Argyle Park is a nursing home in Southport that caters for the needs of older people. It has 31 en-suite bedrooms for both male and female residents.

This inspection was carried out over two days on 17-18 May 2017 and was unannounced.

There was a registered manager in post. 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 last inspected in October 2016 and we found breaches of Regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found staff had been appropriately checked before they started work in the home; the home did not always support people to provide effective outcomes for their health and welfare and there was a continued failure to provided governance [management] systems to ensure appropriate monitoring of standards in the home.

At this inspection we found the home to be meeting all of the regulatory requirements. This was an improvement from our last inspection and we have revised the quality rating for the service from ‘Requires improvement’ to ‘Good’.

There were enough staff on duty to help ensure people’s care needs were consistently met. We looked at how staff were recruited and the processes to ensure staff were suitable to work with vulnerable people. We found recruitment to be well managed and thorough. This was an improvement from our last inspection.

Care records showed that people’s health care needs were addressed with appropriate referral and liaison with external health care professionals when needed. Monitoring records and charts were updated so they provided for effective evaluation of care. This was an improvement from our last inspection.

There was now a clear organisational management structure in place. The registered manager was able to evidence a series of quality assurance processes and audits carried out internally and externally by staff and from visiting senior managers for the provider. These were effective in managing the home; there were systems based on getting feedback from the people living at the home. This was an improvement from our last inspection.

Staff sought consent from people before providing support. When people were unable to consent, the principles of the Mental Capacity Act 2005 [MCA] were followed, in that an assessment of the person’s mental capacity was made and decisions made in the person’s best interest. We had some discussion, however, how this could be further improved by evidencing assessment around individual decisions; this would meet best practice and follow the principles of the MCA.

The registered manager had made appropriate referrals to the local authority applying for authorisations to support people who may be deprived of their liberty under the Deprivation of Liberty Safeguards (DoLS). DoLS is part of the MCA and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. We found the applications were continuing to be monitored by the registered manager.

We reviewed the way people’s medication was managed. We saw there were systems in place to monitor medication so that people received their medicines safely.

Care was organised so any risks were assessed and plans put in place to maximise people’s independence whilst help ensure people’s safety.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. Training records confirmed staff had undertaken safeguarding training and this was ongoing. All of the staff we spoke with were clear about the need to report any concerns they had.

Arrangements were

Argyle Park is a nursing home in Southport that caters for the needs of older people. It has 31 en-suite bedrooms for both male and female residents.

This was an unannounced inspection which took place on 9 and 10 November 2016. The service was last inspected in June 2016 and we found a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found people’s care planning lacked sufficient detail to help ensure their care needs were being effectively monitored and evaluated. Care monitoring records such as diet, fluid and positioning charts were not completed which meant that an accurate evaluation of care needs could not be made. We served a statutory Warning Notice.

This was a comprehensive inspection and we found the service had met the Warning Notice. Care plans were being reviewed and people’s monitoring charts were [mostly] being completed.

We found further breaches of regulations, however, regarding people’s nursing care, staff recruitment and the overall management and governance of the service.

There was no registered manager in post. 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 new manager advised us they would be applying for registration.

We found the home did not always support people to provide effective outcomes for their health and wellbeing. We were concerned that for two people there had not been adequate monitoring and referral for medical review when they had lost excessive weight.

We looked at how staff were recruited and the processes to ensure staff were suitable to work with vulnerable people. We saw not all of the required checks had been to help ensure staff employed were ‘fit’ to work with vulnerable people.

The manager was not able to evidence a full range of quality assurance processes and audits carried out internally and externally from visiting senior managers for the provider. We found the management systems for the provider were not developed and embedded to ensure the most effective monitoring.

You can see what action we told the provider to take at the back of the full version of the report.

Care was organised so any risks were assessed and plans put in place to maximise people’s independence whilst help ensure people’s safety.

We saw there were good systems in place to monitor medication safety and that nursing staff were supported with updates to help ensure their competency so that people received their medicines safely.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. Training records confirmed staff had undertaken safeguarding training. All of the staff we spoke with were clear about the need to report any concerns they had.

Arrangements were in place for checking the environment to ensure it was safe. For example, health and safety checks were completed on a regular basis where obvious hazards were identified. Planned development / maintenance was assessed and planned well so that people were living in a comfortable environment.

Staff sought consent from people before providing support. When people were unable to consent, the principles of the Mental Capacity Act 2005 were followed in that an assessment of the person’s mental capacity was made.

There were two people being supported on a Deprivation of Liberty [DoLS] authorisation. DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. The two people had been assessed and placed on a standard authorisation from the loca

We carried out an unannounced comprehensive inspection of this service in January 2016 when five breaches of legal requirements were found. The breaches of regulations were because we had some concerns about the way people’s care was being planned and monitored and whether this was personalised to their needs; the need to gain consent to care and treatment; the reporting and investigation of allegations of abuse in the home; the effectiveness of management systems to regularly assess and monitor the quality and safety of service that people received and whether there were sufficient care staff to ensure care was carried out effectively.

We asked the provider to take action to address these concerns. We served the provider with a statutory Warning Notice regarding the provision of sufficient care staff.

After the comprehensive inspection, the provider wrote to us to tell us what they would do to meet legal requirements in relation to the breaches. We undertook a focused inspection on 8 June 2016 to check that they had they now met legal requirements. This report only covers our findings in relation to these specific areas / breaches of regulations. They cover four questions we normally asked of services; whether they are 'Safe', ‘Effective’, ‘Responsive’ and ' Well led'. The question ‘was the service caring’ was not assessed at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Argyle Park Nursing Home' on our website at www.cqc.org.uk.

Argyle Park Nursing Home caters for the needs of older people. It has 31 en-suite bedrooms.

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

We found the service had made improvements and all but one of the breaches we had previously found, had now been met. We still had concerns regarding the way care was planned and monitored in the home.

At our last inspection in January 2016 we found people’s care plans evidenced an individual approach to care that was not reflected in daily care records or observations we made. On this inspection we found people’s care planning lacked sufficient detail to help ensure their care needs were being effectively monitored and evaluated. In some instances people’s care needs was not included or updated in the care planning. Care monitoring records such as diet, fluid and positioning charts were not always completed, which meant that an accurate evaluation of care needs could not be made.

We found there was a clearer understanding of the principles of the Mental capacity Act 2005 and how this should be applied with people living in the home. We saw examples where people’s capacity had been assessed with regard to key decisions they were making and where they lacked capacity, decisions had been made in people’s best interest.

We found that staff and managers were clear on their responsibilities with reporting and investigating allegations of abuse. The registered manager had reported through incidents and allegations of possible abuse and liaised effectively with the Local Authority safeguarding team.

We had previously served the provider with a warning notice to improve the care staff numbers to ensure there was sufficient staff to carry out care effectively. We found the provider had taken action and this had improved.

We found action had been taken to improve the management and governance of the home. We found the provider was supporting the registered manager and had developed clearer and more effective systems to monitor standards in the home. This included getting information from people so that the service could be developed with respect to their ne

This inspection was to follow up on a previous inspection in December 2013. At that time the home had failed to meet requirements with respect to maintaining peoples care records. We checked on progress and improvements made.

We looked in detail at three peoples care records. We found improvements in that the assessment and care planning records were clearer, better organised and had been reviewed regularly.

We found some anomalies with records that supported peoples care such as charts to monitor people’s daily health and welfare. Some were not fully up to date and accurate. This mean that important aspects of people’s care were not being recorded and monitored in enough detail.

This inspection was to follow up on a previous inspection in September 2013. At that time the home had failed to meet requirements with respect to maintaining peoples care records. This inspection was to check on progress and improvements made.

We looked in detail at three people’s care records and found they were not up to date and accurate. Important information such as, daily records of care were not being carried out consistently and lacked necessary detail. Plans of care had not been updated effectively. Evidence of people’s consent to care had not been recorded.

Care plans we looked at were person centred and based on the person’s individual assessments and their preferences, providing staff with clear guidance about how to support the person.

Records confirmed staff had received infection control training. Infection control policies and procedures were in place to support staff maintain the necessary hygiene standards.

There were systems in place for the safe administration of medication. Staff we spoke with were knowledgeable about the home’s procedures to support people with their medication

The home used people’s monthly assessments to provide an indication of their dependency level. This was used to help ensure the appropriate number of staff were on duty at different times of the day to meet people’s needs.

Relatives we spoke with told us they would raise concerns with the manager or their relative’s key worker. Three relatives told us they felt the manager listened and their concerns were acted upon.

Relatives we spoke with confirmed that records in people’s rooms were not up to date and this meant they were unsure of what care had been given by the staff.

The home had recently been taken over under new management. The new management had undertaken a full refurbishment of the home. They had incorporated their policies and procedures which they used within their other residential and nursing homes into this service to improve quality standards. As part of the service expansion the providers had also appointed a Quality Manager across all their homes; this role maintains continuity of quality of care throughout the homes owned by the provider.

During our inspection we spent time with people who lived at the home and invited them to share with us their views and experience of the care they received. One person said “I have settled in and like it here, I feel very safe.” Another person told us “It is managed particularly well; it has good facilities and trips arranged for us.”

During our inspection we observed staff being attentive to the needs of the people, their tone and manner was respectful and caring; Showing dignity and respecting privacy as they delivered the care.

Staff told us that they felt supported by the new management and felt they worked well as a team with their peers.

Argyle Park is a nursing home in Southport that caters for the needs of older people. It has 31 en-suite bedrooms for both male and female residents.

This was an unannounced inspection which took place on 8, 11, 13 January 2016. The service was last inspected in June 2014 and was meeting standards at that time.

There was a registered manager in post. 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.

During the inspection we found breaches of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014 relating to staffing, safeguarding, consent to care and treatment, care plans and good governance.

Prior to, during and following the inspection, we received concerns regarding the staffing levels in the home. We found there were not enough staff on duty at all times to help ensure people’s care needs were consistently met.

We looked at how staff were recruited and the processes to ensure staff were suitable to work with vulnerable people. We saw checks had been made so that staff employed were ‘fit’ to work with vulnerable people.

Care was organised so any risks were assessed and plans put in place to maximise people’s independence whilst help ensure people’s safety.

We saw there were good systems in place to monitor medication safety and that nursing staff were supported with updates to help ensure their competency so that people received their medicines safely.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. Training records confirmed staff had undertaken safeguarding training. All of the staff we spoke with were clear about the need to report any concerns they had. A recent safeguarding incident had been investigated by the home and had not, initially, been referred to the local safeguarding team. This did not follow standard safeguarding procedures.

Arrangements were in place for checking the environment to ensure it was safe. For example, health and safety audits were completed on a regular basis where obvious hazards were identified. Planned development / maintenance was assessed and planned well so that people were living in a comfortable environment.

We observed staff interacting with the people they supported. We saw how staff communicated and supported people. Staff were able to explain each person’s care needs and how they communicated these needs. People we spoke with and their relatives were aware that staff had the skills and approach needed to ensure people were receiving the right care.

Staff sought consent from people before providing support. When people were unable to consent, the principles of the Mental Capacity Act 2005 were not always followed in that an assessment of the person’s mental capacity was not made.

There was one person who was being supported on a Deprivation of Liberty [DoLS] authorisation. DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. We found the authorisation had recently been made following referral to the local authority and was being monitored by the manager of the home.

We saw people’s dietary needs were managed with reference to individual preferences and choice.

Most people we spoke with said they were happy living at Argyle park. They spoke about the nursing and care staff positively. However, most interviews also included comments regarding how little time staff could spend talking and providing extra contact to enhance people feelings of wellbeing. A good example was one person who said, “I am very happy at the home but I get lonely sometimes. The staff don’t have a lot of time to chat with me.’’

When we observed staff interacting with people living at Argyle park they showed a caring nature with appropriate interventions to support people. Staff had very limited time however to spend with people and engage with them.

People told us their privacy was respected and staff were careful to ensure people’s dignity was maintained.

We discussed the use of advocacy for people. There was no information available in the home, including the service user guide, regarding local advocacy services if people required these. There was policy statement and the manager said they would ensure this was advertised in the home. The manager was able to discuss some past and current examples of people who had received formal advocacy from legal representation.

We asked people how their care was managed to meet their personal preferences and needs. Most people were satisfied with living in the home and felt the care of offered met their care needs but they also felt this could be improved and made more personalised.

Most people we spoke with said they were consulted about the care planning and we saw some of the care plans were signed or showed evidence of people’s input. This was not consistent however as we saw other care records and plans that displayed very little evidence of people’s input.

Care plans evidenced an individual approach to care that was not reflected in daily care records or observations we made.

Activities were organised in the home but these were not on a daily basis. The activities person was well qualified in terms of background and was motivated to provide meaningful activities. They visited the home for a total of one day a week.

We saw a complaints procedure was in place and people, including relatives, we spoke with were aware of how they could complain. We could not find any obvious display of the complaints procedure in the home and the manager said they would address this. We saw there were good records of complaints made and the registered manager had provided a response to these.

The registered manager was able to evidence a series of quality assurance processes and audits carried out internally and externally from visiting senior managers for the provider. We found some of these were not currently developed to ensure the most effective monitoring and in some areas there needed to be developments to ensure standards were identified and continually maintained.

The manager was aware of their responsibility to notify us [The CQC] of any notifiable incidents in the home. We discussed the fact that a notification had not been made following one person in the home being assessed for a Deprivation of Liberty Authorisation.

You can see what action we told the provider to take at the back of the full version of the report.