The inspection took place on 26 and 27 April 2017 and was unannounced. The service is registered to provide accommodation with personal care for up to 50 older people with varying support needs, including nursing and people living with dementia. On the day of our inspection there were 35 people living at the service.

Parkside Nursing Home is required to have 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 home is run. At the time of our inspection a new manager was in place who had submitted their application with the Care Quality Commission to become the registered manager which was being processed.

People and their relatives told us that they felt staff provided safe care and support. Staff were trained in adult safeguarding procedures and knew what to do if they considered someone was at risk of harm or if they needed to report concerns.

There were systems in place to identify risks and protect people from harm. Risk assessments were in place and reviewed to ensure they continued to reflect people’s needs. Risk plans informed staff of the action required to reduce any associated risks to people’s needs. Accidents and incidents were recorded and reported by staff. The management team analysed these to ensure appropriate action had been taken to protect people, and to consider if there were any themes or patterns that required further action. Contingency plans were in place to support staff to provide a safe service in the event of an untoward incident affecting the service.

There were sufficient staff to keep people safe and meet their needs. Safe recruitment procedures were in place and followed. Medicines were given to people on time and as prescribed, they were also managed and stored safely following best practice guidance. People were supported effectively by staff that had received an induction, ongoing training and support.

Policies and procedures were in place to guide staff in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff had received appropriate training and understood the processes in place for ensuring decisions were made in people’s best interests. People and or their representative where appropriate, had given consent to their care and treatment.

People received sufficient to eat and drink and their nutritional needs had been assessed and planned for. People were appropriately supported with their eating and drinking needs if required, choices were offered and respected, and independence encouraged as fully as possible.

The service worked well with visiting healthcare professionals to ensure they provided effective care and support. When concerns were identified about people’s healthcare needs, appropriate action was taken to support people’s health and well-being.

Staff were kind and caring, they knew people well, and they supported people in a dignified and respectful way. Staff acknowledged and promoted people’s privacy. People felt that staff were understanding of their needs and that they had developed positive relationships with them. Information about an independent advocacy service was available for people should this support have been required.

People and or their representatives where appropriate, were involved in the assessment and review of their needs. Care plans informed staff how to support people and were on the whole personalised to people’s needs, routines and preferences. Activity staff provided a range of one to one and social activities and opportunities, to support people with any interest’s hobbies and pastimes. People and staff knew how to raise concerns and these were dealt with appropriately.

People who used the service and relatives or re

This inspection took place on 14 June 2016 and was unannounced.

Parkside Nursing Home provides accommodation for up to 50 older people with varying support needs including nursing and people living with dementia. On the day of our inspection there were 29 people living at the home.

Parkside Nursing Home is required to have 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. At the time of our inspection a registered manager was in place.

We carried out an unannounced comprehensive inspection of this service on 6 and 7 April 2016. We issued a warning notice to the provider. People had experienced incidents of avoidable harm because the provider had not appropriately assessed how risks to people were monitored and mitigated. We also identified concerns relating to how records of people's care and treatment were completed, monitored and maintained.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the warning notice. We found at this inspection that the provider was compliant with the warning notice.

Improvements had been made to the systems and processes that assessed, managed and monitored quality and safety. People’s individual needs were assessed and care plans and risk plans were in place to advise staff of how to meet people’s needs. People had the required equipment in place to reduce risks from occurring and people’s records were completed accurately and were maintained appropriately.

We inspected the service on 6 and 7 April 2015.

Parkside Nursing Home provides accommodation for up to 50 older people with varying support needs including nursing and people living with dementia. On the day of our inspection there were 38 people living at the home.

Parkside Nursing Home required 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. At the time of our inspection a new manager had been appointed and had been in post since 1 April 2016. They told us and the operations manager confirmed that they had started the process to apply for the registered manager position. We will monitor this.

During our previous inspection on 8 and 9 April 2015 we identified two of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to how risks to people’s needs were assessed, concerns about how people’s medicines were managed and a lack of robust systems in place to effectively assess, monitor and improve the quality of the service. The provider sent us an action plan to tell us of what improvements they would take to meet these breaches in regulation.

At this inspection we found continued problems and a breach in these areas and additional concerns in relation to people’s care records and documentation. Information available for staff that provided guidance of people’s individual needs was variable in quality and content and in some instances no information was provided. People’s daily records were not reviewed effectively to ensure people’s needs were being met and action taken when changes occurred.

Risks to people had been assessed but the control measures identified to reduce harm had not always been in place, resulting in incidents occurring that were preventable.

Staff had received safeguarding adults training and were aware of their role and responsibilities. The provider worked with the local authority and investigated safeguarding concerns appropriately.

Some safety concerns were identified with the environment and people’s personal evacuation plans were limited in detail about people’s behavioural and anxiety needs.

Some improvements had been made to the management of medicines but further concerns were identified. Medicine trolleys were left unlocked when unattended; a person had experienced a delay in their eye drops being ordered. Two discrepancies were found when checking people’s medicines that meant we could not be assured people had received their prescribed medicines.

Safe recruitment practices were in place to reduce the risks of unsuitable staff working at the service. Staffing levels were a concern to people and relatives. Three permanent nursing staff were being recruited and the provider had identified an additional deputy manager was required and this was also being appointed but these were not in place at the time of the inspection. Staff raised concerns about long working hours which may have been a contributing factor for staff absenteeism. This was being addressed by the provider. People’s dependency needs were assessed and reviewed, concerns were identified about the deployment of staff.

Staff training opportunities had improved and support to staff including regular supervision and appraisal meetings to discuss their work and development needs, were improving.

Staff did not always gain consent from people before providing day to day support and before care and treatment. Where people lacked mental capacity to make specific decisions about their care and treatment, The Mental Capacity Act (2005) was adhered to. Where concerns had been identified about people’s liberty and freedom the provider had taken action to ensure people were not unlawfu

We used a number of different methods to help us understand the experiences of people using the service, because they had complex needs which meant they were not able to tell us their experiences. We observed care delivery and checked care records. We spoke with six staff and the manager of the home. We checked other records such as duty records and training records.

We spoke with two people who used the service and a visiting relative. All of these people were happy with the care provided. A relative told us, “My mother has received care here for over two years, she’s well cared for, always nicely dressed and the staff keep me fully informed. I am very happy with the care provided and have no concerns.”

We undertook this inspection because we received information of concern that told us people did not always receive appropriate support because there were not enough staff on duty and that some staff were not trained to move people safely. We found that staff were trained to undertake safe moving and handling. However, the systems in place to maintain planned staffing levels did not ensure that people who used the service received a consistent level of care.

We undertook this inspection to check what improvements the provider had made since our last inspection on 07 October 2013. We checked care delivery records and care plans, spoke with two staff members and undertook a brief tour of the building.

We found that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

We found that the arrangements in place to manage the risks associated with medicines protected people who used the service.

We found that improvements had taken place to the environment to ensure that people who used the service were in safe, accessible surroundings that promoted their wellbeing.

We used a number of different methods to help us understand the experiences of people who used the service, because some people had complex needs which meant they were not all able to tell us their experiences. We spoke with the manager and seven staff. We spoke with four people who used the service and observed how people were being supported.

We found that the staff assessed the risks in the environment so that people who used the service were kept safe.

We found that people who used the service had a care plan that reflected their individuality and described how their wishes and preferences were taken into account with the care and treatment plan.

People who used the service told us, “They look after you here, the food is good and I can’t complain at all.” “Another person commented, The staff are very kind here.”

Time was being taken to make sure that people who used the service were able to consent to their care or that decisions were taken in accordance with the laws that protected their rights.

Recruitment practices made sure that people who used the service were in safe hands and the staff were being supported to obtain the skills they needed to support people in line with best practice.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not fully able to tell us their experiences. We spoke with ten people who used the service and two relatives. We spoke with the manager, three staff and three visiting professionals. We also observed people being supported by staff during mealtime and care delivery.

Without exception all of the people we spoke with told us they were happy with the care and support they received and that they felt safe at the home.

Visiting professionals told us that they found the care and support provided by Parkside was responsive to individual needs and that people who used the service were provided with continuity in their care, treatment and support as a result of the manager ensuring effective communication between all other agencies involved in the person’s assessment and treatment.

One person using the service was fully able to tell us about their experiences of the care and support they received. This person told us, “I have always experienced good care here and I have never had any concerns. The staff are very caring, they look after my health and always consult me about my care. I can have visitors anytime. It’s the best home around.”

We inspected the service on 08 and 09 April 2015. Parkside Nursing Home is registered with the Care Quality Commission to provide accommodation for up to 50 older people with varying support needs including nursing and dementia care needs. On the day of our inspection there were 41 people living at the home.

The home did not have 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.

When we last inspected the service in February 2014 we found there were improvements needed in relation to staffing levels. The provider sent us an action plan on 15 March 2014 telling us they would make these improvements by October 2014. We found at this inspection that improvements had been made. Staffing levels had been increased prior to the inspection.

At times people did not receive safe care because systems to guide staff on how to manage risks people may face were not followed or kept up to date. People were at risk of not having their medicines as required because the arrangements to manage these were deficient.

People told us they felt safe living at the home, but we found systems designed to keep people safe were not being followed.

Staff did not feel fully prepared for their work by the training they received. Staff were unclear about their role in protecting people’s rights to make decisions for themselves or how to lawfully restrict someone’s liberty.

There were arrangements in place to encourage people to eat and drink to ensure their nutritional and hydration needs were met, but these were not being followed. People were supported to have their healthcare needs met.

People did not experience a consistent level of kindness, privacy or dignity.

People had opportunities to take part in activities in the home and go on day trips. People’s care and support was sometimes well provided for and at other times was poorly organised. People could not be assured they would be given choices they were able to make. Staff did not always have the direction they needed on how to meet people’s needs.

People could raise any complaints or concerns and felt assured these could be listened to and considered.

Staff did not feel the management of the home provided them with the encouragement and support to carry out their responsibilities. Systems designed to monitor the quality of the service to help identify improvements had not been effective.

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