We inspected Park House between 3 September 2018 and 5 September 2018.The inspection was unannounced. The service is for elderly people, some of whom may have physical disabilities or dementia. At the last inspection, in October 2016, the service was rated as ‘Good,’ and following this inspection the service retains this rating.

Park House 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. Park House accommodated up to fourteen people, and nine people lived at the service at the time of the inspection.

The service also provides community support (domiciliary care) for people living in their own homes. At the time of the inspection seven people received support. Support currently provided ranged from individuals receiving one or two hours a week from one member of staff to people receiving four visits a day from two staff.

The service did not have a registered manager, although the current manager had submitted an application to be registered with the Care Quality Commission. 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 viewed by people we spoke with as very caring. We received positive comments about the service. For example we were told, “I could not ask for better,” and “(My relative) has only good things to say about the care.” An external professional said, “Park House (provides) a high level of care and support…in a warm and supportive environment,” and another said, “Park House has undergone a significant change in the last year or so and now appears to me to be a vibrant, friendly and safe facility.”

People told us they felt safe. The service had a suitable safeguarding policy, and staff had been appropriately trained to recognise and respond to signs of abuse.

People had suitable risk assessments to ensure any risks of them coming to harm were minimised, and these were regularly reviewed. Health and safety checks on the premises and equipment were carried out appropriately.

There were enough staff on duty to meet people’s needs. The service had an effective recruitment procedure, and appropriate checks were carried out on new staff to ensure they were suitable to work with vulnerable people. Staff were suitably trained. Staff received a comprehensive induction when they started to work at the service, and they received regular supervision to provide them with feedback and guidance about their work. Overall staff had received appropriate training although some staff members still needed to complete some training required by law.

People in the community, who we contacted, said they were happy with staffing provided. The care people received was provided by a small group of staff, who they knew well. Staff arrived on time, stayed to assist them the correct amount of time, and did not leave out any assistance which they were required to give. People said staff had not missed any visits. One person said if there was any lateness, there was usually good reason, for example the carer had been delayed at a previous call. The person said staff were never late by more than 25 minutes. People said they did not receive personal care from someone from the opposite gender if they did not want this.

The medicines’ system was well managed, medicines were stored securely, and comprehensive records were kept regarding receipt, administration, and disposal of medicines. Staff who administered medicines received suitable training.

The service was clean and hygienic. The building was suitable to meet the needs of the people who live

This unannounced comprehensive inspection took place on 29 September 2016. The last inspection took place on 27 April 2015.At this inspection there was a breach of the legal requirements. Following this inspection the provider sent the Care Quality Commission an action plan outlining how they would address the identified breach.

Park House is a care home which offers care and support for up to 12 predominantly older people. At the time of the inspection there were nine people living at the service, one of which was staying for a period of rehabilitation prior to going back home. Some of these people were living with dementia. The service occupies a detatched building over two floors. The service has a lift to support people who require assistance to access the upper floor.

The service also supported a domiciliary care service for 13 people who lived on St Mary's and the off islands. The staff who provided this care were provided with care plans and support out of hours by the social work team of the council.

The service had 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. However, the registered manager had resigned and would leave at the end of October 2016.

We walked around the service which was comfortable and personalised to reflect people’s individual tastes. People were treated with kindness, compassion and respect.

At the previous inspection in 2015 we found concerns with the medicines management and processes used by the staff. We found gaps in the medicine records which meant it was not always possible to establish if a person had received their prescribed medicines. Staff did not always record when they had applied prescribed creams and given eye drops. Medicines were not always stored at the correct temperature with the medicine cupboard reading a temperature of over 25 degrees centigrade. The temperature of the medicine refrigerator was not being recorded in a way that could ensure the safe storage of medicines within. Medicines which required stricter guidelines were not stored securely in accordance with good practice guidelines. Staff were administering medicines from a variety of difference packaging, including blister packs, dossett boxes and original packaging. This meant medicines could not be effectively audited to ensure people always received their prescribed medicines appropriately.

At this inspection we found there were only occasional gaps in the medicine administration records (MAR). Handwritten entries on to the MAR following verbal advice from medical practitioners were signed by two staff to help ensure the risk of any errors was reduced. Regular medicines audits were consistently identifying if errors occurred and these were being addressed with specific staff. Prescribed creams were mostly recorded by staff when applied. The medicine cupboard was recorded at 25 degrees. The staff told us there was a plan to vent the door to this cupboard to ensure that the cupboard did not exceed this temperature. The temperature of the medicine fridge was checked daily and was ensuring the safe storage of medicines that required cold storage. All medicines administered at Park House were given from original packaging. The service was planning to move to a system of blister packs and discussions with the local pharmacy were ongoing to arrange this. Staff regularly audited the medicines at Park House and errors had greatly reduced. Any errors found were now being addressed with specific staff through supervision. Medicines that required stricter controls were being stored securely. This meant that the service was now meeting the legal requirement for the safe and effective management of medici

We spoke with three people who lived at Park House to seek their views of the home. We were told “the staff are pretty good", “they are lovely, very kind and helpful to me” and “they look after me well, the food is lovely and I like living here”.

We spoke with two people who received a care service in their own homes. We were told staff were kind and polite. Both people said the service they received from their main carers was very good, reliable and dependable. Comments they made about their main carers included; ”wonderful”, “very very good” and “looks after me so well”. They said this changed when their main carer was on leave. One person said the visits could be up to two hours late and they were not informed of who was visiting or if the appointment was going to be at a later time.

People who used the service were safeguarded against abuse as the home had provided guidance and training to the staff regarding the action they would take if they became aware of any safeguarding issues. There was insufficient staff in place to meet people's preferred and assessed care needs when they received a service in their own home.

Staff were not supervised, although training was available to support them to carry out their roles effectively.

Not all personal records were not stored securely, some records could not be located promptly and we found records were not consistently up to date or accurate.

We were able to speak with four people who lived at Park House to seek their views of the service that they received. People said the home was clean and tidy and that the staff were kind, caring and helpful.

One person gave us examples of how the staff supported them to make choices on how they spent their day. They told us “I like to stay in my room, I am not bothered about going to the lounge. I choose what I do and the staff always help me to do things”.

We saw the privacy and dignity of people was respected by the staff as prior to entering a bedroom, toilet or bathroom they knocked on the door. We observed the care staff were kind and caring in their approach and when communicating with people who used the service.

The home had, since our last inspection, appointed an activities coordinator, who organised activities three times a week.

We found that while action had been taken to keep people safe from abuse, the correct reporting procedures had not been followed for one issue that had arisen.

The training programme for staff had been reviewed and developed and steps taken to ensure a training schedule was in place for staff to complete. Not all staff had completed the relevant training to ensure they were trained and competent to meet the care needs of people who used the services of Park House.

We spoke with six people who lived at Park House, to seek their views of the service they received. Two people we spoke with were not able to give their views on all aspects of their care due to their medical conditions. We also spoke with two people who received care in their own homes.

All of the people we spoke with in the home, told us they liked living at Park House. One person who used the service told us “the staff are very good and always very polite and kind to me”. Another person said “it is paradise here and I am very lucky to be here as everything is top class”.

We observed interactions between staff and people who lived at Park House and saw they communicated with people in a polite, friendly and respectful manner. The atmosphere in the home was warm and homely.

People did not consistently experience support that met their needs as there were limited activities available in the home, particularly for people who required dementia care. The care and treatment provided to people met their needs but staff did not receive full guidance or instruction in people’s own care plans.

Staff were not provided with sufficient training, policies or procedures to ensure that people who used the services were protected from abuse.

Records were not available to demonstrate that an effective recruitment procedure was in place to ensure that people's needs were met safely by appropriate staff.

Park House is a care home which provides care for up to 12 people. On the day of the inspection there were 10 people living at the home, three of which were there on a short respite stay. The service also provides domiciliary support to eight people who live in their own homes on St Marys.

The registered manager for this service had retired and a new manager was in the process of registering with the Care Quality Committee. The new manager was responsible for the day-to-day running of the service and had been in post for several weeks prior to this 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 and associated Regulations about how the service is run.

We carried out this unannounced inspection on the 27 and 29 April 2015. We last inspected the service on 26 March 2014 at which time the service was fully compliant with the requirements of the regulations.

The atmosphere at the service was welcoming, calm and friendly. People were able to spend their time in various areas of the service as they chose, including going outside to sit in the sun. The service was on two levels. The ground floor contained two lounge/dining areas, offices, kitchen and laundry. The upstairs, which was accessible via stairs and a lift, contained people’s bedrooms, bathrooms and a sluice. Some of the doors to toilets and people’s bedrooms were personalised with pictures that aided recognition. Some people at the service were living with dementia and this supported their need to orientation around the service.

We looked at the arrangements in place for the administration and recording of medicines at the service and found it was not safe. There were gaps in the medicine records for three people. The service had identified this issue at previous audits, however, it had not been addressed and was continuing to occur.

Some people had been prescribed eye drops, creams and lotions. These medicine records had not been signed by staff when such items had been applied. Creams were not dated when opened. This meant staff were not informed when the cream would expire and was no longer safe to use. Medicines were not being stored at the correct temperature. According to the service’s medicines policy the temperature of the medicine storage cupboard should not be above 25 degree centigrade. The temperature of this cupboard was reading 26 degrees centigrade at 11.30am and 27 degrees centigrade at 3.30pm. Some medicines required to be stored in a fridge. The thermometer in this fridge was not recording minimum and maximum temperatures reached over a period of time. This meant the service could not ensure the medicines stored in the fridge had always been stored appropriately and were safe to use. We looked at the process for storing medicines that required stricter controls . The cupboard in which these medicines were stored had a broken lock which meant the service was not be able to store these medicines in accordance good practice guidelines.

Staff were administering medicines from original packaging, blister packs which had medicines clearly marked for each time the item was prescribed and also Dossett boxes. Dossett boxes are devices used by people in their own homes to help them take medicines at the correct time. These devices had been bought in to the service by people who were staying for a short respite stay. The boxes had not been filled by staff at the service therefore they could not be confident what tablets were being taken by the person. This meant medicines could not be effectively audited to ensure people always received their prescribed medicines appropriately.

This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see the action we told the provider to take at the back of the full version of this report.

People were well cared for. Staff were kind and respectful when supporting people. Families told us; “I think they get a level of care that would not be possible elsewhere in the country,” “It is because (the person) gets the care they do they are able to stay at home, they are as safe as they can be” and “If there are every any issues at all they are corrected very quickly,” “They (staff at the service) keep in touch with us, (the person) is well looked after.”

There were sufficient numbers of care staff to support the needs of the people living at the service and in the community. The service had robust recruitment processes in place to ensure new staff were safe to work with older people. The service had vacant staff positions for a cleaner, an administrator and one full time carer. A new carer had been appointed but was not able to find accommodation on the islands and therefore had not taken up the post at the time of the inspection. The new manager had been well supported during her induction and reported working closely with the social services team on the island.

Staff working at the home understood the needs of people they supported. The care plans at the service contained information to direct and inform staff regarding the needs of each person, and how they wished their care to be provided. Staff were aware of people’s preferences and choices. Training and support enabled staff to be effective in their care and support of people in the home. Staff were aware of how to report any concerns of potential abuse, both internally and to external agencies.

All food was prepared on the premises in the kitchen of the service. People told us they enjoyed the food saying; “The food is very good, they just give us too much of it” and “I enjoy the food.” Mealtimes were a social occasion with staff eating their meals together with people who lived at the service.

People were encouraged to go outside and enjoy the local area, and the local community were encouraged to visit people who lived at the service. Staff were all well informed about the past lives of the people they cared for. Staff used this information to have meaningful conversations with people and supported them with relevant activities which they enjoyed. One lady was busy typing the words to her favourite song on an old style typewriter in one of the lounges during our inspection.

The service had good relationships with other external healthcare professionals who ensured effective care delivery for people whenever they needed or wanted it. Families and staff felt they could raise any concerns or issues they may have with the manager who was approachable and ‘on the ball’. People felt their views and experiences were listened to.