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Inspection carried out on 2 May 2018

During a routine inspection

This unannounced inspection took place on 2 and 15 May 2018.

South Park Residential Home is a ‘care home‘. People in care homes receive accommodation and personal care as a single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The home does not provide any nursing care and specialises in supporting older people living with dementia. The care home can accommodate up to 11 people on either a permanent or temporary 'respite' basis in one adapted building across two floors. At the time of our inspection there were ten people permanently residing at the home who were all living with dementia.

The service had a registered manager in post. A registered manager is a person who has registered with the CQC. Registered managers like registered providers 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 last comprehensive inspection of this care home in February 2017 we continued to rate them 'Requires Improvement' overall and for the three key questions 'Is the care home safe', 'effective' and 'well-led?'. This was because we found the provider had failed to appropriately check the suitability and ‘fitness’ of new staff, ensure staff were suitably trained and supported to carry out their duties and effectively manage and scrutinise the quality and safety of the service people living in the home received.

We undertook a focussed inspection in July 2017 and found the provider had followed their action plan to improve and met their legal requirements. However, we continued to rate the service 'Requires Improvement' overall because we wanted to be sure they could maintain what they had achieved over a more sustained period of time. In addition, we identified issues with their fire safety arrangements. Specifically, we found fire safety equipment used in the home was not always appropriately maintained, staff did not routinely participate in fire evacuation drills and fire safety risks were not always identified and mitigated.

At this comprehensive inspection we found the service continued to improve. We saw the provider had taken appropriate action to resolve the fire safety issues we identified at their last inspection. Specifically, we saw fire safety risk assessments were in place, staff had completed their fire safety training and they routinely participated in fire evacuation drills. In addition, we found the provider continued to appropriately check the suitability and ‘fitness’ of new staff, ensured staff were appropriately trained and supported and operated effective governance systems. We have therefore improved the service’s overall rating from ‘Requires Improvement’ to ‘Good’ and for most of the key questions, ‘Is the service safe, effective, caring and well-led?’

However, the service’s rating for one key question, ‘Is the service responsive’, has deteriorated from 'Good' to 'Requires Improvement'. This is because people did not have sufficient opportunities to follow their social interests and take part in meaningful recreational activities inside the home or in the wider community. We received mixed feedback from people living in the home, their relatives, professional representatives and staff about the availability of fulfilling social activities in the home. People were not engaged in particularly meaningful activities throughout our inspection. We recommend the service seek advice and guidance from a reputable source, about developing a more structured and dementia friendly programme of social activities which is based on the interests of people living in the home.

In addition, although people when they were nearing the end of their life received compassionate and supportive care at the home, people’s care plans did not contain a section th

Inspection carried out on 29 June 2017

During an inspection to make sure that the improvements required had been made

At our last comprehensive inspection of this service, which we carried out on 23 and 24 February 2017, we continued to rate Southpark Residential Home ‘Requires Improvement’ overall and for the three key questions ‘Is the care home safe’, ‘effective’ and ‘well-led’. Although we found the service had taken appropriate action to resolve all the outstanding breaches from previous inspections, we identified three new breaches of the regulations that included a failure to check the suitability and fitness of new staff, ensure staff were suitably trained and supported to effectively carry out their duties and effectively monitor the quality and safety of the service people received.

After the February 2017 inspection the provider wrote to us to say what they would do to meet their legal requirements in relation to the three breaches of the regulations described above. We undertook this unannounced focused inspection to check the provider had followed their action plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this inspection. You can read the report from our previous comprehensive and focused inspections, by selecting the 'all reports' link for ‘Southpark Residential Home’ on our website at www.cqc.org.uk.

Southpark Residential Home provides accommodation and personal care for up to 11 people. The home specialises in supporting older people living with dementia. At the time of our inspection there were eleven people living at the home, which included one person receiving temporary respite care.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC). Registered managers like registered providers 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.

During this focussed inspection we found all three outstanding breaches had been satisfactorily resolved. Specifically, the provider had improved their staff recruitment practices by ensuring appropriate employment and criminal record checks had been carried out for all new staff. Staff had either completed or were booked to attend refresher training on dementia awareness, moving and handling, food hygiene and fire safety. This ensured staff had the right knowledge and skills they needed to perform their roles effectively. And, measures had been put in place to ensure the provider operated more effective governance systems to routinely assess and monitor the quality and safety of the service people at the home received. The new quality assurance processes helped the registered manager and staff identify issues promptly and ensure appropriate action was taken to address shortfalls in staff recruitment checks, staff training and one-to-one supervision meetings.

In addition, as we had discussed with the registered manager at our previous inspection we saw the provider had purchased a range of new furniture for people’s bedrooms and the main communal area.

However, while we saw significant improvements had been made by the provider at this inspection, we did identify a new breach in respect of the service’s fire safety arrangements. Specifically, fire safety equipment they used in the home was not always appropriately maintained and safe for its intended use, staff did not routinely participate in fire evacuation drills of the building, and fire safety risk were not always identified, assessed and mitigated.

This meant fire safety risks people might face were not suitably managed and represents a breach of the Health and Social Care (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.

Inspection carried out on 23 February 2017

During a routine inspection

South Park Residential Home is a small care service which can provide personal care and accommodation for up to eleven adults. The service specialises in supporting older people living with dementia. At the time of our inspection there were eleven people residing at the home that included two people receiving temporary respite care.

The service has had a registered manager in post since February 2017. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At our last comprehensive inspection of this service in January 2016 we rated the service ‘Requires Improvement’ overall and for the four key questions ‘Is the service safe’, ‘effective’, ‘responsive’ and ‘well-led?’ This was because the provider had failed to develop detailed risk management plans to help staff prevent or manage risks people might face, comply with the principles of the Mental Capacity Act 2005 (MCA), enable people to engage in meaningful activities that reflected their social interests and to notify the Care Quality Commission (CQC) without delay about incidents involving the people living at the home that had adversely affected their health and/or wellbeing.

During our last focused inspection of this service in August 2016 we found the provider had taken appropriate action to improve their arrangements for managing identified risks, complying with the Mental Capacity Act 2005 (MCA), providing people with sufficient opportunities to participate in fulfilling social activities and submitting statutory notifications to us. At the time of the focused inspection we continued to rate the service as 'Requires Improvement' overall because we needed to see the provider could consistently maintain these improvements over a more sustained period of time.

At this comprehensive inspection we found the provider had maintained improvements in the way they mitigated risk, complied with the Mental Capacity Act 2005 (MCA), offered people opportunities to engage in meaningful activities and dealt with statutory notifications. However, we have continued to rate the service as 'Requires Improvement’ because they still cannot demonstrate they met all the regulations and fundamental standards.

Specifically, the provider failed to operate safe recruitment procedures. Recorded evidence was not always available in staff’s files to show the provider had checked their eligibility to work in the UK and criminal record checks were not being renewed at regular intervals. This meant the provider had not done enough to satisfy themselves about the suitability of new and existing staff to work at the home.

Furthermore, while there was a full training programme in place to enable staff to update their knowledge and skills; we found that half the staff team were not up to date with this programme and had not completed all the necessary training for their role. A system was also in place to support, supervise and appraise staffs working practices. However, this was not being followed and staff were not receiving the formal support they required from their line manager to undertake their duties.

Finally, although there were systems in place to monitor and review the quality of service delivery, which had identified some of the concerns we found during this inspection; these clinical governance systems had nonetheless failed to identify all the issues we found during this inspection. Specifically in relation to staff records, recruitment, training, supervision and appraisal.

These failings represent three breaches of the Health and Social Care (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.

Although we saw

Inspection carried out on 2 August 2016

During an inspection to make sure that the improvements required had been made

The last inspection of this service was carried out on 06 January 2016 when we found the provider in breach of four regulations. This was because the provider had failed to ensure; risk management plans were in place to help staff prevent and/or manage assessed risk; act in accordance with the Mental Capacity Act 2005 (MCA); operate effective governance systems to assess, monitor and improve the quality and safety of the service people received; and, to notify the Care Quality Commission (CQC) without delay about the occurrence of any injury or police incident involving people who lived at the home. We also received negative feedback from people about the lack of opportunities they had to engage in meaningful social, leisure and recreational activities, both within the home and the wider community.

The provider sent us an action plan to say what they would do to meet their legal requirements in relation to the four outstanding breaches described above. We undertook this unannounced focused inspection on 02 August 2016 to check the provider had implemented their action plan and were now meeting 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 ‘South Park Residential Home’ on our website at www.cqc.org.uk.

South Park Residential Home is a care home which provides personal care and support for up to 11 adults. The service specialises in supporting older people living with dementia. There were 11 people living with dementia in the home at the time of our inspection.

The service has not had a registered manager in post since August 2015, although they are required to have one. An interim manager has been in day-to-day charge of South Park Residential Home since April 2016 and they have applied to the Care Quality Commission (CQC) to become the service’s registered manager. A registered manager is a person who has registered with the (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

During our focused inspection, we found the provider had followed their action plan and were meeting their legal requirements. However, while improvements had been made we have not revised the services overall rating which remains 'Requires Improvement'. To improve the homes overall rating would require the provider to demonstrate consistent good practice in all aspects of the care they provide over a longer and more sustained period of time.

Risks to people’s health, safety and wellbeing had been assessed and staff knew how to minimise and manage these risks in order to keep people safe. Specifically, risk management plans were now in place to help staff prevent or manage behaviours that challenged the service. Staff we spoke with were familiar with these risk management plans and clearly knew how to prevent or deescalate behaviours that challenged.

Staff were aware of who had the capacity to make decisions and supported people in line with the Mental Capacity Act 2005. Where appropriate, staff liaised with people’s relatives and professional representatives to ensure they were involved in discussions about people’s care needs.

The provider now notified the CQC in a timely way about the occurrence of any incidents and events that affected the health, safety and welfare of people using the service.

There were effective systems in place to assess and monitor the safety and quality of the service people received. The manager took action if any shortfalls or issues with this were identified through routine checks and audits. Where improvements were needed, action was taken promptly.

The views and suggestions of people living in the home, their relatives, professional representatives and staff were routin

Inspection carried out on 6 January 2016

During a routine inspection

This inspection took place on 6 January 2016 and was unannounced. At the last inspection of the service on 12 August 2014 we found the service was meeting the regulations we checked.

South Park Residential Home is a small care home which provides personal care, support and accommodation for a maximum of 11 adults. The service specialises in caring for older people, some of whom are living with dementia. At the time of our inspection there were 11 people living at the home.

The service is required to have a registered manager in post. 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 a 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 on our records left the service in August 2015. An interim manager has been appointed whilst the provider recruits a new permanent manager for the home.

During this inspection we found the provider had not ensured that risk management systems in place were always used appropriately to ensure people were protected from the risks of injury or harm. They had not ensured risks were appropriately assessed to ensure the safety of two people that were sharing a room and had behaviours that could challenge the service and others.

We also found the provider did not always act in accordance with the Mental Capacity Act 2005 (MCA) and associated code of practice to ensure, where people lacked capacity to make decisions about specific aspects of their care, these were taken in people’s best interest.

The provider also did not operate an effective system to assess, monitor and improve the quality and safety of the service.

Providers are required to inform CQC when there are significant events in a service, including any incidents where people sustained significant injuries or when the police are called. These are called notifications. We found the provider had not submitted notifications about events that happened, to CQC, as required by law.

People’s feedback about the level of activities and engagement within the home was not positive. During our inspection we saw only few activities take place in the home. For long periods of time we observed people had little stimulation or engagement. The interim manager told us they were already in conversations with the provider about improving this aspect of the service for people. We have made a recommendation to the provider to improve the opportunities people have to participate in meaningful leisure and recreational activities in the home.

Despite these issues people and relatives said people were safe at South Park Residential Home. Staff had been trained to identify signs that could indicate people may be at risk of abuse. They knew what action to take to ensure people at risk were protected. They had also been trained to ensure people were not harmed by discriminatory behaviour or practices.

Where risks to people's health, safety and welfare had been identified, staff had access to guidance on the actions to take to ensure people were protected from injury or harm. The provider made arrangements for regular checks of the environment and the equipment in the home to ensure these did not pose unnecessary risks to people. However checks of water systems had not been undertaken recently to ensure these were hygienic. The interim manager was aware of this and taking appropriate action to ensure these were tested. Staff kept the home free from obstacles and trip hazards so people could move around safely.

There were enough staff on duty at the time of our inspection to support people in the home to meet their needs. However the provider did not routinely review staffing in the home as the level of people’s dependency changed to ensure people’s needs could always be met. The provider had carried

Inspection carried out on 12 August 2014

During an inspection to make sure that the improvements required had been made

During our last inspection of the service on 28 May 2014, we identified the provider had not taken the necessary steps to ensure that each person who used the service received prompt and appropriate standards of care and support.

Following that inspection we asked the provider to take action to achieve compliance with the appropriate regulation. The provider sent us an action plan on 18July 2014 setting out the steps they had taken to do this. During this visit we checked these actions had been completed.

This visit was carried out by a single inspector who helped answer one of our five questions: Is the service safe?

Below is a summary of what we found. The summary is based on our observations during the inspection, from looking at records and from speaking with the registered manager. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found at this visit the provider had taken appropriate action to ensure people received prompt and appropriate standards of care. We saw from records and from our own observations there were now enough staff on duty, particularly during busy periods, to meet the needs of people using the service.

We saw the provider had made appropriate arrangements to ensure care support workers were free from unnecessary administrative duties and able to spend their time providing the care and support people needed.

We saw from records and from speaking with the registered manager, the service was improving the availability of activities to promote the overall welfare and wellbeing of people using the service.

Inspection carried out on 28 May 2014

During a routine inspection

We considered our inspection findings to answer questions we always ask; 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, from looking at records and from speaking with five people using the service and their friends and family members. We also spoke with the provider, who was the acting manager for the service at the time of our inspection, and two support workers.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We asked people using the service and their friends and family, if they felt people were safe at the home. One person using the service said, “You feel really well looked after and no one can come in and do anything to you.” A visitor to the home said, “I think people here are safe.” They told us they were very alert to any changes or bruises to people and felt confident that their friend was happy in the home. They said, “I can see it in their face that they are happy.” A relative told us, “I feel mum is safe and they are keeping her safe.”

Any potential risks to people's health, safety and welfare within the home and in the community were regularly assessed by the registered manager. There was appropriate guidance for staff on how to take action to minimise these risks to keep people safe from harm or injury in the home and in the community.

People were cared for in an environment that was kept clean and hygienic. Staff knew how to maintain good standards of cleanliness and personal hygiene to reduce the risk of cross infection. The home was free from clutter and obstacles which meant people were able to move freely around the home.

People received the medicines prescribed for them by healthcare professionals, in a timely manner, to help them manage their health related conditions or illnesses.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The service had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made and in how to submit one. This means that people will be safeguarded as required.

However we were concerned there were not enough suitably trained and experienced staff on duty, particularly during the busy morning period, to meet the care and support needs of all of the people using the service. We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to staffing.

Is the service effective?

People using the service and their relatives were involved in planning and developing their care and support. Their views and experiences were used to develop their individual care and support plan. People’s specific needs had been taken into account and staff demonstrated a good understanding and awareness of these.

People’s care plans were reviewed monthly by staff to ensure these were up to date and people had received the care and support planned for them. Any changes to people’s individual needs were updated on their individual care plans so that staff had the most up to date information about how to care for and support people.

Is the service caring?

People were cared for by friendly and attentive staff. One of the people using the service said, “The staff are all so nice. They don’t make you feel a nuisance.” A relative told us, “I definitely think the staff are very caring. They have the attitude that they will support people to do what they want to do.” Another relative said, “I think the staff are friendly.”

During our inspection we observed friendly and kind interaction between staff and people using the service. Staff spoke with people respectfully and took time to listen and chat with them. People that needed extra help and support moving around the home or with eating and drinking were not rushed or hurried by staff and could do so at their own pace.

Is the service responsive?

There were appropriate mechanisms in place to monitor people’s general health and wellbeing. Regular checks of people’s weights, urine and blood pressure were undertaken by staff. These were documented and reviewed by senior staff to identify any potential underlying issues or concerns.

Staff was responsive to any changes and deterioration in people’s general health and well-being. They took appropriate action so that people got prompt medical care and attention they needed.

Is the service well-led?

The views and experiences of people using the service and their relatives were sought by the service. Changes and improvements to the service were made when people wanted or needed these.

The registered manager understood the importance of robust quality assurance and carried out regular checks to assess and monitor the quality of service provided.

Inspection carried out on 9 July 2013

During a routine inspection

We spoke with three people using the service during our inspection. People were positive about their experiences of the care and support they had received. One person said, “It’s pretty good actually.” And “Staff are very nice.” Another person said, “I think they’re doing a difficult job well.” Another person told us, “Staff are very good, very obliging and they don’t mind what they do.”

We observed from people’s records their individual care and support needs had been assessed and support plans were in place to meet these needs. Where people lacked capacity to make decisions about their care and support, their representatives had been involved in planning and developing their plan of care. Risks to their health and wellbeing had been identified and plans were in place to manage these. From the records we looked at, information was reviewed and updated regularly so that staff had up to date information about people’s current care and support needs.

People received appropriate support to be able to eat and drink sufficient amounts to meet their needs and were provided with a choice of food and drink.

There were effective procedures in place to recruit and appoint staff and appropriate checks were made about staff’s suitability to work for the service.

The provider had systems in place to assess and monitor the quality of service that people received.

During a check to make sure that the improvements required had been made

The provider had taken appropriate action to protect people using the service from the risk of unsafe or unsuitable equipment. We looked at the information sent to us by the provider to see what changes they had made following our previous visit. We saw from this information cables from the large wall mounted television set in the communal lounge had been safely secured and placed out of reach. We also saw the protective cover for the radiator in the communal lounge had been fixed and secured which meant people using the service were not longer at risk of being burnt by the radiator.

Inspection carried out on 17 October 2012

During a routine inspection

Many of the people using the service were unable to speak with us and tell us their views, due to their specific needs. One person using the service told us staff treated them with dignity and gave them the help they needed. From our own observations we saw staff talk to people with care and respect. We also saw staff explaining what they were doing and why, when assisting and supporting people with food, drink and around the home. One person told us they thought there were enough staff to look after them. They also told us they were able to raise concerns with the manager that had been listened to and dealt with. However we found failures to properly maintain equipment in the home put people using the service, staff and visitors at risk .

Reports under our old system of regulation (including those from before CQC was created)