This inspection took place on 14 and 15 February 2017 and was unannounced.

At our last inspection on 13 and 14 January 2016 we rated the service as Requires Improvement. Although the service was compliant with the Health and Social Care Act 2008 (Regulated Activity) Regulations 2014 we did not revise the rating for the service to ‘Good’ as the service had previously been in ‘special measures’. There was a need for the service to be able to demonstrate a longer term track record of consistent good practice.

We found that the registered provider had continued to make improvements to the service in-line with the fundamental standards over the past year. They were able to demonstrate to us at this inspection that sustained improvements had been made and this is reflected in the overall rating of 'Good', which has now been achieved.

South Park Care Home is a purpose built service registered to provide nursing care for older people. There are two separate units or ‘households’ as the service prefers to call them. Ebor accommodates up to 44 people with mental health and/or dementia care needs on two floors. Jorvik accommodates up to 36 people with general nursing needs over three floors. The service is situated in a residential area to the west of the city centre, and on a bus route to the city. There are parking facilities on site and local shops and other amenities close by.

At the time of this inspection there were 59 people using the service, 37 on Ebor and 22 on Jorvik.

People told us they felt safe and were well cared for. The registered provider followed robust recruitment checks, to employ suitable people. There were sufficient staff employed to assist people in a timely way. People’s medicines were managed safely.

People that used the service were supported by qualified and competent staff that were regularly supervised and received appraisal regarding their personal performance. Communication was effective, people’s mental capacity was appropriately assessed and their rights were protected.

People had their health and social care needs assessed and plans of care were developed to guide staff in how to support people. The plans of care were individualised to include people's preferences, likes and dislikes. People who used the service received additional care and treatment from health professionals based in the community. People had risk assessments in their care files to help minimise risks whilst still supporting people to make choices and decisions.

Staff were knowledgeable about people’s individual care needs and care plans were person centred and detailed. There was a range of social activities available and people’s spiritual needs were met through in-house services and one-to-one pastoral care when requested.

People told us that the service was well managed and organised. The registered manager assessed and monitored the quality of care provided to people. People and staff were asked for their views and their suggestions were used to continuously improve the service.

This inspection was unannounced and took place on the 13 and 14 January 2016.

The last inspection took place on 13 and 14 August 2015. At that inspection we asked the registered provider to take action to make improvements to Regulation 18: Staffing; Regulation 12: Safe care and treatment; Regulation 14: Meeting nutritional and hydration needs; Regulation 9: Person centred care; Regulation 15: Premises and Equipment; Regulation 17: Good Governance. These actions have now been completed. After the comprehensive inspection on 13 and 14 August 2015 the registered provider wrote to us to say what they would do to meet the legal requirement in relation to the breaches of regulation.

South Park Care Home is a purpose built home registered to provide nursing care for older people. There are two separate units. Ebor unit accommodates up to 44 people with mental health and/or dementia care needs on two floors. Jorvik unit accommodates up to 36 people with general nursing needs. Jorvik unit has three floors, with most of the communal areas on the ground floor. The unit does have an additional communal lounge on the third floor.

The two units have their own staff teams and each has a ‘Head of Unit’, responsible for the day to day running of the unit. There are lifts on each unit. People living downstairs on Ebor unit have access to a safe garden area. People living upstairs on Ebor unit typically require more personal care and support than those living downstairs. The service is situated in a residential area to the west of York city centre and on a bus route to the city. There are parking facilities on site and local shops and other amenities close by.

At the time of this inspection there were a total of 48 people using the service. On Ebor unit there were 31 people with mental health conditions and/or dementia care needs and Jorvik unit supported 17 people with general nursing needs. At the time of this inspection there was refurbishment work on-going on Jorvik unit so the top floor had been closed and people had moved down into accommodation on the first floor of the unit.

There has not been a registered manager at this service since December 2013. A new manager was appointed in November 2015 and they submitted an application to register with the Care Quality Commission in December 2015. 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 told us that they felt safe living at the home. We found that staff had a good knowledge of how to keep people safe from harm and staff had been employed following robust recruitment and selection processes.

Improvements had been made to the number of staff employed in the service. Recruitment was on-going to ensure enough staff were employed to meet the needs of people who used the service. Sufficient permanent staff had been recruited since our last inspection to ensure the use of agency staff had been reduced to a minimum. Staff did not appear rushed on the two days of our inspection and there was a good atmosphere in the service.

Improvements had been made to the medicine practices in the service. Medicines were administered safely by staff and the arrangements for ordering, storage, administration and recording were robust. However, we did note that the nursing staff continued to be interrupted by other staff and visiting professionals during the medicine rounds.

Improvements were made to the control and prevention of infections systems within the service and we found the service to be clean and hygienic. The registered provider had introduced mattress audits, steam cleaning of furniture, plastic tubing on light cords, purchased new quilts and pillows and new bed linen as some of the activities

This inspection was carried out in order to review compliance actions and warning notices made following the previous inspection completed on 17 July 2013. The provider submitted an action plan and allocated a temporary manager to manage the home and implement improvements. We found during this inspection that improvements had been made and these were having a positive impact for the people living and working at the home.

We spoke to people who use the service and their relatives. Comments included: “They are very kind to me and we often have a good laugh.”, “These carers are smashing!” And “It has got better as they have a new manager now.”

People were involved in making decisions about how their care and support was delivered and where people lacked capacity their rights were respected and the provider acted in accordance with legal requirements.

People had care plans and risk assessments in place which helped staff to understand and meet people's needs.

People were provided with a choice of suitable and nutritious food and drink.

The provider had clear systems in place for supporting people with medication and staff were trained in the safe handling of medicines.

There were sufficient care staff available for the number of people living at the home. We saw people being assisted promptly and staff had time to spend with people.

The provider had an effective system in place to regularly assess and monitor the quality of service that people received.

People were supported to make decisions and choices regarding their care and treatment. They told us that they were treated with dignity and respect. One person said “I can more or less do as I please. The staff help me when I need it and I am fairly well cared for." Another said “The staff ask me about the care I want. They never do anything I am not happy with, they really look after us all very well."

People said they were well cared for and liked living at the home. One person said "I am warm and comfortable. If I need the doctor the staff sort it out for me. I have no health worries; I am very well at the moment."

The home had systems in place to help safeguard people and people told us they felt safe. All of the people we spoke to said that they felt able to talk to the staff about anything that concerned them.

Some areas of the home were shabby and in need of refurbishment. The manager confirmed that some refurbishment work is planned for the New Year. This included to improve and extend the communal living space in the ground floor dementia care unit. Some bedrooms were also going to be refurbished and redecorated.

Staff told us they received regular training to help keep their knowledge and skills up to date. They also told us that supervision was now being provided for them on a more regular basis.

All of the people we spoke with said that they would feel confident in raising any concerns. They told us that staff were friendly and approachable.

We made our first visit to this service after receiving some information of concern about the poor quality and quantity of meals served at the service and that insufficient food had been ordered to cover the Christmas period. We were also told that insufficient care staff had been rostered to work over the same Christmas period.

At subsequent visits in January and March we looked at the outstanding compliance actions made following our visits to the service in August and October 2011. We had to visit South Park more than once because circumstances at the home meant we could not access all the parts of the service that we wanted to on our first visit.

We were unable to talk with many of the people living there because of their physical or mental frailty. However we observed that people looked generally well cared for. People’s personal care needs had been attended to and staff were a visible presence in the different units.

One person on the nursing unit told us that they generally received good care, in line with what they wanted. They thought the care staff were competent and confirmed their room was cleaned every day. We activated the call bell and this was answered within two minutes. The person told us they thought this was “About average.”

Another person told us they had no complaints about the meals they received and thought the quality and quantity was right for them.

We had received some information from an anonymous source, who told us that the home was dirty and short staffed. We had recently inspected the home and made some compliance actions in other outcome areas. At this inspection we did not assess compliance with these outcomes, we only inspected the outcomes raised with us from the anonymous source.

We looked around the home, including some people's bedrooms and some communal areas. We talked generally to people who live at South Park Care Home about the care and support they received. One person said "it's nice here" . Another said " I suppose it's okay".

We also spoke with staff who work at the home. They said that the staff morale was low that they were tired of not having a full compliment of staff on duty. One member of staff said "It's constant, we all work hard non stop, there just isn't enough of us to go around, we are all sick of certain people not turning in for a shift".

Our inspection concentrated on the Ebor unit, which is for people with mental health and /or dementia needs. We spent most of our time on this unit because many of the people living on Ebor are unable to express their views easily. So we spent time observing staff interacting with and supporting people and talking to people’s relatives.

Peoples relatives generally told us they were “satisfied” with the care, and it was as “good as it gets” at South Park and that they had “confidence” in most of the staff and found they generally had an “absolutely lovely attitude”. One relative explained how a person “face lights up when they sees the senior carer if on duty”. However relatives did say the care and attitude differed and depended upon which member of staff it was.

We saw when people interacted with staff they smiled and appeared comfortable. Staff were observed approaching people in a friendly manner and spoke with people in a way which showed they understood their care needs.

Staff told us there was generally enough staff but would be able to spend more time with people carrying out activities if there was “just one more”. Relatives also told us sometimes they do have to wait a while for help. We also observed there were only very limited activities during our visit and often the staff would only talk to people when they were carrying out a personal care task.

South Park Care Home is a purpose built home registered to provide nursing care for older people. There are two separate units. Ebor accommodates up to 44 people with mental health and / or dementia care needs on two floors. Jorvik accommodates up to 36 people with general nursing needs. Jorvik has three floors, with most of the communal areas on the ground floor. The unit though does have an additional communal lounge on the third floor.

The two units have their own staff teams and each has a ‘Head of Unit’, responsible for the day to day running of the unit. There are lifts on each unit. People living downstairs on Ebor have access to a safe garden area. People living upstairs on Ebor mostly require more personal care and support than those living downstairs. The service is situated in a residential area to the west of the city centre, and on a bus route to the city. There are parking facilities on site and local shops and other amenities close by.

At the time of this inspection there was a total of 57 people using the service. On Ebor there were 34 people with mental health conditions and / or dementia care needs and Jorvik supported 23 people with general nursing needs. We were told by the deputy manager that there was no one on end of life care so we did not look at this during the inspection.

This inspection was unannounced and took place on the 13 and 14 August 2015.

The last inspection took place on 3 and 4 December 2014. At that inspection we found the registered provider was breaching three of the essential standards of quality and safety (the regulations) relating to The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

In April 2015 the legislation changed and the above breaches now correspond to Regulation 11, 17 and 19 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3) including Need for consent; Good Governance and Fit and proper persons employed.

This inspection showed that the provider had met two of the three breaches of regulation, but a further six breaches of regulation were found. You can what action we told the registered provider to take at the back of the full version of this report.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

There has not been a registered manager at this service since December 2013. A new manager was appointed in January 2015, but they have yet to submit an acceptable application to register with the Care Quality Commission. This has been discussed with the registered provider’s regional management team at 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.

The service was not safe. There were insufficient numbers of suitably qualified, skilled and experienced persons employed in the service to meet people’s needs. The registered provider had employed a number of agency staff to fill the staff vacancies, but people who used the service said they did not feel safe when these workers were on duty and we observed some unsafe care practices during our inspection.

The registered provider failed to protect people who used the service against the risks associated with the unsafe use and management of medicines. We saw evidence of unsafe handling of medicines when staff left trolleys unattended with the doors unlocked or medicines left on top of them.

We found problems with the cleanliness and hygiene within the service. In particular there was a significant and unpleasant odour in three bedrooms, two sluices and a number of bathing facilities on both units.

We had a number of concerns about the skills and knowledge of the staff on duty. The registered provider had an induction and training programme in place, but we found little evidence that care staff were supervised appropriately. The care staff told us the online training programmes were difficult to access and use and that they lacked the time to complete the e-learning sessions. People and relatives who spoke with us expressed worry about the competency of some of the care staff and we witnessed examples of poor care during our inspection which were brought to the attention of the management team.

We saw that the premises had not been made safe in all areas of the service. We found that bathrooms and shower rooms were being used as storage facilities for equipment whilst people were still using the areas for bathing or toilet needs. We saw the service was untidy and cluttered with boxes and miscellaneous items stored in corridors, dining rooms and in every available space. This created trip and fall hazards to people using the service.

Observations of the dining rooms and bedrooms on both units in the home showed that some people had a very good dining experience and others did not. We saw that a number of very dependent people were unable to access drinks and others were left struggling to eat their meals when they needed full assistance. Staff were very task orientated, although we did see them being kind and patient with people.

People, relatives and staff told us that communication within the home was poor. People and relatives were not involved in the planning and delivery of care and treatment within the service and they felt their opinions were not listened to by the staff. We were told that sometimes there were delays in obtaining personal and health care within the service. We found that people’s care plans and risk assessments did not always represent their needs or ensure staff had the information to help meet people’s needs. Staff had made efforts to offer people choice, but people were not enabled to be fully independent in their actions or decisions.

People were not consistently treated the way they wanted to be treated. People told us the staff were kind and did their best to see to everyone, but were too busy to spend time with them other than when carrying out care tasks. We observed people calling out for attention and being ignored by some staff and others received less than acceptable standards of care. We saw that one or two staff knew people using the service well and were polite and friendly when speaking to them. However, the staff were so busy there was little time for them to engage in casual greetings or day to day banter. People’s privacy and dignity was not always respected.

We found evidence of poor record keeping during the inspection. Care plans were difficult for staff to read and complete and staff had not been keeping the kitchen cleaning and temperature records up to date which resulted in a poor star rating from environmental health. Archived records were not being kept appropriately as the cupboard they were stored in was left open and used to keep items of unwanted equipment in.

We found that the quality monitoring system was ineffective and had not been used to ensure the safety of people who used the service and staff. The registered provider had introduced a new electronic system called TRACA, but we found that this had not been utilised appropriately by the home manager. During this inspection we have found breaches of regulation with regard to staffing, medicines, infection control, staff training and supervision, nutrition, health, premises safety, personal care, privacy and dignity, care assessment and planning, quality assurance, notifications and record keeping.