The inspection visit took place on 17 October 2016 and was unannounced.

ParkHouse Grange is a residential care home providing accommodation for up to 40 people. The home is purpose built with accommodation on two floors. People have use of four communal lounges, a summer house and garden. At the time of our inspection 36 people used the service.

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.

People who used the service were safe. They were supported and cared for by staff that had been recruited under recruitment procedures that ensured only staff that were suited to work at the service were employed. Staff understood and discharged their responsibilities for protecting people from abuse and avoidable harm.

People’s care plans included risk assessments of activities associated with their personal care and support routines. The risk assessments provided information for care workers that enabled them to support people safely but without restricting their independence.

Enough suitably skilled and knowledgeable staff were deployed to meet the needs of the people using the service. At the time of our inspection the service was using agency care staff to ensure enough staff were available to support people with their needs. An agency staff almost put a person at risk but for a timely intervention by permanent staff.

People were supported to receive the medicines by staff who were trained in medicines management. Medicines were stored safely, but temperature checks of storage areas were not consistently carried out.

Care workers were supported through supervision and training. People who used the service told us told us they felt staff were well trained and competent.

The registered manager understood their responsibilities under the Mental Capacity Act (MCA) 2015. Staff had awareness of the MCA and understood they could provide care and support only if a person consented to it and if the proper safeguards were put in place to protect their rights. There were people at ParkHouse Grange who were being cared for under Deprivation of Liberty Safeguards.

Staff understood the importance of people having healthy diets and eating and drinking well. They supported people at meal times to have their meals. They also supported people to access health services when they needed them.

People were involved in decisions about their care and support. They received the information they needed about the service and about their care and support.

People told us they were treated with dignity and respect. The registered manager actively promoted values of compassion and kindness in the service. They were a `dementia friend’ and `dignity champion’.

People contributed to the assessment of their needs and to reviews of their care plans. Their care plans were centred on their individual needs. People knew how to raise concerns if they felt they had to and they were confident they would be taken seriously by the provider. When people expressed preferences about their care and support these were acted upon by the service.

The service had effective arrangements for monitoring the quality of the service. These arrangements included asking for people’s feedback about the service and a range of checks and audits. The provider carried out weekly visits to ParkHouse Grange to monitor the quality of service. The quality assurance procedures were used to identify and implement improvements to people’s experience of the service.

The inspection visit took place on 17 October 2016 and was unannounced.

ParkHouse Grange is a residential care home providing accommodation for up to 40 people. The home is purpose built with accommodation on two floors. People have use of four communal lounges, a summer house and garden. At the time of our inspection 36 people used the service.

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.

People who used the service were safe. They were supported and cared for by staff that had been recruited under recruitment procedures that ensured only staff that were suited to work at the service were employed. Staff understood and discharged their responsibilities for protecting people from abuse and avoidable harm.

People’s care plans included risk assessments of activities associated with their personal care and support routines. The risk assessments provided information for care workers that enabled them to support people safely but without restricting their independence.

Enough suitably skilled and knowledgeable staff were deployed to meet the needs of the people using the service. At the time of our inspection the service was using agency care staff to ensure enough staff were available to support people with their needs. An agency staff almost put a person at risk but for a timely intervention by permanent staff.

People were supported to receive the medicines by staff who were trained in medicines management. Medicines were stored safely, but temperature checks of storage areas were not consistently carried out.

Care workers were supported through supervision and training. People who used the service told us told us they felt staff were well trained and competent.

The registered manager understood their responsibilities under the Mental Capacity Act (MCA) 2015. Staff had awareness of the MCA and understood they could provide care and support only if a person consented to it and if the proper safeguards were put in place to protect their rights. There were people at ParkHouse Grange who were being cared for under Deprivation of Liberty Safeguards.

Staff understood the importance of people having healthy diets and eating and drinking well. They supported people at meal times to have their meals. They also supported people to access health services when they needed them.

People were involved in decisions about their care and support. They received the information they needed about the service and about their care and support.

People told us they were treated with dignity and respect. The registered manager actively promoted values of compassion and kindness in the service. They were a `dementia friend’ and `dignity champion’.

People contributed to the assessment of their needs and to reviews of their care plans. Their care plans were centred on their individual needs. People knew how to raise concerns if they felt they had to and they were confident they would be taken seriously by the provider. When people expressed preferences about their care and support these were acted upon by the service.

The service had effective arrangements for monitoring the quality of the service. These arrangements included asking for people’s feedback about the service and a range of checks and audits. The provider carried out weekly visits to ParkHouse Grange to monitor the quality of service. The quality assurance procedures were used to identify and implement improvements to people’s experience of the service.

The inspection was carried out by a CQC inspector. We spoke with six people who lived at the service and four visiting relatives. We gained information about the service from reviews of care records and discussions with two managers, a senior care worker and two care workers. Below is a summary of what we found.

Is the service safe?

People who used the service and relatives we spoke with told us they trusted the managers and staff. One person told us, “I feel safe here.” Another said, “I wouldn’t leave my (relative) if I didn’t trust the staff.”

Staff we spoke with knew how to recognise signs of vulnerability and abuse and had received training in the protection of vulnerable adults. Records we looked at showed the service managed concerns about people’s safety effectively in consultation with health and social care professionals, people’s families and if required the local safeguarding authorities.

We looked at systems to ensure people’s health and safety including the management of water safety, fire risk and crisis evacuation planning. We saw effective systems were in place and were monitored and reviewed on a regular basis.

Records showed the service monitored and reviewed any accidents people experienced in order to reduce the likelihood of similar problems occurring.

Managers we spoke with understood their legal duty and knew how to refer people who might have been at risk of receiving inappropriate care, for independent assessment under a law called the Deprivation of Liberties Safeguards (DoLS).

Is the service effective?

People and their relatives told us they were happy with the service provided. One person said, “I can now walk.” This person told us this was because of the support and encouragement they had received from staff. One relative told us staff were, “Always very good” in supporting their relatives care needs. Another said staff cared for their relative, “Just the way I would do.”

We saw people’s plans of care were clear and well written. Staff we spoke with told us they were easy to understand and helped them to provide safe and effective care.

Staff told us about people’s assessed needs and plans of care. We saw from records and observations that staff delivered care effectively in ways described in plans of care. One relative told us about the importance of cleanliness and tidiness to their relative who lived at the care home. They highlighted their satisfaction that these standards were maintained with routine practical help from care staff.

Records including completed survey questionnaires showed staff worked well with doctors, community nurses and social workers to ensure people’s health and care needs were met and reviewed regularly.

Relatives we spoke with said they were always consulted about important issues and felt staff and managers were approachable and helpful.

Is the service caring?

We observed staff offering people respectful and patient support and care. One relative told us, “The girls are lovely and gentle.” A person who received a service told us, “They’re good to you here.”

Staff and managers we spoke with told us about the importance of respect and dignity for the people they supported. One relative told us they believed, “People are more important than anything else.” This person was referring to care service staff and managers at the service.

Throughout our inspection visit we observed warm and courteous interaction from staff towards the people they cared for and visiting relatives.

We saw from records and observations that staff sought people’s opinions and consent about the care they offered.

Is the service responsive?

Visiting relatives told us the service contacted them promptly about any problems or issues they needed to discuss. One person told us staff had responded to their relatives need for healthcare support by calling the GP quickly and informing them of the issue promptly.

Staff told us about work they did to identify and address changes in people’s care needs. We saw that plans of care were regularly reviewed and changed to better meet the person’s needs.

We looked at daily records of care provided and diary appointments in relation to people’s support needs. We saw that information was effectively shared between staff on duty and staff on the following shift.

We looked at records of meetings between managers and staff and between managers, people who used the service and their families. We noted problems and ideas to improve the service were discussed. Relatives told us issues they had raised had been effectively addressed by the service and we saw records that showed the service regularly reviewed people’s health and safety and the effectiveness of the way they worked.

Is the service well-led?

Records we looked at showed staff received appropriate training to ensure they had the skills and knowledge required to do their job. We noted the service applied for and received awards for their work and learning in relation to dignity in care.

Managers told us about work they were doing to improve the skills and morale of care staff. These included creative initiates to recognise and value staff and to better understand the experience of people who used the service.

Managers sought the views and opinions of people who used the service, their families and health and social care professionals involved in supporting people. We saw regular meetings with people took place and agreed decisions and actions were clearly recorded.

We saw records of regular monthly audits were carried out to ensure the quality of care and health and safety systems were maintained and improved.

We noted some systems, including maintenance and repair records and the recording and management of complaints, required evaluation and review to ensure improvement.

Managers and staff we spoke with told us they enjoyed their work. Staff attitudes and behaviours we observed indicated competence, a commitment to care and a pride in providing respectful and effective care for people.

We spoke with three people using the service, three relatives and two visitors. We also spoke to four staff members.

We found people were able to make informed decisions about their care and support. One person told us the care staff are ”very nice and kind. They always respect me and explain things to me before doing anything.”

We found people experienced care and support that met their needs and protected their rights. We found people’s care needs had been assessed. Care and support was delivered in a way that met people’s needs and ensured their safety and welfare.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. We found the provider had robust systems in place relating to the management of medicines.

We found there was a clear and up to date recruitment procedure in place that was followed by the service. This meant that people were cared for, or supported by, suitably qualified, skilled and experienced staff.

We found systems were in place to regularly obtain people's views about the care and service they receive. We found the provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service.

Some people living at Parkhouse Grange had limited communication and were unable to answer direct questions about some of the essential standards we reviewed. We did speak with people in a general way and asked some questions. We observed people and their interactions with each other and with staff.

We saw people sitting in the lounges with their visitors, listening to taped music, and some staff sitting with people chatting quietly or holding their hands. Staff told us they were planning the Queen’s Jubilee celebrations with people living at Parkhouse Grange. They were making decorations and bunting for a garden party for people and their families.

Two people told us,

“I am well looked after and like the view from my bedroom, staff are wonderful to me.”

“I am quite satisfied and have no complaints.”

We spoke with seven people living at the home and some relatives visiting and received very positive comments about service user’s care and treatment and support.

People told us about how much they valued the care and support staff gave them. They told us,

“Staff go the extra mile to help you.”

“Food is freshly cooked, lovely soups. No rubbish served.”

““I watch them dust the surfaces, hoover and wash the sink in my bedroom every day.”

People who use services also told us they felt safe and well looked after by staff at the home. They also felt confident to speak to the registered manager.

We saw staff treat people with respect at all times, in the manner they spoke with and how they supported people. Staff were patient, offered choices and encouraged people to make decisions about daily routines and the activities going on around them.

The visit was very positive across many of the outcome areas checked. There were unpleasant odours identified in some parts of the home which we are told will be addressed immediately. Quality monitoring although evident was not robust enough. Improvements in both these areas will ensure safe quality care, treatment and support due to effective management decision making.