This inspection took place on 12 July 2016 and was unannounced. An inspection took place on 5 January 2016. At that inspection we found the home was in breach of seven legal requirements and regulation associated with the Health and Social Care Act 2008. We found that risk assessments were not in place for people to protect people from harm and medicines were not being managed safely. Mental capacity training and assessment had not been carried out in accordance to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) application had not been made to deprive people of their liberty lawfully. We also found that supervisions and training were not being carried out consistently. Some people’s food was not being monitored and actions plans were not in place for people at risk of losing weight. Some care plans had not been completed in full. Parkside Residential Home is a residential home for up to 30 adults with dementia and mental health needs. There were 27 people staying there at the time of the inspection.
The home did not have a registered manager in place during our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The home had a manager in place and the provider told us that the manager will be applying for registration.
People were put at risk of harm as improvements had not been made with medicines. Medicines were not being managed safely. We found that some medicines were not stored and disposed safely, service users Medicine Administration Records (MAR) were not always completed in full or accurately and medicine were not being followed as instructed on people’s MAR. We found two people had received an overdose of their medicine and action had not been taken immediately. Internal medicines audits had not been carried out. An external medicine audit, carried out by a pharmacist in February 2016 that identified the shortfalls we found on this inspection had not been addressed.
We found some improvements had been made with identifying and assessing risks to people. Assessments had been made specific to some people’s circumstances and health conditions. However, we still found that some risk assessments had not been identified or completed in full during the inspection.
Some people, relatives and staff raised concerns with staffing levels. Comprehensive systems were not in place to calculate staffing levels contingent with people’s dependency levels. The role of the manager combined managerial and significant caring duties had an impact on the ability of a manager to manage the service.
Improvements had not been made in assessing people’s capacity to make decisions on a particular area. MCA assessment had not been carried out for three people out of the nine care plans we looked at. Where people had been deemed to lack or have capacity, the assessment did not record what area people lacked or had capacity in. Staff still had not received MCA and Deprivation of Liberty Safeguarding (DoLS) training. Two staff were not able to tell us about the principles of the MCA and how the test was applied to determine if a person had capacity to make a specific decision about their care.
DoLS applications had been made to deprive people of their liberty lawfully in order to ensure people’s safety. Outcomes of the DoLS application were not sent to the CQC.
We did not find food was being monitored for three people with specific health concerns to ensure they had a healthy balanced diet. Blood level was not being monitored and recorded for two people. One person required weekly weight monitoring, we found the person’s weight was not being monitored and recorded weekly. One person’s fluid intake was not being monitored to prevent the risk of infection.
Some improvements had been made with supervisions. Appraisals were carried out with staff but this did not cover training, objectives and development needs. Recent supervisions took place with staff members.
Not all of the staff working at the home had received the training they needed to do their jobs effectively. Staff had received induction when starting employment.
Some care plans were inconsistent and were not completed in full.
An action plan of the breaches identified at the last inspection was not sent to the CQC.
We did not find evidence that quality assurance monitoring was being carried out, that would have helped identify the shortfalls we found during the inspection. Surveys were carried out but was not analysed to ensure people received high quality care therefore there was no culture of continuous improvement.
Some of the shortfalls found at our last inspection with medicines, nutrition, risk assessments, MCA and person centred care had not been addressed in full.
Staff were aware on how to manage complaints and we found most complaints were investigated. Two complaints had not been investigated, the provider told us this was investigated by the previous manager but the actions were not recorded.
People told us they felt safe. Staff knew how to keep people safe from abuse. They knew how to recognise abuse and who to report to and understood how to whistle blow. Whistleblowing is when someone who works for an employer raises a concern which harms, or creates a risk of harm, to people who use the service.
Recruitment and selection procedures were in place. Checks had been undertaken to ensure staff were suitable for the role.
We observed caring and friendly interactions between people, management and staff. There was an activities programme in place.
People were encouraged to be independent. People were able to go to their rooms and move freely around the house.
Overall, we found significant shortfalls in the care provided to people. We identified breaches of regulations relating to consent, risk management, medicines, staffing, person centred care, nutrition and hydration, complaints, notifications, record keeping and quality assurance.
The overall rating for this service is ‘Inadequate’ and the service is therefore in 'Special Measures'. The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, 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.