This inspection took place on 13 and 20 September. Day one was unannounced. We arranged by appointment to give feedback on day two with the registered manager.

At our last inspection on 31 January and 16 February 2018 we rated the service as ‘Inadequate’ and identified nine breaches which related to dignity and respect, receiving and acting upon complaints, person centred care, meeting nutritional and hydration needs, staffing, safeguarding service users from abuse and improper treatment, safe care and treatment, need for consent and good governance. 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 have 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.

Hemsworth Park is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service is arranged into three units, people living with dementia (Vale View), Younger People's Rehabilitation (Bailey) and Residential (Lake View). The service can accommodate up to 93 people. At the time of inspection, the service was not providing nursing care and were in the process of removing this from their registration. On the day of inspection 48 people were using the service.

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. On the day of inspection, the registered manager was on annual leave. On the second day we spoke to the registered manager to give feedback only.

We found the provider; registered manager and staff had worked hard to build on the improvements we had found at the last inspection. We found improvements in all areas.

We found medicine management had improved since the last inspection, however there were still improvements to be made in relation to labelling of medication and excessive stock. The management team told us on day two they had already arranged a meeting with the local practice manager at the GP surgery to look at the overall medication process and excess stock moving forward and how to improve performance.

Accident and incidents were acted upon and reported accordingly to the relevant professionals.

People, relatives and staff told us they felt there was enough staff to support them. We observed throughout the inspection staff were visible in communal areas.

We saw people were receiving appropriate pressure relief care and the care plans reflected these changes.

We saw improvements to the supervision process were more effective and gave staff opportunities to discuss training and any support needs which had been identified. We saw training had been implemented in the home and this was an ongoing process.

We found consent was sought with people, relatives and outside professionals who worked together to provide effective outcomes for people.

We saw mealtime experience had improved throughout the home. People were given choices and the service gained feedback from people on what they would like on the menu. We saw accurate records of people’s nutrition and hydration needs in care plans. People were encouraged to make their own drinks where appropriate and we saw relevant risk assessments in place for these people.

People told us staff were caring and kind towards them. We saw staff were genuinely caring and spoke in a compassi

Our unannounced inspection took place on 31 January 2018 and 16 February 2018.

At our last inspection we rated the service as ‘requires improvement’ and identified five breaches of regulation. These were in relation to;

Safe Care and Treatment. This was a repeated breach. We found information in care plans and associated documentation was not always accurate or up to date, and we saw a lack of guidance for staff to show how risks could be minimised. We observed a number of incidents which showed risk was not always managed robustly.

Dignity and respect: This was a repeated breach. We found there was an on-going lack of support for service users who did not speak English. This had a negative impact on their experience of care and support at the service.

Need for Consent: We found consent was not recorded in line with the requirements of the Mental Capacity Act 2005. Staff routinely signed consent documentation rather than the person using the service or their representative.

Good Governance: We found governance systems were in place but had failed to identify some issues which we saw at inspection. Insufficient action had been taken to ensure breaches of regulation identified at our previous inspection were rectified.

Staffing: We found our observations and some feedback from people and staff identified staffing levels were not always adequate to meet people's care and support needs in an effective way. We also saw staff did not always receive supervision in a manner which supported them to remain

effective in their roles.

Following the last inspection, we met with the provider to confirm what they would do and by when to improve the key questions ‘safe’, ‘effective’, ‘responsive’, ‘caring’ and ‘well-led’ to at least good.

At this inspection we found improvements only in terms of the support for people whose first language was not English. The remaining breaches were not resolved and the provider was still not meeting these regulations.

Hemsworth Park is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service is arranged into four units, for nursing (Creighton), people living with dementia (Vale View), Younger People’s Rehabilitation (Bailey) and Residential (Lake View). The service can accommodate up to 93 people. At the time of our second day of inspection there were 81 people using the service.

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.

Staff were recruited safely, however we found they were not always deployed in sufficient numbers to provide safe and timely care. They could not always minimise risks appropriately as they did not always have access to up to date or detailed information in care plans. Care plans were not always updated in response to changes in people’s needs. We observed a number of occasions where people were not assisted with appropriate moving and handling support.

Medicines were not always managed safely, and we saw a number of occasions where people were without medicines because re-ordering systems had not been robust. Secure recording and ordering of controlled medicines was not always in place.

Although staff said they understood how to report concerns about potential abuse, we found systems in place to manage this were not sufficiently strong. Several incidents were reported to the safeguarding teams at our request during the inspection. Staff had access to personal protective equipment (PPE) but we found some areas of the home to be malodorous and not always c

Our inspection took place over two days, 23 and 25 May 2017. The first day of our inspection was unannounced, and we told the provider when we would be returning to conclude the inspection.

At our last inspection we identified five breaches of regulations. These related to dignity, safe care and treatment in relation to medicines management, nutrition and hydration, staffing levels and support and governance systems. At our recent inspection we found action had been taken to ensure improvements had been made in relation to medicines management and nutrition and hydration. The provider remained in breach of regulations relating to staff, dignity and governance. We also identified two further breaches of regulations relating to safe care and treatment and consent.

Hemsworth Park provides residential and nursing care for older adults, some of whom are living with dementia, and younger people with disabilities. It is arranged into four units, with communal living and dining facilities in each unit. There is a terraced outdoor area which some people could use. The home can accommodate a maximum of 93 people, and at the time of our inspection there were 82 people using the service.

There was not a registered manager in post when we inspected. 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. There was a manager in post who was still in their induction period. They were planning to register with the CQC.

People told us they felt safe living at Hemsworth Park, and we saw the provider ensured maintenance was attended to, including regular checks to fire, gas and electrical installations. Risks associated with people’s care and support were not always well documented, and we saw some instances of poor risk management. We identified this as a breach of regulations relating to safe care and treatment.

Improvements in relation to the storage of medicines which we asked to be made had been actioned. We identified one medicines storage room and fridge had been regularly above the temperature recommended for the storage of medicines, and the provider took action on the day of our inspection to rectify this. Medicines administration was managed safely, with records kept fully up to date.

We saw recruitment was managed safely, with appropriate checks to ensure new staff were not barred from working with vulnerable people. However, we identified concerns with the numbers of staff on duty, and saw staff did not always get the support they needed to remain effective in their roles. These examples contributed to a repeated breach of regulations relating to staffing.

Staff had access to training which gave them the skills and experience needed to be effective in their roles, and people told us they had confidence in the staff’s ability to care for them. The provider was undertaking work to improve training, knowledge and environments relating to people living with dementia. Staff received an annual appraisal at which performance was discussed.

The provider was recognising when applications for Deprivation of Liberty Safeguards (DoLS) were needed, and we saw applications for renewals were being made in a timely way. People told us they felt able to make choices, and we found staff had received training which had given them an understanding of the requirements of the Mental Capacity Act 2005. However, we found consent documentation was not always completed appropriately, and concluded the provider was in breach of regulations relating to consent.

Feedback about meals served was generally positive from people who used the service, and less favourable from staff. We saw the provider had met with the catering supplier to discuss quality. We found the chef was k

The inspection took place over two days on 3 and 4 December 2015. The inspection was unannounced. The service was last inspected 12 & 16 December 2014, at which time we rated the service as ‘requires improvement’. We had particular concerns from the last inspection in relation to the management of medicines and the cleanliness of the environment in which people were cared for at this time. We found that whilst there had been some improvements in terms of the management of medicines, there were still some errors occurring. We found that there had been significant improvements made to the environment, and that the home was undergoing a phased refurbishment, which was partially completed at the time of our inspection. This refurbishment included action on previously unsanitary sluice areas and bathrooms being replaced to improve their hygiene standards. However at this inspection we found multiple breaches of the Health and Social Care Act (regulated activities) Regulations 2014.

At the time of our inspection there were 61 people living at the home, split across four units. The ground floor had a nursing unit and a younger adults’ unit. The first floor had a residential unit and a unit for people who were living with dementia.

There was a registered manager in post at the time of our 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.

We found that the care plans which were in place for most of the people living at the service were not person centred and were not clear in terms of the needs of the person and what care they required from staff to meet their needs. However the provider had introduced a new format for care plans which was person centred and addressed the issue of not being able to find the most important information for each person quickly. The registered manager told us and we saw that the staff were being trained to complete these new documents and that they were in the process of replacing everyone’s care plans, however we found that the progress on this had been very slow with only a handful of care plans having been updated since August 2015.

We saw that there were activities coordinators within the service, and there were activities provided to occupy people, however there were not enough activities coordinators at the time of our inspection to ensure that the people on each unit had activities every day which would interest and engage them.

There were not enough staff on the nursing unit in particular; the lounge area on this unit was out of action as it was being redecorated as part of the refurbishment, which meant that people were spending more time in their rooms. This meant that staff were with people in their rooms over this period and were not visible or available to people who were calling for assistance.

This was a breach of Regulation 18 (1) and (2) staffing of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The management of medicines had improved however there were still some errors occurring and we saw that there had been an incident where over the counter medicines had been given to a person who used the service.

This was a breach of Regulation 12 (2) (g) Safe care and treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Staff had a good understanding of the Mental Capacity Act (MCA) 2005, the Deprivation of Liberty Safeguards (DoLS) and safeguarding and were able to demonstrate to us that they knew what they needed to look out for and understood who to report this to and what action should be taken if there needed to be any escalation of a matter.

We saw that there were do not attempt cardio pulmonary resuscitation orders (D

This inspection was carried out to ensure previously identified shortfalls in the standards of care had been rectified.

We saw examples of good quality and compassionate care being provided in the home. For instance, we observed gentle and reassuring interactions taking place between staff and residents, and saw staff responded in a timely manner to residents’ needs. We observed residents to be generally well presented and dressed appropriately.

We received mixed feedback from residents regarding the care which was provided at Hemsworth Park. Positive comments include:

"Everyone is nice to me. I like it here. I don't want to go home, I feel safe here."

"There's nothing I don't like about this place - thumbs up!"

"I would recommend this home to other people."

Less favourable feedback we received includes:

"It's not brilliant here but it's okay."

"Some staff look after me better than others, but some could have a better attitude."

"Some of the carers are not very nice. They don't always talk to me nicely. I don't know if I'd recommend this place to anyone."

We saw care assessments, care plans and care reviews had been carried out. This helped to protect residents from the risks associated with inappropriate and unsafe care. We also found examples, however, of when care had not been delivered in accordance with the care plans. We saw some occasions in the care records when there was conflicting information about residents’ needs. This conflicting information meant there was a risk of inappropriate and potentially unsafe care being delivered.

Whilst we saw evidence of some meaningful activities taking place to help stimulate and occupy residents, we saw a number of residents who appeared to be bored. Some of the comments we received about this confirmed what we saw. For example:

"There's not much activities. So I go for a laydown."

"It's always the same, nothing to do. I sit here in the chair all day. They don't take us out."

"I wouldn't recommend this place, it's the same every day."

We found significant improvements had taken place regarding how the home managed medications. We saw numerous examples of personalised medication care plans, and medication records were both up to date and clear. A range of checks were being carried out by the home to make sure medicines management was both effective and appropriate.

We saw care records were being held securely and found care related information could be promptly located by staff.

It should be noted that in this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We spoke with at least eight service users in order to hear their experiences regarding the care provided at the home.

Service users gave a range of feedback. One person said staff were “pleasant”. Another person told us some staff were “marvellous” but others were “rubbish”. One person described the care they received as being “good” but another person said it was “passable”.

All three relatives we spoke with had good things to say about the home. One relative said “I can’t fault them, everything is fine” and another told us they had “no concerns”.

During our inspection, we found a lack of activity for those living at the home which meant there was a lack of stimulation. Some service users complained to us about the length of time it took for staff to answer their call bells. We saw that call buttons were not always in easy reach of service users.

Care plans were not always followed. This resulted in, at times, unsafe care having been delivered. A number of medication related problems were found. Despite staff having had safeguarding training, we had concerns that service users were not always being fully protected from the risk of abuse, and their human rights were not always being promoted.

We found some good practice of dealing with complaints but a consistent audit trail was not found to show lessons were learnt and improvements made. Records were not easy to use and care related information was not always easily located.

One person told us that they think the home is wonderful and the people caring for them. Another told us that the meals are very good and that they have a choice of menu. Another person who was preparing to go out told us they like living in the home and they feel supported to live as independently as possible. Another person told us they are very happy and have a say in what they do and how they are cared for.

People living in the home told us they feel safe and well cared for. One person told us if they have any problems they tell someone and it is dealt with right away. People we could not communicate with were observed to be relaxed and comfortable.

People told us that they like the people caring for them. One person said the staff are wonderful and very approachable and nothing is to much trouble.

People we could not communicate with were observed to be relaxed and comfortable and positive relationships were observed being fostered between them and those caring for them.

People told us they are looking forward to the Halloween party and said they liked the big spiders and cobwebs decorating the lounges. One person said that the staff are very good and that they had helped the staff put up the decorations.

People who have a physical disability told us that they feel supported by the service to live as independent a lifestyle as possible. People also said that the staff are very good and in particular the manager who has an open door policy and they can go and see them at anytime about anything.

People told us they attend meetings and can say what they want to. People said they are asked their opinion about, the meals, the staff and what activities or outings they would like.

This inspection took place on 12 and 16 December 2014 and was unannounced. At the last inspection in December 2013 the home was not meeting legal requirements with regard to care and welfare of service users. We asked them to make improvements. The provider sent us an action plan telling us what they were going to do to ensure they were meeting the regulations. On this visit we checked and found improvements had been made.

Hemsworth Park Care Home is part of Four Seasons Health Care. It provides residential care for older adults, and those with dementia. The home also consists of a residential unit for adults, and a unit for younger people with disabilities. The home is registered to provide care for up to 93 people.

There was an acting manager in post; however this person was not registered. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

On the days of our visits we saw the majority of people looked well cared for. We saw staff speaking in a caring and respectful manner to people who lived in the home. Staff demonstrated that they knew people’s individual characters, likes and dislikes.

We found there were issues with regard to the managements of medicines within the home. This was in relation to the storage, administration and lack of guidance in place for staff to follow when administering ‘as required’ medicines to people. This breached Regulation 13 (Management of medicines) of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

We found areas of the home were not clean and equipment in place to assist people with their continence needs had not been attended to by staff. On the second day of our inspection we were told by the regional manager a ‘deep clean’ of the home would be carried out in response to this.

We saw areas of the home required updating. On the first day of our inspection new fire doors were being fitted to people’s bedrooms on the residential unit. The regional manager told us there were plans in place for improvements to be carried out at the home.

Information and guidance within care records varied across the units within the home. For example, we saw that one person’s care records on the nursing unit did not reflect their up to date mobility needs.

Staff we spoke with were aware of their responsibilities with regard to safeguarding people who lived at the home. They were able to tell us about the symptoms of possible abuse taking place and how they would report this.

People we spoke with told us they felt safe living at the home and felt they were well looked after. They told us they trusted the staff and felt the staff knew them well and how they liked support to be provided for them. We observed interactions between staff and people in the home and we saw staff appeared to know people well.

People told us the food at the home was good and that they had enough to eat and drink. We observed lunch being served to people on all four units within the home. We found there were differences in the way staff were deployed which impacted on the support people received.

People’s privacy was respected. All rooms at the home were used for single occupancy. This meant that people were able to spend time in private if they wished to. Bedrooms had been personalised with people’s belongings, such as photographs and ornaments, to assist people to feel at home. We saw that bedroom doors were always kept closed when people were being supported with personal care.

We saw the provider had a robust system in place for the purpose of assessing and monitoring the quality of the service. However, we found some of the audits in place had not been regularly completed or correctly with regard to medicines and daily management reports on the units.

We looked at four staff personnel files and saw the recruitment process in place ensured that staff were suitable and safe to work in the home. Staff we spoke with told us they received regular training and support. They told us they had annual appraisals by their line manager and regular training updates which ensured they had the skills they required for their role.

We found some breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.