Alt Park Nursing Home

People's experience of using the service and what we found

The provider had improved some of their approach to governance. Audits of care plans we viewed identified concerns, however, there were no follow up audits completed to check actions had been completed. Therefore, we could not demonstrate a consistent approach to oversight and governance. Medication audits did not identify the concerns we found during our inspection. People were at risk of receiving care that did not meet their needs. Some records were either incomplete, inaccurate, or lacked detail to provide staff with guidance on how to support people appropriately. Records relating to complaints and incident and accidents required further development. There were no records of mattress checks on day 1 of our inspection, which we fed back to the provider, when we returned for day 2, these had been implemented.

Despite some improvements made since the last inspection people remained at risk of avoidable harm because some risk assessments lacked detail and also contained some conflicting and confusing information. We fed back some of our concerns after day 1 of our inspection, and the provider took action to ensure people were safe.

The provider had not addressed all of the issues from the last inspection, we found the systems in place to manage people’s medicines were unsafe which placed them at risk of harm.

People told us they felt safe and well cared for at Alt Park, one comment included, “I have no doubt that my [family member] is safe here at Alt Park.” Staff we spoke with said the home had improved and they liked the manager. Comments included, “The manager is open and transparent."

Everyone we spoke with commented on the kind and caring nature of the staff. Comments included, “The care is excellent; the staff are like Angels.”

The environment had improved and the home was clean, tidy and in a good state of repair. A maintenance person had been employed and was working through a home improvement plan.

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

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

The last rating for this service was Inadequate, report published 26/6/23

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 the provider had made some improvements, however, remained in breach of regulations in relation to safe care and treatment and governance.

This service has been in Special Measures since 26/6/23. During this inspection the provider demonstrated improvements that 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

When we last inspected Alt Park in March 2023 breaches of legal requirements were found. This inspection was undertaken to check whether they were now meeting the legal requirements.

Enforcement

We have identified breaches in relation to safe care and treatment, governance and records.

Please see the action we have told the provider to take at the end of this report.

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

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Alt Park Nursing Home is a residential care home providing personal and nursing care for up to 35 people aged 65 and over. At the time of the inspection there were 33 people who used the service.

People's experience of using the service and what we found

The service was not well-led. The manager and provider failed to carry out their regulatory responsibilities. Quality assurance processes were ineffective. During the inspection the senior management team and nominated individual ensured immediate actions were taken to mitigate the failures highlighted in this report. However, we are not yet assured these actions were effective or embedded to ensure the quality and safety of the service was consistently monitored and improved to keep people safe.

People were at risk of avoidable harm because accidents and incidents were not always assessed, recorded, or manged effectively to prevent further incidents. Staff were not subject to safe or robust recruitment checks. Staff were not provided with effective guidance to know how to keep people safe from harm. Medicines were not managed safely and placed people at avoidable harm. Covert medications were not administered in line with policies and procedures and as and when required medication protocols were insufficient.

People were at risk of harm because health and safety checks within the building were not effective and did not always evidence hazards were actioned within a timely manner. Trip hazards in communal areas had not been addressed to prevent falls. Appropriate measures had not been taken to ensure the safety of people in the event of an emergency. Good infection prevention and control measures were not always followed by staff. This put people at risk of infection and harm.

People were at risk of receiving care that did not meet their needs records were either incomplete, inaccurate, or lacked detail to provide staff with guidance on how to support people appropriately. People were not always supported to make informed decisions about their care in a person-centred or timely way.

People’s privacy and dignity was not always maintained. Communal bathrooms did not have handles to close the door, and several doors had no lock. Many areas were in need of decoration including people’s bedrooms and communal areas.

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.

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 21 September 2021).

Why we inspected

The inspection was prompted due to CQC receiving multiple concerns regarding the management of the home, people not being sufficiently hydrated and concerns relating to a poor culture within the service.

A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe and well-led only. However, during the inspection further risks were identified which resulted in all key questions being reviewed to include, effective, caring, and responsive.

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.

Enforcement and Recommendations

We have identified multiple breaches in relation to protecting people from the risk of abuse, the delivery of safe care and treatment, and good governance. We also identified breaches in ensuring people received care in a way which promoted dignity and respect and person-centred care. Staff were not safely recruited and there was a failure to ensure people’s rights were upheld in line with the Mental Capacity Act 2005.

Please see the action we have told the provider to take, and what action CQC has taken at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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 time frame 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.

Alt Park Nursing Home is a residential care home providing personal and nursing care for up to 35 people aged 65 and over. At the time of the inspection there were 35 people accommodated.

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

The service was following good practice guidance regarding the management of COVID-19 and maintaining standards of hygiene and infection control.

People's experience of using the service was positive. Overall, people received the care and support they needed when required. Feedback we received from relatives and visitors evidenced staff were helpful and kind and treated people with dignity and respect. Positive relationships had been developed between staff and people they supported.

Relatives told us people were safe at Alt Park Nursing Home. One relative commented, “I have no complaints; this is more than a service. (Person) is safe – there have been no incidents. There is a care plan and there are regular staff. Everything is always calm, relaxed and homely.”

There was good support regarding the management of medicines and people got their medicines on time. The medications records supported best practice. Any anomalies were monitored by the auditing process in place. Nursing staff who administered medicines were suitably trained and competent.

Risks associated with people’s care were identified and managed to minimise harm. Supporting care records identified risks and there were plans in place to help keep people safe.

The registered manager was providing effective leadership and was supported by a senior manager who visited regularly and a deputy manager had recently been appointed. The provider’s governance systems and organisational structure provided monitoring and support for the service.

Rating at last inspection and update

At the last inspection the service was rated Good (report published 31 January 2020).

Why we inspected

The inspection was prompted in part due to concerns received about aspects of safe care including management of people with high levels of nursing needs; in particular management of people who were at risk of pressure ulcers and peoples diet and fluid intake.

A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them.

Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has remained as Good. This is based on the findings at this inspection.

Overall, we found no evidence during this inspection that people were at risk of harm. Please see the safe and well-led sections of this full report.

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 coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Alt Park 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.

Alt Park is a residential care home providing personal and nursing care for up to 35 adults. At the time of the inspection, the service was supporting 34 people across two floors. The upper floor was dedicated to accommodation while the ground floor provided a mix of accommodation, lounges, a dining area and office space.

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

Improvements had been made and sustained since the last inspection. Quality assurances processes were more robust and effective. Notifications to the Care Quality Commission (CQC) had been submitted as required. The service had a positive learning culture where people were supported to reflect on performance and improve practice. The provider regularly engaged people using the service, their relatives and staff through, surveys, meetings and informal discussions. People said communication with the registered manager was good.

Medicines were received, stored, administered and disposed of safely. Systems and processes were in place to safeguard people from the risk of abuse. Individual risks to people were assessed. There were sufficient numbers of staff deployed to meet people's assessed needs. Arrangements were in place for making sure that premises were kept clean and hygienic so that people were protected from the risk of infections.

The service operated in accordance with the principles of the Mental Capacity Act 2005 (MCA). 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.

Staff had good relationships with health and social care professionals who had contact with the service. People's individual needs were assessed before they moved into Alt Park. Staff received a good range of support including regular training. People were supported to eat a varied and nutritious diet based on their individual preferences. The premises were suitable for people's needs. However, the dining experience and environment could be further improved.

Staff treated people with kindness, compassion and respect. People’s faith and cultural needs were recorded and understood by staff. People were encouraged to be as independent as possible. Staff understood the need to protect people’s privacy and dignity when providing care.

Care records were electronic and personalised for each individual. Care plans were reviewed regularly to ensure they remained accurate and reflected people’s needs. Staff adapted the way in which they communicated with people to engage them and to ensure important information was shared. People were supported to engage in a range of activities and to maintain important relationships. People’s end of life wishes were considered as part of the assessment and care planning process.

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 26 January 2019) and there were two breaches of regulation. 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.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Since the previous inspection the registered provider has made improvements, however further improvements were required.

Processes for checking the quality and safety of the service had improved since the last inspection, however further improvements were required because they were not always effective in identifying areas of improvement.

Service leadership, management and governance was not always effective. Statutory notifications regarding incidents and events which occurred at the home were not always submitted to the Care Quality Commission (CQC) as required by law.

Some concerns about the safety of the environment were identified during the inspection; these were discussed with the interim manager and immediately responded to.

We have made a recommendation about the safety of the environment.

Medication management procedures had improved since the last inspection. However, further improvements were needed so that medication administration records (MARs) were appropriately completed.

People were protected from harm. Staff understood safeguarding and whistleblowing procedures and knew how to report any concerns as and when they presented.

Staffing levels had improved since the last inspection. People received care and support from the right amount of staff in a responsive, timely and considerate manner.

Recruitment was safely managed. Staff had undergone the appropriate recruitments checks and provided the right care and support to people.

The registered provider complied with the principles of the Mental Capacity Act (MCA) 2005. People’s level of capacity was appropriately assessed and measures were in place to ensure people received support in the least restrictive way possible.

We received positive feedback about the quality and standard of food. Staff were familiar with people’s dietary needs as well as their likes and dislikes.

People received care and treatment in a dignified and respectful manner. We received positive feedback about the quality and safety of care people received.

There was a complaints process and policy in place. People and relatives knew how to make and a complaint and felt confident that any concerns would be responded to accordingly.

More information is in the full report below.

Rating at last inspection: Requires Improvement (report published 28 December 2017) This is the third consecutive time the service has been rated Requires Improvement.

About the service: Alt Park is a ‘care home’ that provides nursing and personal care for up to 35 older people living with dementia. At the time of the inspection 25 people lived at the service.

Why we inspected: This was a planned comprehensive inspection based on the ratings at the last inspection.

Please refer to the end of the report for the action the registered provider needs to take.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner. We will meet with the registered provider to discuss how they plan to address the issues identified during this inspection.

Alt Park is a ‘care home’, registered to provide accommodation and nursing or personal care for older people. The care home is registered to provide support for up to 35 people. At the time of the inspection there were 30 people living at the home. People in care homes receive accommodation and nursing or personal care as 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.

Alt Park is a purpose-built care home situated in Gillmoss, a suburb of Liverpool. Accommodation can be found over two floors, there is an available passenger lift and stairwell, as well as a lounge/dining area and garden areas located around the home.

At the time of the inspection the was no registered manager in post. A registered manager is a person who has registered with CQC 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 and how the service is run. The registered provider had appointed a manager in April 2018 but they had not submitted the relevant documentation to CQC.

At the previous comprehensive inspection which took place in November 2017, the home was rated as ‘Requires Improvement’. This focused inspection was carried out due to notifications of concern which CQC received in relation to the clinical support people received, particularly in relation to effective wound care management.

This focused inspection was carried out to ensure people received effective care and the registered provider was meeting all legal requirements. The team inspected the service against two of the five key questions we ask always ask: is the service effective and is it well-led?

Consent to care was not obtained in accordance with the Mental Capacity Act (MCA) 2005; records did not indicate that principles of the MCA were being followed and it was not clear to see if people were involved in the decisions which were made in relation to the care provided.

Quality assurance systems were not always effectively assessing, monitoring or identifying areas of improvement and development. Audits and checks were not identifying the areas we identified during the inspection and were not effectively monitoring the safety and quality of care people received.

We recommend that the registered provider reviews the quality assurance systems which are currently in place.

During this inspection we looked at the clinical care people received in relation to wound care and the management of vulnerable skin. We did this in order to assess whether relevant risks had been effectively assessed by nursing and care staff. People’s vulnerable skin conditions were clearly recorded and staff followed specific care and treatment plans to support the risks that presented.

We reviewed clinical support processes that were in place manage and mitigate risk. These included repositioning charts, topical (medicated) administration records, waterlow assessment tools and pressure relieving equipment. The clinical support measures which were in place helped to provide an evaluation of the care provided and demonstrated how risks were assessed and monitored.

The day to day support needs of people living at Alt Park were being met. We found staff liaised with external health and social care professionals at the appropriate time to optimise people’s health and well-being.

Staff received regular supervision and were supported with their learning and development. Staff told us they felt supported and were able to develop the necessary skills and competencies to deliver effective care. Relatives also told us that staff were well equipped and trained to provide the care which was expected.

The overall governance of the home required improvement. Quality assurance systems which were in place were not always effectively assessing, monitoring or identifying areas of improvement and developments. The manager was responsive to the feedback we provided in relation to the improvements that were required.

Policies and procedures were up to date, contained the relevant information and were available and accessible to staff. Staff were able to discuss specific procedures and processes with us during the inspection.

The registered provider was aware of their responsibilities and had notified CQC of events and incidents that occurred in the home in accordance with their regulatory requirements. The registered provider ensured that the ratings from the previous inspection were on display within the home, these were also available for the public to review on the registered provider website, as required.

Improvements were identified during this inspection however, we have not revised the overall rating from ‘requires improvement’. To receive a rating of ‘good’, this requires evidence of consistent long term good practice.

Alt Park is a purpose built care home situated in Gillmoss, a suburb of Liverpool. Alt Park provides nursing and personal care for up to 35 older people who have dementia. There is a car park to the front of the building and accommodation is located on two floors, with access to all areas of the home by a passenger lift. During the inspection, there were 28 people living in the home.

At the last inspection in May 2017, we found that the provider was in breach of Regulations in relation to the safety of the environment, risk management, medicines management, recruitment, staff training, consent, care planning, feedback systems, audit systems, policies and procedures and submission of notifications. The service was rated as inadequate and placed in special measures. This inspection looked to see whether sufficient improvements had been made to ensure the provider was meeting the fundamental standards of care.

At the last inspection we found that medicines were not always managed safely. There were gaps in recording, PRN (as and when required) protocols and plans for covert (hidden in food or drink) medicines were not detailed. During this inspection we found that some improvements had been made and plans were now detailed. However, we found that one medicine was not given as prescribed as minimum times between the doses were not always maintained and not all stock balances were accurate. The provider was still in breach of regulation regarding this.

In May 2017, we found that people’s personal emergency evacuation plans (PEEPs) were not detailed and risk assessments were not always completed accurately. During this inspection we found that risk assessments had not all been completed accurately and provided inconsistent information about risk to people. Information within care plans was not always clear or consistent to ensure staff had relevant information as to how best to support people. We also found that planned care was not always evidenced when provided and PEEPs had not all been updated. Risk was still not assessed accurately for people and the provider was still in breach of regulation regarding this.

At the last inspection we found that consent was not always sought in line with the principles of the Mental Capacity Act 2005 (MCA). During this inspection we found that applications to deprive people of their liberty had been made appropriately, however mental capacity assessments were not always completed when required. When assessments were in place, they had not all been completed in line with the principles of the MCA. The provider was still in breach of regulation regarding this.

In May 2017 we found that the audit system in place was ineffective. During this inspection we saw that the provider had implemented a new audit system which was comprehensive and identified areas that required improvement. Many of the actions highlighted had been addressed, however, due to the limited time since the new provider took over, not all of the actions had been completed.

Many of the concerns identified at the last inspection had been addressed, but not all had been fully addressed. It was evident that the provider had made a number of improvements but they needed further time to complete all of the required actions. The provider was no longer in breach of regulation regarding this.

During the last inspection we found that the provider failed to notify CQC about incidents that had occurred. During this inspection we found that notifications had been submitted regarding events and incidents that the provider was required to inform us of. The provider was no longer in breach of regulation regarding this.

In May 2017, we found that new staff were not fully supported in their roles. During this inspection we saw that all staff had completed an induction in line with the requirements of the care certificate; had regular supervision and an annual appraisal. We also found that staff had completed training in courses considered mandatory to ensure they had the knowledge to support people safely. The provider was no longer in breach of regulation regarding this.

In May 2017, we found that the environment was not always maintained safely. During this inspection we found that improvements had been made and the environment was safe. Chemicals were stored safely and systems were in place to help ensure people’s safety in the event of a fire. Window restrictors were in place and the home was adequately lit to ensure people could move around safely. The provider was no longer in breach of regulation regarding this.

During the last inspection we saw that staff were not always recruited safely. During this inspection we looked to see if improvements had been made and they had. All appropriate checks had been completed prior to staff starting in post. The provider was no longer in breach of regulation regarding this.

People told us there were always enough staff on duty to meet people’s needs in a timely way and staff were knowledgeable about safeguarding and how to report any concerns they had.

Accidents and incidents that had occurred within the home were recorded and reported appropriately. We saw that appropriate actions were taken following incidents.

People’s dietary needs were known and met within the home. A menu was available for people and staff were available to support people to eat and drink when required.

People told us that staff were kind and caring and treated people with respect. We observed people’s dignity and privacy being respected by staff and support was provided discreetly. Care files were stored securely in order to maintain people’s confidentiality.

We saw that interactions between staff and people living in the home were warm and familiar and it was clear that staff knew people well. Care plans provided information regarding people’s preferences and lives which helped staff get to know them as individuals.

Visitors were able to visit the home when they chose and told us they were made welcome. When people had no friends or family to support them, staff involved advocates in their care.

Not all care files had been updated regularly to ensure they reflected people’s current needs. Care plans were not all sufficiently detailed as some provided vague guidance as to how best to support people, such as when people became agitated. However, we saw that staff provided individualised care during the inspection.

Improvements had been made regarding gathering feedback as regular meetings had taken place with people’s relatives and quality assurance questionnaires had been completed. A complaints procedure was also available and people told us they knew how to make a complaint, but had not had to recently.

There was a schedule of activities available to people and the inspection we saw staff providing activities during the inspection and encouraging people to participate.

A new manager commenced in post on the day of the inspection. 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.

The rating from the last inspection was clearly displayed within the home and on the provider’s website as required.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Alt Park is a purpose built care home situated in Gillmoss, a suburb of Liverpool. Alt Park provides nursing and personal care for up to 33 elderly people who have dementia. There is a car park to the front of the building and accommodation is located on two floors, with access to all areas of the home by a passenger lift. During the inspection, there were 32 people living in the home.

At the last inspection in March 2016 we made a recommendation regarding staff training and induction. During this inspection we checked to see that improvements had been made. Records showed and staff told us that they had not completed all of the training considered mandatory. The training records provided by the registered manager did not reflect all of the staff employed.

Records showed that staff were provided with regular supervisions and an annual appraisal to support them in their role. Staff felt they had received a sufficient induction; however this did not meet the requirements of the Care Certificate.

External contracts and internal checks were in place to help maintain the safety of the building and equipment; however we found that the building was not always safely maintained. Window restrictors were fitted to the windows on the first floor; however they did not meet current requirements. Chemicals were not always stored securely appropriate lighting was not always maintained.

We saw that risk assessments regarding people’s health and wellbeing had been completed. These assessments had been reviewed regularly; however they were not always completed accurately. This meant that people’s risk may not be accurately assessed and mitigated.

We looked at how the service managed fire safety and found that risk regarding fire was not effectively managed. Fire doors were not adequately maintained and appropriate equipment was not available to assist people to evacuate the home in the event of an emergency. Personal emergency evacuation plans (PEEPs) had been completed, but not all contained sufficient information as to how people should be supported to evacuate the home. Not all staff had completed fire safety training. We shared our concerns with Merseyside Fire and Rescue Service.

Records showed that staff had their competency assessed to ensure they administered medicines safely. We found however that medicines were not always managed safely. There were gaps in the recording of medicine administration and plans to inform staff when to administer PRN medicines (as required) were not all in place. Those that were in place did not provide sufficient information to ensure people would receive their medicines when they needed them. One chart we viewed showed that a medicine had not been administered as prescribed.

The personnel files we viewed all contained two references and a Disclosure and Barring Service (DBS) checks. However two of the files we viewed contained gaps in the staff member’s employment history and one file did not contain any photographic identification as is required.

DoLS applications were made appropriately, however not all staff were aware who this applied to in the home and not all staff had completed training in this area.

Consent was not always sought in line with the principles of the Mental Capacity Act 2005. Mental capacity assessments were completed but best interest decisions were not always clear. Records showed that only two staff had completed mental capacity training.

Care plans were specific to the individual person and most were detailed and informative. We found however, the plans did not always contain up to date information regarding people or their needs.

We saw that planned care was recorded as provided, however not all records were completed accurately.

There were some systems in place to gather feedback regarding the service, though these systems had room for further improvement. We made a recommendation regarding this.

We found that audits had been completed to look at various areas of service provision. We found that actions were not always identified following completion of the audits. We also found that the audits were not always completed accurately. Actions identified from external audits had not all been addressed.

Although the audits that had been completed identified some of the areas of concern highlighted during the inspection, they had not been addressed. The audits did not identify all of the areas of concern raised through the inspection, such as those regarding the safety of the environment, risk management, staff recruitment, medicines management, adherence to the MCA and care planning.

Recommendations made during the last inspection in March 2016 had not been addressed by the provider, such as those relating to staff training and completion of the Care Certificate.

The registered manager had not notified the Care Quality Commission (CQC) of all events and incidents that occurred in the home in accordance with our statutory notifications, specifically safeguarding incidents.

Policies and procedures were available to guide staff in their role; however we found that a number of these required updating to ensure they reflected current legislation and best practice.

Feedback regarding meals was mainly positive. When people required support to eat, we saw that staff supported them in a dignified and unrushed manner. We spoke with the chef who was knowledgeable regarding people’s preferences and nutritional needs. We found however, that not all staff we spoke with were aware of people’s specific dietary requirements.

Staff we spoke with were knowledgeable about adult safeguarding and how to report any concerns.

We found that there were sufficient numbers of staff on duty to meet people’s needs effectively. All people we spoke with told us they felt Alt Park was a safe place to live.

The manager had taken steps within the home for people living with dementia, towards the environment being appropriate to assist people with orientation and safety.

Everyone we spoke with told us the staff were kind and caring. We observed people’s dignity and privacy being respected during the inspection and staff we spoke with explained how they maintained people’s privacy and dignity when providing care.

People’s preferences were recorded throughout care files, as well as information regarding their life history. This helped staff to get to know people and their experiences so they could provide support based on people’s preferences.

We observed a number of relatives visiting throughout both days of the inspection. The registered manager told us there were no restrictions in visiting, encouraging relationships to be maintained.

Advocacy services were available for people who had no friends of family to represent them. The registered manager told us they would support people to access these services when required.

We saw that care plans were reviewed regularly and all relatives we spoke with told us they were involved with the reviews. We viewed a number of care files that contained a pre admission assessment. These assessments were detailed and helped to ensure the service was aware of people’s needs and that they could be met effectively from the day of admission to the home.

An activities coordinator was employed, who told us there was no planned schedule of activities and no group activities took place. Instead one to one activities were provided, such as chatting individually to people or some craft activities. Regular external entertainers were arranged and nobody raised concerns regarding the activities available.

People had access to a complaints procedure and this was displayed within the home. All people we spoke with told us they knew how to make a complaint should they need to, but had not had reason to complain.

A registered manager was in post. 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. Feedback regarding the management of the service was positive.

Staff we spoke with were aware of the home’s whistle blowing policy and told us they would not hesitate to raise any issue they had.

Ratings from the last inspection were displayed within the home and on the provider’s website as required.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures.’ Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measu

Situated in North Liverpool and located close to public transport links, leisure and shopping facilities, Alt Park Nursing Home is registered to provide accommodation for up to 35 people with nursing and personal care needs. The location is a two storey property with a passenger lift giving access to the upper floor.

A registered manager was in post. 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.

People’s medication was generally stored and administered in accordance with good practice. However we saw that administration instructions relating to the use of covert medicines were lacking in detail and some records relating to topical medicines (creams) were not complete.

Staff were not always suitably trained and skilled to meet the needs of people living at the home. The staff we spoke with confirmed that they felt equipped for their role. However the training records that we saw showed that not all training had been completed or refreshed according to the home’s schedule.

During discussions with staff we found that not all people were able to demonstrate that they had the necessary language skills to communicate effectively with people living at the home, relatives, colleagues and healthcare professionals.

We have made a recommendation regarding staff training and support.

We asked people and their relatives if they felt safe living at the home. All of the people that responded told us that they felt the home was safe.

Staff knew how to recognise abuse and discrimination and were seen to intervene in a timely and appropriate manner when people showed signs of distress. This reduced the risk of behaviours escalating and reduced people’s anxiety.

People living at the home had detailed care plans which included an assessment of risk. Each of the care records that we saw contained risk assessments relating to; nutrition, use of bed rails, falls, pressure area care, smoking, balance, eyesight, choking and moving and handling. These were subject to regular review and contained sufficient detail to inform staff of risk factors and appropriate responses. We saw that risk assessments had been reviewed and care plans amended following recent incidents.

The records that we saw showed that the home was operating in accordance with the principles of the MCA.

We saw staff engaging with people in a positive and caring manner. Staff spoke to people in a respectful way and used language, pace and tone that was appropriate to the individual.

Throughout the inspection we saw people moving around the building independently and engaging in activities of their own choosing. We saw that people declined care at times during the inspection and that staff respected their views.

People’s privacy and dignity were respected throughout the inspection. We saw that staff were attentive to people’s needs regarding personal care.

People’s preferences and personalities were reflected in the décor and personal items present in their rooms. Important items and photographs were prominently displayed. All the bedrooms we saw were personalised.

We observed that care was not provided routinely or according to a strict timetable. Staff were able to respond to people’s needs and provided care as it was required.

Information regarding compliments and complaints was clearly displayed and the provider showed us evidence of addressing complaints in a systematic manner. All of the people that we spoke with said that they knew what to do if they wanted to make a complaint.

Each of the people that we spoke with told us that the registered manager was aware of the day to day culture of the home. We saw that the registered manager’s office was positioned to offer a good view of the reception/lounge and the main corridor. They were highly visible and actively involved with people living at the home, their relatives and staff throughout the inspection.

The registered manager understood their responsibilities in relation to the management of the home and their registration with the Commission. We saw that the majority notifications had been submitted in accordance with requirements. However some notifications relating to safeguarding referrals had not been submitted.

The home completed a series of quality and safety audits on a regular basis. We saw evidence of monthly audits of the physical environment, care records and catering. We also saw that focused audits relating to; meals, privacy and dignity and other topics had been completed on a regular basis.

Is the service safe?

People who lived at the home told us they were treated with respect and dignity by staff. People told us they felt safe and that if they had any concerns they would raise these with staff or with the manager.

The service was managed in people's best interests and the manager was aware of her responsibility to refer to external professionals if it was felt that a person may be being deprived of their liberty. CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to residential services and care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Records we reviewed confirmed that staff had been trained to understand the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People's health, safety and welfare were protected in how the service was provided. People got the support they needed when they needed it and risks to people's safety were appropriately managed.

Our observations and the records we looked at, assured us that the equipment used to support people living at Alt Park Nursing home, was clean and well maintained to ensure that each piece of equipment was safe for people to use.

Is the service effective?

People received the care and support they required to meet their needs and maintain their health and welfare.

People were supported by kind and attentive staff. We saw staff were patient and gave encouragement when supporting people. People told us they were able to do things at their own pace and in their own way. Our observations confirmed this.

Is the service caring?

People who lived at the home told us staff were caring and respectful. Staff told us they were clear about their roles and responsibilities to promote people's independence and respect their privacy and dignity.

Some of the people who lived at the home had done so for many years and we saw that staff showed warmth and familiarity when supporting people. People comments included: 'The staff are a good bunch, we're treated well' and 'I am happy here, the carers are good and I have everything I need.'

Is the service responsive?

The service worked well with other agencies and services to make sure people received their care in a joined up way. GPs and other health professionals were referred to promptly when people required support with their health care needs.

People who lived at the service and their relatives told us they felt listened to and included in day to day decision making. We found that people who lived at the home were listened to and their views were acted upon. People were asked to give feedback on their experience of the service. This was done through the use of surveys and meetings with people who lived at the home. This feedback was then used to make improvements to the service.

Is the service well-led?

The provider had a system in place for checking on the quality of the service and this involved seeking the views of people who lived at the home on a regular basis. We reviewed records which confirmed that actions had been taken to make improvements to the service based on people's feedback.

The service was managed in a way that ensured people's health, safety and welfare were protected. The service was managed in the interests of the people who lived at the home.

There were enough skilled and experienced staff to be able to meet the needs of the people who lived at Alt Park in a timely manner and there were appropriate procedures in place to deal with complaints. However, during our inspection we found that appropriate arrangements were not in place for the management of the medicines.