This inspection took place on 16 and 17 October 2018. The first day of the inspection was unannounced, which meant that the staff and provider did not know we would be visiting. The second day was announced.

Parkville Care Centre is a purpose-built care home located in central Middlesbrough. It comprises of two buildings, both have two floors. This service provides support and accommodation for up to 93 people assessed as requiring residential or nursing care. This includes support for people living with a dementia type illness. At time of our inspection there were 69 people living at Parkville Care Centre.

Parkville Care Centre is a 'care home'. 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.

There was a registered manager in post however they were absent from the service during this 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.

During this inspection we identified a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities 2014) relating to Safe care and treatment.

You can see what action we told the provider to take at the back of the full version of this report.

This is the first time the service has been rated Requires Improvement.

We observed one occasion where staff transferred a person using an unsafe technique. We brought this to the attention of the management team who took appropriate action to address the issue. All other observations of transferring people were carried out by staff in a safe and competent way.

Medicines were not always managed safely. We could not be confident that people had received their medicines as prescribed. This could put people at risk of ill health. Medicine records were not comprehensive. Medicine audits had not identified most of the issues we found in this area.

Policies and procedures were in place to support staff in protecting people from harm, such as safeguarding and whistleblowing polices. Staff knew how to identify and report suspected abuse. People and their relatives felt the service was safe.

People’s files contained the information staff needed to support them. Risks to individuals were documented with information available for staff in how to manage these to reduce risks to people. Risk assessments were reviewed on a regular basis.

Most people and their relatives told us that there were sufficient numbers of care staff on duty to ensure people’s needs were met. Some staff felt that the service would benefit from staffing levels being increased. The management team used a dependency tool to ascertain staff levels were sufficient. During this inspection we saw call bells were answered in a timely manner.

Safe recruitment practices were in place. Pre-employment checks were made to reduce the likelihood of employing staff who were unsuitable to work with vulnerable people.

Staff said that they received regular supervision. We received mixed feedback from staff regarding how supported they felt by the management team.

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. However, some additional work was required with record keeping in this area.

People had access to, and the service worked with, a range of healthcare services such as GPs, hospital departments and dentists. People’s nutritional needs were met.

The premises were spacious and tidy. One of the two buildings had been updated and adapted to meet the

This inspection was unannounced and the visit took place on 14 July 2016. The staff and registered provider did not know that we would be visiting.

The last inspection was conducted on 9 August, 3 and 10 September 2015, which rated the service as requires improvement and identified breaches in two of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to adhering to the requirements of the Mental Capacity Act 2005, assessing the performance of the home, maintenance of the building and the records. The registered provider wrote to us to outline how these breaches would be rectified. At this inspection, we found that the action taken had ensured the breaches were resolved.

Parkville Care Centre is a care home that can accommodate up to 94 people, which is registered for both residential and nursing care. The service has two buildings but in December 2015 the registered provider choose to close the smaller and to stop providing nursing care. The remaining building can support up to 54 older people with general care needs and people who may be living with dementia. The home is currently full.

There was a registered manager in post. 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.

We found the refurbishment programme commenced before our last inspection was nearing completion. The registered provider had made marked improvements to the home. We saw that the bathrooms and showers had been renewed and a redecoration programme was being completed.

At the last inspection, we found that staff were still completing work to ensure each care record clearly recorded people’s individualised care. At this inspection, we found that people’s care plans were tailored for them as individuals and created with them and their family involvement.

We found that the operational manager and registered manager had introduced a range of quality assurance processes and audits that ensured the care and treatment was delivered in a safe and effective manner.

People were cared for by staff that knew them really well and understood how to support them. We observed that staff had developed very positive relationships with the people who used the service. The interactions between people and staff were jovial and supportive.

People who used the service and the staff we spoke with told us there were enough staff on duty to meet people’s needs. The registered provider and registered manager had closely considered people’s needs. For the 54 people using the service, there were two senior carers and seven care staff on duty during the day and two senior carers and five care staff member on duty overnight.

We found that a range of stimulating and engaging activities were provided at the home. People told us staff worked with them and supported them to continue to lead fulfilling lifestyles. Staff outlined how they supported people to continue to lead independent lives. We found that people were encouraged and supported to take responsible risks and positive risk-taking practices were followed. Those people who were able to were encouraged and supported to go out independently, and others routinely went out with staff.

Where people had difficulty making decisions, we saw staff gently worked with them to work out what they felt was best. Staff understood the requirements of the Mental Capacity Act 2005 and had appropriately requested Deprivation of Liberty Safeguard (DoLS) authorisations. Staff had been working hard to ensure capacity assessments were completed in line with the Mental Capacity Act 2005 code of practice.

People told us they were offered plenty to eat and we observed staff assisting individuals to have sufficie

We inspected Parkville Care Centre on 30 January 2015. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting. At the last inspection in May 2015 we found the home did not meet the regulations related to care and welfare and ensuring staff were appropriately trained. The provider sent us an action plan that detailed how they intended to take action to ensure compliance with these two regulations.

Parkville Care Centre is a residential and nursing care home that can accommodate up to 94 people. The service is divided into two buildings and both have two floors. One building supports older people with general care needs. The other building supports older people with dementia care needs, which includes providing nursing care on the top floor of the unit.

The home has not had a registered manager in place since July 2014. 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. Since the registered manager left in July 2014, three managers have been in post with the latest manager coming into post the week we commenced the inspection.

Staff had received Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards training but were unclear about the requirements of the Act. We found that there was no information to show whether relatives had become Court of Protection approved deputies, or if they had enacted power of attorney for care and welfare or finance or if they were appointees for the person’s finances. No records were in place to show that staff completed capacity assessments where appropriate and made ‘best interest’ decisions. We found that some people had difficulty making decisions; were under constant supervision; and prevented from going anywhere on their own. Staff did not know whether people were subject to DoLS authorisations, which were needed if people lack capacity to make decisions and these types of restrictions are made.

We found that the senior staff felt the guidance from the supervisory body instructed them to complete DoLS applications for all of the people who used the service, irrespective of whether the person lacked the capacity to make a decision. This was an incorrect interpretation of the MCA and DoLS authorisations can only be made for people who have a mental disorder or impairment of the brain, which has led to them being unable to make decisions about the care and treatment they receive. The registered manager recognised that further action was needed to ensure the staff understood how to apply the requirements of the MCA.

We found that many areas of the building were in need of refurbishment. For instance the shower rooms flooring was coming away from the tiles and the drains were not covered, paintwork was in a poor state of repair; the baths were too low to enable staff to bathe the residents in a safe position; and the environment was not conducive to supporting people living with dementia. Checks of the building and maintenance systems were undertaken to ensure health and safety but these needed to ensure bath thermometers were available and staff checked the bath water prior to bathing every person.

We saw that assessments were completed, which identified people’s health and support needs as well as any risks to people who used the service and others. These assessments were used to create plans to support plans for people to follow whilst they used the service. We found that staff needed to ensure these were updated and altered as people’s needs changed. At times staff were not recording the review of people’s needs that they had completed. Staff were able to discuss in-depth the support each person needed and how they worked with people.

Albeit the provider had systems for monitoring and assessing the service due to the number of changes in management over the last few months these had not been effectively implemented. We also found that the performance monitoring tools in place did not capture information about monitoring water temperatures and ensuring care records were accurately maintained.

We visited from the early hours of the morning and spent time with people in each of the units. We found that people required varying levels of support. We saw that staff provided people with support to manage their day-to-day care needs and on the whole staff had taken appropriate steps to ensure people received care and support, which was tailored to their needs.

However, we noted that on one unit the night staff routinely assisted most people to get up before the day staff started work. These people were assisted to have a shower when rising, which meant they could be bathed anywhere from 5 am. None of the care records we reviewed showed any reason why the person would want to do this or what time they preferred to rise. One person told us they got up early because every hour the staff went into their room and this disturbed their sleep. We ensured this matter was dealt with as a safeguarding concern. We also noted that although seven people on this unit were up when we arrived at 5.30 am no one was offered a drink until 6.45 am whereas on the other units very few people were up and all had been offered a number of drinks. We discussed this with the operational director and manager who took appropriate action.

Throughout the day on all the units we observed the care and support people received and saw that they were treated with respect and dignity.

People we met were able to tell us their experiences of the service. They were complementary about the staff and found that home met their needs. People told us that they felt the staff had their best interests at heart and if they ever had a problem staff helped them to sort this out. They told us that they made their own choices and decisions, which were respected by staff but they found staff provided really helpful advice.

People told us they were offered plenty to eat and were assisted to select healthy food and drinks which helped to ensure that their nutritional needs were met. We saw that individual’s preference was catered for and people were supported to manage their weight and nutritional needs. We saw that people living at Parkville Care Centre were supported to maintain good health.

We saw there were systems and processes in place to protect people from the risk of harm.

We reviewed the systems for the management of medicines and found that people received their medicines safely.

We saw that the provider had a system in place for dealing with people’s concerns and complaints. People we spoke with told us that they knew how to complain and felt confident that staff would respond and take action to support them.

People and the staff we spoke with told us that there were enough staff on duty to meet people’s needs. They found the staff worked very hard and were always busy supporting people. The deputy manager, a nurse, head of care, three senior care staff and ten care staff were on duty during the day and a nurse, three senior care staff and four staff on duty overnight. We found information about people’s needs had been used to determine that this number of staff could meet people’s needs.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Staff had received a range of training, which covered mandatory courses such as fire safety, infection control, food hygiene as well as condition specific training such as working with people who had diabetes. We found that the staff had the skills and knowledge to provide support to the people who used the service.

We found that all relevant infection control procedures were followed by the staff at the home.

We found the provider was breaching four of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These related to adhering to the requirements of the Mental Capacity Act 2005, assessing the performance of the home, maintenance of the building and the records. You can see what action we took at the back of the full version of this report.

We decided to visit the home during the late evening to gain a wider view of the service provided. This was part of an out of normal hours pilot project being undertaken in the North East region. We found that the provider had ensured staff applied the requirements of the Mental Capacity Act 2005. Staff understood the action they needed to take if people did not have capacity to make decisions; when they restricted people’s lifestyles; and when to apply for Deprivation of Liberty Safeguards.

We spoke with seven people who used the service and one relative. People told us that they found the staff were good at their jobs. They told us that they were able to make their own daily life decisions, had choices and that staff did not impose restrictions on them. People said, “I make my own decision, sometimes I decide to have a lie in and I usually like to go to bed at about 10.30 pm”, “You don’t have to be up at a specific time. I don’t feel like life is restricted by being here” and “It’s really lovely here, it’s a nice home.” The relative we spoke with thought that staff supported the people well..

Many of the people who lived at the home found it difficult to think about recent events or at times, to have a conversation. During the visit we used a specific way of observing care to help to understand peoples’ experience of the service. We found that the nursing and care staff were empathetic, sensitive and supported people to meet their care needs.

During the visit, we spoke with 12 people who used the service and five relatives. As this was a routine visit we asked people about the choices on offer; what the care was like; and what people thought about the staff. People told us that they always found the staff delivered a high standard of care; were really kind and went out of their way to make sure their needs were met. Relatives thought the staff were excellent at their jobs and their loved ones were being appropriately supported.

However people also told us that they found the management of the home in recent months had been problematic. We were told that a manager had left in June 2012 and was replaced in July 2012 but this person had not been as effective as the previous manager. People told us that this new manager had now left. They also said that there had been a lot of changes to the nursing and senior care team. We confirmed that this was the case and that the deputy manager and one of the nurses was also about to leave. The Operational Director was overseeing the home and ensuring that the new management team and replacement staff were appointed.

People said, “I’m happy with the care and the staff really know how to look after us but I never saw that new manager and from what I heard she wasn’t very good”, “The hands on care is brilliant but the oversight of the home has been lacking in recent months and this led to information not being passed on as it should”, and “The girls really work hard to make sure we are alright but they were really pushed recently. There didn’t seem to be as many on duty the last couple of months but this had now improved.”

Relatives said, “I found that when I raised complaints the last manager did nothing about them but since she has left the senior staff have been a bit quicker at getting back to me. We are just about to have a meeting with the deputy manager”, “I am delighted with the care being provided” and “The staff are fantastic.”.

Many people who lived at the home had problems with their memory and found it difficult to think about recent events or at times to have a conversation. So we used a specific way of observing care to help to understand their experience called the short observational framework for inspection (SOFI).This involved spending a substantial part of the visit watching groups of people to see how they occupied their time; appeared to feel; and how staff engaged with them. We completed this type of observation in both units and various lounges.

From our observations and discussions with the people who used the service we found that care staff worked in ways that supported the people and treated individuals with humanity as well as empathy. Staff worked in ways that showed they valued and respected the people who used the service. We observed that staff continuously involved people in discussions and always sought their views.

People in the one unit said activities were extremely limited and we found that although there was an activities coordinator they focused their attention on only one of the units. Staff tried to compensate for this and did provide activities including coming in on their days off to take people out but in recent months had been difficult because of the staffing levels. We found that the provider had identified the issues and over the previous week had put measures in place to increase staffing levels and improve activities.

We visited the home, as a part of our regular programme of inspections and looked at how the home cared for the people who used the service. Therefore when talking with people we asked about their experience of the service and for their views about how the home was run. We spoke with fifteen people who used the service and three relatives. People were very complimentary about the staff. People said ''The care is absolutely marvellous'', ''I find the staff in this unit are fantastic and they really know how to care for my relative'', ''The care is excellent, I certainly don't have any complaints as I find staff are always pleasant and available when I need a hand''.

We were told that the previous manager had left and the new manager had been in post for around six months. People told that she was approachable but found that, as the home covered two different buildings and had units in each building, they tended not to see her regularly. However, they felt that, when needed, she was always available and did listen to what they said. People felt that on the whole their opinion was taken into account. People said ''The staff genuinely care about us'' and ''I visit the home everyday and find that the staff ask my opinion about what works well for my relative''.

A proportion of the people living at the home had marked problems with their memory and found it difficult to think about recent events or at times to hold a conversation. Therefore we used a specific way of observing care to help to understand the experience of people who could not talk with us. This involved spending a substantial part of the visit observing a group of people to see how they occupied their time, appeared to feel and how staff engaged with them. From our observation staff on the dementia care unit appeared to have a good understanding of how to work with people. Thus, staff were seen to be attentive and involved people in discussions about their lived history. They regularly checked people were content and used a range of effective techniques to reduce any anxiety. Also staff made sure individuals could follow what was being said. For those people who had difficulty communicating, staff identified what was being asked and intuitively worked with them to meet their needs.

We inspected Parkville Care Centre on 19 August, 3 and 10 September. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

At the last inspection on 30 January 2015 we found the home did not meet the Health and Social Care Act 2008, regulation 10: Assessing and monitoring the quality of service provision; regulation 15 Safety and suitability of the premises; regulation 18 Consent to care and treatment; and regulation 20 Records. The provider sent us an action plan that detailed how they intended to take action to ensure compliance with these four regulations.

Parkville Care Centre is a residential and nursing care home that can accommodate up to 94 people. The service is divided into two buildings and both have two floors. One building supports older people with general care needs. The other building supports older people with dementia care needs, which includes providing nursing care on the top floor of the unit.

At the last inspection a new manager had just been in post a week. The manager has now become the registered manager for Parkville Care Centre. 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 found that since the last inspection staff had received additional training around the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards. We found that the care records were now providing this level of information and staff were much clearer about their roles and responsibilities under the MCA. The registered manager had ensure that additional training had been provided and staff had familiarised themselves with the MCA code of practice.

We found that some people had difficulty making decisions; were under constant supervision; and prevented from going anywhere on their own. The registered manager had taken action to ensure where appropriate Deprivation of Liberty Safeguard (DoLS) authorisations had been sought. Staff could now inform us as to which people were subject to DoLS authorisations.

However, we found that staff needed to be more proactive when DoLS authorisations were about to lapse in order to ensure there was a smooth continuation of the DoLS. We found that staff had recorded information about the DoLS authorisation and expiry date in each individual’s care records but were not taking action to find out from the senior staff if DoLS authorisation renewal were in place. We saw that the senior staff kept the DoLS authorisation information in the office and did contact the supervisory body but got no confirmation from the supervisory body that extensions to DoLS authorisations were agreed prior to the paperwork being received at the home. We found that in light of this lack of clarity staff were not making urgent DoLS authorisations. This meant that there were periods when the DoLS authorisation had lapsed and therefore people could have been illegally subject to a deprivation of liberty.

We saw that assessments were completed, which identified people’s health and support needs as well as any risks to people who used the service and others. These assessments were used to create support plans for staff to follow whilst people used the service. We found that staff now ensured these were updated and altered as people’s needs changed. Staff were able to discuss in-depth the support each person needed and how they worked with people. However we found that they were still completing work to ensure each care record clearly recorded people’s individualised care.

At the last inspection we found that many areas of the building were in need of refurbishment. The registered provider submitted an action plan outlining how they intended to improve the environment. At this inspection we found the registered provider had addressed the urgent matters and was continuing the programme of refurbishment. The registered manager told us that the registered provider visited on a weekly basis and reviewed the works to the home. The registered manager told us that because the registered provider was so involved in the home they had found that the refurbishment plan was on track to be completed by early next year.

On the first day of the inspection we highlighted to the registered manager that some equipment such as shower chairs were no longer fit for purpose. These had been replaced when we returned but the system for staff reporting these matters needed to be enhanced. The registered manager recognised the reporting system needed to be improved and was using daily ‘flash’ meetings to get the message to staff that if equipment was needed this could readily be obtained.

We found that the registered manager had improved the systems for monitoring and assessing the service and now was in the main able to identify the weaknesses in the delivery of the service.

Throughout the inspection we spent time with people in each of the units. We found that people required varying levels of support. We saw that staff provided people with support to manage their day-to-day care needs and on the whole staff had taken appropriate steps to ensure people received care and support, which was tailored to their needs.

We found that the activity co-ordinator was very proactive and constantly engaged people in stimulating and meaningful activities. These were designed to ensure people remained as independent as possible and the activities gave them a sense of purpose.

Throughout the day on all the units we observed the care and support people received and saw that they were treated with respect and dignity.

People we met were able to tell us their experiences of the service. They were complementary about the staff and found that home met their needs. People told us that they felt the staff genuinely cared about them and ensured the service met their needs. They told us that they made their own choices and decisions, which were respected by staff.

People told us they were offered plenty to eat and assisted to select healthy food and drinks which helped to ensure that their nutritional needs were met. We saw that individual preferences were catered for and people were supported to manage their weight and nutritional needs. We saw that people living at Parkville Care Centre were supported to maintain good health.

We saw there were systems and processes in place to protect people from the risk of harm.

We reviewed the systems for the management of medicines and found that people received their medicines safely.

We saw that the provider had a system in place for dealing with people’s concerns and complaints. People we spoke with told us that they knew how to complain and felt confident that staff would respond and take action to support them.

People and the staff we spoke with told us that there were enough staff on duty to meet 61 people who used the service’s needs. They found the staff worked very hard and were always busy supporting people. A nurse, three senior care staff and eleven care staff were on duty during the day. A nurse, three senior care staff and five staff were on duty overnight. The registered manager, deputy manager, clinical lead worked five days a week, We found information about people’s needs had been used to determine that this number of staff could meet people’s needs.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Staff had received a range of training, which covered mandatory courses such as fire safety, infection control, food hygiene as well as condition specific training such as working with people who had diabetes. We found that the staff had the skills and knowledge to provide support to the people who used the service. People and the staff we spoke with told us that there were enough staff on duty to meet people’s needs.

We found that all relevant infection control procedures were followed by the staff at the home.

We found the provider was breaching two of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to adhering to the requirements of the Mental Capacity Act 2005, assessing the performance of the home, maintenance of the building and the records. You can see what action we took at the back of the full version of this report.