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 there. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (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 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 registrat

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 i

The inspection took place on 16 August 2016 and was unannounced. This meant the provider or staff did not know about our inspection visit.

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 a

This follow up inspection was to check whether the Registered Provider had taken action to address the five areas of concern we identified at our previous inspection in May 2012. The provider sent us an action plan with timescales telling us how they would improve the service provided at Care at Parkside.

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.

The deputy manager was in charge at the time of our inspection visit. We heard that she was temporarily covering for the manager who was absent.

At the time of our visit, 17 people were being cared for. Many of the people living in the home had some complex care needs. This meant that it was difficult for people to tell us of their experiences of living at Parkside. However, we spoke with three people who were living at the home and two visitors.

People told us that it was “Okay” living in the home. One person said “Staff are very good” and “Staff are helpful to me”. We heard that there were activities but they said “I do get bored keep sitting here but when the weather improves we can sit out” and “The food is very good and there’s plenty of it”.

Another person told us that the care provided at the home had helped them get better. They said “The staff are great. All of them are very good”. We heard that the food was “Plain and simple” and there were alternatives available. They told us “if they’ve got it (alternative foods) you can have it”. The person told us that they enjoyed having responsibility for looking after the home’s pet rabbit and the two cats. The person said that when they were fed up they went for a walk in the nearby park.

One visitor said they were happy with the care their relative received. They said “The staff worked with (their relative) and looked after them”.

Another visitor said “It’s absolutely wonderful”; “The staff are so caring” and “I cannot fault anything”. We heard that the food was good and choices were available. The visitor told us that the staff were very caring and treated all people with respect and dignity despite their different care needs and temperament.

We spoke with a health care professional who visited the home regularly and they said the home was “Okay”; staff were “Helpful” and “Things are quite good”.

Care at Parkside is a detached house which has been converted to offer accommodation and support for up to 24 people. At the time of our visit there were 18 people living at the home.

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.