This inspection took place on 20 December 2017 and was unannounced. Our last inspection was in November 2015 where we rated the service as ‘Good’.

Queen Elizabeth Park is a nursing home providing support to a maximum of 77 older people. People living at the service had physical disabilities, long term medical conditions and many people were living with dementia. Care was provided across three floors in a purpose-built building.

Queen Elizabeth Park 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.

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.

Staff were committed to improving people's lives and they found innovative ways to do so. The provider found creative ways to encourage people to have fun and engage in activities they would enjoy. Care was planned and delivered in a person centred way and technology was utilised to achieve outcomes for people. Projects were undertaken in areas such as exercise and the provider built strong links with the local community which people benefitted from. These interventions had seen people develop confidence and skills. Staff understood the importance of promoting people’s independence and care was planned in a way that helped them to achieve this. Where people received end of life care, this was delivered sensitively and in line with best practice.

People received food that they liked and their dietary needs were met. People’s care plans were person-centred and reflected their needs and preferences. Risk assessments identified and managed risks people faced. Where clinical needs were identified, these were met by competent clinical staff. People’s medicines were administered in line with best practice and people had regular support from healthcare professionals, who worked alongside care staff to ensure people’s health was maintained. There were effective systems in place to manage the risk of the spread of infection and we found the home environment to be clean and staff were knowledgeable in this area.

Where accidents or incidents occurred, staff responded appropriately. Staff took actions to ensure that people were safe following incidents such as falls or illness. Staff understood how to respond if they suspected abuse had occurred and we saw evidence of them doing so. The provider analysed accidents and incidents as well as clinical needs and risks. Where patterns or trends were identified, appropriate actions to reduce risks were identified and implemented by staff.

People were supported by respectful staff that they got along well with. Staff had a good understanding of people’s needs and we observed pleasant interactions taking place during our inspection. Staff routinely involved people in choices about their care and the provider had systems in place to ensure that people could give feedback and make decisions wherever appropriate. The provider carried out a regular survey and a clear complaints procedure was in place and was known to people.

There were appropriate numbers of trained staff to meet people’s needs. Clinical staff got the support they needed to remain up to date with current practice. Staff received training to support them in their roles and had regular contact with their line managers. Regular meetings took place to involve staff in the running of the home and staff felt supported by the management.

Regular checks were carried out on the quality of the care that people received. The provider had a robust regime of audits in place that identif

On the day of our visit we were met by the registered manager who was employed on an interim basis whilst a new permanent manager was being recruited. She told us that there were 72 people residing in the home out of a total capacity of 77. Later on we were joined by the business manager from the provider’s head office. Although there were a relatively large number of people living in the home we were unable to engage in conversation with most of them because of their level of need. However, we were able to have a long and in-depth conversation with a group of four people who used the service.

We found that people’s individual preferences and choices were being respected, and that there were a wide range of social activities for people to be involved in.

We found that, overall, people were satisfied with their level of care, and that the provider had an effective system in place for assessing, managing and reviewing people’s needs.

We found that staff were properly trained in safeguarding people from abuse and would be able to report any incidents of abuse without fear of recrimination from their employer.

We found that staff had received a full induction and training appropriate to their roles. We also found they received regular supervision and appraisal.

We found that the provider obtained regular feedback from people who used the service, relatives and staff. We also found they regularly assessed and monitored all aspects of the service.

Residents who spoke with us were very happy living at the home, telling us about their experiences. For example, we were told that “They are a lovely team of carers.” Another resident said “It suits me fine here, the staff treat me well.” A visiting relative to the home spoke with us and said “We are very happy, the care is personalised.”

People felt that their care was individualised and that independence was encouraged as far as possible. One person said “I can come and go as I please, and I like going to the pub for lunch on a Thursday.”

The meal service was thought to be on the whole good, with enough food, choices and assistance provided where needed. Less positive comments were made in relation to availability of fresh fruit and vegetables, as well as food temperature.

On this occasion, we did not ask people using the service as the focus of the inspection visit was to ensure that the enforcement actions regarding staff training had been complied with.

We were advised that the registered manager was no longer employed at the service. We met with an interim manager, who is a registered manager of another Care base Ltd service, who told us they had been undertaking the day to day management of the service for 3 weeks.

They supported the inspection process by providing during and following the inspection, the commission with the relevant evidence in order that compliance of several essential standards of quality and safety could be assessed as documented within this report.

We spoke with a number of residents and a visitor of one resident. Overall, we were told that people were happy in the home and that the care was good. There were variations in residents understanding of the range of social activities available and some advised us that they chose not to participate in them. One resident indicated to us that she would have liked staff to have more time to sit and talk about issues outside of the home.

Whilst we were inspected the home, residents were receiving eye tests and assessments of their need for spectacles. The person undertaking these talked with us and indicated that she had heard staff dealing with residents in a very caring manner, with patience and a positive approach.

We spoke to residents from each of the three residential floors of the home and took into account the capabilities and understanding of respondents in asking our questions, particularly those residents in the dementia unit. All respondents had positive comments to make about the home and the staff, such as feeling involved in discussion about their care and needs. We were told that there is opportunity to discuss with staff personal needs on a weekly basis and also when participating in six monthly reviews. The home was said to be 'very good,' with pleasant staff who could not be faulted.

People using the service said that they were able to express their preferences and their needs, including the activities they wished to participate in. If these needs had not been met, generally residents felt able to tell staff if they were unhappy about this and any other aspect of their care.

People said that there was sufficient choice in respect to activities, both inside the home and in relation to externally organised events. There is a good choice of meals and specific needs can be catered for, such as vegetarianism.

The residents were pleased with the standard of cleanliness and one said that the staff had been 'trained right' The staff were felt to be kind, particularly if the resident was unwell. One resident did say that "there isn't always enough time for the staff to talk and they appear rushed. This makes it hard to build up a good relationship."

Queen Elizabeth Park provides residential and nursing care for up to 77 older people and those who have needs associated with dementia. The home is purpose built providing accommodation on three floors, with the ground floor being for elderly frail people, the second floor being for people with nursing care needs, and the second floor providing care for people with dementia. There are a range of on-site amenities including a cinema, lounge areas, a bar, a hairdressing salon and a small library.

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.’

This inspection took place on the 9 and 10 November 2015 and was unannounced. There were 73 people living in Queen Elisabeth Park. There were 26 people living on the nursing unit, 25 people living on the dementia unit and 22 people living on the residential unit.

The home had an activity programme and staff who were part of an activity team. We observed that the activities were specific to each unit for small groups, guided by their specific social needs. There was also larger group activities for all units to join if they should choose to.

The care planning system had been reviewed and records for each person were specific to their needs, with guidance for staff to ensure people received the support and care they needed and wanted. Staff said the care plans were easy to follow on the computer system and that improvements were always being made as they continued to learn the system. For example adding particular medicines and the reasons prescribed. Nurses and senior care staff developed the care plans and all staff were expected to record the care and support provided and any changes in people’s needs. The manager said care staff were being supported to do this and additional training had been provided. Food and fluid charts were completed and showed people were supported to have a nutritious diet.

Staff and relatives felt there were enough staff working in the home and relatives said staff were available to support people when they needed assistance.

Pre-employment checks for staff were completed, which meant only suitable staff were working in the home.

Essential training and updates were provided for all staff, including safeguarding people, moving and handling, management of challenging behaviour, pressure area care, falls prevention and dementia care. Staff said the training was very good and helped them to understand people’s needs.

All staff had attended safeguarding training. They demonstrated a clear understanding of abuse and said they would talk to the management or external bodies immediately if they had any concerns, and they had a clear understanding of making referrals to the local authority and CQC. People said they were comfortable and relatives felt people were safe.

Visits from healthcare professionals were recorded in the care plans, with information about any changes and guidance for staff to ensure people’s needs were met. There were systems in place for the management of medicines and we observed staff completing records as they administered medicines.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The provider, manager and staff had an understanding of their responsibilities and processes of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

Staff had a good understanding of people’s needs and treated them with respect and protected their dignity when supporting them..

Staff said the management was fair and approachable, care meetings were held every morning to discuss people’s changing needs and how staff would meet these. Staff meetings were held monthly and staff were able to contribute to the meetings and make suggestions. Relatives said the management was very good; the manager was always available, they would be happy to talk to them if they had any concerns and residents meetings provided an opportunity to discuss issues with other relatives and staff.

The provider had systems in place to review the support and care provided. A number of audits had been developed including those for care plans, medicines and health and safety. Maintenance records for equipment and the environment were up to date, such as fire safety equipment and hoists. Policies and procedures had been reviewed and updated and were available for staff to refer to as required. Staff said they were encouraged to suggest improvements to the service and relatives told us they could visit at any time and they were always made to feel welcome and involved in the care provided.