This inspection took place on 30 April 2018 and was unannounced. This meant no-one at the service knew we were planning to visit.

At our last inspection we rated the service good with one breach of regulation of the Health and Social Care Act 2008 (Regulated Activities) 2014; regulation 17, Good Governance. This was because people living at the service had not been protected against the risks of inappropriate or unsafe care or treatment because the registered provider did not have effective systems to monitor the quality of service provision. At this inspection we found the registered provider was no longer in breach of regulations. 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.

Park House Residential Home is a ‘care 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. Park House Residential Home is a care home providing accommodation and personal care up to 20 older people. There were 13 people living at Park House Residential Home at the time of this inspection.

There was a registered manager employed at the service. 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.

People spoken with were very positive about their experience of living at Park House Residential Home. They told us they were happy, felt safe and were respected.

Staff recruitment procedures were in place. The registered provider ensured pre-employment checks were carried out prior to new staff commencing employment to make sure they were safe to employ. We have made a recommendation about the completion of a risk assessment for one staff member employed at the service, to ensure they were of good character and promote people’s safety at the home.

Staff had the necessary skills and understanding to support people to evacuate safely in the event of a fire. We found the service’s fire risk assessment was five years old and therefore recommended the registered provider review the risk assessment, so that changes in legislation and guidance can be taken into account. After the inspection, we received confirmation from the registered provider that the fire risk assessment was to be reviewed by an external company specialising in fire safety.

People’s care records contained detailed information and reflected the care and support being given. We found some care reviews had been missed in records we checked. After the inspection, the registered provider submitted an action plan to the CQC to review everyone’s care records.

The registered provider had a complaints procedure and kept a record of any concerns received. We have made a recommendation about recording completed actions once a complaint is received, to evidence when they have followed their complaints procedure.

There were systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure full and safe procedures were adhered to. We have made a recommendation about the completion of infection control audits.

We found systems were in place to make sure people received their medicines safely so their health needs were met. Medicine protocols were in place to guide staff when to administer medicines prescribed on an ‘as and when’ basis to meet people’s health needs.

Staff were provided with relevant training,

Park House Residential Home is an old stone built property adapted to provide accommodation and personal care for 20 older people.

There was a manager at the service who was registered with CQC. 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.

Our last inspection at Park House Residential Home took place on 11 March 2014. The home was found to be meeting the requirements of the regulations we inspected at that time.

This inspection took place on 12 January 2016 and was unannounced. This meant the staff who worked at Park House did not know we were coming. On the day of our inspection there were 15 people living at Park House.

People spoken with and their relatives were very positive about the experience of living at Park House and the staff who worked there. They told us they felt safe and staff were “second to none,” “lovely,” and “fantastic.”

Healthcare professionals spoken with had no concerns with the home and told us they found the staff to be caring. One professional told us, “The care is very good and staff are very responsive to residents.”

The interior and grounds of Park House were well maintained, clean and felt homely.

We found systems were in place to make sure people received their medication safely although the auditing of medicine records and systems does need to improve.

Staff recruitment procedures were thorough and ensured people’s safety was promoted.

Staff were provided with relevant training to make sure they had the right skills and knowledge for their role.

The service followed the requirements of the Mental Capacity Act 2005 (MCA) Code of practice and Deprivation of Liberty Safeguards (DoLS). This helped to protect the rights of people who may not be able to make important decisions themselves.

People had access to a range of healthcare professionals to help maintain their health. People told us a varied and nutritious diet was provided and their preferences were taken into account so their health was promoted and choices could be respected.

People said they could speak with the registered manager or senior staff if they had any worries or concerns and felt that they would be listened to.

We saw people participated in a range of daily activities both in and outside of the home which were meaningful and promoted independence.

Quality assurance systems were not fully in operation to assess, monitor and improve the quality of Park House.

We found a breach in one regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was a breach in; Regulation 17; Good governance.

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

We talked with four people who used the service. People told us they were happy with the service, thought the home was kept clean, enjoyed their food, participated in activities, liked the staff who looked after them and felt well supported by staff. Some comments captured included, “Absolutely couldn’t be better here,” “There is something to do every day,” “We want for nothing,” “Staff [are] pleasant …very well run [home] on the whole” and “[It’s] wonderful!”

We found there were effective recruitment and retention processes in place.

We found people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records had been maintained.

Before people were given any care or support they were asked if they agreed to it. People told us the care they received met their needs. One person said, “Mrs Crabtree’s (the owner/manager) is kind and good. She’s fastidious in making sure everything’s alright for you. She goes out of her way to try and keep us happy.”

People told us ‘the meals were very good’. One person said, “meal times are a social occasion and the food here is excellent. What I find quite pleasing, is that on one’s birthday, you get to choose the lunch and you can go to town. It’s unlimited what you can choose. We have a very good cook.”

We found the provider worked in co-operation with other health and social care professionals to meet people’s needs.

The environment was clean and people were protected from the risk of infection. They had access to surroundings that were conducive in supporting their health and welfare.

Safe recruitment practices were not being followed.

Records which are required to be kept in the management of the regulated activity were not all available when requested. There was a lack of proper information about people and staff, which meant people were not always protected for the risks associated with unsafe or inappropriate care.

People told us that staff at Park House respected their dignity and privacy. One person told us that staff at the home checked on them throughout the night. They told us that staff carried out these checks in an, “unobtrusive way.”

People were positive about the care they received at Park House. One person described Park House as, “very comfortable” and said that the home had, “exceeded their expectations.” During our inspection we saw that the direct care provided at Park House was safe, appropriate and took people’s individual needs into account.

We found that the majority of care plans at Park House were appropriate. We found some negative comments and words within the care plan of one person. This did not promote or portray a positive impression of this person and their specific needs.

We found that medication was administered safely. People told us that they received their medication on time and had never experienced any difficulties with it.

Our observations and conversations with staff and people who used the service demonstrated that there were enough staff to meet people’s needs.

None of the people we spoke with during our inspection had any concerns about Park House. We saw that a complaints policy was in place and reviewed the two complaints within the homes complaints book. There was no documentation to acknowledge the second complaint and the action taken to resolve it.

People using the service told us that staff were “Very good” and “Caring”. Staff told us that they were provided with opportunities to develop their skills and that staff training and supervision was provided to help them to do their jobs. .

People using the service told us they were “Very happy” with the service they received. We observed staff interacting with people in a sensitive and courteous manner to ensure their dignity was maintained. People living in the home said they were “Very comfortable” and confirmed they were consulted about how their support was provided. People told us that prompt action was taken to ensure their care and treatment met their personal wishes and needs. People living in the home said that staff listened to them and had no concerns about the service they received. Staff were observed to be helpful and friendly, providing gentle support and assistance when needed. People living in the home told us that staff were “Helpful” and “kind”. People confirmed that staff supported them appropriately to ensure their needs were met.