Care at Parkside

Care at Parkside is a residential care home providing accommodation and personal care for up to 24 people. The service is based in Oldham. At the time of our inspection there were 15 people living at the home.

People’s experience of using this service and what we found

We found improvements were needed in the documentation used for the administration of medicines and in the governance of the service. Although audits and checks were completed regularly, some were not effective and action had not always been taken when problems were identified.

On the whole, feedback from relatives about the home was positive. Staff had received training in safeguarding and knew how to identify and report any concerns. There were enough staff to meet people's needs and keep them safe. The home was clean and nicely decorated and good infection control practices were followed. Equipment was regularly checked and serviced in line with guidance. However, no action had been taken when bathroom water temperatures were found to be too high. This concern was rectified after our inspection.

Care records were person-centred and described people’s likes and dislikes and how they wished to be supported. People were encouraged to take part in activities. There had been an improvement in the way participation in activities was recorded in people’s care records.

Since our last inspection there had been a change to the management structure of the service, with the owner taking on the additional responsibility of managing the home on a day to day basis. They were in the process of registering with the CQC to become the registered manager.

Staff, people who used the service and relatives were encouraged to provide feedback about the home and the care and support provided. This was used to drive forward change. On the whole relatives felt they were kept informed and communication was good, although one person we spoke with felt this could be improved.

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

Rating at last inspection and update

At our last inspection (report published 30 October 2020) we did not rate the service. However, we identified a breach of regulation 17 (good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

At the last inspection that we provided a rating (report published 20 July 2019) this service was rated requires improvement.

Why we inspected

We undertook this focussed inspection to follow up on enforcement action we took following our last inspection and to confirm the service now met legal requirements. This report only covers our findings in relation to the key questions of Safe, Responsive and Well-Led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Care at Parkside on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

At this inspection we have identified a breach in relation to the governance of the service. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Care at Parkside is a residential care home providing accommodation and personal care for up to 24 people. At the time of our inspection there were 16 people living at the home.

People’s experience of using this service and what we found

Improvements were needed in the governance of the service to ensure the premises were properly maintained. Checks and audits had not picked up the concerns we found during our inspection. Oversight of the service has been found to be poor on five different Care Quality Commission (CQC) inspections over the last six years.

Improvements were needed in the maintenance and decoration of the building. Some areas of the home were poorly maintained and dirty. Staff did not always wear personal protective equipment (PPE) in line with current government guidance.

People told us they were happy living at Care at Parkside and with the care provided by staff, who knew them well. Staff understood safeguarding procedures. Risks to people's health had been assessed and were well managed. There were sufficient numbers of staff on duty to provide care promptly. The necessary employment checks had been completed, to ensure new staff were suitable to work with vulnerable people. Since our last inspection there had been an improvement in the management of medicines and this was now carried out safely.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People had care plans and risk assessments in place and these had been regularly reviewed. The provision of meaningful activities was poor. People told us they did not have enough to do or to occupy themselves. We have made a recommendation about the provision of activities.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 23 September 2021).

At this inspection we found the provider remained in breach of regulations. The service remains rated requires improvement.

Why we inspected

We undertook this inspection to check whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained requires improvement. This is based on the findings at this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Care at Parkside on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the Safe, Responsive and Well-led sections of this full report.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the maintenance and governance of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Care at Parkside is a residential care home providing personal care to 15 people aged 65 and over at the time of the inspection. The service can support up to 24 people.

People’s experience of using this service and what we found

The provider had made improvement in medicine processes. However, improvement was required with medicine records. Medicine care plans were sparse and lacked detail. Best practice guidance for medicines was not always followed.

Staff had an understanding in infection control and had completed the relevant training. The home had increased infection control practises and implemented risk assessments during the COVID-19 pandemic, however not all areas of best practice were considered. We have made a recommendation about the provider implementing best practices in infection prevention and control.

We saw activities taking place and information about people's interests had been gathered as part of the assessment process. However, the information was not always used to develop or inform meaningful activities or opportunities for people. Documentation in relation to activity planning and recording was poor.

Quality monitoring systems were not always robust. Audit systems had not picked up on the discrepancies found during the inspection. Daily recording processes were not effective.

The provider had appointed a new manager who intended to register with the CQC. The manager had started to implement some changes to systems and processes; however the new systems had not yet embedded to make a positive impact.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 22 July 2019) and there was a breach of regulation 12. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We undertook this targeted inspection to follow up on specific concerns identified at the previous inspection; in respect of medicines, activities and records. A decision was made for us to inspect and examine those risks.

CQC have introduced targeted inspections to follow up on Requirement Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a new breach in relation to governance systems and records.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Care at Parkside is a residential care home providing personal care for up to 24 people. At the time of our inspection there were 14 people living at the home.

People’s experience of using this service and what we found:

We found continued problems with the management of medicines. This was not always carried out safely. There were systems in place to ensure only staff who were suitable to work with vulnerable people were recruited. There were enough staff to provide the appropriate level of support to people.

Some recent refurbishment, including the laying of new flooring, had been completed. The communal areas were nicely decorated. Infection control practices had improved. Regular checks had been completed to ensure the safety of equipment and the premises.

Staff received the training, support and supervision they needed to carry out their roles effectively. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Risk assessments had been completed. These helped identify if people were at risk from everyday harms, such as falls or poor nutrition. Care plans contained enough information to guide staff with how peopled wished to be supported.

People were supported to eat a well-balanced diet and were offered a choice of meals. People told us they were happy with the staff.

People were not provided with enough opportunities to take part in activities to occupy their time and provide enjoyment and stimulation. We have made a recommendation about the provision of meaningful activities.

Since our last inspection the management and oversight of the home had improved. The registered manager had a clearer understanding of her managerial role and responsibilities.

Rating at last inspection:

At the last inspection the service was rated inadequate (report published 18 December 2018).

This was a planned inspection based on the rating at the last inspection. At the last inspection, the provider was in breach of regulations 12, 17 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements had been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

However, we have identified a continued breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This is in relation to the safe management of medicines.

Please see the action we have asked the provider to take at the end of this report.

Follow up:

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

The home is situated approximately one mile from the centre of Oldham. It is a large detached property which has been extended to the rear and provides accommodation over two floors. It has a garden to the front and rear of the property and a small car park.

This was an unannounced inspection which took place on 7, 8 and 9 November 2018. The CQC has previously inspected Care at Parkside twice; in August 2016 and February 2018. Both times it has been rated as Requires Improvement, overall.

The service has a history of non-compliance with meeting the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. At our inspection in August 2016 we found breaches of three regulations relating to training, risk assessments, care plans and governance of the service. The provider was issued with requirement notices and asked to complete an action plan telling us how they would make improvements.

We next inspected the home in February 2018. At that inspection, although we found there had been an improvement in the training the service provided to staff, we again found concerns relating to risk assessments, care plans and the governance of the service. In addition, we found concerns relating to fire safety, maintenance of the premises, infection control and medicines management. This meant the service was in breach of regulations 12, 15 and 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014. We issued warning notices for breaches of regulations 12 and 17 and a requirement notice for the breach of regulation 15. The provider completed an action plan to show how they intended to improve the service.

At this inspection we found improvements had been made in some of these areas. However, we identified shortfalls in the management of medicines, recruitment practices, the management of risk, infection control and governance. The service remains in breach of regulations 12 and 17 of the Health and Social Care Act (2008) Regulated Activities 2014. We have also identified a breach of regulation 19 of the Health and Social Care Act (2008) Regulated Activities 2014. This is because of poor recruitment practices.

We have made three recommendations. These are that the service seeks further guidance around the assessment and documentation of mental capacity and best interest decisions and that they ensure there is a suitable qualified member of staff to carry out moving and handling training and assessments. We have also recommended the service seek further guidance around equality and human rights.

Over the three inspections the CQC has carried out at this service, we have found repeated breaches of the regulations. The provider has failed to maintain and improve the standard of care at the service.

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 act in line with our enforcement procedures to begin the process of preventing the provider from operating this 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 continue to 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 act 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.

Following this inspection, we met with the provider to discuss the steps they intend to take to improve the service. We have received assurance that some of the concerns we identified have been addressed and we will review these at our next inspection. However, further improvement is needed at this service.

At our last inspection in February 2018 the service did not have a registered manager. Since then the former deputy manager of the home has become the 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At this inspection we found that safe recruitment practices were not always followed. Two staff had been employed without any references.

Medicines were not always managed safely. During our inspection we identified an error in the documentation used for the administration of a controlled drug. Although no harm came to the person, staff had failed to follow the correct administration procedure. Protocols to guide staff on how to administer ‘when required’ medicines were not being used.

Risks to people’s health and safety had not always been identified. One person who had been at the home for two weeks did not have any risk assessments in place, for mobility or falls. This person was frail and struggled to walk without help. No risk assessment had been completed before flooring contractors started work in the building. On two occasions we found tools and equipment were accessible to people living at the home. This put their safety at risk.

Since our last inspection there had been some redecoration of bedrooms and new flooring was being laid throughout the communal areas. The lounges and dining rooms were nicely decorated and furniture was a decent quality. However, further redecoration is needed to improve the condition of the downstairs bathroom. Infection prevention and control measures had improved since our last inspection. However, we observed one care assistant undertaking medicines administration without first washing their hands.

Checks and servicing of equipment, such as for the gas, electricity and fire-fighting equipment were up-to-date. However, we found regular maintenance checks to prevent legionella were not being carried out.

There were systems in place to help safeguard people from abuse. Staff understood how to identify signs of abuse and what action to take to protect people in their care. At the time of our inspection there were sufficient staff to support people. However, the registered manager did not have any time allocated specifically for managerial work, as they were usually counted as part of the care team. We found the home was poorly managed.

Staff had undergone training to ensure they had the knowledge and skills to support people safely. All staff received regular supervision. This ensured the standard of their work was monitored and gave them the opportunity to raise any concerns.

Deprivation of Liberty Safeguards (DoLS) were in place where necessary. Staff sought consent from people before helping them with their care needs and people were helped to make choices about everyday routines, such as what to wear and what to eat. However, care records did not always contain information to show people had been involved with planning and reviewing their care where they had capacity to do so. When they lacked capacity, it was not always recorded who was involved with helping them make important decisions.

We received positive comments from people about the staff and about the care provided at the home. Staff supported people to take part in some activities. People were supported to eat a well-balanced diet and were offered a choice of meals. Staff worked with health and social care professionals, such as district nurses, to ensure people maintained good health.

We found a continued problem with the lack of detail and accuracy in some care records. This meant staff did not have the correct information about how they should support people.

The service had a process for handling complaints and concerns. No complaints had been received since our last inspection. The registered manager told us she dealt with any minor concerns when they happened to prevent them from escalating.

Very few quality monitoring checks had been completed since our last inspection, despite the service having an audit schedule, and we found there was a lack of oversight of the service. After our last inspection in February 2018 the provider submitted an action plan telling us how they would make improvements to the service. Although the action plan was completed, we found at this inspection that some of the improvements have not been sustained and we have identified further concerns about the service and how it is managed.

Care at Parkside is a care home that provides 24-hour residential care for up to 24 people. At the time of our inspection there were 18 people living at the 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.

The home is situated approximately one mile from the centre of Oldham. It is a large detached building which has been extended to the rear of the property and provides accommodation over two floors. It has a garden to the front and rear of the property and a small car park.

This was an unannounced inspection which took place on 6 and 7 February 2018. We last inspected the service in October 2016. At that inspection we rated the service ‘Requires Improvement’ overall. We identified two regulatory breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. These were in relation to risk assessments, poor staff induction and lack of nutritional and diabetes care plans.

At this inspection we found that staff now received an adequate induction programme. However, we found that improvements had not been made in the other areas, as we again identified concerns in relation to risk assessments and lack of up-to-date nutritional and diabetes care plans. At this inspection we also identified concerns in relation to medicines, infection control, maintenance of the premises and fire safety. This meant there was a continued breach Regulations 12 and 17 of the Health and Social Care Act (2008) Regulated Activities 2014 and a breach of Regulation 15 of the Health and Social Care Act (2008) Regulated Activities 2014. Where regulations have been breached information regarding these breaches is at the back of this report. Where we have identified a breach of regulation which is more serious we will make sure action is taken. We will report on this when it is complete. Where providers are not meeting the fundamental standards we have a range of enforcement powers we can use to protect the health, safety and welfare of people who use this service. When we propose to take enforcement action our decision is open to challenge by the provider through a variety of internal and external appeal processes. We will publish a further report on any action we take.

We have made one recommendation. This is in relation to the accurate documentation of people’s food intake.

The service did not have 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The previous registered manager had left the service in February 2017. The deputy manager had recently started the process of applying to become the registered manager. We are dealing with this matter outside of the inspection process.

There were systems in place to help safeguard people from abuse. Recruitment checks had been carried out to ensure staff were suitable to work in a care setting with vulnerable people. At the time of our inspection, although there were sufficient staff to respond to people’s needs during the day, we found there were occasions when no staff trained in medicines administration were available during the night.

We found concerns around fire safety. Following our inspection we referred the service to Great Manchester Fire and Rescue Service, who carried out their own inspection of the property.

Although the communal areas were clean and the furnishings and decoration were in good condition, we found some areas, such as the bathroom and downstairs toilet, and some bedrooms, where maintenance and cleaning was needed. Infection prevention and control measures were not fully implemented in order to protect people from the risk of infection. Checks on services and equipment were not all up-to-date.

Medicines were stored safely. We found that some medicines administration records did not have photographs of the person. These can help minimise the possibility of a medicines administration error. Medicines records did not contain information to guide staff when administering ‘when required’ medicines. This could increase the risk that such medicines were not administered in response to a person’s need for them.

Although some risk assessments were in place, we found that some people did not have risk assessments for specific risks, such as for smoking or for the use of oxygen. This meant the service had not considered measures that might be needed to keep people safe in these circumstances.

New staff received an induction and staff received regular training and supervision. This ensured they had the skills and training to carry out their roles.

Staff encouraged people to make choices where they were able. The service was working within the principles of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS).

We received a mixed response when we asked people about the quality of food. However, we found there was a choice of food on offer. People had their weight monitored regularly.

People had care and support plans in place to guide staff on the care people required. However, we found some people lacked care plans for specific conditions, such as for diabetes and for the use of oxygen. This meant there was no guidance available for staff on these matters.

There were some quality assurance processes in place, such as annual, biannual and monthly audits. However, these had failed to identify the concerns we found at this inspection.

The service had failed to notify the Care Quality Commission (CQC) about DoLS which had been authorised and a police incident. This is a requirement of their registration with the CQC. We are dealing with this matter outside of the inspection process.

The home had failed to display the rating from our previous inspection so that it was visible to the public. We are dealing with this matter outside of the inspection process.

We previously inspected Care at Parkside on 27 June 2014, at which time the service was compliant with all regulatory standards.

Care at Parkside is a residential home in Oldham providing accommodation and personal care for up to 24 older people. There were 19 people using the service at the time of our inspection.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like directors, 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 there were sufficient numbers of staff on duty in order to meet the needs of people using the service, as well as to ensure premises were clean and well maintained. The registered manager had recently employed a domestic assistant to maintain cleanliness.

People who used the service, their relatives and a range of external professionals all expressed confidence in the ability of staff to protect people from harm. Staff we spoke with displayed an understanding of safeguarding principles and how to look out for signs of abuse.

We saw there were pre-employment checks of staff in place, including Disclosure and Barring Service checks, references and identity checks, which helped to reduce the risk of unsuitable people working with people who may be vulnerable.

Risks people faced were not always well documented and people with diabetes did not have specific care plans in place to minimise the risks they faced.

The storage, administration and disposal of medicines was safe and in line with guidance issued by the National Institute for Health and Clinical Excellence (NICE).

We found all communal areas of the building to be clean, although areas such as the first floor w/c and people’s bedrooms were in need of further refurbishment and redecoration.

Visiting professionals had confidence in the experience and knowledge of staff and told us they liaised well with them. There was regular liaison with GPs, chiropody, nurses and specialists to ensure people received the treatment they needed.

Staff were trained in a range of mandatory topics such as manual handling, safeguarding, fire safety, health and safety and infection control but had not been trained to meet people’s specific needs, for example in dementia care.

We saw people had choices at each meal although people with diabetes did not have specific nutritional plans in place that care staff were aware of.

Group activities were planned via a weekly activities chart but we found more could be done to ensure people’s individual histories, likes and preferences contributed to activity planning. The registered manager showed us work they had started to identify people's preferences and committed to continue this work and incorporate into activity planning.

We checked whether the service was working within the principles of the Mental Capacity Act 2005 (MCA). The registered manager displayed a good understanding of capacity and we found related assessments and decisions had been properly taken and the provider had followed the requirements in the Deprivation of Liberty Safeguards (DoLS).

The atmosphere at the home was welcoming, relaxed and homely. People who used the service, relatives and external stakeholders told us staff were familiar to them, caring and kind and we saw numerous instances of warm interactions.

Staff, people who used the service, relatives and external professionals we spoke with knew the registered manager and spoke positively about their approachability, flexibility and knowledge of people who used the service.

Quality assurance and auditing systems were not effective and meant concerns were not always identified, nor were opportunities to share good practice.

We found the service to be in breach of two of the regulations. You can read more about the action we told the provider to take at the back of the full version of the report.

It is a legal requirement that a manger is registered with us for this service. Registration ensures a manger shares legal accountability for the service with the service provider. At the time of our visit to Care at Parkside the manager was not registered with us. However, their application to us for registration was being progressed.

The inspection was undertaken by one inspector. This summary addresses five key questions: is the service safe; is the service effective; is the service caring; is the service responsive and is the service well led?

This summary is based on a visit to the home where we spoke to the senior member of staff on duty and observed staff interactions with people using the service. We looked at records and talked in private with two people using the service and four members of staff.

The full report contains the evidence to support this summary.

Is the service safe?

All the people who used the service and staff who we spoke with said that they believed people living at the home were safe. Staff training included safeguarding. Staff who we asked understood the need to be vigilant about the possibility of poor practice. They told us they would whistle blow if necessary. One member of staff said 'I wouldn't be doing my job' if they were not prepared to 'blow the whistle'.

One person who was using the service said 'I've not seen anyone treated as I wouldn't want to be treated'.

Staff had access to training and support which would help to enable them to provide care in a way which was safe both for them and the people who used the service.

Quality audits included issues relating to health and safety in the building and aspects of infection control. Staff were trained in good hand washing which would help to minimise the risk of people acquiring infections.

Is the service effective?

People who used the service had their needs assessed. The assessment included assessments of potential risks posed by the behaviour or abilities of the Individual. A care plan was developed on the basis of the assessments. People who used the service could influence the way in which care and support was provided to them.

Care plans were regularly reviewed to help ensure the information and instructions to staff were up to date. Staff told us that communication within the home was good.

Feedback received by the home from people who used the service and their relatives indicated a good level of satisfaction with the quality of the service provided.

Is the service caring?

Observations of interactions between staff and people using the service indicated a warm and caring atmosphere. Several staff mentioned to us that they could 'simply' sit and chat to people. One member of staff, when asked what the best thing about the home said 'the residents, it's a good place'.

During our visits to the home there were no visitors for us to talk with. However we did see 'comment cards' which had been completed by visitors in 2014. All the comments we saw were positive. One person had written 'Whilst my Aunt was at Parkside I was happy to leave her when I went home as I knew she was in safe, caring hands'.

People using the service who we asked, were positive about the care provided. One person said '[staff are] very kind and thoughtful' and 'they listen to you, nothing is too much trouble'. This person, when asked what the best thing about the home was, replied 'They [staff] make you feel at home. They sit and talk to you.' Another person said 'You can talk to staff about your care needs ' they don't embarrass you and don't do it like they are doing you a favour, they are just helpful.'

Is the service responsive?

Staff told us that people who used the service were listened to and could influence the way in which care was provided. This was confirmed by people who were using the service who we asked.

Meetings are arranged for families and residents and for staff. We were told these meetings are for people to air their views. Staff and people who used the service told us they believed they were listened to by members of the management team.

There was a number of quality monitoring processes. The service provider told us they used information from the quality monitoring to help identify any areas where the service needed to improve.

People who used the service and staff told us that they believed any complaints would be listened to and dealt with.

Is the service well led?

The owners (service provider) were frequent visitors to the home. There were some areas where greater clarity about administrative processes such as the frequency of quality audits could strengthen the service's ability to demonstrate good leadership.

The manager was not registered with us at the time of this inspection visit. However staff described the manager as approachable and fair. They were also described as someone who 'would not tolerate poor practice'.

Staff told us they felt supported by the manager who had clear expectations of them. One staff member told us the manager was 'a good leader' who 'helps the staff' and always had time for them.

At this inspection, we found improvements had been made in all the areas of concern previously identified.

We spoke with seven people living in the home and a visiting health care professional. All praised the quality of care and the staff. People said 'I can't fault this place', 'Staff always speak to me respectfully' and 'The home is run really well'.

We saw evidence that people who received services were involved in day to day decisions about how their care was provided. People's care records provided evidence that they received an assessment of their care needs before admission to the home. We saw that people's health care needs were monitored and the appropriate health care professionals involved as needed. Medication practices were safe.

We saw that staff files provided evidence recruitment procedures were robust. We saw that checks on the quality of the service were carried. People and visitors were asked for their views of the service they received. We saw evidence that people were listened to.