Parkside Nursing Home Also known as Part of the abbey total care group ltd group of services

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of legal regulation in relation to the governance at the service.

This service scored 39 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not always understand the challenges and the needs of people and their communities.

The shared strategy, culture and values were not embedded within the team. We observed staff providing care that was task focused as they were busy, this was not identified or challenged by leaders.

The provider failed to ensure the needs of those living with dementia. We were told by staff that all people were required to choose their meals the day before. This is not good practice for people living with dementia. However, most people told us they did not recall choosing their meal with comments including, “You don't get to choose, it is just given to you” and "It (the meal) just arrives." Another person told us there were days they got to choose their meal but other days they were just given the same meal day after day. Menu boards within the service were confusing and not clear. This meant people where not supported to make choices.

Staff referred to people that required support with meals as ‘feeders.’ This is an extremely undignified and disrespectful term. One relative told us that at weekends staff sat on their phones rather than providing care. A person told us, “Staff will act if you point things out to them, but we shouldn’t have to do that, they should be noticing things.”

Not all leaders understood the context in which the provider delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively.

Staff reported concerns regarding the quality of care they were able to provide based on the levels of staff. There was a willingness by the staff to provide more person-centred care. Quality assurance processes were not consistently implemented, and the delegation of responsibilities was unclear, resulting in a lack of clarity about who held responsibility and accountability for key areas of the service.

However, staff told us that since the new manager had started they felt more supported. One member of staff said, “The manager and deputy manager are supportive. [Deputy manager], if you call her, even if she is busy, she will step away and help you. She is a flexible person." Of the manager a member of staff said, "He is always around. He is helping us." Said staff they supported one another well and there was a good sense of teamwork.

People did not feel they could speak up and that their voice would be heard. Staff said they were reluctant to raise the concerns around staff levels as when they had they did not feel listened to. One member of staff said, “They (staff) asked for 1 staff extra, but management did not reply to anything." In a conversation with the manager about whether any concerns had been raised about staff levels they told us, “Not really, we had a staff meeting but didn’t talk about the staffing. Wherever we go staff will say they want more staff.” However, we saw from a meeting with the manager, staff had raised concerns in October 2025 about the staff levels at night, placing people at risk. There was no evidence this had been considered.

We were not assured people living at the service were able to speak up regarding the way they were cared for.

However, in a 2025 staff survey that the Provider undertook, staff fed back positively about the leadership team.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes.

Governance arrangements failed to provide effective oversight, ensure accurate auditing, or prompt appropriate follow-up actions. They had not identified the shortfalls found within this inspection.

Although the manager told us there were plans in place to improve the environment, they had only been in post a short time. The provider had not been effective in identifying the areas of improvement in the environment to reduce the risk of people injuring themselves. There had also not been a registered manager at the service since August 2024 which is a legal requirement.

A representative of the provider told us that they had asked by the previous manager for an additional member of housekeeping staff at the weekend. They told us this had been approved however no action had been taken to implement this. The representative told us, “We authorised it and why it didn’t happen I don’t know.” The manager, however, was not aware that an additional housekeeper had been approved for the weekend.

Weekly call bell analysis was taking place; this had not been effective in improving response times. The audits showed calls bells were taking longer that the required time to answer. The call bell policy stated that call bells needed to be responded to within 3-10 minutes. We saw from the call bell analysis that between the 13 October and 2 November 2025 there were 27 incidents of call bells not being responded to within the required time. The findings from the analysis were that staff were forgetting to turn the call bell off or there was an issue with a faulter buzzer. These ‘reasons’ for the delay were repeated on each of the weekly analysis and there was no additional consideration of whether there were other reasons the call bells were not answered quickly such as staff deployment.

Safety and quality processes were not embedded, leaving systemic weaknesses and ongoing risks to people’s safety and care. Leaders had failed to make sustain the improvements since the previous inspection to assess, monitor and mitigate the risks relating to the health, safety and welfare of service users. We found there had been limited identification, assessment or mitigation of individual risks. Staff did not always have guidance in how to manage people’s risks when providing their care.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The provider did not focus on continuous learning, innovation and improvement across the organisation and local system. They did not encourage creative ways of delivering equality of experience, outcome and quality of life for people. The lack of effective systems, governance and management meant there was no drive to improve the safety of the care and support being delivered. People continued to have poor experiences of care, with a lack of action to improve people’s outcomes.

The provider did not have oversight of how care was delivered. This meant opportunities to analyse and review accidents and incidents for themes and trends did not occur. Effective learning was therefore not identified or shared with staff. This meant improvements to the service and the care people received were not always considered or implemented.