Parkside Nursing Home

Parkside Nursing Home is a care home that provides nursing and personal care for up to 50 people in one purpose-built building. At the time of the inspection 17 people lived at the home, including people living with dementia.

People’s experience of using this service and what we found

There had been a number of changes in the management team and these changes had not yet been embedded to provide sustained changes at the home. Relatives told us they were not consistently involved in planning and reviewing peoples care. The providers senior leadership team had supported the service in making numerous changes in order to improve the quality and safety of care. Governance systems and processes had improved and as a result incidents had reduced. The home worked well and acted on feedback from health and social care professionals.

People were protected from the risk of harm or abuse. Safeguarding incidents were investigated and reported in a timely manner to safeguarding authorities. Medicines were managed safely. Staff were recruited safely, and people were supported by staff who knew them well. Infection control measures were in place to protect people from the risk of infection. Lessons had been learnt and people’s outcomes had improved as result of the changes since our last inspection.

People were involved in planning their care. The provider had been open and honest when issues occurred and responded and acted upon complaints in a timely manner. People were supported to spend their time undertaking activities they enjoyed.

People were offered choice in what they wanted to eat and drink, risks associated with eating and drinking were managed and specialist advice had been sought when needed. Staff were trained and competent and care was delivered in line with best practice guidance and the law. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were provided with consistently kind and caring support; they were given choices and they were consulted about all aspects of their care. Staff supported people in a dignified way, and people were supported in a timely manner. Staff communicated with people respectfully.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 18 November 2021) and there were multiple breaches of regulation. Following our last inspection, we held a provider meeting and the provider completed an action plan to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 13 September 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

The overall rating for the service has changed from inadequate to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Parkside Nursing Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Parkside Nursing Home is a care home that provides nursing and personal care for up to 50 people in one purpose-built building. At the time of the inspection 32 people lived at the home, including people living with dementia.

People’s experience of using this service and what we found

People were not protected from the risk of harm or abuse. Not all staff knew how to report or who to report safeguarding incidents too. Medicines were not managed safely, and people did not always receive their prescribed medicines on time. Risks associated with people’s healthcare needs had not always been assessed and risk reduction measures were either not in place or not followed.

Infection control practices were not in line with current guidance and did not protect people from risk of harm, lessons were not learnt which resulted in incidents being repeated. Safe recruitment practices were followed.

People did not always have their needs fully assessed and care was not always delivered in line with best practice guidance and the law. This left people at risk of receiving unsafe care. People were not always offered choice in what they wanted to eat, or drink and risks associated with eating and drinking were not always managed appropriately.

People were not always supported by competent staff. Staff had received training, however, they did not always implement training into practice in areas such as moving and handling and behaviour management.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People were not provided with consistently kind and caring support, they were not always given choices or consulted with about their care. Staff did not always support people in a dignified way, and they did not always acknowledge people who required support. Staff did not always communicate with people respectfully.

The leadership, management and governance measures did not provide assurances the service was well led, and that people lived and were cared for in a safe environment. Lessons were not being learnt and this resulted in a pattern of incidents which placed people at risk of harm.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 6 May 2021).

Why we inspected

We received concerns in relation to the management of medicines, people’s nursing care needs, management of behaviours that may challenge, staff training and overall management of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective, caring and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key question. We therefore did not inspect it. The rating from the previous focused inspection for that key question was used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the key questions safe, effective, caring and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Parkside Nursing Home www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to keeping people safe, risk management, medicines, infection control, staffing, care planning, maintaining people’s dignity and governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Parkside Nursing Home is a care home that provides nursing and personal care for up to 50 people in one purpose-built building. At the time of the inspection 25 people lived at the home, including people living with dementia.

People’s experience of using this service and what we found

People were protected from the risk of abuse by staff who knew how to report safeguarding issues appropriately. The care home environment was safe, people’s individual risks were assessed, and action taken to reduce them. There were enough staff to meet people’s assessed care needs.

People’s prescribed medicines were managed in a safe manner and the provider’s infection prevention and control measures reduced the risk of the spread of health infections. When things occasionally went wrong, lessons were learned, and the learning was shared openly.

People’s individual care plans were informative, concise, and accessible to the staff who used them as a guide. Individuals, or their families, were involved in decisions about their care where possible. Referrals were made to community health services when needed and the care staff worked well with other agencies.

People enjoyed the food and there were always drinks and snacks available. Staff were appropriately trained to meet people’s care needs. The care home environment met people’s needs and was being further refurbished. Where people lacked the mental capacity to make certain decisions, appropriate best interest processes had been undertaken.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People received personalised support and staff were creative when they supported people’s communication needs. Staff had helped people to maintain contact with their loved ones during the COVID-19 pandemic and the care home had followed government guidance on safe visiting. Compassionate end of life care was provided by staff.

People were supported to achieve good outcomes. Staff were well supported by the registered manager, who had an open approach to people. When serious incidents occurred, the registered manager investigated them thoroughly and shared the findings with relevant people.

The provider’s quality assurance processes were effective and well embedded. Improvements had been made as a result of the provider’s quality audits of the service. The service had a continuous improvement plan in place. Staff told us they enjoyed working at the care home and that morale was high.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 28 September 2020).

This service has been in Special Measures since 26 November 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned focussed inspection based on the previous rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection, for those key questions not looked at on this occasion, were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Parkside Nursing Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Parkside Nursing Home is a care home that provides nursing and personal care for up to 50 people in one purpose-built building. At the time of the inspection 25 people lived at the home.

People’s experience of using this service and what we found

People’s living environment did not always protect them from the risk of scalding and the provider had not taken all the necessary safety actions identified in their fire risk assessment and legionella risk assessments. Improvements were needed in how the provider managed their environmental risk assessment processes to ensure people were safe. However, people’s individual risks were clearly identified, well managed, and supported by staff who understood them.

People were protected from the risk of infectious diseases, such as covid19, by staff who wore the necessary PPE and the provider’s cleaning and hygiene routines. Arrangements were in place to support people to self-isolate if necessary. People’s prescribed medicines were well managed and safely administered by suitably qualified staff.

People were protected from the risk of abuse by staff who had received the necessary training and knew how to implement it. They were supported by enough staff to meet their assessed care needs and the provider ensured that any new staff had been safely recruited to ensure they were suitable.

People were cared for by staff who had a kind approach, and people were supported to make everyday choices about the care they received. Staff respected people’s dignity and privacy.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The management of the service supported people to achieve good outcomes from the care they received. The registered managers provided supportive leadership and were person centred. The registered managers understood their responsibilities for being open and honest when something went wrong; and ensured the necessary notifications were made to the CQC and other relevant authorities. The provider asked people, and their relatives and staff, for feedback on the service which was then used to make improvements when necessary.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Inadequate (report published 26 November 2019)

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations in the Safe, Caring and Well-Led key questions.

This service has been in Special Measures since the last inspection. During this inspection the provider demonstrated that improvements have been made in Safe, Caring and Well-Led key questions; and the service is no longer rated as Inadequate overall or in any of those three key questions. However, the provider was also previously rated Inadequate in the Effective key question. That key question was not considered as part of this focused inspection and so that rating is unchanged. This means the service continues to be in special measures.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 14 August 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve; person centred care, dignity and respect, need for consent, safe care and treatment, staffing and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Caring and Well-Led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Parkside Nursing Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Parkside Nursing Home is a care home that provides personal care and nursing for up to 50 people in one purpose-built building. At the time of the inspection 46 people lived at the home.

People’s experience of using this service and what we found

Although many people told us they felt safe at Parkside, this was not reflected in our findings.

People were not protected from abusive practices, concerns had not always been reported and investigated and action had not been taken to keep people safe. Risks associated with people’s care and support were not managed safely. Measures were not always in place to reduce risks such as choking, falls and pressure ulcers. This placed people at risk of harm.

There were not always enough staff to meet people’s needs and ensure their safety. Furthermore, staff did not all know how to provide safe care. Consequently, their actions placed people at risk of harm. Medicines were not managed safely and the come was not clean and hygienic in all areas. Safe recruitment practices were followed.

People were at risk of inconsistent and unsafe care as their needs had not always been fully assessed and planned for. People’s health needs were not managed safely or effectively. Good practice guidance and advice from specialist health professionals was not always followed.

People were not always supported by competent staff. Although staff had received training they did not always implement learning in areas such as safeguarding and behaviour management. Risks associated with eating and drinking were not managed safely and people’s feedback about the food was mixed.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Support was provided against people’s wishes and when people lacked capacity to make decisions there was no evidence that staff were providing support in the least restrictive way.

There was not a culture of person-centred care at the home. People were not provided with consistently kind and caring support, they were not always given choices or consulted with about their care. Staff did not always support people in a dignified way and aspects of the environment meant staff could not ensure their privacy. Staff did not always communicate with people in a respectful manner and were not always responsive to people’s distress.

People were not consistently provided with support that met their needs and preferences and people told us there were not always enough staff available to respond to their requests for support. People were not consistently provided with compassionate care at the end of their lives, care in the dedicate end of life unit was poor. People could not be assured concerns and complaints would be addressed. People were supported to keep in touch with their family and friends and had some opportunity for social activity.

The home was not well led. There was blame culture at the home and a lack of accountability for issues found. Although the registered manager was experienced and had a clear understanding of their role, they had not ensured the home was run safely or effectively. People’s health and safety was risk due a failure to identify and address issues and due to poor practices by senior staff at the home. There was a lack of clinical governance and care documentation had been falsified.

Although we found that the service worked with partner agencies, people’s feedback about working relationships was poor. Morale in the staff team was low, there was a culture of mistrust and this had a negative impact on the care people received.

The service met the characteristics of Inadequate in most areas. For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection

The last rating for this service was good (published 19 May 2017).

Why we inspected

The inspection was prompted in part due to concerns received about safety, quality and leadership. A decision was made for us to inspect and examine those risks.

Enforcement

We have identified seven breaches of the legal regulations. These were in relation to, dignity and respect, person centred care, consent, safe care and treatment, safeguarding, governance and staffing. Information about the action we have taken can be found at the end of this report.

Follow up

We will continue to monitor information we receive about the service. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Parkside Nursing Home is required to have a registered manager. 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 home is run. At the time of our inspection a new manager was in place who had submitted their application with the Care Quality Commission to become the registered manager which was being processed.

People and their relatives told us that they felt staff provided safe care and support. Staff were trained in adult safeguarding procedures and knew what to do if they considered someone was at risk of harm or if they needed to report concerns.

There were systems in place to identify risks and protect people from harm. Risk assessments were in place and reviewed to ensure they continued to reflect people’s needs. Risk plans informed staff of the action required to reduce any associated risks to people’s needs. Accidents and incidents were recorded and reported by staff. The management team analysed these to ensure appropriate action had been taken to protect people, and to consider if there were any themes or patterns that required further action. Contingency plans were in place to support staff to provide a safe service in the event of an untoward incident affecting the service.

There were sufficient staff to keep people safe and meet their needs. Safe recruitment procedures were in place and followed. Medicines were given to people on time and as prescribed, they were also managed and stored safely following best practice guidance. People were supported effectively by staff that had received an induction, ongoing training and support.

Policies and procedures were in place to guide staff in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff had received appropriate training and understood the processes in place for ensuring decisions were made in people’s best interests. People and or their representative where appropriate, had given consent to their care and treatment.

People received sufficient to eat and drink and their nutritional needs had been assessed and planned for. People were appropriately supported with their eating and drinking needs if required, choices were offered and respected, and independence encouraged as fully as possible.

The service worked well with visiting healthcare professionals to ensure they provided effective care and support. When concerns were identified about people’s healthcare needs, appropriate action was taken to support people’s health and well-being.

Staff were kind and caring, they knew people well, and they supported people in a dignified and respectful way. Staff acknowledged and promoted people’s privacy. People felt that staff were understanding of their needs and that they had developed positive relationships with them. Information about an independent advocacy service was available for people should this support have been required.

People and or their representatives where appropriate, were involved in the assessment and review of their needs. Care plans informed staff how to support people and were on the whole personalised to people’s needs, routines and preferences. Activity staff provided a range of one to one and social activities and opportunities, to support people with any interest’s hobbies and pastimes. People and staff knew how to raise concerns and these were dealt with appropriately.

People who used the service and relatives or representatives, were given opportunities to share their experience of the service. Quality assurance systems were in place to regularly review the quality and safety of the service provided. Since our last inspection the service had improved in all areas and there was a clear plan in place to continually drive forward improvements and to sustain those already made.

Parkside Nursing Home provides accommodation for up to 50 older people with varying support needs including nursing and people living with dementia. On the day of our inspection there were 29 people living at the home.

Parkside Nursing Home is required to have registered manager. 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 our inspection a registered manager was in place.

We carried out an unannounced comprehensive inspection of this service on 6 and 7 April 2016. We issued a warning notice to the provider. People had experienced incidents of avoidable harm because the provider had not appropriately assessed how risks to people were monitored and mitigated. We also identified concerns relating to how records of people's care and treatment were completed, monitored and maintained.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the warning notice. We found at this inspection that the provider was compliant with the warning notice.

Improvements had been made to the systems and processes that assessed, managed and monitored quality and safety. People’s individual needs were assessed and care plans and risk plans were in place to advise staff of how to meet people’s needs. People had the required equipment in place to reduce risks from occurring and people’s records were completed accurately and were maintained appropriately.

Parkside Nursing Home provides accommodation for up to 50 older people with varying support needs including nursing and people living with dementia. On the day of our inspection there were 38 people living at the home.

Parkside Nursing Home required a registered manager. 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 our inspection a new manager had been appointed and had been in post since 1 April 2016. They told us and the operations manager confirmed that they had started the process to apply for the registered manager position. We will monitor this.

During our previous inspection on 8 and 9 April 2015 we identified two of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to how risks to people’s needs were assessed, concerns about how people’s medicines were managed and a lack of robust systems in place to effectively assess, monitor and improve the quality of the service. The provider sent us an action plan to tell us of what improvements they would take to meet these breaches in regulation.

At this inspection we found continued problems and a breach in these areas and additional concerns in relation to people’s care records and documentation. Information available for staff that provided guidance of people’s individual needs was variable in quality and content and in some instances no information was provided. People’s daily records were not reviewed effectively to ensure people’s needs were being met and action taken when changes occurred.

Risks to people had been assessed but the control measures identified to reduce harm had not always been in place, resulting in incidents occurring that were preventable.

Staff had received safeguarding adults training and were aware of their role and responsibilities. The provider worked with the local authority and investigated safeguarding concerns appropriately.

Some safety concerns were identified with the environment and people’s personal evacuation plans were limited in detail about people’s behavioural and anxiety needs.

Some improvements had been made to the management of medicines but further concerns were identified. Medicine trolleys were left unlocked when unattended; a person had experienced a delay in their eye drops being ordered. Two discrepancies were found when checking people’s medicines that meant we could not be assured people had received their prescribed medicines.

Safe recruitment practices were in place to reduce the risks of unsuitable staff working at the service. Staffing levels were a concern to people and relatives. Three permanent nursing staff were being recruited and the provider had identified an additional deputy manager was required and this was also being appointed but these were not in place at the time of the inspection. Staff raised concerns about long working hours which may have been a contributing factor for staff absenteeism. This was being addressed by the provider. People’s dependency needs were assessed and reviewed, concerns were identified about the deployment of staff.

Staff training opportunities had improved and support to staff including regular supervision and appraisal meetings to discuss their work and development needs, were improving.

Staff did not always gain consent from people before providing day to day support and before care and treatment. Where people lacked mental capacity to make specific decisions about their care and treatment, The Mental Capacity Act (2005) was adhered to. Where concerns had been identified about people’s liberty and freedom the provider had taken action to ensure people were not unlawfully being restricted.

Some staff showed a caring and compassionate approach and were attentive to people’s needs and used effective communication. Concerns were identified that not all staff treated people with dignity and respect and did not meet people’s needs in a timely manner. The mealtime experience for people could have been better. Staff were frequently distracted and interrupted when supporting people with eating and drinking, affecting the quality and effectiveness of support provided.

People had information about advocacy information. The complaints procedure was being updated. People and their relatives received opportunities to attend meetings to discuss how the service was provided. However, relatives felt communication and the exchange of information and being informed of changes could be improved upon.

People had an assessment of their needs prior to moving to the service but information about people’s needs, preferences, routines and social history was limited and variable. Activity coordinators provided activities over a seven day period.

Relatives and staff raised concerns about the changes with the management of the service and felt this had affected how the service was managed and provided. Staff were positive about the new manager and felt they were supportive and would be a good leader.

People and relatives received opportunities to feedback their experience about the service. The service and provider conducted checks and audits on the quality and safety of the service but these were not fully effective as they did not identify the issues we found during the inspection.

We spoke with two people who used the service and a visiting relative. All of these people were happy with the care provided. A relative told us, 'My mother has received care here for over two years, she's well cared for, always nicely dressed and the staff keep me fully informed. I am very happy with the care provided and have no concerns.'

We undertook this inspection because we received information of concern that told us people did not always receive appropriate support because there were not enough staff on duty and that some staff were not trained to move people safely. We found that staff were trained to undertake safe moving and handling. However, the systems in place to maintain planned staffing levels did not ensure that people who used the service received a consistent level of care.

We found that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

We found that the arrangements in place to manage the risks associated with medicines protected people who used the service.

We found that improvements had taken place to the environment to ensure that people who used the service were in safe, accessible surroundings that promoted their wellbeing.

We found that since our last inspection proper steps had not been taken by the provider to ensure that the quality of the service was maintained.

We found that care plans were not up to date and did not reflect the current needs of people who used the service.

We found that medicines were not always managed safely and the environment required improvements.

We found that the staff assessed the risks in the environment so that people who used the service were kept safe.

We found that people who used the service had a care plan that reflected their individuality and described how their wishes and preferences were taken into account with the care and treatment plan.

People who used the service told us, 'They look after you here, the food is good and I can't complain at all.' 'Another person commented, The staff are very kind here.'

Time was being taken to make sure that people who used the service were able to consent to their care or that decisions were taken in accordance with the laws that protected their rights.

Recruitment practices made sure that people who used the service were in safe hands and the staff were being supported to obtain the skills they needed to support people in line with best practice.

Without exception all of the people we spoke with told us they were happy with the care and support they received and that they felt safe at the home.

Visiting professionals told us that they found the care and support provided by Parkside was responsive to individual needs and that people who used the service were provided with continuity in their care, treatment and support as a result of the manager ensuring effective communication between all other agencies involved in the person's assessment and treatment.

One person using the service was fully able to tell us about their experiences of the care and support they received. This person told us, 'I have always experienced good care here and I have never had any concerns. The staff are very caring, they look after my health and always consult me about my care. I can have visitors anytime. It's the best home around.'