This inspection of Pearson Park Care Home took place on 24 July 2018 and was unannounced. Pearson Park Care Home 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.

At the last inspection the provider was in breach of the regulation on safe care and treatment because they had failed to ensure people’s safety from potential hazards. They were in breach of the regulation on person-centred care because they had failed to ensure people’s needs were fully recorded and their needs met to maintain good health. They were also in breach of the regulation on good governance because they had failed to carry out effective audits on the premises and care plans. In addition, there were poor systems in place to maintain the cleanliness of the building.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions on the service being safe, responsive and well-led, to at least good.

Pearson Park Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service accommodates 24 people in one adapted building, some of whom may be living with dementia. There are a mixture of single and shared bedrooms. There were 18 people receiving the service at the time of the inspection.

The provider holds an individual registration and therefore does not require a registered manager in post. Mrs K Crosskey manages the service herself and is referred to throughout the report as the provider/manager. She is a ‘registered person’ in her own right. 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 provider/manager was not available on the day of our inspection and so we were assisted by the administrator and the deputy manager. The deputy manager was training to become a registered manager in the future.

At this inspection we found improvements in the provision of safe care and treatment as work to landscape the rear of the property was complete and the garden was now accessible to people. People’s care plans had been revised and afforded improved accountability with instructions to staff on how to meet their needs and reduce or remove safety risks. Improvements had been made regarding quality assurance system and action plans, but further development of systems would ensure greater effectiveness in further identifying shortfalls and aiding improvement to service delivery. Improvements were found in the cleanliness of the premises since our last inspection and there were systems in place to maintain this.

We found that notifications were made to the CQC, with the exception of approvals for 'deprivation of liberty safeguards' having been missed. This was a breach of the regulation on sending notifications to the CQC, but we are addressing this outside of the inspection process.

Review of the medicine administration systems revealed some very minor shortfalls that had potential to become detrimental to people if not checked.

People were safeguarded from harm and recruitment systems were safe. Care staffing levels were safe. The premises and equipment used was safely maintained.

People’s needs were assessed and staff were suitably trained. People’s needs were met in respect of nutrition and hydration, staff were adhering to mental capacity legislation and the premises were suitably designed for the people living there.

Staff demonstrated a caring approach to people and understood and enabled their preferences and wishes to be met. St

Pearson Park Care Home is registered with the Care Quality Commission (CQC) to provide care and accommodation for 24 older people some of whom may be living with dementia. The accommodation is provided over two floors and a lift is available to access the first floor. There are communal areas for people to use and accommodation is provided in shared and single bedrooms.

This inspection took place on 31 May 2017 and was unannounced. The service was last inspected April 2016, recommendations were made about the safety of the garden area, the use of bed rails, environmental risk assessments, people’s care plans and the quality monitoring of the service. This resulted in the service being rated as requires improvement.

At the time of the inspection 19 people were living at the service.

There was a registered manager in post. A registered manager is a person who has registered with the CQC to manage the service. Like providers, they are ‘registered persons’. Registered persons have a 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 not protected from potential hazards which posed a risk of harm. The garden area was still cordoned off, was in-accessible and contained items of plant machinery, for example, a metal work bench, sewer pipes and a cement mixer which posed a risk of harm to the people who used the service. One person had breached the cordon which the provider had erected and had sustained a fall in the garden area which had resulted in them sustaining a fractured femur.

Areas of the building still required refurbishment and redecoration. For example, bedrooms were in need of repainting and carpets replaced. Some of the rooms were dirty and bed linen was stained. Paper towels and soap were not available for staff or the people who used the service in some rooms and toilets. This exposed people and staff to the unnecessary risk of cross infection.

People’s care plans did not describe the person or their actual needs, for example, one care plan indicated the person was mobile, could eat and drink independently and sometimes displayed behaviour which put themselves and others at risk. However, the provider told us the same person was on bed rest and receiving end of life care and had been since April 2017.

People were not always provided with the level of fluid required to keep them healthy and ensure their wellbeing. For example, one person should have been consuming 1950mls of fluid in a 24 hour period but records showed they only received 450mls. One person’s care plan did not contain information which instructed the staff in how to manage their catheter or how to prevent the risk of cross infection when dealing with the catheter. There was no effective audit, monitoring or quality assurance systems in place which identified shortfall in the service and put in place time limited actions plans to address these. We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The action we have asked the provider to take can be found at the end of this report.

People were cared for by staff who had received training in how to recognise abuse and how to report this to the investigating authorities. Staff had been recruited safely and were provided in enough numbers to meet the needs of the people who used the service. People’s medicines were handled safely by the staff and their training was updated in this area.

People were provided with a wholesome and varied diet which was of their choosing. Staff received training which equipped them to meet the needs of the people who used the service, and were supported gain further qualifications and experience. People who needed help with make informed choices and decision were protected by the use of relevant legislation. People were supported by staff to access health care professionals when needed.

People wer

Pearson Park Care Home is situated within the boundary of the park and is close to local shops, amenities and bus routes into Hull city centre. The service is registered to provide accommodation and personal care for to up to 24 people with a mixture of shared and single occupancy bedrooms. However, the registered provider has made some of the shared bedrooms into single occupancy so the current total of people that can be accommodated is 21; there are 13 bedrooms for single occupancy and four shared bedrooms. Refurbishment is currently underway to change an unused room into two en suite bedrooms.

The registered provider is also the registered manager and will be referred to as the registered provider/manager throughout this inspection report. 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 undertook this unannounced inspection on the 8 April 2016; there were 19 people using the service at the time of the inspection. At the last inspection on 6 and 7 November 2014, we issued a compliance action to ensure the registered provider acted within the principles of the Mental Capacity Act 2005 (MCA). We found at this inspection there had been improvements in the way the registered provider/manager worked within MCA. Most people were able to make their own decisions but assessments of capacity and best interest meetings had taken place to discuss decisions to be made on people’s behalf when they lacked capacity.

We found potential risk areas had not always been identified and recorded. For example, the rear garden area was accessible to people and there were some areas of the garden and the external environment that were potentially unsafe. These had not been included in the environmental risk assessment. Some people had bed rails in place but assessments of need for them and risk assessments had not been completed. We have made a recommendation about these points. There were other areas where the registered provider/manager had identified risk and taken measures to minimise it.

Most people received care tailored to their needs although we found this could be improved in some areas. People had plans of care to guide staff but on occasions these lacked full information about specific issues. We also found the layout of the environment did not take into account the needs of people living with dementia. For example, there was a lack of signage to help people locate their way about the service. We have made a recommendation about this.

We found people’s health needs were met and they had access to community health care professionals when required. We found medicines were managed well and people received them as prescribed. One person received a medicine when required to support with their anxieties and although we saw staff did not administer this very often, the guidance regarding its use was not very clear.

People liked the meals provided to them and they told us they had enough to eat and drink. Staff referred people to dietetic services when they had concerns about their nutritional intake or weight loss. We found the choice of desserts for people with diabetes was limited. This was mentioned to the registered provider/manager to discuss with catering staff.

People told us staff treated them well and were kind and caring. We observed this in practice. We found staff were recruited safely and deployed in sufficient numbers to safely meet people’s current needs. Staff received access to training, supervision and support. We found staff were able to raise concerns with the registered provider/manager.

There were some activities for people to participate in and some people chose not to join in and preferred to ‘do their own thing’. Some peopl

People spoke appreciatively about their experience of the service. Comments included, “They look after you well here,” “The room itself is nice,” and “I do like it here.” Recent survey responses included, “The home is a nice and peaceful place for all residents” and “We are very pleased with what we have seen so far.”

We looked at menus and meals provided for people and their choices. One person told us, “I’ve never bothered with breakfast, that is my choice. The dinners are nice but there is not much variety at teatime.” Another person said, “The food is quite adequate. There is a choice of what to eat if I ask. I get a small portion and I’m quite happy with it. We are asked if we want more.” Vegetarian meals were provided.

People were complimentary about the cleanliness of the service. One person said, “I think the place is clean.” Another person told us, “They are always clean here, and vacuuming up all the time. You see staff with aprons and that on.” Recent survey responses confirmed that people felt the service was clean and well presented.

An annual survey was issued to people who used the service and other stakeholders in January 2013 and we reviewed the responses to this survey, which were positive. Meetings for residents were held regularly in 2013. The manager undertook regular audits of the service so that risks to people's health and safety were managed appropriately.

People told us they were respected, their dignity was upheld and their privacy was maintained. People’s comments included, “They are very good,” and “It’s all very nice.” People and their relatives spoke positively about their care. One person told us, “They still keep their eye on you and if you need something they are there straight away. There is no waiting. We do have an input to the care plan and attend a review meeting.” Relatives told us they had no concerns with care. People spoke positively about the staff that worked with them. One person told us, “I think the staff are brilliant,” and another person said, “The staff are very nice.” A visitor commented, “The staff are really nice with my relative.”

People we spoke with said they felt safe in the service. However, we found that there were not effective systems in place to maintain and monitor cleanliness and risk of infection. A relative we spoke with said, “It is obvious they don’t clean properly.” We also found there were issues with maintenance of the physical environment. Risks to the safe care of people were not identified, monitored or managed appropriately. This may compromise the health and safety of people who used the service.

One person who used this service said that she gets a little bored at times. She said that she does go and sit in the garden and goes for short walks. We spoke to another lady who was able to understand and gave consent to her care. However, the majority of people who used this service had complex needs and were not able to comment on this outcome.

We spoke to one resident who said that the carers were ‘lovely’ and would do anything for you.

We undertook this unannounced inspection on the 6 and 7 November 2014.

Pearson Park Care Home is situated within the boundary of the park and is close to local shops, amenities and bus routes into Hull city centre. The service can provide personal care to up to 24 people, some of whom may have dementia care needs. At the time of the inspection there were 17 people resident in the service. There was a mixture of single and shared bedrooms, a dining room, a sitting room and bathrooms on each floor.

The service has a registered manager who is also the registered provider. 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 the last inspection on 21 August 2014 we asked the registered provider to take action to make improvements to cleanliness and infection control, respecting and involving people who use services, assessing and monitoring the quality of service provision and records. We received an action plan which stated the registered provider would be compliant by 18 October 2014. We saw during our inspection that this action plan had been completed.

Some people who used the service were living with dementia which meant they may be unable to make important decisions for themselves. Staff had consulted with relatives about decisions and made them in their best interest. However, they had not involved other professionals and had not followed legal guidance about assessing people’s capacity to make their own decisions. You can see what action we told the registered provider to take at the back of the full version of the report.

The induction that new members of staff received, could be more thorough so their skills in completing care tasks were checked out. We recommend that the registered manager/provider seek information from Skills for Care regarding the common induction standards (CIS). Skills for Care is an organisation recognised for promoting the skills and competence of staff in the care sector.

There were enough staff to provide care and support to people and we saw staff were recruited safely. Staff completed essential training and also completed more specific training in order for them to feel confident when supporting people.

Staff completed safeguarding training and carried out risk assessments which helped to protect people who used the service and safeguard them from abuse and potential harm.

People had their health needs met and had visits from professionals for advice and treatment. Staff administered medicines in a timely way so that people were not left waiting for their tablets.

Staff approach was seen as caring; they took time to speak to people, they respected privacy and dignity and they involved them in day to day decisions. We saw the care plans could be improved to include more personalised care and to show staff were flexible in their approach when people required specific support.

People told us they enjoyed their meals and, when required, we saw staff assisted people to eat and drink in a sensitive way.

The staff monitored the quality of the service and completed checks of the environment to ensure it remained safe and clean. People’s views were sought in meetings and via questionnaires about the service. This helped to identify shortfalls so they could be addressed.