Our inspection of Allerton Park Care Centre took place on 6 February 2017 and was unannounced. At the previous inspection in August 2015 we had found two breaches of legal requirements regarding dignity and respect and staffing. At this inspection we found improvements had been made to meet these requirements.

Allerton Park Care Centre provides nursing care for up to 50 people including some who are living with dementia and some who have mental health needs. There were 49 people living at the service when we visited. Accommodation is provided in two units over two floors with lift access between the floors. There is a communal lounge and dining room on each unit as well as toilets and bathroom facilities. A central kitchen and laundry are located on the ground floor.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager had tendered their resignation and was due to leave the service. However, a new manager had been appointed who was due to commence employment two weeks after our inspection. On the day of our inspection the registered manager was on leave and the service was supported by the area manager and the provider.

Safeguarding policies and procedures were in place and appropriate referrals made to the local authority and Care Quality Commission. Staff had received safeguarding training, were able to recognise signs of abuse and understood how to report this. Detailed risk assessments and management plans were in place to mitigate risks to people.

Although some areas of the premises looked tired and requiring refreshing and some bedrooms looked more homely than others, a refurbishment plan was in place to address these. Some areas had new flooring and dementia friendly signage with memory boxes in place. However, the service needed to ensure all people had access to personal toiletries in their rooms. Maintenance checks were in place and any maintenance issues addressed.

People's monies were kept safely although transaction management needed to be more robust.

Medicines were managed and administered in a safe manner.

Accidents and incidents were reported effectively and actions taken as a result documented.

Staffing levels were sufficient to support people safely. Staff employed had checks in place to ensure their suitability to care and support vulnerable people and appropriate staff training was up to date. Supervisions and appraisals were in place to ensure staff received support in their roles. Staff told us morale was good and they received good support from the management team.

Evidence of consent and best interest decisions were visible in people's care records and the service was acting within the legal framework of the Mental Capacity Act 2005.

People's health care needs were met and referrals were made to health care professionals appropriately.

People were supported to consume a varied diet and supplements were in place where people were at risk nutritionally. Referrals were made to the dietician where required.

Interactions between staff and people were positive and staff were kind and caring in their manner. We saw staff knew people well and people were happy and relaxed in their presence.

People and/or their relatives were involved in the planning of their care. Advocates were involved where people lacked capacity and did not have any relatives to speak on their behalf.

Plans of care were clear and easy to follow and personalised according to people's needs. However in some cases these required further details of specific needs to increase person centred care planning. Reviews of care records were regular and reflected people's changing needs.

A varied acti

This inspection took place on 5 August 2015 and was unannounced. At the last inspection on 9 and 26 February 2015 we found breaches in regulations which related to person-centred care, safeguarding, dignity and respect, staffing and quality assurance. We took enforcement action and issued four warning notices for the breaches relating to safeguarding, dignity and respect, person-centred care and quality assurance which included timescales for compliance by 8 May 2015. The provider sent us an action plan showing how these improvements would be made. At this inspection we found improvements had been made to meet the relevant requirements.

Allerton Park Care Centre provides nursing care for up to 50 people, including some who are living with dementia and some who have mental health needs. There were 44 people living at the home when we visited. Accommodation is provided in two separate units over two floors with lift access between the floors. There is a communal lounge and dining room on each unit as well as toilets and bathroom facilities. A central kitchen and laundry are located on the ground floor.

The home has a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they felt safe in the home. We found risks were well managed which ensured people were kept safe and any restrictions on their freedom were discussed, agreed and planned as part of their overall care.

Staff had a good understanding of what constituted abuse and the reporting mechanisms. We saw any allegations were dealt with appropriately and were referred to safeguarding apart from one incident. This incident involved bruising to a person suspected to be caused by staff assisting the person to be moved. Although appropriate action had been taken to address the issue, the incident had not been correctly referred to safeguarding.

Staffing levels were sufficient to meet people’s needs and additional resources had been provided to assist the nursing and care staff at mealtimes. We found leadership and direction of staff had improved which resulted in better teamwork and meant there were always staff present in communal areas to assist and support people. Staff induction, training and supervision had improved and staff understood their roles and told us they felt better supported.

Recruitment procedures ensured staff were suitable and safe to work with people. Full recruitment records were not available in the home for one staff member as they were kept at head office. However after speaking with this staff member we were assured that full recruitment checks had been completed. The director told us recruitment records for all staff would be kept in the home in future.

Improvements had been made to the environment such as new flooring and furniture as well as memorabilia to interest people living with dementia such as rummage and memory boxes, photographs and pictures. Communal areas had been rearranged to make it more homely with clusters of seating areas where people could sit together and chat. Staff told us maintenance works were dealt with promptly and we found the home was clean and free of odours.

Staff understood the legal requirements relating to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Authorised DoLS were in place for four people and the provider was complying with the conditions applied to the authorisations.

People were involved in decisions about their care and felt their views were listened to. Staff engaged with people at every opportunity and we observed people were comfortable and relaxed around staff. Care plans had improved and focussed on people’s individual needs. People were able to participate in a wide variety of activities both in and outside the home. People said they enjoyed the food and we saw mealtimes were relaxed and sociable occasions.

Safe systems were in place to manage medicines which ensured people received their medicines when they needed them. People knew how to make a complaint and we saw complaints received were investigated and the outcome fed back to the complainant.

The registered manager and senior management team had worked hard to change the culture of the home and make improvements to the lives of people living in the home. We found the home was well managed with a registered manager who led by example and who staff praised for their leadership and direction. Robust quality assurance systems had been implemented which identified where further improvements were required and were being used to continuously improve practices. The registered manager recognised these improvements need to be sustained and developed further to make sure people consistently receive high quality care.

The inspection visit was carried out by two inspectors, a specialist advisor in mental health and an expert by experience. During the inspection, they spoke with the registered manager, operational manager, quality assurance manager, one of the company directors, three care workers, two team leaders and the nurse on duty. They also spoke with 16 people who lived at the home and three relatives who were regular visitors. The inspectors also looked around the premises, looked at records and observed staff interactions with people who lived at the home in the communal lounges, dining areas, in the courtyard and in people’s bedrooms. There were 45 people living at the home on the day of the visit.

At the last inspections in May 2013 and July 2013 the home was found to be meeting the regulations we looked at.

Before this visit we had received information of concern about people’s care at the home. We looked at these areas during our visit and found no evidence to support this information.

We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five key questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

The service was not safe. People were not protected from abuse and avoidable harm. We identified a number of accidents and incidents involving people who lived at the home which had been recorded by staff and not followed up appropriately. Following our visit we made a safeguarding referral to the local authority so that someone independent of the service could consider the issues. We have asked the provider to make improvements.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines correctly and within the law. We have asked the provider to make improvements.

Following our visit we made a referral to the local Controlled Drugs Accountable Officer so that someone independent of the service could consider the issues we had identified.

People were cared for in an environment that was safe, secure and clean. However, we found parts of the building and premises were not well maintained. Plans were in place for redecoration and refurbishment of the building.

Is the service effective?

Care provided at the home was effective. Peoples’ care, treatment and support achieved good outcomes. However, we found audits carried out at the home were not effective; issues identified were not always followed up.

Care was planned and delivered in a way that ensured people's safety and welfare. There were sufficient numbers of appropriately trained staff to meet peoples’ needs.

People and relatives we spoke with told us they were happy with the care provided at the home and their care needs were being met. From our observations, and from speaking with people, we found staff knew people well and were aware of their needs.

People were protected from the risks of poor nutrition and dehydration and were supported with food and drink. The food served at lunchtime on the day of our visit looked appetising and people were allowed time to eat at their own pace as independently as possible.

Is the service caring?

People who lived at the home were cared for by kind and attentive care workers who treated people with respect. Staff were patient and encouraging when they were supporting people. We heard care workers speaking courteously with people and asking permission before assisting them.

We observed how care staff interacted with people whilst medicines were administered. We observed staff were gentle and patient with people and provided assistance to those who required help. Staff were respectful when they spoke with people and enabled people to take their medicines in an unhurried manner.

We spoke with one relative who visited their family member every day for several hours. This relative did not speak much English, but told us that they came every day because they wanted to spend time with their relative and they were happy with the care provided by staff. The person receiving care could not speak much, but they understood English, so communication with staff was possible. Staff told us they were able to communicate well with this person and their relative.

Most people we spoke with who lived at the home told us they were happy living there. One person said “It’s quite nice here. I like the view from my window.” Another person said “It’s a good place to be. It’s got a nice feel to it.” One of the staff said, “We try to make it homely for them.”

This showed us staff treated people with compassion and kindness. Peoples’ privacy, dignity and independence were generally respected.

Is the service responsive?

The service was responsive. Care and support was generally provided in accordance with peoples’ wishes. We observed interactions between people care workers and people who lived at the home, including people with dementia, that were cheerful, patient, friendly and affectionate. Care workers seemed to know people’s interests, preferences and family histories.

Relatives we spoke with told us they were happy that their family members were living there. One relative said “It’s much better than the last care home X was in. They look after X much better here.”

One person who lived at the home told us the home was “alright, but I don’t want to live here, I want to be more independent. I think this home is more for older people with problems, not for me.”

We found people had limited access to activities and were not always supported to maintain relationships with friends and relatives. We spoke with one person whose wife had been in hospital and was reliant on neighbours to bring her to the home to visit them. They told us they would like to see their wife more and go out more, but they were not allowed out without an escort. They told us, “It’s like being in jail.”

The home did not promote people's wellbeing by taking account of their social and emotional needs and providing meaningful activities. We saw people were able to choose where they spent their day. During our inspection some people were taken out to lunch by the activities co-ordinator. However, we did not see any meaningful activities taking place in the home for the people who did not go out for lunch.

This meant that activities at the home were not organised to meet everyone’s needs.

Is the service well-led?

The service was not well-led. People were not protected against the risks of inappropriate or unsafe care because the provider did not have effective systems to assess and monitor the quality of the service people received; the home was also failing to identify, assess and manage risks to the health, safety and welfare of people who lived at the home.

Staff were not receiving appraisal to monitor their performance and development needs and there was a lack of evidence to demonstrate that the home consulted with people who lived there, relatives and staff. We have asked the provider to make improvements.

We found people’s complaints were not fully investigated and resolved, and there were no systems in place for responding to complaints that were not made in writing. We have asked the provider to make improvements.

The registered manager was a Registered General Nurse who had been in post since 28 October 2013. They had registered with the Care Quality Commission as the home’s registered manager in February 2014.

We found there were appropriate systems in place for recognising and reporting alleged abuse and the staff we spoke with were clear about the expectations placed on them to report any concerns. Staff were clear about the different types of abuse, the signs of abuse and how to report concerns. We also found there was a clear complaints process in place and managers had the main responsibility for investigating and resolving complaints. The complaints process was made clear to the people who used the services.

We found staff were satisfied with the culture of the home and commented how there was an open culture and any concerns they expressed were listened to and acted upon appropriately.

We found the care records we reviewed provided appropriate information which enabled people to provide the necessary care and support for people who used the services. We found people had a varied choice of food, care records in relation to nutrition were completed appropriately and staff supported people as necessary with their food and drink intake.

We found the environment of the home was comfortable for people but there were areas requiring attention; the areas highlighted during the inspection formed part of the current refurbishment programme.

We also found the staff were well supported in terms of supervisions and one-to-one support but formal appraisals were out-of-date. The provider had recognised this and was in the process of introducing a new appraisal system.

We spoke with three people who used the service; one person said they were happy and comfortable at the home. They also enjoyed the food and found staff to be helpful. Another person we spoke with said the food was okay and the third person we spoke with stated they felt safe at the home and they liked living there.

During the inspection we looked at all the communal areas of the home as refurbishment work was underway. We saw the nursing unit lounge layout had been changed to ensure there was enough space for people. People in the lounge were watching the television after lunch when we visited. We noted an activities coordinator had been employed and there was evidence of regular supported activities. We spoke with one person who used the service and their relative. They told us the staff were "very good", the food was "alright" and they were happy with the service.

We looked at the systems the provider had in place to monitor the quality of service. This included health and safety checks; audit and monitoring of care planning and delivery; staff training and competency; staff and resident questionnaires and their involvement in a local improvement programme. We judged the provider had an effective system to regularly assess and monitor the quality of service that people received.

We found the home was making firm moves to improve the environment at Allerton Park Care Home although this was not completed at the time of our inspection.

The care people received had improved. We spoke with two relatives, they told us the ‘’door was always open’’ and that staff were always ‘’ready and willing to listen’’ to them. They also said their relative was really happy and settled in the home and they ‘’could not fault’’ the care they received. They recalled an instance when access to health professionals was required. Staff had noticed a rash and promptly sent their relative to the GP for treatment. The staff had then contacted them to explain the treatment and what it meant for their relative and how staff would support them.

Overall, they felt their relative was safe living at the home and they had never had to complain.

Despite the positive comments people made we found the home lacking monitoring systems for the quality of the care provided.

We used a number of different methods to help us understand the experiences of people using the service because the people using the service had complex needs which meant that they were not able to tell us their experiences. We observed care for six hours over the two units and looked at care records.

We spoke with a relative who told us the staff looked after their relative but they thought that the home was looking shabby. They also said that the staff were nice.

People we spoke with told us they like the staff and they get assistance when they need it. People also said they were satisfied with the care and support they receive.

During the day we spoke with visiting relatives, who told us that they were invited to attend review meetings to discuss people's care and that staff were very good at keeping them informed of any significant changes in people's general health. One person told us “they always tell me what my husband’s been up to and they let me know if he’s not well. I feel I can always talk to the staff if I have any worries”. Another relative who contacted us said they did not feel they were kept up to date and they had to ask staff for information.

Two visitors told us about the relatives meetings, they said they were informative and useful for getting to know other relatives.

People who use the service who we were able to talk to told us that they were happy with the care they receive.

Everyone we talked to was very complimentary about the staff. They said they were caring, helpful and very patient with people.

People told us the food was good, with plenty of choice on the menu. We saw people being offered snacks and drinks throughout the day.

We asked people who use the service and their relatives for their views about the standard of the accommodation and facilities and they told us that it was satisfactory but said some parts of the home would benefit from redecoration.

This inspection took place on 9 and 26 February 2015 and was unannounced. At the last inspection on 2 July 2014 we found three breaches in regulations which related to medicines, complaints and quality assurance. The provider sent us an action plan which told us improvements would be made by 31 December 2014. At this inspection we found some improvements had been made to meet the relevant requirements.

Allerton Park Care Centre provides nursing care for up to 50 people, including some who are living with dementia and some who have mental health needs. There were 46 people living at the home when we visited. Accommodation is provided in two separate units over two floors with lift access between the floors. There is a communal lounge and dining room on each unit as well as toilets and bathroom facilities. A central kitchen and laundry are located on the ground floor.

The home did not have a registered manager. The registered manager left in December 2014 and a new manager has been appointed and they told us they were in the process of applying for registration with the Commission. 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.

Although people told us they felt safe we found people’s safety was compromised. There were not always enough staff to meet people’s needs and systems used to calculate staffing levels were ineffective. People were not kept safe from harm as although staff were trained in safeguarding, allegations of abuse were not always recognised or reported.

Improvements had been made in the way people’s medicines were managed which meant they received them safely and when they needed them. We also found people had access to health care services when they needed them.

Communication systems between staff were poor which meant senior staff were not always aware of what was happening in the home. For example, there were accidents and incidents involving people using the service which the manager did not know about. Chaotic systems meant senior staff were confused about how many people were in the home and which people were subject to Deprivation of Liberty Safeguards (DoLS) authorisations. Quality assurance systems were ineffective and did not support the management of the home in identifying where improvements were needed.

People’s care was not always planned or delivered in a way that met their individual needs and preferences. Some staff training was not up-to-date which put people at risk of unsafe or inappropriate care.

People told us they enjoyed the food, although we found choices were limited and mealtimes were poorly organised. There was a lack of meaningful activities for people and, although one or two people enjoyed trips out in the community, for the majority of people there was little stimulation other than the television.

People spoke positively about the staff who they felt were kind and caring. Yet we saw practices that showed a lack of respect for people and compromised their dignity.

The management of complaints had improved and we saw complaints were being recorded, investigated and responded to.

Overall, although we found some improvements had been made with regard to complaints and the management of medicines, there were significant shortfalls in the care and service provided to people and the home’s internal quality assurance systems had failed to pick these up. We identified seven breaches in regulations and you can see what action we told the provider to take at the back of the full version of the report.