About the service:

Parkside is a residential care home providing accommodation and personal care to 32 older people. At the time of the inspection, 28 people were living in the home.

People’s experience of using this service:

•People's medicines were not being managed safely in the home. We found medicine records were inaccurate and incomplete.

•This put people at risk of harm because people may not have received their medicines as prescribed.

•Staff were not fully supported with adequate assessments and training to ensure they were competent to manage medicines.

•Quality assurance systems within the home were not always effective and had not identified the shortfalls we found with medicines management.

•Risks associated with people’s needs were assessed.

•People had evacuation plans in place in the event of a fire but it was not always clear which person the plan related to. The registered manager said they would address this.

•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 received care from staff who were kind and compassionate.

•Staff treated people with dignity and respected their privacy. They developed positive relationships with the people they supported. They understood people’s needs, preferences, and what was important to them.

•However, some people and relatives raised concerns about night staff because they did not always feel supported during night times. The registered manager told us these concerns about the home at night would be addressed.

•People were supported with their nutritional needs and had meal choices, although some people were not always happy with the quality of the food.

•People had access to health care professionals such as GPs, when required.

•People’s independence was promoted. Care plans were person centred and detailed people’s support needs.

•There was a complaints process for people and complaints were investigated by the registered manager.

•Staff were recruited safely and were provided with supervisions and appraisals to discuss their performance and any issues.

•Staff told us there was a positive culture and could approach the management team with any concerns.

•The registered manager was committed to making improvements to the home and there was a clear management structure in place.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

At the last inspection on 21 September 2017 (report published 7 November 2017), the service was rated ‘Good’. At this inspection, the rating for the service has deteriorated to ‘Requires Improvement’.

Why we inspected:

This was a planned inspection based on the rating of the previous inspection.

Enforcement:

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment and good governance. We issued a Warning Notice to the provider in relation to the breach of Regulation 12, Safe care and treatment.

Follow up:

We will continue to monitor information and intelligence we receive about the service until we return to visit as per our re-inspection guidelines. We may inspect sooner if any concerning information is received.

We carried out an unannounced comprehensive inspection of this service on 24 August 2016 at which the service was rated as Good. After that inspection, we received concerns in relation to safeguarding people and to the management of the service. As a result, we undertook an unannounced focused inspection on 21 September 2017 to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Parkside on our website at www.cqc.org.uk.

Parkside is registered to provide accommodation and personal care for up to 32 people. At the time of the inspection there were 30 people using the service.

The service 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. However, since July 2016, the registered manager had been absent from the service for approximately eight months and for the remainder of the time worked on a part-time basis. The registered manager was absent from the service at the time of this inspection and had not been there since June 2017.

Management arrangements had not been consistent or robust since our last inspection and had not ensured people continued to receive a good service. Shortfalls in the service had been acknowledged by the provider and action had been and was still being, taken to address these. Management arrangements had been reviewed and were changing. This included the appointment of a deputy manager and the pending recruitment of a temporary manager. Further time was needed to ensure these changes were embedded and that the service was effectively managed.

In response to the findings of a safeguarding investigation, all staff had received further safeguarding training. People and their relatives had been advised about safeguarding and what to do if they had concerns. Systems had been put in place, and were being used, to ensure that incidents and concerns were reported and dealt with appropriately and that people were safeguarded from abuse as far as possible.

This inspection was unannounced and took place on 24 August 2016. At our last inspection in May 2014 we found the provider was meeting the regulations we inspected.

Parkside is registered to provide accommodation for up to 32 people requiring personal care. At the time of inspection there were 30 people living at the service, 29 were permanent and one person was having respite care.

There was a registered manager in place. 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 were happy with the care and support they received. Relatives were complimentary about the service. Some people had chosen the service because of the Christian ethos and values although people did not have to be practising the Christian faith to use the service.

Staff knew how to keep people safe from abuse and risks to their health and wellbeing. People’s medicines were managed safely and there were robust arrangements to keep people safe in the event of an emergency. Risks had been assessed and there were strategies to minimise these.

There were enough staff to support people throughout the day and night and there were activities both inside and outside the service. People were invited to join in Christian fellowship twice a week at the service and were invited to attend the Baptist church each Sunday.

Staff were friendly and caring. We saw people were relaxed and chatting to each other and the staff throughout our visit. People told us they were treated with dignity and respect and that staff obtained their consent before carrying out any tasks.

People’s care plans were kept up to date and people were fully involved with this. The care plans were individualised and contained evidence people had agreed with the contents. There were also comprehensive plans for end of life care.

Staff were supported with supervision and training and through meetings. They kept their skills and knowledge up to date to provide effective care and were motivated to continually find ways to improve the service.

Staff ensured people had good nutrition and hydration that met their dietary requirements. Staff made sure that people had prompt access to health care as required and there were good transition arrangements in place if people had to go into hospital.

People, their relatives and staff told us they found the management team approachable and supportive.

There were systems in place for people, their relatives and visiting professionals to make comments, complaints, suggestions and compliments and these were responded to appropriately.

There were regular health and safety checks and audits to ensure that the premises and the care were continuously improved.

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.

Below is a summary of what we found. The summary describes what people using the service, their relatives 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 told us they felt safe. One person who used the service told us “I feel safe, I would tell the manager if I didn't feel safe here.” Staff had completed protection of vulnerable adults training and understood how to safeguard people they supported. People’s files included all relevant risk assessments for each individual, indicating the risks to the person and how these could be minimised to ensure that they were supported as safely as possible. Staff had received Mental Capacity Act 2005 and Deprivation of Liberty Safeguards training. The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. The deputy manager told us that no applications for deprivation of liberty had needed to be submitted. Before people were admitted to the home, arrangements were in place to make sure they would be safe in a environment and that staff had the skill and experience to meet their needs.

• Is the service effective?

People told us they were happy with their care. They had their own preferred routines, likes and dislikes that staff knew about. One person told us "they are first class.They do everything I ask them to do." People's health and well-being were monitored and appropriate advice and support had been sought in response to changes in their condition. The service had good links with other health care professionals to make sure people received prompt, co-ordinated and effective care. People told us if they were not well staff arranged a doctor's visit. Staff worked to a key worker system to oversee people's care. Staff had been trained in dealing with health conditions people presented such as diabetes, dementia and Parkinsons disease.

People told us they were consulted with and listened to. Quality monitoring of the service took place.

• Is the service caring?

We spoke with people who used the service. We asked them for their opinion about the staff that supported them. One person told us "they (staff) are lovely, they do everything for us. I like the food, we always get two choices and we are offered other choices if we don't want anything from the menu." Another person told us "they (staff) are very good, kind and caring." A relative told us "they provide good care, overall happy with the care mum gets. The staff are helpful and if there is a problem they always sort it out." People's preferences and diverse needs were recorded and daily notes showed that care and support was provided in accordance with this. We saw that staff supported people in a respectful and kind way. They offered people choices and talked to them about what was happening or what they needed to do.

• Is the service responsive?

Staff we spoke to were knowledgeable about the needs of people they supported and how to meet them. Care plans included information about people's preferred routines and healthcare needs as well as their likes and dislikes. This ensured that they received an individualised service. Care plans were reviewed and updated monthly or when people's needs had changed. Senior staff referred people to appropriate professionals for assessment and advice. Any actions advised by them were implemented by staff. People were supported to access a range of healthcare professionals to promote their wellbeing.

• Is the service well led?

The service had a quality assurance process in place. Annual customer satisfaction questionnaires were sent to people and their representatives to seek their views and opinions about the service in order to find out where improvements were needed. Staff told us they were clear about their roles and responsibilities. They were supported by the management team to provide good, quality care and were encouraged regularly to complete relevant training. People knew how to make a complaint if they were unhappy. Relatives and service users' views were also sought at meetings which were held regularly and were acted upon by the management team. We found a number of audits were undertaken by staff, the manager and by the registered provider to ensure that people received safe, quality care.

We spoke with ten people using the service and three relatives of people living at Parkside. We also spoke with staff including the chief executive, senior managers and care workers.

People spoke positively about the staff and the care they received at Parkside. One person said, “this is a well run home.” Another person told us, “my relative is well looked after here, the staff attitude is always good. I have no criticism, its excellent here.”

We found people were treated with dignity and respect. People were protected from abuse and their needs were appropriately assessed and met. The service managed and administered medication safely and had effective systems in place for monitoring the quality of the service people received.

People we spoke with told us that they felt Parkside provided good care. One person told us “they give me respect where it’s due, they’re alright to me. Anything I want I get”. Another person told us “my daughter and son talk to the staff. They put things right but in most cases it’s right anyway”. A relative told us “it’s caring and always sweet smelling”.

We found that people were treated with dignity and respect and people’s needs were being appropriately assessed and met. People were protected from potential abuse and there were appropriate numbers of adequately trained staff. We also found that the service had an effective system to monitor the quality of the services they provided to people.