This unannounced inspection took place on 10 February 2016. At our last inspection in January 2015, we found that the provider was meeting the regulations that we assessed.

Parkside Health Care Limited is registered to provide accommodation, nursing or personal care for up to 20 people, who have a mental health or physical health condition. At the time of our visit 19 people were using the service.

The manager was registered with us as is required by law. 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 were provided with the training they needed to support their knowledge about how to protect people from harm. Overall, medicines management within the service were effective. The service had sufficient staff on duty with the skills and experience required in order to meet people’s needs. Risks in relation to people’s health conditions were regularly assessed to minimise them; staff were clear about the individual risks to people using the service.

People were supported to access the nutrition they needed and were monitored for any changes in their dietary needs. Staff received a high level of support through induction, training and with on-going supervision to develop their knowledge and skills.

The service had appropriately identified those people who may need a Deprivation of Liberty Safeguards (DoLS) in relation to potential restrictions they were subject to. People were supported to access reviews from a variety external healthcare professionals and also in relation to any more urgent needs.

People spoke to us about how genuinely caring and kind staff were towards them. We saw and people told us they felt involved in decisions by how they were communicated with and cared for. People told us they were encouraged to remain independent as possible in all elements of daily living activities by staff. We observed staff ensuring people’s privacy and dignity was maintained.

People were consulted about all aspects of the planning of their care and in relation to the daily activities they were involved in. Activities available within the service were centred on people’s individual abilities, preferences and interests. Feedback about the service was actively sought in a variety of ways, analysed, shared and acted upon. The provider’s complaints process was clear and was displayed on communal noticeboards for people to refer to.

All of the people and staff we spoke were very complimentary about their experience of the service and the quality of the leadership. Staff were well supported by management and told us they felt involved in the future development of the service. Regular audits to reduce any risks to people were undertaken at service and provider level to ensure that standards were maintained.

This unannounced inspection took place on 8 January 2015. At our last inspection in December 2013, we found the provider to be compliant with all the regulations we considered.

Parkside Health Care Limited is registered to provide accommodation, nursing or personal care for up to 20 people, who have a mental health condition. At the time of our visit 20 people were using the service.

The service had 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.

We found that staffing levels, particularly during the day time were inconsistent and the numbers staff on shift was not determined by people’s level of dependency. Some recent improvements to staffing levels on nights were apparent and people and staff commented positively about the impact of the increased availability of staff.

Medicines were stored and handled safely. However, some people in daily receipt of ‘as required’ medicines would benefit from a review by the prescribing doctor.

Over half of the staff had not received timely updates in regard to the provider’s basic training. The service provided specialist care to people with mental health and related physical health conditions, however only a small number of staff had received specialised training to educate them about people’s specific conditions.

People’s nutritional needs were monitored regularly and reassessed when changes in their needs arose. We observed that staff supported people in line with their care plan and risk assessments to maintain adequate nutrition and hydration.

We found that eight people using the service were subject to a Deprivation of Liberties Safeguard (DoLS). Staff were able to give an account of what this meant when supporting these people and how they complied with the terms of the authorisation.

We observed staff interacting with people in a positive manner. People, their relatives and professionals spoke highly about the genuine caring nature of the staff.

People told us they were encouraged to remain as independent as possible by staff. We observed staff maintain people’s privacy and dignity whilst supporting them.

People were consulted about all aspects of the planning of their care and in relation to the activities they were involved in. Activities available within the service were centred on people’s individual abilities and interests.

Feedback was actively sought from people and those with knowledge of the service. This information was analysed and shared with actions for improvements outlined.

The complaints process was made available for people and their relatives in the ‘service user’s guide’ they received on admission to the service. This contained the contact details of external agencies, where any concerns or issues about the service could also be reported.

The provider undertook regular audits to reduce any risks to people and ensure that standards were maintained. We saw that the most recent audits undertaken prior to our inspection had identified staffing levels were low and that staff training was not up to date. Comments about how the registered manager was hoping to improve these risks were evident.

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

No one knew we would be visiting on the Sunday morning of our inspection as our inspection was unannounced.

At the time of our inspection 15 people lived at Parkside. During our inspection we spoke with eight people who lived there, one relative, seven staff (including the night nurse who was just going off duty when we arrived), the registered manager and the operations manager.

Although a number of people told us that they would rather live at home in the community everyone we spoke with was complimentary about the overall service provided, their care, and the staff. One person who lived there told us, “I have lived here for a long time and I am happy”. Another person said, “The staff are nice and kind”. A relative told us, “They have not been here long. They were in another place before. I am so glad that they are here. In the short time they have been here they look so much better, much calmer and less agitated”.

We saw that people's needs had been assessed by a range of health care professionals including specialist doctors, specialist nurses and the dentist. This meant that staff had enabled people to have their health care and safety needs monitored and met.

Safeguarding procedures were in place so that staff would recognise and report any allegations of abuse to protect people from the risk of harm.

We determined that staffing levels were adequate to ensure that people’s needs were met and that they were safe.

Staff had the skills and knowledge to know how to safely support people who lived there to meet their needs. Staff told us that they were well supported in their role and this helped them to know how to support people who lived there.

Generally record keeping was well maintained and sufficient to ensure that people would be protected from the risks of unsafe or inappropriate care.

The service was split into two units called Unicorn and Bloomfield. The units varied in the level of care provided and people lived on a specific unit depending on the complexity of their needs. On the day of our inspection there were fourteen people living at the home.

We spoke with four people using the service and three relatives. We spoke with four members of staff which included qualified nurses. We spoke with a registered manager from another of the provider’s service and the regional manager. We looked at four care records to see how people's care needs where being met.

People were generally happy with the care that they received. One person that we spoke with told us, "The care is good". Another person that we spoke said, "The staff are brilliant".

People’s privacy, dignity and independence were respected.

People experienced care, treatment and support that met their needs and protected their rights.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained. The implementation of new records would improve people's accessibility and involvement in their care.

We spoke with five people who used the service and four members of staff.

People that live at Parkside told us that they have some involvement in their care. People we spoke with told us about staff discussing their care plans with them. They also told us that staff supported them in the way they wanted, asking their permission before they did anything. Our observations at the time of our visit also showed us that staff supported people in a way that was recorded in their individual plans.

People also told us that staff will sit and talk to them about what is happening and they can all join in with occasional meetings about food and activities. People also said that staff will listen to them. We also heard from people about how the service has responded to their requests.

We looked at three people’s care records. The amount of information within these could potentially be a barrier to their involvement, this as there is a lot of information to retain and digest.

People we spoke with told us that they were happy with the care and support that they received. We heard that “Carers here are great”. One person said that their key worker was their “Favourite member of staff” and that they “like them”. One person we spoke with said staff “Do their job properly”. We heard that staff are usually able to response to people’s requests quickly with the exception of busier periods when they may need to wait for a short while.

We saw good responses from staff to people living at the home, with staff addressing people in a dignified and respectful way. We heard people called by their preferred names. We saw staff assisting people to transfer in a safe way, whilst also offering encouragement and appropriate support. We observed staff respond to people in a calm and relaxed manner on all occasions.

People we spoke with told us that they have access to health professionals with support from staff when needed. People’s contact with health services was not always recorded in individual records.

Most people said they are involved in activities. One person said they are never bored although another told us “Could do with a bit more on “, although they recounted going out on numerous outings with staff. We saw during the day of the visit that the staff were engaging with people so as to provide stimulation through activity. People told us they are supported to practice their chosen religion.

Some people told us that they could raise concerns with staff, the manager and their families. People expressed confidence in the staff team and told us they felt safe at the home. Not every one we spoke with was clear as to how they raise concerns beyond the manager though, one telling us they were not aware of the complaints procedure.

People told us there were no restrictions beyond those legally placed so as to protect people. We saw people moving freely around the home. People were supported to form consenting relationships with others as they wish.

We heard from staff that they felt “Well supported” and that team work was good. Staff felt that they received good support from the management team. The staff said that if they needed support management were approachable and available. Staff also told us that appropriate training was provided to them.