This inspection took place on 7 February 2019 and was unannounced.

Parkside Nursing Home 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. Parkside Nursing Home accommodates up to 34 people in one adapted building across two floors. At the time of the inspection there were 18 people living in the service.

There was 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.

When we last inspected the service it was rated Good however at this inspection we found that areas there were areas that required improvement.

Whilst we received positive feedback from people, relatives and staff we found consent was not always obtained in line with the Mental Capacity Act 2005. There were no decision specific capacity assessments in place for important decisions such as the use of bedrails. People told us permanent staff were competent in their roles. The service was using agency staff which people told us sometimes affected the quality of the care provided. The environment for people living with dementia needed to be updated to help people move around the service.

Whilst permanent staff knew people’s needs very well there was a risk that care delivery could be affected as care plans contained incomplete or contradictory information. This was an area that the registered manager and staff told us work was needed to improve. Activities were provided however people told us they felt these were not always enough to help stimulate them or keep them interested. Some of the required refresher training for staff had not been completed.

There was a system of auditing in place however this had not identified the issues we found. Where audits were completed these did not always state what action should be taken to address the findings or give a timescale for this to be completed by.

People told us there were enough staff to keep them safe and we saw people being supported when they needed. A number of staff had recently left and there were plans in place to recruit new staff to address this. People received their medicines when they needed them by trained nursing staff who explained what the medicines were for. All medicines were stored and disposed of appropriately. Where there were risks to people these had been identified and managed well to help keep them safe. The registered manager monitored accidents and incidents to identify any themes or patterns. Staff spoke confidently about the actions they would take if they had a safeguarding concern. The service was clean and staff followed safe infection control practices.

People told us they liked the food provided and their nutritional needs were met. Staff supported people at mealtimes which were calm and relaxed. People’s needs were assessed and their healthcare needs met, specialist support was provided and guidance followed to maintain good health.

People and relatives told us staff were kind and caring and treated them with respect and compassion. Where possible people were able to discuss the care they received and make decisions on how this should be provided. People’s privacy, dignity and independence was promoted and visitors welcomed.

People told us they would have no concerns making a complaint if necessary and were confident this would be acted upon by the registered manager and staff. There was an experienced and established staff team who worked well together and followed guidance given by external healthcare professionals. The atmosphere in the service was homely and the registered m

Parkside Nursing Home is a care home which provides nursing care for up to 34 older people, some of who may have dementia. At the time of our inspection 24 people were living at the service.

There was 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.

The inspection took place on 27 July 2016 and was unannounced.

There was positive feedback about the home and caring nature of staff from people who live here.

People were safe at Parkside Nursing Home.

Staff understood their duty should they suspect abuse was taking place, including the agencies that needed to be notified, such as the local authority safeguarding team, CQC or the police.

Risks of harm to people had been identified and clear plans and guidelines were in place to minimise these risks. Accidents and incidents were recorded and acted upon. In the event of an emergency people would be protected because there were clear procedures in place to evacuate the building.

There were sufficient staff on duty to meet the dependency needs and preferences of the people that lived there. The provider had carried out appropriate recruitment checks to ensure staff were suitable to support people in the home.

People received their medicines when they needed them. Staff managed the medicines in a safe way and were trained in the safe administration of medicines.

Staff were knowledgeable and received a comprehensive induction and ongoing training, tailored to the needs of the people they supported. They also received regular supervision.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people’s ability to make decisions for themselves had been completed. Throughout the inspection day staff were heard to ask people for their permission before they provided care.

Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected.

People had enough to eat and drink, and specialist diets either through medical requirements e.g. diabetic meals, or personal choices organic foods were provided.

People were supported to maintain good health as they had access to healthcare professionals when they needed them. When people’s health deteriorated staff responded quickly to help and made sure they received appropriate treatment.

The staff were kind and caring and treated people with dignity and respect. Good interactions were seen throughout the day of our inspection, such as staff talking with people and showing interest in what people were doing and comforting them in an appropriate manner.

People could have visitors from family and friends whenever they wanted and there were positive relationships between people and staff which allowed people to express their views.

Care plans were detailed and provided good guidance for staff to reference if they needed to know what support was required. People received the care and support that reflected their needs and preferences.

People told us they enjoyed the activities on offer. There was a range of activities that met their social needs.

People knew how to make a complaint if they needed to. Complaints had been effectively resolved in line with the complaint procedures.

People and relatives gave positive feedback about the management of the service and felt they could speak to the registered manager whenever they needed to.

Quality assurance checks were effective at identifying areas where the service could improve. We saw that the records and polic

As part of our inspection we spoke with 10 people who used the service about the care and support they received. Some people who lived at the home had dementia and were not able to tell us their views so we used different methods to help us understand the experiences of people who used the service, such as observation.

People told us they "Liked" living at Parkside. Comments included "I like it here", "Well the food is wonderful" and "They are really superb here".

We found that the service had appropriate procedures in place to ensure that people received the correct medication at the correct times.

People spoke highly of staff and described them as "Wonderful" and "Kind". However, we found concerns that there were not enough staff to meet the individual social needs for people who lived in the home.

Staff we spoke with told us they felt "Supported" and "Enjoyed" working in the home. They told us that they received good training opportunities which helped them in their role.

We found that the service had completed the appropriate checks in order to maintain a safe and suitable environment for people. We also saw that there were systems in place to monitor the quality and effectiveness of the care that people received.

People told us they were happy living in Parkside Nursing Home. Comments included "I like it here and feel very safe" "I have a nice room" and "I'm very well looked after".

People spoke highly of the staff and described them as "Caring" "Loving" and "Kind". Another person said "It has really improved recently and staff are happy".

All of the people we spoke to said they liked the food and they haD plenty to eat. One person told us "The cook makes me the food I ask for" and "The food here is lovely".

People told us they were able to get involved in different activities and were able to choose what they wanted to do. One person said "I really enjoy doing the exercises here" and "I've started to improve with doing the activities".

People told us they were involved in their care and support. Comments included "You can get involved as much as you want to" and "The staff talk to me and tell me why it will help me if I do things".

All of the people we spoke with told us the home was kept clean and tidy.

People who live at the services, their carers and staff consistently told us about improvements to the service. This included improvements to the environment, mental stimulation, standards of care and quality of staff. A staff member said “we are getting back to how it used to be, a really nice well run home which cared about its residents”.

Some people do not use verbal forms of communication. Observation showed that some residents use single words or gestures. Other people had their own style of communicating. For example, the use of body language, facial expressions or other forms of behaviour. Staff recognised these and responded to them. People we observed showing relaxed body language and enjoyed interacting with staff.

We observed people being given choices about what to eat and what activities to be involved in. People confirmed that their preferred times of rising and retiring was respected by staff and that they could vary these times according to their personal choice. People told us that they felt that their privacy was promoted.

Carers told us how they have recently been involved in discussions with staff about their relatives care and how they felt listened to. People told us that they felt able to approach staff with any feedback or concerns they had.

We observed people being given a range of choices about what to eat and drink and were provided with snacks and drinks throughout our visit. People described their lunch as: “lovely” “very nice” and “we now have a very good cook”. A carer said “how much better the food was as they seem to care a bit more about what she eats and they go out of their way to ensure that it looks nice”.

Carers continue to tell us that the service acts promptly in seeking medical advice or intervention. People who live at the service told us that they felt safe and had never seen any one being mistreated.

Staff were observed interacting with people who live at the service in a relaxed and gentle manor. People told us that there is always staff around to get the support they need when they want it and from staff who were knowledgeable and helpful. People told us how there had been some turnover of staff and that there was “a few new faces”. We observed interactions between staff and people where staff provided encouragement and reassurance to join in with games and puzzles. Carers consistently told us that since the appointment of a new manager more staff have been recruited and that this has had a positive effect on the standards of care provided.

Carers consistently said that they could visit the service at any reasonable time and that they are made to feel welcome. Variable feedback was received from carers about their experiences in relation to the care and welfare their relative receives. This included a carer commenting on how they felt that the service had gone “down hill” since their relative had moved in a year ago. Consistent feedback was received from careers and people who use the service that there was not enough things to do.

Carers spoke of how the service ensures that prompt action has been taken to address any health issues.

People told us that staff knock on their bedroom door when they are about to enter. Several carers expressed their frustrations that there was no place to meet in private when visiting and that sitting in the lounge was very distracting and noisy. Carers told us that they felt that their relative’s rights are not always respected.

We received consistent feedback from people who use the service, staff and relatives that people were not always provided with control or choice in relation to food and when and how they receive support. People told us that they did not always understand the choices being offered to them by a staff member due to their accent. A carer said that their relative “has to eat it or she would not get anything else”. Consistent feedback was received from people who use the service and their carers about the poor standard of some meals. A person on a specialist diet told us that they had been provided with an alternative pudding to meet their medical needs and were offered further portions of it. People told us about not being able to physical eat some of the food as it had not been cut up or it was burnt or too cold.

People and carers consistently told us how kind staff were. People and carers consistently told us about how there was insufficient staff to get the help that they and their relatives needed in a timely way. People gave us examples of when they had to wait for assistance and the impact that this had for them. A carer commented about their relative “She does not do anything she just sits in the chair all day as there is only four staff for the whole home. When they do seem to have the time they don’t even talk to her then and if they did not sure she could understand as some staff have heavy accents”. A social care professional spoke about the skills that staff had in being able to support a person they placed at the home. We observed a staff member showing compassing and using humour with a person to help ease their anxieties and help orientate them.

People who live at the service told us that they felt safe and had never seen any one being mistreated.

Carers told us that they have been asked in the past for their views on the service and if there is anything that could be improved. Some said that they did not always feel confident that their views have been acted upon, in relation to menus, laundry and staffing.