Parkside Residential Home is a residential care home registered to provide accommodation and care to 30 older people. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At the time of this inspection there were 24 people at the service, though one was in hospital. Many of the people living in the home were living with dementia.

There was a registered manager in place at the service. 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.

At our last inspection of Parkside Residential Home on 9 and 10 January 2017 we rated the service Requires Improvement. Prior to that, at the previous inspection the home was rated Inadequate and was placed in Special Measures. The provider made improvements which led to the home being rated Requires Improvement with one breach of regulation as risk assessments were not of a good enough standard to address risks to people’s health and safety. These had improved at this inspection.

This inspection took place on 28 February 2018 and was unannounced.

Ten of the fourteen people we spoke to said they were happy in the home and felt safe. Staff demonstrated an understanding of safeguarding people from risk of abuse.

Care plans contained risk assessments which gave guidance to staff on how to support people by minimising any risks to their safety or wellbeing. Each person had a care plan setting out their needs and wishes. People’s cultural needs were not addressed well in care plans and we have made a recommendation regarding this. Care plans were reviewed monthly or as people’s needs changed. There was a full time activity coordinator who carried out a daily programme of activities for people which they enjoyed.

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There were enough staff employed to meet the needs of people living at the service. Staff recruitment practices were safe and staff received training and supervision to support them in their role. Staff felt well supported by the registered manager.

The service had satisfactory systems and processes in place to ensure the safe management of people’s medicines.

Records showed that people who needed special diets to help them put on weight were not receiving the extra calories they required. People said they would like to be consulted more about what they wanted to eat and some said they didn’t get the specific food they liked to eat.

Staff worked with healthcare professionals to ensure people's health was looked after.

People and their relatives were generally positive about the service and the staff who supported them. Most people told us they liked the staff and the registered manager. A complaints procedure was in place and people and most of their relatives said they felt comfortable raising concerns and that their views would be listened to and acted on.

Where people's liberty was deprived, the registered manager had applied for authorisation from the appropriate authority.

The provider had processes in place to ensure that the quality of care was regularly monitored.

There was one breach of regulation as the provider did not always ensure certain people received the type of food they needed. You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place on 9 and 10 January 2017 and was unannounced. When we last inspected this service on 12 July 2016, we found significant shortfalls in the care provided to people. At that inspection we found the home was in breach of eight legal requirements and regulations associated with the Health and Social Care Act 2008. We found that risk assessments were not in place to protect people from harm and medicines were not being managed safely. Mental capacity training and assessment had not been carried out in accordance to the Mental Capacity Act 2005 (MCA). We also found training was not being carried out consistently. Some people’s food intake was not being monitored and actions plans were not in place for people at risk of malnutrition. Some care plans had not been completed in full and complaints had not been appropriately dealt with.

Parkside Residential Home is a residential home for up to 30 adults with dementia. There were 28 people staying there at the time of the inspection.

The home had a registered manager in place during our inspection. 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.

Improvements had been made with the management of medicines and medicines were now being managed safely. People were receiving their medicines on time and as needed medicines when they needed them. Medicines were stored securely and systems were in place to order from, and return medicines to, the pharmacist. Dispersible tablets or liquid medicines were given to people with swallowing risks. Medicines records were being completed and were up to date. Training had been delivered to staff on managing medicines and staff had been competency assessed.

Risks were being identified and preventative measures put in place to prevent the risk of health complications. However, risk assessments had not been made specific to some people’s circumstances and health conditions. Risk assessments relating to falls and skin integrity were identical and not person centred.

Quality assurance monitoring was in place which identified issues and prompt action was taken to make improvements where necessary. However, the audits had not identified the concerns we found with risk assessments.

The home had adequate staffing levels. We observed that staff were prompt in supporting people and call bells were being answered within acceptable time limits.

Improvements had been made in assessing people’s capacity to make decisions on a particular area. MCA assessments had been carried out assessing people’s ability to make decisions. Staff had received training in MCA. Staff that had not received training had been booked to receive this training. Most staff we spoke to were able to tell us about the principles of the MCA and how the test was applied to determine if a person had capacity to make a specific decision about their care.

Deprivation of Liberty Safeguarding’s (DoLS) applications had been made to deprive people of their liberty lawfully in order to ensure people’s safety. CQC was notified of outcomes of DoLS applications.

Food and fluid intake was being monitored for most people with specific health concerns and appropriate intervention had been made to ensure people were at best of health such as referral to dieticians and GP.

Supervisions were being carried out with staff and staff told us that they were supported.

Staff had received essential training and had been booked into training they needed to do their jobs effectively. Staff had received an induction when starting employment.

The provider had submitted an action plan to the CQC to address the breaches identified at the last inspection.

Surveys were carried out and analysed to

We carried out an unannounced comprehensive inspection of this service on 12 July 2016 and found significant shortfalls in the care provided to people. We identified breaches of regulations relating to consent, risk management, staffing, person centred care, nutrition and hydration, complaints, notifications, record keeping and quality assurance. In addition, the provider was not providing care in a safe way as they were not doing all that was reasonably practicable to ensure the safe management of medicines. Following the inspection we served a warning notice on the provider requiring them to comply with the regulations for the safe management of medicines.

We undertook this unannounced focused inspection on 8 November 2016 to check that the provider had met the requirements of the warning notice. At this inspection we looked at aspects of the key question 'Is the service safe?’ This report only covers our findings in relation to the focused inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Parkside Residential Home’ on our website at www.cqc.org.uk.

Parkside Residential Home is a residential home for up to 30 adults with dementia and mental health needs.

The home had a registered manager. 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.

During our focused inspection we found the provider had made considerable improvements with medicines. Medicines were stored and managed safely. People were receiving their medicines on time and when they needed them. Staff had been recently trained and their competency had been assessed to ensure they handled medicines safely. Regular audits were being completed to ensure the management of medicines was safe and follow up action was recorded.

The home had met the requirements and regulations identified in the warning notice. We have changed the rating for this key question to 'Requires Improvement'. Although improvements had been made we need to see consistent improvements over time and there were other issues within this key question that we identified at the last comprehensive inspection that need to be addressed.

This inspection took place on 12 July 2016 and was unannounced. An inspection took place on 5 January 2016. At that inspection we found the home was in breach of seven legal requirements and regulation associated with the Health and Social Care Act 2008. We found that risk assessments were not in place for people to protect people from harm and medicines were not being managed safely. Mental capacity training and assessment had not been carried out in accordance to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) application had not been made to deprive people of their liberty lawfully. We also found that supervisions and training were not being carried out consistently. Some people’s food was not being monitored and actions plans were not in place for people at risk of losing weight. Some care plans had not been completed in full.

Parkside Residential Home is a residential home for up to 30 adults with dementia and mental health needs. There were 27 people staying there at the time of the inspection.

The home did not have a registered manager in place during our inspection. 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. The home had a manager in place and the provider told us that the manager will be applying for registration.

People were put at risk of harm as improvements had not been made with medicines. Medicines were not being managed safely. We found that some medicines were not stored and disposed safely, service users Medicine Administration Records (MAR) were not always completed in full or accurately and medicine were not being followed as instructed on people’s MAR. We found two people had received an overdose of their medicine and action had not been taken immediately. Internal medicines audits had not been carried out. An external medicine audit, carried out by a pharmacist in February 2016 that identified the shortfalls we found on this inspection had not been addressed.

We found some improvements had been made with identifying and assessing risks to people. Assessments had been made specific to some people’s circumstances and health conditions. However, we still found that some risk assessments had not been identified or completed in full during the inspection.

Some people, relatives and staff raised concerns with staffing levels. Comprehensive systems were not in place to calculate staffing levels contingent with people’s dependency levels. The role of the manager combined managerial and significant caring duties had an impact on the ability of a manager to manage the service.

Improvements had not been made in assessing people’s capacity to make decisions on a particular area. MCA assessment had not been carried out for three people out of the nine care plans we looked at. Where people had been deemed to lack or have capacity, the assessment did not record what area people lacked or had capacity in. Staff still had not received MCA and Deprivation of Liberty Safeguarding (DoLS) training. Two staff were not able to tell us about the principles of the MCA and how the test was applied to determine if a person had capacity to make a specific decision about their care.

DoLS applications had been made to deprive people of their liberty lawfully in order to ensure people’s safety. Outcomes of the DoLS application were not sent to the CQC.

We did not find food was being monitored for three people with specific health concerns to ensure they had a healthy balanced diet. Blood level was not being monitored and recorded for two people. One person required weekly weight monitoring, we found the person’s weight was not being monitored and recorded weekly. One person’s fluid intake was not being

This inspection took place on 5 January 2016 and was unannounced. An inspection took place on 14 and 15 June 2014 and found that two safeguarding allegations had not been appropriately responded to and were not reported to the safeguarding team. The home did not have a code of conduct or policy on the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Mental capacity assessments examined were not sufficiently comprehensive as they did not contain assessments of people's mental capacity. A follow up inspection on 22 September 2014 found the service to be meeting the requirements of the regulations.

Parkside Residential Home is a residential home for up to 30 adults with dementia and mental health needs. There were 25 people staying there at the time of the inspection.

The home had a registered manager, who had recently come back from extended leave. An acting manager was deputising whilst the registered manager was away. 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.

Some risk assessments were not updated to reflect people’s current needs and did not take into consideration people’s health needs. When a risk was identified it did not provide clear guidance to staff on the actions they needed to take to mitigate risks in protecting people from behaviours that challenged the service.

A person had a penicillin allergy and this was not recorded on the medicines record. Medicines were administered on time and were stored safely.

Systems were not in place to calculate staffing levels contingent with people’s dependency levels. We made a recommendation that staffing levels are assessed against people’s dependency needs.

Supervision was not consistent and regular one to one meetings were not being carried out. Staff had not received annual appraisals.

Not all of the staff working at the home had received the training they needed to do their jobs effectively.

People were given choices during meal times and their needs and preferences were taken into account. Nutritional assessments were in place for people, which included the type of food people liked and disliked. However, food was not being monitored for two people with specific health concerns to ensure they had a healthy balanced diet. Blood and glucose levels were not monitored.

Due to risks to their safety most people living at the home were not allowed to go outside without staff or relative accompanying them. Appropriate Deprivation of Liberty safeguards had not been applied for.

Some mental capacity assessments assessed people to have ‘limited capacity’. The assessment did not detail the specific decisions that people did not have the capacity to make and we did not see any evidence of best interest meetings or decisions being made on their behalf. The home managed four people’s finances. However, we did not see capacity assessments to evidence that this was in their best interests or if people had the capacity to manage their own finances.

Bedroom doors did not have names or photos of people who were occupying them. Some clocks were incorrect. There was also no directional signage around the home that indicated where bedrooms or toilets were. We made a recommendation that the provider seeks guidance to ensure the premises meets people’s individual needs particularly for people with dementia.

Some care plans were inconsistent and were not completed in full. Reviews in some care plans contained limited information and did not reflect the changes in the previous month

Staff and resident meetings were not held regularly. The last staff meeting was held on March 2015 and we did not see evidence of residents meetings being held since March 2015.

Questionnaires were completed by people and their relatives about the service. However, we did not see systems were in place to analyse the findings of the survey.

Quality assurance and quality monitoring systems had been implemented to allow the service to demonstrate effectively the safety and quality of the home. Regular health and safety audits were carried out to ensure the premises was safe. However, the provider’s quality monitoring had not identified the shortfalls we found during our inspection.

People told us they felt safe. Staff were trained in safeguarding adults and knew how to keep people safe. They knew how to recognise abuse and who to report to and understood how to whistle blow. Whistleblowing is when someone who works for an employer raises a concern which harms, or creates a risk of harm, to people who use the service.

Recruitment and selection procedures were in place. Checks had been undertaken to ensure staff were suitable for the role.

People were supported to maintain good health and appropriate referrals to other healthcare professionals were made.

People enjoyed a number of activities such as going to the library, park, café’s and theatre.

Complaints were handled and response was provided appropriately. People were aware on how to make complaints and staff knew how to respond to complaints in accordance with the services complaint policy.

People were encouraged to be independent and their privacy and dignity was maintained. People were able to go to their rooms and move freely around the house.

We identified breaches of regulations relating to consent, medicines, risk management, nutrition and hydration, person centred care, staff support and training. You can see what action we have asked the provider to take at the back of the full version of this report.

The registered manager acknowledged the findings we made and told us she was aware of some of the issues since coming back from extended leave and assured us that improvements will be made.

During our inspection on 18 June 2014, we found that the service was not meeting essential standards relating to Safeguarding people who use services from abuse and the maintenance of records. The provider submitted an action plan detailing what they would do to meet the standards. During this visit, on 22 September 2014, we checked whether the provider had carried out the actions and whether the standards were now being met.

We found that the provider had a system in place to protect people who used the service from abuse. With one exception people who used the service and two relatives informed us that people who used the service were safe and not subject to any ill treatment. This was confirmed by a healthcare professional who stated that they had no concerns regarding the welfare of people. We observed that staff were pleasant and attentive towards people. Staff had received training in safeguarding people and were knowledgeable regarding how to respond to allegations or incidents of abuse. One person expressed concerns regarding the behaviour of some staff. This was promptly and appropriately responded to.

People were protected from the risks of unsafe or inappropriate care and treatment because appropriate information related to the care of people and the management of the regulated activity were available. At the last inspection we found that people’s care records did not contain assessments of their mental capacity. This was needed to provide guidance for staff and information regarding the arrangements for decision making in areas affecting people. At this inspection the home had assessments of people's mental capacity. These included details of their representatives or relatives who could make decisions on their behalf.

At the last inspection, the home did not have a service user guide which included details of staff, services available and the complaints procedure. At this inspection the home had a service user guide with information on the complaints procedure. The home now had policies and procedures for safeguarding people and guidance on the Mental Capacity Act 2005 (MCA). These policies were needed so that people were protected and staff were fully informed regarding their responsibilities.

We spoke with 13 of the people using the service. They told us they liked the home and the staff and felt safe there. One person said, “the staff are very good.” Another said, “I’m pleased to be here, it's company.” A third said, “I like the place.” We saw staff interacting with people calmly and kindly.

We spoke with a visiting relative who told us that there was a “homely feel” to the service and that their relative was “settled” and had been,“made welcome."

People’s care needs were identified and clearly set out in care plans for staff to follow. The care plans had been reviewed and updated regularly. Medication was stored safely and there were checks to make sure medicines were administered properly.

Staff recruitment included interviews and relevant checks being made before work was offered. Systems were in place to assess and monitor the quality of the service provided. All parts of the home were clean, tidy and comfortably furnished. The service was provided in premises which were safe. Regular safety checks of the premises had been carried out.

The acting manager had been in post since September 2012 and must now apply for registration as the manager. It is a condition of registration for this service that there is a registered manager.

People who use the service told us that staff were kind and respected their privacy. They confirmed that staff treated them with care, respect and dignity. One person commented, “I’m well looked after. The staff are very good.”

People told us that they were offered a choice in relation to activities, care preferences and food and drink. Staff we interviewed had a good understanding of the needs of the people they supported.

People told us that they felt safe at the home. They said they had no concerns or complaints about their care but they would speak with their relatives, the person in charge or the staff if they needed to.

People told us they were satisfied with the support they received to take their medication.

People described the staff as, “very caring”, “kind” and “helpful.”

People were positive about the home and confirmed that the management and staff often asked them for their views about the quality of care they received.

Relatives we spoke with said that Parkside was, “homely” and “non institutional.”

Not everyone in the home can communicate verbally so we spent time observing people who use the service to see what effect the environment and staff interactions had on peoples’ wellbeing. People told us that staff were kind and respected their privacy. One person commented, “There is no problem here. You more or less get what you want”.

People told us that staff would knock on their door before entering their room. One person told us, “They don’t just walk in”.

People also confirmed that they could talk with the manager or staff about any issues in the home.

We observed staff supporting people in a friendly and professional way and saw that people were being offered choice with regard to menus and activities.

Staff we interviewed were able to give us examples of how they maintained peoples’ dignity, privacy, independence and how they offered choices to people on a daily basis.

People who use the service said they enjoyed going out of the home and told us about a recent trip to the Pantomime.

We asked people who use the service what they thought about the care and treatment they received at the service. They responded positively with many commenting that the care home had a “very nice atmosphere” and the staff, “were very nice” with many adding that they were “well looked after”.

One person commented, “We couldn’t have anything better”.

We observed that the way staff were supporting people in the home had a positive effect on their well being. Staff we interviewed had a good understanding of the needs of the people they supported.

People who use the service indicated to us that they felt safe with the staff at the home. They told us they had no concerns about their care but would speak with a relative or the staff if they needed to.

We observed kind and positive interactions between staff and people living at the home.

Staff we interviewed were aware of the different types of abuse that can happen to people in a care setting. Staff were able to give us examples of signs they would look out for that may indicate a person may be being abused. Staff told us that if they ever suspected abuse was taking place they would inform the manager immediately.

The service was not always ensuring that medication procedures were being followed properly.

People who use the service indicated that they were happy with the staff who support them. People told us that a new face was seen every once in a while but this didn’t have much impact on their care. They also said that staff had time for their needs most of time, but understood that there were busy times and that there were other people that had needs too.

One person we spoke to told us, “They (the staff) need more training” and we did see a number of gaps in staff training records.

People who use the service confirmed that the staff asked them how things were going and if they were happy with the care provided at Parkside Residential Home.

We saw that the home was decorated and furnished to a satisfactory standard and extensive building work was underway to increase the number of en suite rooms in the home.

Health and safety audits were not taking place on a regular basis which made identifying potential risks to peoples’ safety difficult.

We looked at the personal care or treatment records of people who use the service, carried out a visit on 18 June 2014 and 19 June 2014, observed how people were being cared for and talked with people who use the service. We talked with carers and / or family members, talked with staff, reviewed information given to us by the provider and talked with another regulator.

What people told us and what we found

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, is the service effective, is the service caring, is the service responsive, is the service well led?

At the time of this inspection there were twenty nine older people living in the home. Some people who used the service had dementia and mental healthcare needs.

We observed the care provided and the interaction between staff and people who used the service. We spoke with six people who used the service, a relative and a healthcare professional. We also spoke with one of the registered providers, the manager, the activities organiser, three staff individually and with twelve staff attending the staff meeting.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

If you want to see evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People indicated to us that they felt safe with staff. This was also reiterated by a relative we spoke with. There was evidence that new staff had been carefully recruited and their records indicated that essential checks such as criminal record checks and references had been obtained. The premises were clean and regular health & safety checks had been carried out. Staff had received training in safeguarding people and were aware of action to take if they were aware that people who used the service were being abused. We however, noted that two safeguarding allegations had not been appropriately responded to and were not reported to the safeguarding team. This places people at risk since the allegations would not have been properly investigated. We have made a compliance action accordingly.

Is the service effective?

Feedback from a healthcare professional, a relative and people who used the service indicated that the service was effective in ensuring that people were well cared for. People’s care needs had been assessed before they arrived at the home and care plans were in place to ensure that their needs were met. People had been consulted regarding their preferences and activities they liked to engage in. The service had a varied programme of social and therapeutic activities and we saw that people could participate in activities if they chose to. We were informed by the healthcare professional and the manager that none of the people who used the service had pressure sores.

Is the service caring?

The results of a recent satisfaction survey indicated that people who used the service and their representatives were satisfied with the care provided and they made positive comments about staff. One relative wrote, “Thank you for your kindness and care of X. You treated him with respect and consideration.” One person who used the service told us, “The provider is very kind to me. They ask me what I food like and orders it.” We were also informed by another person that they had been provided with their cultural food.

Staff had an understanding of people’s cultural and religious needs and where appropriate, arrangements had been made to meet these needs. We observed that staff spoke in a gentle and friendly manner towards people.

We saw evidence that checks had been made to ensure that a person with mobility needs could leave their bedroom and go to the lounge or elsewhere if needed. The manager stated that hourly checks were also carried out on others with similar needs so that they could move freely within the home if they chose to.

Arrangements were in place to ensure that people with medical conditions such as diabetes were closely monitored and received appropriate medical care. Regular reviews of care plans had been carried out.

Is the service responsive?

People who used the service indicated that staff were responsive to their needs. One person who used the service stated, “I have high regard for the provider. If I have a problem, they sort it out.” Another person stated, “If I need help and press the buzzer. They come and help me.”

The provider had organised regular meetings with people who used to service and suggestions made by people had been recorded. We were provided with examples of what had been done in response to suggestions made. These included visiting a local place of interest and providing a table sauce requested.

The service had a complaints procedure. Complaints made by people had been responded to, usually within a few days. People who used the service and a relative stated that they knew who to complain to if they had any concerns.

Is the service well-led?

Staff meetings had been held and the minutes of these meetings indicated that staff had been updated regarding the management of the home and the care of people. Staff we spoke with said they had been provided with appropriate support to enable them to take good care of people. Essential training had been provided and staff were knowledgeable regarding their roles and responsibilities.

There were arrangements for monitoring the quality of care. Regular audits and checks had been carried out in areas such as the medication arrangements and the cleanliness of the premises.

Some important policies and procedures were either not available or not sufficiently comprehensive. The home did not have a code of conduct or policy on the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards. These policies were needed so that people were protected and staff were fully informed regarding their responsibilities. We have made a compliance action accordingly.

The provider had been served with a fixed penalty notice by the Care Quality Commission. This was because it was not meeting the conditions of registration which required them to have a registered manager.