014 in response to the CQC receiving information of concern about the safety of people who used the service. We found the provider was not meeting all the regulations we inspected against. People were not protected against risks associated with abuse as the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. There were not enough qualified, skilled and experienced staff to meet people's assessed needs. The provider submitted an action plan which stated the required improvements would be made by January 2015. At this inspection we found that there had been improvements in these areas. The provider had taken steps to liaise with the Local Authority where there had been allegations of abuse. The staffing levels had increased.

A registered manager was in post. 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 and associated Regulations about how the service is run.

The provider had not submitted all statutory notifications to the Care Quality Commission, as required. Under the Health and Social Care Act 2008, providers are required by law to submit notifications.

People told us that they felt safe living at Parkgate Manor. However, we identified concerns that could place people at risk. We found that the provider did not have robust systems in place to cover short notice staff absences. The registered manager had some quality assurance processes in place but they were not always effective in identifying short falls within the service. We observed some staff employed poor moving and techniques whist supporting people. Risk assessments in some people’s care plans did not reflect the most up-to-date information staff held about them in relation to their behaviour.

Meal times were not always efficiently run by staff which resulted in people’s dignity not being respected.

Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests.

Some people’s clothes and appearance were untidy and uncared for. Staff had not supported people effectively in this area and people’s dignity had not been respected.

People who did not wish or were unable to participate in group activities were provided with limited interaction from staff to meet their assessed social needs. However some people told us they enjoyed the activities and looked forward to specific activities or events.

Although people, staff and visitors spoke positively of the management, care staff at busy times were not effectively led by senior staff. This was apparent at meal times.

There were sufficient numbers of staff to care for people. Care staff had completed safeguarding training and knew how to identify if people were at risk of abuse or harm and knew what to do to ensure they were protected.

Medicines were stored and disposed of correctly. We observed staff administering medicines safely and they made sure people’s tablets were taken before signing medicine records.

People’s health needs were proactively met. Care plans provided clear guidance on how to manage these risks. There were areas of good practice and a visiting GP was complimentary about the responsiveness of staff when dealing with people health needs.

Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. Staff underwent induction and told us they felt confident to undertake their role when they began. Staff spoke positively about working at Parkgate Manor, they said they were supported and could approach management with any concerns.

We saw examples where staff engaged with people in a kind and caring way utilising strategies that demonstrated they knew them well.

Friends and relatives were able to visit people whenever they chose and were made welcome by staff. We saw a number of visitors come and go during the inspection and they were greeted warmly by staff.

We found a number of breaches of regulations. You can see what action we told the provider to take at the back of the full version of this report.