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 requires improvement. At this assessment the rating has remained 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 good governance.

This service scored 62 (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 had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities. The registered manager stated, “We aim to build up a reputation that it’s a good home. Get more integrated in the community. It’s a nice community. I think that’s the vision. Also to provide the best possible care for our residents.”

The provider set a culture that valued reflection, learning and improvement. The registered manager effectively used staff supervision and regular team meetings as a platform for staff to raise any concerns and an opportunity to share their views and opinions.

For example, the last staff meeting was also used as a group supervision. One of the subjects discussed was an increase in skin tears on some people which could have been caused by people being admitted with existing skin condition and the hot weather. During this meeting, the deputy manager delivered refresher training to staff in relation to skin integrity and how to prevent people’s skin deteriorating including early identification of this.

There were monthly heads of department meetings. These included management, nursing and care staff, kitchen and housekeeping. We saw evidence these were regular and actions from previous meetings were reviewed and addressed.

The operations manager provided support and supervision to the registered manager who told us, “[Operations manager] is amazing. [They] put me on a course for management when we met 8 years ago. [They are] very supportive.”

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

The registered manager had experience of working in health and social care and were a qualified nurse. They had been in post for 4 months and were keen on developing the home in order to benefit people and the staff team. A healthcare professional told us, “The management team has undergone some changes recently, and since then there has been a noticeable improvement in standards, organisation and communication across the service.”

Staff told us they felt supported by the registered manager and management team. Their comments included, “The manager treats everyone fairly. We can approach [them] whenever we have concerns or any requirements”, “Absolutely at any time we can make suggestions and raise our own questions and concerns about issues in general either in handovers or directly to the nurses and manager” and “I have worked here for a long time and I'm able to talk to the management and staff if I have any issues.”

In addition to team meetings, there were daily handover meetings to discuss important information, and any risks to service delivery. There were processes to support managers and senior staff in meeting their responsibilities.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

People were given information when they moved to the home about how to raise a concern and said they knew how to make a complaint. One person told us, “I would always go to the owner but I’ve not complained about anything.”

People were supported to provide feedback about the care and support they received through regular ‘resident of the day’, daily chats with care workers and ‘Residents and relatives’ meetings. People and relatives were encouraged to raise any concerns or queries and make suggestions on how to improve areas of the service. The provider took these seriously and took actions to make improvements. For example, when new staff members had been employed, their photographs were added to the ‘Home family tree display’ so people and relatives would know who they were.

Staff said they knew about the provider’s whistleblowing policy and would not hesitate to use this to benefit staff and people living at the home. A staff member told us, “I am aware of the whistleblowing policy. I have not had to use it but I do know there is a number or an email to contact if I feel issues haven’t been looked at.”

The provider had processes in place to support staff to speak up. This included supervision meetings, handover meetings, staff meetings and a whistleblowing policy. Staff had also received training in safeguarding to reinforce their understanding and their responsibility to speak up.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Staff told us they enjoyed working in a diverse team. Staff reported they were treated fairly by their colleagues and management. The registered manager told us, “Equality is for everybody. The majority of staff are from Indian background. We have quite a few staff from different backgrounds. A few of our staff has a particular time they liked to pray. We allow them that time.”

The provider had policies to promote equality, diversity and inclusion and to protect staff from discrimination and harassment.

Staff who had healthcare needs were supported appropriately. The registered manager told us they met with them regularly to establish how they were feeling and how they could meet their needs within the workplace.

The provider did not have clear responsibilities, roles, systems of accountability or good governance. They did not always act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

The provider’s governance systems for auditing the service had not been effective in identifying or addressing areas for improvement to ensure that people were not placed at risk of receiving unsafe and inappropriate care.

The provider’s quality assurance systems had not identified these concerns, indicating that their checks and audits had failed to pick up the issues or prompted timely action to address them.

There were significant shortfalls identified in the management of medicines. Medicines audits had failed to identify these shortfalls. This put people at risk of not having their pain and healthcare conditions effectively managed.

Environmental checks had failed to identify exposed pipes and broken tiles. This posed a risk of avoidable harm to people. The provider took action after we informed them of this.

Although records indicated call bells were responded to in a timely manner, some people reported staff did not always respond to their needs in a timely manner and this had led to discomfort and continence incidents. This posed a risk to people’s skin integrity as well as their dignity.

Although risk assessments were in place, monitoring systems had not identified that a person’s toenails were excessively long and sharp and this may cause a risk of skin injury.

Staff often supported people in a task-centred manner which felt institutionalised. This included how people were supported during lunch and how activities were delivered on the day of our inspection.

The provider was responsive to our feedback and provided evidence they were taking appropriate action and to make the necessary improvement in all areas of concern we identified.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

Staff told us they worked well with healthcare professionals to ensure people’s needs were met. The registered manager confirmed they had a good working relationship with a range of external professionals. They told us, “There is an amazing care home nearby. I contacted them to introduce ourselves and learn from them. They sometimes call us and we liaise with them. We have a good relationship with the local chemist too, also with the tissue viability nurse and other healthcare professionals.”

Healthcare professionals said they had a good working relationship with the staff team and management. A healthcare professional told us, “People’s individual needs are taken seriously and staff make every effort to ensure people receive the right care and support. The team is responsive when needs change and works hard to make sure people are followed up appropriately.”

The provider had systems and processes to ensure people’s needs were reviewed with external professionals. The provider listened to feedback from them and where a need was identified, amended their policies and procedures to promote effective communication and partnership working.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not actively contribute to safe, effective practice and research.

Some people said they were consulted during meetings, reviews or regular conversation, to find out if they had any concerns or requests. However, some said they were not. One person told us, “No I don’t get asked, we haven’t had any surveys.” Relatives said they were aware and invited to meetings, but these were not always regular. A recent provider audit indicated there had not been a meeting since January 2026.

The registered manager told us they listened to people’s feedback and made the necessary improvements. They responded positively to concerns raised and shortfalls in the service being identified during auditing processes. They worked alongside the provider to develop a service improvement plan and to work with the local authority and safeguarding teams to address issues raised. The registered manager told us, “We learn from accidents and incidents, falls, we introduce equipment and hourly checks for example. We liaise with the local authority if we need more support for people. The frailty team from Epsom hospital help us to look at people’s need in a pro-active way to prevent incidents. Sometimes you don’t really look at things as a whole.”

The provider conducted a yearly survey for all staff. The registered manager took any concerns seriously and had put in place a ‘You said, we did’ report whereby they responded to the concerns with actions they had taken to improve. For example, additional staff had been recruited.

The management team were given feedback in relation to the concerns we identified. They were responsive and took this feedback seriously. They took appropriate action to make the necessary improvements and learn from the concerns, by communicating with the staff and upper management, and strengthening their monitoring systems, including the frequency of their audits.