Parkhills Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package. CQC regulates both the premises and the care provided and both were looked at during this inspection. Park Hills Nursing Home is registered to provide care for 17 people. At the time of our inspection there were 16 people living at the home. Parkhills also provides a home care service. This offers a variety of services, including assistance with personal care, support with medicines, help with meals and domestic tasks. At the time of our inspection there were 23 people receiving care from the home care agency. During this inspection we looked at the care provided both at the nursing home and by the home care agency.

Our last inspection of the service was in February 2016. At that inspection we rated the service good overall, although we found one breach of the regulations of the Health and Social Care Act (2008). This was because the service had failed to provide adequate supervision of its care and nursing staff. At this inspection we found improvements had been made and the service was no longer in breach of the regulations. We found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

We have made two recommendations. The first is in relation to the documentation for recording decisions around consent to treatment. The second is in relation to providing meaningful activities/stimulation for people.

The service 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.

Systems remained in place to help safeguard people from abuse. Staff had a good understanding of safeguarding matters, how to identify signs of abuse and what action to take to protect people in their care.

Risk assessments had been completed to show how people should be supported with everyday risks, such as risks of falls and pressure ulcers. Risk assessments had been completed to identify potential hazards in people’s homes for those people receiving care from the home care agency.

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 there were sufficient staff on duty in the nursing home to respond promptly to people’s needs. People receiving support from the home care agency told us they received care from a consistent team of care assistants, who were familiar with their needs.

Systems were in place to ensure medicines were managed safety.

The home was well-maintained, clean and decorated to a good standard. There were effective infection control and prevention measures within the service. Checks and servicing of equipment, such as for the gas, electricity, fire-fighting equipment and hoists were up-to-date. The service did not have a Legionella risk assessment. We have asked for this to be carried out.

Staff had undergone training to ensure they had the knowledge and skills to support people safely. All staff received regular supervision. This ensured the standard of their work was monitored and gave them the opportunity to raise any concerns.

The service was working within the principles of the Mental Capacity Act (MCA) 2005 and theDeprivation of Liberty Safeguards (DoLS). However, consent to care and treatment had not always been recorded properly in care files.

People we spoke with were complimentary about the care and support they received fro

This inspection took place on the 16, 17 and 23 February 2016. Our visit on 16 February was unannounced.

We last inspected Park Hills Nursing Home in April 2014. At that inspection we found that the service was meeting all the regulations we assessed.

Park Hills Nursing Home is a Victorian house that has been extended to the rear of the building and is situated approximately one mile from Oldham town centre. The service is registered to provide nursing and personal care for up to17 people and specialises in end-of-life nursing care. At the time of our inspection there were 17 people living at the home. In addition, since February 2015 Park Hills Nursing Home is registered to provide personal care to people in their own homes in the community, and currently supports two people in this manner.

When we visited the service a registered manager was in place. 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 one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to the supervision of staff. You can see what action we told the provider to take at the back of the full version of the report.

Staff had a good understanding of safeguarding procedures and what action they should take in order to protect vulnerable people in their care. Risk assessments had been completed to show how people should be supported with everyday risks, such as risks to their nutrition or mobility.

Environmental checks of the home, such as of the passenger lift and emergency lighting were up-to-date and the building was well-maintained and decorated.

There were sufficient numbers of appropriately trained staff on duty to care for people, both in the nursing home and in the community.

Recruitment checks had been carried out on all staff to ensure they were suitable to work in a care setting with vulnerable people.

Medicines were safely administered by staff who had received appropriate training.

Equipment, such as hoists, bathing aids and pressure relieving mattresses were available in the home and these helped promote people’s safety and comfort. The equipment we saw was well-maintained. No equipment was currently needed to support people in their own homes.

Staff had undertaken a variety of training to ensure they had the skills and knowledge required for their roles. Although some staff had not received training in ‘safeguarding vulnerable adults’ and ‘infection control’ staff we spoke with had a good understanding about the processes need to protect vulnerable adults from abuse and to prevent the spread of infection in both a residential and community setting.

Staff understood the importance of encouraging people to make choices, where they were able to, and always sought consent before undertaking any care. People we spoke with were happy with the quality and choice of food provided at the home.

People told us the staff were caring and their dignity and privacy were respected. Care plans were ‘person-centred’ and were reviewed regularly by the trained nurses. Staff cared safely for people with a variety of complex health problems.

The home specialised in ‘end of life’ care and had taken part in the ‘six steps end of life training programme’ which provided staff with a deeper understanding of the needs of people approaching the end of their life.

People were supported to maintain good health and where needed specialist healthcare professionals, such as dieticians, were involved with their care. Families were kept informed of any changes to their relatives’ health and were invited to comment on the quality of the service through an annual survey.

The service had a complaints procedure in p

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five 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-

Is the service safe?

We found that the people who lived in the home were cared for in a clean, safe environment.

People told us that they felt they were well looked after and relatives were also pleased with the standard of care. There were safeguarding procedures in place and a programme to ensure all staff had received safeguarding training. CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. An application had been in the process of being submitted which showed that staff had been trained to understand when an application should be made.

The people living at the home had a comprehensive care plan with risk assessments in place for people with particular needs. Staff understood where these were stored what their purpose was.

There was a staffing rota in place and everyone we spoke to including staff, visitors and people living in the home all felt there was enough staff on duty at any time. All staff felt they received plenty of training and felt competent to do their job.

Through audit and reviewing of complaints, incidents, and resident and relative engagement this meant the provider is able to regularly monitor and assess the quality of the service provided.

Is the service effective?

Everyone living at the home had a care plan identifying individual’s needs. Training such as six steps for end of life care had been undertaken by staff to enable them to deliver care effectively.

People told us that they like living at the home. One said “It is my home and I like it” and another said “of all the places I have been to this is the best.” One relative told us that it was “Absolutely fantastic here.”

People who had experienced care at the home for their relatives commented “We were so lucky finding such a special place for my dad.” And another “There was care, compassion and dignity shown to him.”

Is the service caring?

Everybody we spoke to thought the staff were kind and caring. We observed staff caring for people and they were polite and unhurried. One person told us “When I use my call bell they answer promptly.” Another told us “The staff are happy and friendly and there are plenty of people around.”

One relative told us “As soon as I come in people are saying hello, they don’t just walk past you.” Another relative told us “When I come in it is just like home and people always have time to speak to me.”

The management undertake a satisfaction survey including staff, relatives and people living at the home. The results were very positive.

Is the service responsive?

People’s needs had been assessed before they moved to the home. People’s records identified personal preferences and choices and the support that needed to be provided. The home worked with other services to ensure all care needs were met for the person such as a speech and language therapist or social care.

People who lived at the home, and relatives that we spoke to all felt that they could approach staff and the manager about anything and that they would be listened to and acted upon. Staff felt the manager was very supportive of both work and personal circumstances.

Is the service well-led?

The service had a quality assurance system in place. Staff had a good understanding of the philosophy of the home particularly with end of life care. Staff had job descriptions and appropriate checks in place. Staff felt listened to and supported by the manager.

During this inspection we found that the provider had taken action to address the areas that we brought to their attention when we inspected the home in June 2013.

The provider had carried out a survey to establish staff knowledge and understanding about safeguarding vulnerable adults and deprivation of liberty safeguards. Each staff member had subsequently had an individual supervision session where this had been further discussed and any clarification required given. The provider had made arrangements with the local authority for staff to attend their training courses about safeguarding vulnerable adults.

We found that all staff files had been reviewed. The provider had acted to obtain any missing information that ought to be there, for example, a photograph. A system was in place to monitor progress of this task to completion. No new staff had been recruited since our last inspection but the interview questions to be used for the future had been reviewed to include consideration of the applicant's physical and mental fitness.

The provider had reviewed the records held in relation to staff training so that they were comprehensive and up to date. Changes had been made to the way in which records were maintained regarding review of individual care plans and monitoring people's weight to ensure staff made complete and timely entries.

We spoke with two people living at the home. They told us they were “treated well” and that staff would “do things for you if they can”. A visiting relative told us they “wouldn’t like [their relative] to go anywhere else”.

In January 2013 Pennine Care Trust Community Nutrition and Dietetics Service awarded the provider a bronze award for “ongoing excellence in nutritional care and maintaining nutritional training”. The provider was also awarded a 5* rating by Oldham Local Authority following a food safety inspection in January 2013. This is the highest rating available.

People were not always protected from the risk of abuse because the provider had not taken reasonable steps to make sure staff could identify the possibility of abuse and prevent it before it occurred. We saw the staff training records. Out of 21 staff listed it was only recorded that one person had been trained in safeguarding adults.

We found Park Hills Nursing Home to be well maintained and furnished. People told us they were happy with their bedrooms and the home was “spotlessly clean”.

We looked at the personnel files for four members of staff. Appropriate checks were not always carried out before staff started work.

The provider had a complaints policy in place. We saw that complaints were recorded and any taken to resolve them noted by the manager. Staff were aware of the policy.

Some of the records we looked at during our inspection had not been accurately maintained.

At this visit, 17 people were living at Parkhills Nursing Home. Almost all had complex health care needs requiring palliative or end of life care.

We spoke with six people however, not all of them could tell us about their views of living in the home. People told us about the things that were important to them like their health problems. Three people told us about the care home. We heard “They are very good, you only have to ask and they are there”; “They are very considerate and helpful. They respect your wishes” and “It’s great. They [the staff] are looking after me too well. They are really good”.

We spoke with a health care professional who visited the home. They said the home was like a “real home”, “everyone [living there] always looked comfortable and cared for” and “the home is always spotlessly clean”.

We saw that people living in the home and their relatives had been asked to complete a feedback questionnaire in May 2012. Almost all of the returned questionnaires contained positive responses. Every one of the 14 returned relative questionnaires also included positive comments such as, “It is comforting to know mum is so well cared for”; “I have no complaints and I think Parkhills is wonderful”; “My mother feels secure and part of the family” and “In the short time my mum has been here I have been really impressed with everything”.