We inspected the service on 25 and 26 April 2017. The first day was unannounced and the second announced.

Parkmanor Care Home is a registered care service providing personal care, nursing care and support for up to 40 older people. There were 37 people using the service when we visited and some were living with dementia.

There was a manager in place who was in the process of applying to become the registered manager. It is a requirement that the service has 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.

Staff knew their responsibilities to help keep people safe from harm and abuse. The manager took action where an accident or incident occurred to try to prevent a reoccurrence. Risks to people’s health and well-being were assessed and monitored so that staff had guidance on how to help people to remain safe. The provider had safely recruited a suitable number of staff to provide care and support to people.

People received their medicines when they required them by staff who had received training to administer them safely.

People received care and support from staff members with the necessary skills and knowledge. Staff received good support and they knew their responsibilities. They received training in areas such as medicines, dementia care and specific health conditions that people were living with.

People were asked for their consent before care and support was undertaken. Staff knew the importance of doing this and gave people additional information where this was required to aid their understanding.

People were supported in line with the Mental Capacity Act 2005. People’s mental capacity had been assessed for specific decisions. Any decision made in a person’s best interest involved important people in their life. The provider had made applications to the appropriate body where they had sought to deprive some people using the service of their liberties to make sure this was agreeable. Staff understood the requirements under the Act.

People were satisfied with the food and drink available to them. Staff knew people’s dietary requirements and where there were concerns about a person’s eating and drinking, specialist advice was sought.

People were supported to maintain their health and close observation occurred where this was required. People had access to healthcare professionals such as to a doctor, optician and district nursing services.

People’s dignity and privacy was protected and staff offered their support in caring and compassionate ways. People’s friends and family could visit without undue restriction.

People’s histories and things that mattered to them were known by staff. Their independence was maintained for as long as possible by staff who offered encouragement.

People received care and support based on their preferences and routines that were important to them. People and their relatives contributed to the planning and review of their care wherever possible. Staff had guidance available to them about people’s preferences and care requirements.

People were mainly satisfied with the activities available to them. We received feedback that some people preferred to be reminded about daily activities. The manager said they would make sure this occurred.

The provider had made available to people and their visitors a complaints procedure that was used. Action was taken by the provider where improvements were required.

The service was well-led and it had an open approach to sharing information with other agencies. The provider learnt from mistakes and events that had occurred. There were opportunities for staff, people and their families to offer suggestions for how the service could improve. The

We inspected the service on 31 August 2016 and the visit was unannounced. This meant the provider and staff did not know that we would be visiting.

We carried out an unannounced comprehensive inspection of this service on 25 April 2016. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to a breach of Regulation 11; need for consent and a breach of Regulation 17; good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Parkmanor Care Home on our website at www.cqc.org.uk.

At the last inspection we carried out on 25 April 2016 we found that where people lacked the capacity to consent to their care and treatment the provider had failed to act in accordance with the provisions of the Mental Capacity Act 2005 (MCA). At this inspection we found the provider had made the required improvements. We also found that the provider did not have quality checks in place to assess, monitor and improve the quality and safety of the service. The provider did not always maintain an accurate and complete record in respect of each person including a record of the care and treatment provided. At this inspection we found the provider had made the required improvements.

Parkmanor Care Home provides care and support for up to 40 older people. At the time of our inspection 33 people were using the service and many were living with dementia or similar conditions. The accommodation is offered over two floors accessible by a passenger lift and stairs. There is a large accessible garden for people to use should they wish to.

At the time of our inspection there was a manager in place who was in the process of registering to become the registered manager. It is a requirement that the service has 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.

The provider had a range of systems in place to identify and drive improvement. The provider took action where necessary.

The provider maintained accurate care records for each person who used the service so staff had the information required to support people in a way that met their individual needs.

People were supported in line with the Mental Capacity Act 2005 (MCA). People were asked for their consent before staff carried out care and support. Where people’s capacity to make decisions required assessment, the provider had assessed people’s mental capacity and decisions were made in people’s best interests. Staff understood their responsibilities under the Act. The provider had made applications to the appropriate body where they had sought to deprive a person of their liberties.

People and their relatives felt safe with the support offered to them. Staff understood their duties to protect people from abuse and avoidable harm and to remain safe. The provider managed accidents and incidents appropriately and looked at ways to minimise these wherever possible. Risks to people’s health and well-being were regularly assessed. For example, where people were at risk of falling, staff followed guidance the provider had made available to them.

People received their prescribed medicines in a safe way. Staff followed national guidance when handling medicines and received regular training and guidance to understand their responsibilities. People’s medi

We inspected the service on 25 April 2016 and the visit was unannounced.

At the last inspection on 21 and 26 November 2014 we asked the provider to take action to make improvements. We asked them to improve their practices in relation to obtaining people’s consent to their care. We also asked the provider to improve their practices in relation to their arrangements for monitoring the quality of the service. Following that inspection the provider sent us an action plan detailing what improvements they were going to make.

During this inspection we found that some improvements had been made. However, we were still concerned that people’s consent had not been obtained in line with the Mental Capacity Act (MCA) 2005. We were also concerned that people’s capacity to make specific decisions had not always been assessed. We still had concerns that checks by the provider on the quality of the service provided had failed to identify concerns found at this visit and therefore necessary action had not been taken.

Parkmanor Care Home is a registered care service providing care for up to 40 older people. At the time of our inspection 38 people were using the service, a significant number of whom had dementia. The service is offered over two floors accessible via the stairs or passenger lift. There are two lounges and two dining areas for people to use and all bedrooms are single occupancy. There is also access to a garden area for people to use should they wish to.

The service had a registered manager. It is a requirement that the home has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 provider had not always consistently managed or assessed risks that people were vulnerable to. For example, where people were at risk of skin damage this risk had not been carefully considered and documented. Staff members had recorded accidents and incidents but the registered manager had not analysed ways to prevent them from reoccurring.

The provider did not always have safe systems and processes for managing people’s medicines. For example, the storage and recording of people’s medicines was not always robust. Staff supported people to take their medicines in a safe way.

The provider had carried out regular checks on the equipment people used and the premises.

There were not always plans available to staff to support people to keep them safe during emergencies. For example, where people needed individual support to evacuate the home, the plans were not thorough.

People did not have concerns about their safety and staff knew how to protect them from abuse and avoidable harm.

People and their relatives had mixed views about the amount of staff available but we found there were enough staff to meet people’s basic care needs. The provider’s recruitment process was robust and included checking prospective staff before they started to work at the home. This helped the provider to make safer recruitment decisions.

Staff understood the requirements of the MCA 2005 and could describe how to obtain people’s consent before they offered care and support. Where people may have lacked the capacity to make their own decisions, the provider had not always followed the requirements of the MCA. For example, how the provider had assessed people’s capacity to make decisions was not always clear.

People were supported by staff that had received regular training. However, the regular checking of staff’s knowledge and skills had not always been recorded. Staff did not always receive regular support from their supervisor.

People were not always aware what food choices were available to them but food and drink was available to them throughout the

We spoke with six people using the service; observed care and support provided by staff and spoke with visiting relatives. People were complimentary about the care and support they received. People were confident that staff listened to their views and acted accordingly. Visiting relatives told us they were involved in their family member’s care needs to ensure that decisions made were in their person's best interest. Comments received from people included: “It’s a lovely place and I wouldn’t swap it for anything else” and “it’s clean, staff are pleasant and the food is good, especially when I can have second helpings.”

People lived in an environment that was safe, comfortable and adequately maintained. One person said: “I have my own private bathroom and you can also have shower or a bath anytime.” Another person who was asked for their view about Parkmanor Care Home said: “It’s perfect.” Risks were assessed and suitable equipment was provided to ensure people’s needs could be met safely. Arrangements were in place to ensure staff were trained; the premises and equipment were adequately maintained.

People were supported by staff that underwent a robust recruitment process to ensure they were suitable and qualified to work with vulnerable people. All staff received induction and regular mandatory training so that people could be confident that their needs were met by trained staff.

People who live at Parkmanor Care Home told us they were satisfied with the care and support they received. People were involved to make sure their care and supports needs were provided in a manner that suited them. One person said “The care is good” and “I’ve been here a few months and I chose to make this my permanent home.”

People had opportunity to take part in social activities and seasonal events organised by staff. People received personalised support that promoted their rights and independence.

People told us they were treated with respect and their care needs were met safely. People had a range of assessments and care plans in place that detailed the care and treatment they needed. Records showed people’s health and care needs were monitored and reviewed regularly. People had their prescribed medicines on time and saw health care professionals when needed. Arrangements were in place to support people safely and to deal with foreseeable emergencies.

People’s health and care needs were met by qualified nurses and care staff. The provider increased the staffing levels in response to our findings on the day and assured us staffing levels would be reviewed in response to people’s needs.

People had opportunities to make comment about the service and had information about how to make a complaint. They said they were confident to raise concerns with the registered manager. One person said “We all have little grumbles which they do sort out quickly.”

People told us that staff were competent, respectful and helpful. Some people felt there were not always enough staff at the home.

Parkmanor Care Home provides nursing and personal care for up to 40 older adults, including people with mental health needs, physical disabilities and sensory impairments. Many of the people who use the service have dementia care needs. The home is purpose built and accommodation is provided across two floors with a number of communal areas.

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.

Our previous inspection of 22 August 2013 found the provider had met all the regulations we inspected.

People we spoke with were confident their care and support needs were being met. They told us about the positive relationships they had developed with the staff team and were certain that their views were sought and listened to. People felt their individual needs and preferences were known and understood by staff working at the home.

We saw that people were well supported by a staff team that understood their individual needs. We observed that staff were friendly, kind and treated people with respect. Staff had worked hard to make the atmosphere of the home welcoming. We saw examples of where people had been involved in the running of the service during the staff award ceremony that took place on the first day of our inspection.

People’s medication had not always been managed and administered in a way that ensured people’s safety and welfare, particularly with regard to the management of PRN medication. This is medication that is given as required.

The provider was also not meeting the requirements of the Mental Capacity Act 2005 and had not always acted within the law. Where people lacked mental capacity to make decisions about their care, the proper procedures to ensure best interest decisions were made had not been followed.

The provider had a number of audits and management systems in place to assess and monitor the quality of service provided. However, these were not always effective as they had failed to identify a number of issues we found during our inspection.

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

Staff recruitment procedures were robust and ensured that appropriate checks were carried out before staff started work. Staff received a thorough induction and on-going training to ensure they had up to date knowledge and skills to provide the right support for people. They also received regular supervision and appraisals in line with the provider’s policy, although there were some gaps in the supervision of clinical staff. Staff told us they were well supported by the manager and provider and felt they had received sufficient training.

Staff were aware of how to manage concerns relating to people’s safety and welfare and the registered manager had a good understanding of the local procedures in responding to and reporting allegations of abuse. These processes had been followed when required. The premises and equipment had been well-maintained and were safe for people who lived there.

People’s needs were assessed and plans were in place to meet those needs. Staff understood what people’s individual needs were and acted accordingly. Risks to people’s health and well-being were identified and plans were in place to manage those risks. People were supported to access healthcare professionals whenever they needed to. We spoke with a visiting healthcare professional who told us people received good nursing care at the home. People’s nutritional and dietary requirements had been assessed and a nutritionally balanced diet was provided.

Staff were clear about the values and aims of the home and told us how they focused on giving people choices and promoted their involvement. Staff and people who lived there told us the registered manager was approachable and were confident that any concerns or issues they raised would be dealt with appropriately.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we took at the back of this report.