Parton House 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. Parton House provides accommodation and personal care. The care home accommodates 36 people in one adapted building. At the time of the inspection 22 people were living there, of whom 11 people were living with dementia.

Parton House is being refurbished. It provides spacious communal areas including three lounges, a reception room, a dining room, a cinema, seating areas on each floor and accessible gardens. People’s rooms are individualised and some have en suite facilities. They also have access to shared toilets, showers and bathrooms.

This inspection took place on 20 and 21 February 2018. At the last comprehensive inspection in December 2016 the service was rated as Requires Improvement overall.

At this inspection we found the service had improved to Good overall.

There was a registered manager in place who had recently transferred from another of the provider’s homes. 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 were benefiting from sustained improvements to the service they received. Their care and support was individualised reflecting their preferences, routines and lifestyle choices. Staff understood people well anticipating their emotions, helping them to stay calm. People’s health and wellbeing were promoted. They had access to a range of healthcare professionals. Their medicines were safely administered at times to suit them. People’s dietary needs were considered when offering them a choice of meals, snacks and drinks. Fortified foods and drinks were provided to those at risk of malnutrition. People at risk of developing pressure ulcers were provided with equipment to protect their skin and staff followed strategies to prevent deterioration in their skin. People had discussed their end of life wishes which were respected. A relative said, “You all went the extra mile for her in her last few days, and [Name] and I are extremely grateful for your dedication.”

People’s care records were kept up to date with their changing needs. They and their relatives were involved in developing their care and support. Information was shared with other agencies and organisations, when needed, to ensure a smooth transition between services. People were kept safe from the risk of abuse. Staff had a good understanding of safeguarding procedures and were confident management would take the appropriate action. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People had access to a range of meaningful activities which included visits by people and children living in their local community. Visitors were made to feel welcome and arrangements could be made for private dining.

People were supported by staff who had been through a robust recruitment process before starting work. Staff had access to a range of training to equip them with the skills and knowledge they needed to meet people’s needs. Staff were supported to develop in their roles. Disciplinary procedures were in place should they be needed. The registered manager was open and accessible and understood the challenges of introducing change management. There were plans to recognise best practice and to introduce staff champions in key areas.

People, their relatives and staff had a variety of ways to express their views about the service. Their feedback was used to drive through imp

This was an unannounced inspection which took place over two days on the 8 and 9 December 2016. Parton House provides care to 36 older people with a physical and/or sensory disability. At the time of our inspection 23 people were living in the home. Accommodation was provided over two floors with shaft lifts to access the first floor. There were 36 bedrooms, each of which had en suite facilities and there were an additional bathrooms and shower rooms. People had access to three lounges and a dining room. There were pleasant grounds around the home which were accessible to people.

The registered manager had been in post just under two months at the time of the inspection. She had been previously registered at another home owned by CTCH Limited. 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 inspection on 10 May 2015 the overall rating was requires improvement. We asked the provider to take action to make improvements to:

• the accuracy of people’s care records

• the way in which people were treated, ensuring dignity and respect at all times

• people having access to the appropriate diet and nutritional input

• staff recruitment procedures

and these actions had been completed.

Despite the action taken to address issues we identified and on-going positive changes to people’s experience of their care, there was still room for improvement. People’s dignity was not being promoted when they were assisted with moving and handling. Staff did not use blankets provided to cover them when being hoisted. A new range of quality assurance audits had been introduced which identified where further improvements were needed. However actions had not been recorded to evidence what was going to be done to address these issues, by whom and by when. Other quality assurance audits also failed to identify actions although the registered manager was able to evidence through other records these had been completed. We made a recommendation in relation to this.

People received individualised care which reflected any changes in their health and wellbeing. Improved communication by staff ensured their changing needs were addressed and they had access to health care professionals when needed and action had been taken to keep them safe and well. Accidents and incidents had been monitored and staff had looked for explanations of possible causes, taking action to minimise these where they could. People’s needs had been assessed and new care plans put in place which reflected their individual wishes and needs.

People were supported by staff who understood their needs. They had been appointed after all the necessary recruitment checks had been completed. They had access to training and support to develop in their roles and reported that morale had significantly improved and they felt valued in their roles. People’s rights were upheld and staff understood how to recognise and report suspected abuse. People were supported to make day to day decisions and were supported to make larger decisions in their best interests if they were unable to do this. When people had been restricted, the least restrictive option had been explored, and deprivation of liberty safeguards had been requested. There were enough staff with the right skill mix to meet their individual needs.

People had access to a range of meaningful activities reflecting their likes, interests and hobbies. They enjoyed entertainment by local choirs, schools and other services. Consideration was being given to the needs of people living with dementia, making their environment more accessible to them. Signs around the home helped them to find their way around and brightly coloured crockery helped them to eat and

We carried out an unannounced comprehensive inspection of this service on 10 May 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 the breaches.

We undertook this focused inspection on 23 September 2016 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 Parton House on our website at www.cqc.org.uk”

Parton House provides care to 36 older people with a physical and/or sensory disability. At the time of our inspection 24 people were living in the home. Accommodation was provided over two floors with shaft lifts to access the first floor. There were 36 bedrooms, each of which had en suite facilities and there were an additional bathrooms and shower rooms. People had access to three lounges and a dining room. There were pleasant grounds around the home which were accessible to people.

At the time of the inspection there was no 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. A representative of the provider was temporarily managing the home until a manager had been appointed.

At the inspection on 10 May 2015, we asked the provider to take action to make improvements to:

• the accuracy of people’s care records.

These actions still needed further improvement. You can see what action we told the provider to take at the back of the full version of the report.

At the inspection on 10 May 2015, we also asked the provider to take action to make improvements to:

• keeping people safe from harm or injury, by reducing risks and ensuring medicines were

administered appropriately

• records evidencing people’s capacity to consent to their care and support

• the quality assurance systems,

and these actions had been completed.

People had access to their call bells whether in their bedrooms or in the lounges. Any unexplained bruising or injuries had been reported and recorded. When necessary health care professionals had been contacted for their advice and support to help people to stay healthy and well. New arrangements had been put in place for the administration of medicines. Medicine administration records had been completed and people had their medicines when they needed them. Any errors had been followed up and the appropriate action taken. People’s capacity to consent to their care and support had been assessed and new records had been introduced to confirm when decisions would be made in their best interests. Quality assurance processes had been improved and evidenced any shortfalls and when improvements had been made.

This inspection took place on 10 and 11 May 2016 and was unannounced. Parton House provides care to 36 older people with a physical and/or sensory disability. The home was last inspected on 18 September 2015 to follow up on breaches of regulations found at the comprehensive inspection on 20 April 2015. These had been met. At the time of our inspection 27 people were living in the home and of these 14 people were living with dementia. Accommodation was provided over two floors with shaft lifts to access the first floor. There were 36 bedrooms, each of which had en suite facilities and there were an additional bathrooms and shower rooms. People had access to three lounges, a home cinema and a dining room. There were pleasant grounds around the home which were accessible to people.

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 and associated Regulations about how the service is run. The registered manager was on annual leave at the time of our inspection. A representative of the provider was present in their absence.

People received inconsistent care and support which impacted on their safety and well-being. Changes in people’s physical or mental well-being were not always responded to in a timely fashion. Staff were reactive rather than proactive and people’s health potentially suffered as a result. Risks to people had not always been explored or investigated to prevent them from reoccurring. This was not helped by poor record keeping and making sure care records and medicines administration records were accurate and up to date. People were not always treated with dignity and respect. They had access to a range of activities which were being reviewed to make sure they provided meaningful and individualised opportunities for people. When staff were appointed not all of the checks needed had been carried out to ensure they were fit to carry out their duties. Quality assurance audits were not robust and the service was not always well-led.

People and visitors were positive about the care and support they received. They were involved in planning and reviewing their care and support. Their concerns were listened to and action had been taken in response. People were supported by enough staff who understood them well. Staff were kind and compassionate and cared for people. They were supported to develop in their role and their training needs were monitored. A range of training had been provided and more was scheduled. Staff had individual meetings to help them reflect on their performance.

People and their relatives were able to express their views through residents and relatives meetings as well as annual surveys. As a result trips and outings had been arranged and there had been improvements to the laundry. A three year refurbishment of the home had reassured them about concerns about the environment. The provider recognised the issues raised at the inspection and confirmed action would be taken to improve the standards of care and support provided.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We carried out an unannounced comprehensive inspection of this service on 20 April 2015 at which breaches of legal requirements were found. This was because the registered person had not protected people against the risks associated with their care and support being provided safely and they had not protected people against the risks of employing unfit or proper staff.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook a focused inspection on 18 September 2015 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 this topic. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for ‘Parton House’ on our website at www.cqc.org.uk.

Parton House had a registered manager. 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 our focused inspection on 18 September 2015 we found the provider had followed the action plan which they had told us would be completed by 31 July 2015 and legal requirements had been met. People who needed help with moving and transferring were supported by staff who had completed additional practical training. Staff were observed in these tasks to make sure they were confident and competent. People’s care records were kept up to date with changes in their moving and handling needs to make sure this was done as safely as possible. Health care professionals were involved when needed and the appropriate equipment was provided.

People were protected from the risks of inappropriate care because the staff recruitment process made sure all checks and records required by law were in place. Recruitment procedures had been reviewed and further checks had been introduced to make sure the reason why staff left former employment with children or adults was checked and verified.

The inspection team who carried out this inspection consisted of an adult social care inspector. The focus of the inspection was to answer three key questions; is the service safe, effective and well-led?

As part of this inspection we spoke with five people who use the service, the registered provider, four staff and other authorities. We also observed how people were being cared for. We reviewed records relating to the management of the service which included four care plans, daily care records, accident and incident records and staff training documents.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

People were safe because staff shared information on risks associated with their care, treatment and support. Accidents and incidents were analysed and actions were taken to keep people safe from the risk of further accidents or incidents.

People were safe because they received their medicines as prescribed because they were stored, administered and disposed of safely in line with current and relevant regulations and guidance. Systems were in place to make sure the administration and control of medicines was monitored and action taken to address any issues which might affect the wellbeing of people living in the home.

Is the service effective?

The service was effective because people were supported by care staff who had the necessary skills and knowledge to meet their assessed needs, preferences and choices. Staff had access to support, induction, one to one meetings, annual appraisals and training. People told us, "Staff are very gentle and kind", "Staff are lovely", "Staff are very good".

People received an effective service because when their needs changed, referrals were made quickly to relevant health services. Their care records were updated to make sure all staff were kept informed of any changes.

Is the service well led?

The service was well led because they monitored accidents and incidents. Systems were in place to continually review the incidence, type and timing of accidents and incidents. There was evidence the service learnt from incidents and accidents to prevent them happening again.

The service was well led because there were clear and transparent processes in place for staff to account for their decisions, actions, behaviours and performance. One to one and group meetings provided the opportunity for staff to discuss their roles and responsibilities and to reflect on their performance.

At our inspection on 2 October 2013 we found that the registered person did not have suitable arrangements in place to ensure that people employed for the purposes of carrying on the regulated activity. They were not supported to receive professional development, supervision and appraisal to enable them to deliver care to service users safely and to the appropriate standard. We had minor concerns about this outcome. The provider sent us an action plan telling us how they were going to address these shortfalls.

We did not speak with people about this follow up inspection. We looked at schedules which identified when staff would receive supervisions and their annual appraisal. Training records confirmed that the training needs of staff were being monitored. Staff were having access to refresher training.

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

For a complete overview of the outcomes for people at this location please also read the report for 2 October 2013.

We spoke with seven people who lived in the home and a visitor. We also spent time observing the care and support being provided to people. We discussed people's care needs and the service provided with seven members of staff.

People told us, "I wouldn't want to live anywhere else", "I couldn't fault staff, I am really happy here" and "I am well looked after". A visitor said they were really happy with the care provided and that staff were always friendly and welcoming.

People's care records identified their individual needs and reflected any changes to their health or wellbeing. People's wishes, preferences and routines were noted and respected.

People were protected from abuse or the risk of abuse. Safeguarding procedures were in place to identify and prevent abuse from happening.

Infection control measures ensured that people were protected against the risk of infection. Standards of cleanliness and hygiene were monitored and new systems were being put in place to make sure these were more robust.

Staff had access to training to keep their knowledge and skills up to date. Staff were not receiving supervision and appraisals to help them reflect on their roles and responsibilities.

People's personal records and other records were kept up to date and reviewed at appropriate intervals.

Two people told us 'it's very good here" and "they look after you very well".

Four people said there were not many activities. They said they enjoyed music and movement every fortnight. Two people said they went to their rooms when this was on. People had mixed feelings about the home's cinema where films were shown regularly. People said they would like to spend more time in the garden in the good weather.

One person said, "staff are very nice, they are polite", "call bells are answered without too much delay" and "they have patience with us". Another person confirmed, "staff are very good, very patient and friendly".

All people spoken with said if they had any concerns they would talk to the managers or to staff. They said if the manager's door was open they knew they could go and have a chat with her. They said they would be listened to and action taken to address their concerns. One person told us, "they do their best to sort out our concerns".

People told us "staff couldn't be faulted", "staff are really caring" and "its a home from home."

Relatives told us they were impressed with the way staff communicated with residents, talking to them face to face, kneeling if they had to or sitting beside people. Visitors also said, "we would reccommend anyone coming here" and "staff are patient, considerate and always have time for our relative."

People said the "food wasn't bad", "they do a lovely homemade soup" and "I am offered a choice of whether to have breakfast in my room or the dining room". Visitors told us, "there is a choice of meals. They are individualised and alternatives are always offered."

A person told us "staff always answer call bells and if they can't see to us straight away they explain why." Visitors to one person said they were well informed about the service provided to their relative and were always told about changes in their health or appointments with the Doctor. Other visitors confirmed this saying "they tell us everything and we feel they couldn't do more for our sister."

People said they would talk to the staff or registered manager if they had any concerns. Most people we talked to said they had no issues.

This was an unannounced inspection which took place over two days on the 20 and 21 April 2015. Parton House provides care for up to 36 people. Accommodation can be provided for people who wish to live together. People have access to three lounge areas, a dining room, en-suite bedrooms, and assisted bathrooms. The grounds around the home are well presented and accessible to all people. At the time of our inspection 34 people were living there. There were 15 people who had been diagnosed as living with dementia.

The home 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.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had not protected people against the risks of unsafe moving and handling procedures. New staff had been appointed without first checking why they had left former employment with children or adults. You can see what action we told the provider to take at the back of the full version of the report. There were inconsistencies in the way in which medicines were managed and administered. People’s engagement with staff and activities fluctuated according to the demands on staff.

Before people moved into the home their needs were assessed with input from their relatives to make sure Parton House could provide the care and support they needed. From these assessments individualised care plans were developed which considered any risks which might impact on people’s safety. People were supported to maintain their independence whilst hazards were minimised. Where necessary referrals were made to health care professionals for advice and support. If specialist equipment or adaptations were needed to keep people safe from harm these were provided.

People’s needs were understood by staff who worked hard to provide care and support at times when people wanted it. People were supported to stay healthy and well through a nutritional and balanced diet and access to social and health care professionals. When people’s needs changed staff responded by raising their concerns and the care was adjusted to help people stay well and safe. Any accidents or incidents were fully recorded and action was taken to prevent them happening again.

People’s views and feedback were used to improve the service they received. Their relatives and staff also raised concerns or issues which were listened to and resulted in positive changes to the service. People were comfortable raising concerns. A person told us, “We get on ever so well - all of us. We’re ever so friendly here .”

Quality assurance systems included feedback from people, their relatives, staff and professionals. Quality audits monitored the standard of service provided and identified actions for improvement. A member of staff told us, “ We give the best care we can.”