This inspection took place on 6 September 2017 and was announced.

Stanley Park provides care and accommodation for up to 71 people, some of whom have a dementia related condition or require nursing care. On the day of our inspection there were 59 people using the service.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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.

Stanley Park was last inspected by CQC in February 2016 and was rated Requires improvement overall. At the inspection in February 2016 we identified the following breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014:

Regulation 9 (Person-centred care)

Regulation 15 (Premises and equipment)

Regulation 18 (Staffing)

At this inspection we checked to see whether improvements had been made and we found improvements had been made in all the areas identified at the previous inspection.

Accidents and incidents were appropriately recorded and investigated.

Risk assessments were in place for people who used the service and described potential risks and the safeguards in place to mitigate these risks. The manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

Procedures were in place to ensure people received medicines as prescribed.

The home was clean, spacious and suitable for the people who used the service and appropriate health and safety checks had been carried out.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant vetting checks when they employed staff. Staff were suitably trained and training was arranged for any due or overdue refresher training. Staff received regular supervisions and appraisals.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of people being supported during visits to and from external health care specialists.

People who used the service and family members were complimentary about the standard of care at Stanley Park. Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

Care plans were in place that recorded people’s plans and wishes for their end of life care.

Care records showed that people’s needs were assessed before they started using the service and care plans were written in a person-centred way. Person-centred is about ensuring the person is at the centre of any care or support plans and their individual wishes, needs and choices are taken into account.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs. The service had good links with the local community.

An effective complaints procedure was in place and people who used the service and family members were aware of how to make a complaint.

The provider had an effective quality assurance process in place. People who used the service, family members and staff were regularly consulted about the quality of the service via meetings and surveys.

This inspection took place on 10, 11 and 16 February 2016. The inspection was unannounced.

We last inspected Stanley Park on 4 September 2014. At that time the home was found to be compliant with the regulatory requirements

Stanley Park is a modern purpose built building on two floors. The ground floor provides residential accommodation for up to 34 people. The first floor accommodation provides care for up to 37 people with dementia type conditions, some of who require nursing care. Stanley Park is located close to the town centre of Stanley.

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 the inspection there was a registered manager in post.

There were sufficient numbers of staff on duty in order to meet the needs of people using the service. The registered provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff.

The staff had a good knowledge about infection control and its associated policies and procedures and we witnessed cleaners and housekeepers going about their duties systematically.

We saw staff supporting people in the dining rooms at lunch and choices of food and drinks were being offered. People told us the food was always good with a good selection of choices available at every meal.

PRN are medicines which are given as and when required. We found a number of people who did not have detailed PRN plans in place to describe to staff when people and under what circumstances should they be give their medicines. We saw the registered provider had already found this in their audits and put actions in place to ensure they were updated. Staff showed us the new plans in progress.

We saw new staff were provided with training during their induction and were registered to undertake the Care Certificate. The Care Certificate is an identified set of standards that health and social care workers adhere to in their daily working life. The certificate has been introduced to give staff new to caring an opportunity to learn.

In the registered provider’s policy staff were expected to meet six times per year with their manager for supervision. We found staff had not been receiving supervision in line with the policy.

We saw staff supporting and helping to maintain people’s independence. We saw staff treated people with dignity and respect and people were encouraged to remain as independent where possible.

We found the building required further adaptions to support people with dementia type conditions and assist them to navigate their way through the building.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. We found the provider was following the requirements of DoLS.

Staff knocked on doors before entering people’s rooms and closed doors when they were administering personal care or having conversations with people. This maintained people’s privacy.

During the last year, the registered manager informed CQC promptly of any notifiable incidents that it was required to tell us about. This meant the registered provider was meeting regulatory requirements regarding notifications.

Relatives were invited to be involved in the home through monthly relative meetings where they were asked for their feedback and ideas to improve the home.

We saw a copy of the provider’s complaints policy and procedure and saw that complaints had been fully investigated.

The regi

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time. The new manager has begun the application process to become the registered manager

At our last inspection we found the provider to be non-complaint in each of the areas we looked at. We asked the provider to submit an action plan to tell us how they were going to improve the service. The reason for this inspection was to follow up on enforcement action we took after the last inspection.

During our inspection we asked the provider, staff and people who used the service specific questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them and from looking at records

Is the service caring?

We found the staff sought the permission of people before providing any care or treatment. We found people’s care needs were assessed and their care plans described people’s needs

Two relatives told us they found the staff to be kind and patient.

We found people were supported to eat their meals with dignity.

Is the service safe?

The service was safe, clean or hygienic. All areas of the building were found to be safe clean and well maintained. We saw parts of the premises had undergone a major refurbishment. By the end of October 2014 the refurbishment of the whole building is expected to have been completed.

We found robust cleaning audits were in place, including one for the main kitchen.

People’s photographs were kept within their medication records which meant risks were reduced of being given the wrong medication by agency or new staff.

Is the service effective?

Staff told us they were able to raise issues or concerns with the management. We found staff had received regular supervision meetings to support them. We saw that staff also received an annual appraisal.

Is the service responsive?

At the last inspection, we identified a number of areas that required significant improvements; this led to enforcement action being served on the provider.

During this inspection, we found all areas that required action/improvement had been met by the provider.

Is the service well led?

The service had a quality assurance system. The records we looked at showed the systems in place addressed any shortfalls. As a result the quality of the service was continuingly improving.

Prior to our inspection visit, concerns had been raised about the quality of care provided to one person who had lived at Stanley Park. Other concerns had also been raised with regard to the quality of food given to people living there, and regarding the cleanliness of the building.

On the day of our visit we found 63 people were living at Stanley Park. We spoke with seven people living in the home and spent time on both of the two floors of the home. Those able to express an opinion told us they were happy and were well cared for, although due to their needs some comments were not directly relevant to the service they received. We also spoke with two visiting relatives. People appeared generally content, at ease in the home and with the staff on duty. Comments included, “The girls in here are worth their weight in gold,” and, “The place is tip top clean,” and, “The meals are good. I know my relative is enthusiastic about his food, and I know that if he wasn’t, we’d know about it!”

We saw the home was in the process of introducing a new menu which included a comprehensive range and choice of nutritional food.

We found the building to be in need of decorative refurbishment, but to be a clean and safe environment for people to live.

We found the provider had suitable arrangements in place with regard to complaints, and that any complaints made were properly investigated.

Most people who lived on the upper floor of Stanley Park were not always able to tell us about their experiences of living at the home. We therefore spent time watching how people were supported. People appeared generally content, at ease in the home and with the staff on duty.

We spoke with six people living on the ground floor. Everyone said they were happy and were well cared for. Comments included, "We’re well looked after and the food is good,” and “We’ve got some good lasses here,” and “They do a good job; they run the place very efficiently.”

We found people had received their medication appropriately and people’s care and welfare needs were met by sufficient staff.

Everyone we spoke with said they were happy with the care they received from the staff at Stanley Park. Most people said they believed there were sufficient staff on duty to meet their needs. People said their ‘call bell’ was always answered promptly. One person thought he waited too long to receive his meals but the person’s relative felt this was unfair criticism and reflected her relative’s personal preferences prior to moving to Stanley Park.

One relative told us that they thought that there was not enough staff on duty in the elderly mentally ill nursing section of the home to look after all the people who used the service. They told us of a recent incident where he had to wait over thirty minutes to get support after their relative soiled themselves as staff were very busy with other people.

Another relative commented “He is well looked after and the staff are brilliant”. Someone else said “The staff are lovely and work very hard”

We visited this location on a weekday and on this occasion we did not ask people about this specific essential standard.

We spoke with two relatives who told us that they had no concerns about staffing levels on a night time.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time. A new manager has been appointed for the home.

During our inspection we asked the provider, staff and people who used the service specific questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them and from looking at records

Is the service caring?

We found the staff sought the permission of people before providing any care or treatment

Relatives told us they found the staff to be kind and patient.

We found people were not supported to eat their meals with dignity.

Is the service safe?

The service was not safe, clean or hygienic. Areas of the building were found to be dirty and the premises required some refurbishment and repairs to make sure people were safe.

We found cleaning audits had not addressed the cleanliness deficits in the home.

People’s photographs were missing from their medication records which meant people were at risk of being given the wrong medication by agency or new staff.

People told us they felt safe about their relative being in Stanley Park where they were cared for “24 hour a day”

Is the service effective?

People who used the service and their relatives told us they were involved in the assessment of their needs. Family members told us the care was ‘adequate’.

Relatives told us that they would have liked more private facilities in the home to enable them to see their relatives bring younger family members into visit.

Staff told us they did not feel able to raise issues or concerns with the management. We found staff had not received regular supervision meetings to support them

Is the service responsive?

People we spoke with knew how to make a complaint if they were unhappy. We looked at how complaints had been dealt with. We found people had not been given responses to their complaints. One person told us they had made a complaint ‘months ago’ and not received a reply. This meant people were not assured that complaints would be investigated and action taken when necessary.

Is the service well led?

The service had a quality assurance system. The records we looked at showed the systems in place did not address any shortfalls. As a result the quality of the service was not continuingly improving.

Staff told us they did not have confidence in the management.

The management were aware of the latest Supreme Court judgement on the Deprivation of Liberty Safeguards and what actions were required to ensure people were safe. They told us what actions they had planned.