People’s experience of using this service:

The provider had made many improvements to the home since our last inspection and we have recognised these and have reflected them within the report There was a new registered manager who ensure we received notifications and that the last rating was displayed. We saw that audits had been used to drive improvements and used to reflect standards of care across the providers business. Staff felt supported and this meant they could develop their skills with their roles. People’s views had been considered, and any developments or changes had been shared with people. Partnerships had been developed with a range of professionals.

People felt safe and staff had a good understanding of how to raise any concerns. When concerns had been raised, these were investigated and lessons were learnt and shared. Risk assessments were in place to support the needs of people and measures taken to reduce the risks. There was enough staff to support the required needs of the people and recruitment was completed to ensure the appropriate checks were completed. Medicine was managed safety, ensuring stock and recording was in place. The homes hygiene standards were in place to reduce the risks of infection.

Staff had received the training they required for their roles and guidance was provided for specific health conditions. People enjoyed the meals on offer and we saw that specific diets had been catered for and any ongoing health care had been monitored. Referrals had been made to a range of health care professionals to support people’s wellbeing and ongoing health needs. The home had developed the environment to meet people’s needs.

Staff had established positive relationships with people. There was friendly banter and this produced a relaxed feel with much laughter. People’s privacy was respected and their dignity maintained. Visitors were welcomed.

The care plans provided detailed guidance on the care required. They included details of people’s history and their daily needs. Peoples equality needs were reflected and information was provided in a range of formats. When complaints had been raised they were investigated and responded to. When end of life care was required, consideration was made for the persons wishes and any pain relief.

Rating at last inspection: Requires Improvement (Published September 2017)

About the service:

April Park is a care home that provides personal care for up to 40 people, some of whom are living with dementia. At the time of the inspection there were 35 people using the service. The accommodation is split across two floors. Each floor contained bedrooms, a communal lounge and a dining area. There was an accessible secure garden.

Why we inspected: This was a planned inspection based on the rating at the last inspection which was Requires Improvement. At this inspection we found the service had improved to the rating of ‘Good’.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The inspection took place on 17 and 19 May 2017, the first day was unannounced. The service was last inspected in May 2016, when it was found to require improvement in all areas. We found that the service still required improvement at this inspection.

The service is a residential service registered to provide personal care for 40 people; on the days of inspection there were 36 people living there and two people were attending for respite care but lived in their own homes. The service does not provide nursing care.

There was a registered manager in post and they were present for the first day of 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.

People were not always safe at April Park Nursing Home. We found accidents and incidents were not always recorded or investigated thoroughly and staff were not always informed of how best to care for people. There were inconsistencies in how people with limited mobility, were supported to mobilise or transfer safely by staff. Risk assessments were not always updated following incidents and care practice was not always changed to reduce the risk of reoccurrence.

Not all staff understood how to report safeguarding concerns, outside of the organisation. The provider was unable to produce all the relevant documents relating to staff recruitment and could not assure us that all staff working at the service had been thoroughly checked before they started caring for people. There was not always sufficient staff available to care for people, especially at busy times.

Medicines were managed safely and people received their medicines as prescribed.

Tools and processes available to monitor people’s health were not used effectively, which meant it was not always possible to identify when people were at risk of dehydration or at nutritional risk. Training was not always up-to-date and we saw the impact of this on how some staff supported people with limited mobility. Staff did not always follow the advice from specialist healthcare practitioners.

Staff did not always engage with people when decisions had been made about their care. Staff were task focused and peoples care was not always personalised. People and relatives did not feel consulted by the service or the provider and said changes were made to people’s care or the service, without any involvement of the people it affected. Relatives were welcomed into the home when they were visiting.

The service did not always respond positively, or constructively, to comments and complaints. Families were unhappy with the lack of response to their comments or complaints and felt the management team did not listen to them.

The tools and systems in place to monitor the effectiveness of the service, had not always been used effectively. They had not always identified areas for development and had not always led to improved care of people. Information they were required to share with us and other authorities, was not always shared in a timely manner.

Staff were supportive of each other and full of praise for the management team.

At this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The inspection took place on 5 May 2016 and was unannounced.

April Park Nursing Home provides a residential service to older people. It is registered for 40 people and at the time of the inspection there were 32 people living there. There was no registered manager in post. However, the new manager was in the process of applying for registration. 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.

Staff understood their responsibilities to care for people and keep them safe from harm. They knew how to recognise and report abuse or any concerns they may have regarding a person’s safety. Staff were recruited using safe recruitment policies and all appropriate checks were completed before they started work ensuring they were safe to work with vulnerable adults. Medicines were managed safely and records and systems were audited to ensure safe practice was followed which reduced the risk of harm to people.

Risk assessments were not always completed thoroughly or reviewed in a timely manner. This meant that risks to people were not always identified or mitigated by appropriate risk management plans. On the day of our inspection possible risks to people due to the work being carried out had not been appropriately assessed.

Staff had access to a variety of training. They were supervised and observed by senior workers or managers and received constructive feedback on their practice and knowledge. However, we were concerned that the necessary authorisations had not always been sought to protect people who lacked capacity to make decisions about their care and treatment.

People were cared for by staff who enjoyed their work and developed relationships with people based on respect and dignity. Staff appeared to know people well and understood their personal needs and preferences. Support was offered in a discreet and timely way. However, when staff were busy they adopted a task-focused approach and did not have the same amount of time to spend with people on a one-to-one basis.

People and their families actively contributed to their initial assessments and care planning, however, we found little evidence of this continuing when care plans were reviewed. Staff were not always aware of people’s previous lifestyles and interests. The provider had recently imposed a new menu, food list and supplier onto the service and there was no evidence of any consultation with people or their families.

The service was going through a period of change and staff were supportive of this. However, the process of improvement was not very clear and appeared to be disjointed, with no evidence of the involvement or impact on people who used the service.

This was a responsive inspection carried out because we received concerning information about people’s personal care, nutrition, and hydration. We also followed up outstanding areas of non-compliance from our last inspection of this service on 21 May 2013

People told us they were happy living at April Park. One person said, “The staff are lovely here and very good. They are always looking after me and asking what I want.” Another person commented, “This is a nice home and the manager and the carers are fantastic.”

People were consulted on all aspects of their care. One person told us, “The staff always ask me before they do anything. They ask if it’s OK and if it’s what I want.” Another person said, “The staff know what time I like to be woken up in the morning. I told them when I came here and it’s written down so they know.”

People told us they liked the food and drinks at the home. One person said, “The food’s good. You get a choice. I love the breakfasts. I have egg, bacon, tomatoes and toast.” Another person commented, “They give us lovely drinks, particularly the lemon flavour. That's my favourite and the staff know it. We have orange and blackcurrant juice too.”

We spoke with one of the people who use the service and with two relatives. They told us that staff respected their privacy and dignity and one relative said, “Staff sensitively manage my [relative’s] care.” People also told us that staff encouraged them to be as independent as possible. One relative told us, “Staff respect my [relative’s] independence and wish to do things for themselves.”

People told us that staff talked things over with them before carrying out their care and asked for their consent before decisions regarding their treatment. However, from reading people’s care records, we found that where people were unable to make informed choices about important life decisions their best interests were not always being fully considered.

People told us there were generally enough activities available to them. They also felt that staff respected their personal preferences and interests. We found that written care plans sufficiently guided staff to meet people’s needs.

People told us that the premises were kept clean, tidy and hygienic. Our observations showed that most systems were in place to reduce the risk and spread of infection.

We spoke to five people receiving care and April Park, and looked at four care files and other records.

We found that although people's files needed more information about respecting and involving them, we saw that in practice people were consulted about their care.

We saw that infection control and cleaning systems had been improved, including the introduction of audits to check that people at the home were safe from the risk of infection.

We looked at care files and found that consent was not being appropriately sought for people's care, particularly if they were unable to consent, for example due to dementia.

Allthough the manages told us that they were about to introduce new care plans and risk assessments, we saw that risk management and care planning did not currently ensure that people received appropriate and safe care at April Park.

People we spoke with were generally content with the service. Some people told us that they would like to be involved in more activities outside of the service. A family member said that they felt the staff were caring.

There were care planning files in place, and staff training was found to be largely satisfactory.

We found, however, that April Park Nursing Home did not operate systems that fully protected people against infection. We also found that the service was not always obtaining appropriate consent for people’s care and treatment, and that people's dignity and privacy was not always respected.