Deer Park Care Centre

Deer Park Care Centre is a residential care home providing accommodation and personal care to up to 38 people. The service provides support to older people with mental health support needs. Some people also had a learning disability. At the time of our inspection there were 31 people using the service. Care was provided to people in one two story building. There was a lift and accessible garden for people. People also had access to kitchen and laundry facilities where they were able to access these independently.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Right Support:

Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome.

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 supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs.

There were mechanisms for people to feedback their views on the service. People’s views were listened to and action was taken as a result. Staff felt supported in their role.

Right Care:

People’s care, treatment and support plans didn’t always reflect their range of needs. Some risk assessments were not in place prior to the inspection. However, the service had enough appropriately skilled staff who knew how to meet people’s needs and keep them safe.

Staff understood how to protect people from poor care and abuse. The service worked with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. People were protected from the risk of infection by infection control procedures.

Right Culture:

Quality checks at the service continued to need improvement. Checks had failed to identify concerns such as care plans which required updating. Some checks had not identified actions were needed, such as supporting people to access dental care. Recruitment processes had not always followed safe practices.

Incidents were reported and action taken to minimise risks to people. However, the analysis of some incidents needed to be improved to reduce the risk of re-occurrence. CQC had not always been notified of reportable incidents.

The management of environmental risks had improved since the last inspection.

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 09 August 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last eight consecutive rated inspections.

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 remained in breach of regulations.

Why we inspected

The inspection was prompted in part by a notification of a specific incident. Following which a person using the service died. This incident is subject to ongoing investigation. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk to people’s health and well-being. This inspection examined those risks. As a result, we undertook a focused inspection to review the key questions of Safe 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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report. The overall rating for the service has remained requires improvement.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Deer Park Care Centre on our website at 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 monitor the service and will take further action if needed.

We have identified breaches in relation to good governance and failure to notify CQC of a serious injury at this inspection.

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.

Deer Park Care Centre is a residential care home providing personal care to 26 people who are living with a mental health diagnosis. The service can support up to 38 people.

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

People and a relative told us they were happy living at Deer Park. We observed people to be at ease with the staff.

The registered manager and provider had not prioritised addressing risks in the environment including windows that were in need of replacing and uneven surfaces which caused falls risks. Guidance was not as detailed as needed to inform staff on how best to support people, especially if their mental health deteriorated. The registered manager and provider had not sourced sufficient training for staff in supporting people with their mental health.

Staff understood how to support people from the risk of abuse. People told us there were sufficient numbers of staff to meet their needs. People’s opinions were sought and acted on.

Risks to people’s health and wellbeing had been assessed, and when incidents occurred guidance was updated to reflect any changes in risks.

There was a good culture within the service, that promoted good outcomes for people. Staff told us they enjoyed working at Deer Park Care Centre. The registered manager and provider had made improvements since our last inspection, however we identified areas of the service which continued to need improvement.

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 (and update)

The last rating for this service was requires improvement (published 20 December 2020) and there were multiple 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 some improvements had been made but the provider was still in breach of one regulation.

Why we inspected

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

We carried out an unannounced focused inspection of this service on 20 August 2020. 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 safe care and treatment, premises and equipment, 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 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 not changed. This is based on the findings at this 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Deer Park Care Centre on our website at 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 monitor the service 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 checks and audits at this inspection.

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

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.

We found the following examples of good practice.

There was adequate amount of personal protective equipment (PPE) around the service. Staff used PPE appropriately.

There were clear processes in place for visitors to follow. Visitors were temperature checked, completed a health declaration and wore appropriate PPE. There was a designated room called the hub with a separate entrance, so visitors did not have to walk through the main house.

No visits from relatives were currently permitted due to the current situation. People were supported to remain in contact with loved ones by video calls. Relatives were updated about the service by phone calls and a newsletter.

People were adhering to isolation and social distancing guidelines. People were provided information and updated guidance to help them make their own choices.

The service was clean and extra cleaning duties were being carried out such as cleaning areas that were frequently touched. Some areas of the service had recently been redecorated and flooring had been changed in some parts of the service to make cleaning easier and more effective.

The registered manager was working with other local services and agencies in the area regarding infection control and had updated risk assessment for all staff and people.

Further information is in the detailed findings below.

Deer Park Care Centre is a residential care home providing personal care to people living with complex and enduring mental health conditions. In addition to this some people were living with a range of physical health conditions. At the time of our inspection 26 people were living at the service. The service accommodates up to 38 people in one adapted building.

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

People told us they liked living at Deer Park Care Centre, their comments included, “I think its very good here” and “The staff are marvellous. There is always something to do”.

The provider did not have the required oversite of the service. They had not taken action to ensure people always received a good quality service that kept them safe and well. A system was in operation to check the quality of the service. This had not been effective and shortfalls we found had not been identified. When checks had identified shortfalls, and these had been addressed.

There were not enough staff on duty at night to ensure people’s needs were met and their safety was maintained. The manager increased the number of staff on duty each night shortly after our inspection. There were enough staff on duty during the day. Staff had been recruited safely.

The service was not clean. The manager arranged for a deep clean to be completed to address this. Government guidance was not consistently followed to reduce the risks to people from COVID-19.

Care had not always been planned to mitigate risks to people. No one had come to any harm and the management team put guidance in place following our inspection. Risks relating to the building were managed safely. Accidents and incidents were analysed, and action was taken to make sure they did not happen again.

People were protected from the risks of abuse. Their medicines were managed safely and staff worked with other professionals to ensure people’s needs were met and processes were up to date.

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 requires improvement (published 23 August 2019).

Why we inspected

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

We carried out an unannounced comprehensive inspection of this service on 16 July 2019. The provider had complied with warning notices from the previous inspection in relation to medicines management, the management of risks and building safety but we needed to be assured the improvements they had made were sustained.

We undertook this focused inspection to check the action the provider had taken to improve the service had been sustained. This report only covers our findings in relation to the Key Questions Safe 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 not changed. 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 Deer Park Care Centre on our website at 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 risk management, staffing levels, hygiene and checks and audits at this inspection.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Deer Park Care Centre is a residential care home providing personal care to 31 people who are living with a mental health diagnosis. The service can support up to 38 people.

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

People told us they were supported by staff who knew them well and who were caring. People were treated with dignity and respect. Staff supported people to maintain their independence and manage their relationships with other people at the service.

Improvements had been made to the management of risks and the environment. Risks to people were assessed and guidance was in place to minimise risk. People were supported to understand risk and to keep themselves safe when leaving the service. Staff understood their responsibilities in safeguarding people from abuse. The service was clean and smelt fresh. Improvements had been made to the storage and management of medicines, some of these changes were new and we will check at our next inspection if they have been sustained.

People’s needs were assessed and reviewed regularly. People had a choice of food and drink, they were supported to manage their diet to stay healthy. Staff supported people to understand and manage their health needs, both mental and physical. Referrals to health professionals were made as required. 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 respected people’s right to make unwise decisions.

People were involved in planning their own care. People’s care plans were detailed and gave staff clear guidance about how people liked to be supported. People were given the opportunity to take part in a range of activities including redecorating the service. Information was available in an accessible format including the complaints procedure. There had been no complaints since the last inspection. People had been spoken with about their end of life wishes and these were recorded in their care plans.

People and staff told us the management team were approachable and supportive. There were enough staff to meet people’s needs. Staff were recruited safely and had the training and support needed to carry out their roles. There was a culture of learning and staff were happy to seek advice and support to improve people’s care. There had been an improvement to audits, which were carried out to monitor the quality of the care. Some of these changes were new and the service had previously been rated requires improvement for the last four inspections. In order for a service to be rated good we need to be sure that changes are embedded and sustainable. Therefore we will check at our next inspection if they had been sustained.

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 11 March 2019) and there were multiple 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. This is the fifth time the service has been rated requires improvement.

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.

Deer Park Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. People received nursing and personal care.

Deer Park Care Centre accommodates up to 38 people with mental health issues in one two storey building. There were 35 people living at the service when we inspected. Two people received their care in bed. Some people lived with dementia, most people had a diagnosed mental illness.

At the last inspection on 22 January 2018, we rated the service Requires Improvement overall. The provider had failed to ensure water temperatures did not pose a risk to people. This was a continued breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also recommended that the provider and registered manager continued to embed auditing processes and improvements in the culture.

We requested the provider to send an action plan to detail how they planned to meet the breach of Regulation 12 by the 12 April 2018. The registered manager sent an action plan to CQC on 10 April 2018. They said they would meet Regulation 12 by 10 August 2018.

At this inspection, there continued to be a breach of Regulation 12. We also found two other breaches of Regulation. The service has been rated Requires Improvement overall. This is the fourth consecutive time the service has been rated Requires Improvement.

There was a registered manager in place. 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.

Medicines were not always well managed. The provider was not following their medicines policies and procedures. Stock medicines were not recorded on the medicines administration records (MAR sheets). Some medicines had not been kept securely locked away. People were not always supported with their medicines at the appropriate times.

Risks to people’s health and safety were not always well managed. People that required moving and handling equipment such as hoists and slings did not have robust risk assessments to evidence to staff the safest way of working with the person. Accidents and incidents involving people were recorded. Action taken by the registered manager following the incident/accident was not always clear or recorded, so it was unclear how lessons were learnt from the incidents.

The provider had carried out sufficient checks on all staff to ensure they were suitable to work around people who needed safeguarding from harm. However, the provider had not asked applicants for a full employment history and documented reasons for gaps in interview records. We made a recommendation about this.

People had access to food and drink which met their needs and to maintain good health and were supported to be as independent as possible at meal times. People were supported to put together a pictorial menu plan for the week. People were able to choose different foods from the menu plan when they wanted. Some people experienced delays to their meals. This is an area for improvement.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, the policies and systems in the service did not always support this practice. This is an area for improvement.

Records showed that the premises and equipment received regular servicing. Some actions identified by contractors had not always been dealt with in a timely manner. Some hot water temperatures remained too hot, which increased the risk of scalding. The building was suitable for the needs of the people who lived there. Some parts of the building were being redecorated.

There were enough staff deployed to meet people's needs, the provider had a system to ensure people's assessed dependency levels were assessed. However, these had not always been updated in a timely fashion when people’s needs changed. We made a recommendation about this.

People received personalised care which met their needs. Support plans were not always person centred and did not include information about their oral hygiene. We made a recommendation about this.

People knew the management team. Relatives had confidence in the management of the service. Some audits and checks were carried out by the provider. The provider had not always taken timely action to address issues identified within their audits. The provider’s policies had not been updated as and when regulations changed. Records relating to people’s care were not always accurate and complete. Quality assurance processes had not been successful in recognising all the issues we identified in this inspection.

Staff treated people with kindness and compassion. Staff knew people’s needs well and people told us they liked their staff and enjoyed their company. People and their relatives were consulted around their care and support and their views were acted upon. People’s dignity and privacy was respected and upheld and staff encouraged people to be as independent as possible.

Where known, people’s wishes around their end of life care were recorded. People were encouraged to take part in activities they liked. People felt they could raise any complaints and concerns with the registered manager. Complaints had been investigated and resolved. However, people had not always had the outcome of their complaint in writing. This is an area for improvement.

The provider sought feedback from people and their relatives which was recorded and reviewed. Staff assisted people to complete satisfaction surveys, which meant that people may not be as open about their experiences. This was an area for improvement.

Staff understood the various types of abuse to look out for to make sure people were protected from harm.

A number of new staff had been recruited in the last 12 months. Staff had not completed induction training. The training records evidenced that staff had not always received the training needed to give them the skills and knowledge to care for people. Staff confirmed they had received regular supervision. Staff told us they felt well supported by the management team.

People’s needs and rights to equality had been assessed and care plans had been kept up to date when people’s needs changed. People received medical assistance from healthcare professionals when they needed it. Staff recognised when people were not acting in their usual manner, which could evidence that they were in pain.

The registered manager kept up to date with good practice, local and national hot topics by attending registered manager forums. Staff meetings were held on a regular basis to ensure that staff had opportunities to come together, share information and gain information from the management team.

The provider had notified CQC about important events such as safeguarding concerns, serious injuries and DoLS authorisations that had occurred. It is a legal requirement that a provider’s latest CQC inspection report rating is displayed at the service where a rating has been given. The provider had displayed the rating in the service.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations and one breach of the Health and Social Care Act 2008. You can see what action we told the provider to take at the back of the full version of this report. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

There was a registered manager at the service who was supported by a deputy manager, both of whom had worked at the service for a number of years. 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 last inspection on 30 May 2017, we asked the provider to take action to make improvements related to, concerns about a lack of oversight and auditing of the service. Feedback from people had not been analysed and there was a lack of action to minimise risks and prevent incidents reoccurring. Risks related to the environment had not been minimised effectively and staff had not received the training and support required to carry out their roles. People were not always involved in planning their care and were not always treated with dignity and respect by staff. People were also being restricted and no consideration had been given to less restrictive options.

At this inspection, improvements had been made, however there remained a small number of ongoing concerns. Water temperatures continued to be inconsistent, sometimes at a temperature which put people at risk of scalding. A variety of solutions had been tried unsuccessfully, a plan was in place to fit valves which control temperatures but this had not yet been carried out. Auditing had improved and an action plan was in place which identified improvements. However this was an ongoing piece of work and had not yet been fully embedded in to practice. We made a recommendation about this.

People were supported by staff who understood their role in keeping people safe. Staff encouraged people to be respectful of each other and appropriately challenged people when their behaviours impacted on others. Risks relating to people had been assessed and staff had the guidance required to minimise risks. Staff treated people with kindness and respect. People were offered reassurance when they were distressed. Staff communicated with each other effectively to ensure people’s needs were met.

People were supported to have maximum choice and control of their lives and staff supported people in the least restrictive way possible; the policies and systems in the service supported this. People were encouraged to be involved in planning their support and activities they wished to take part in. People enjoyed a range of meals which they chose from a menu which was displayed in the dining room. People were encouraged to have a diet which supported them in remaining healthy. Staff supported people to access health professionals when required and to understand any information given to them. Staff worked closely with local mental health professionals to ensure people had access to support swiftly when required. People were supported to have their medicines by trained staff, in the way they preferred.

Adaptations had been made to the premises when required, with grab rails being fitted to support people to move around the service independently. Staff were aware of infection control measures and used these appropriately. People could choose to stay at the service for as long as they liked. When people were having end of life care this was given based on the wishes of the person and their family.

There were enough staff to meet people’s needs and they were recruited safely. Staff had the training and support they required to meet people’s needs. They told us that the registered manager and deputy manager were open, accessible and provided them with good role models. People, staff and other stakeholders were encouraged to give feedback on the quality of the service and this was reviewed for learning. People were supported to make complaints in a range of ways and they were responded to appropriately. The registered manager was aware of their responsibilities and had informed CQC of incidents as required. Services are required to display their most recent rating; the rating was clearly displayed in the entrance hall.

This is the third consecutive time the service has been rated Requires Improvement. We found one continued breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.

Deer Park Care Centre is a privately owned residential care home supporting up to 38 people with mental health issues. At the time of our inspection there were 32 people living at the service, however one person was in hospital. Accommodation is arranged over two floors and not all of the rooms had en-suite facilities. One part of the service supported people living with dementia and the main part of the home, supported people who had a diagnosed mental health condition.

There was registered manager working at the service. The registered manager was supported by a deputy manager, business manager and team of staff. 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 and associated Regulations about how the service is run.

On the day of the inspection the registered manager was not available but they did come to the service briefly and introduce themselves. The deputy manager, business manager and a senior care worker supported the inspectors throughout the visit. We spoke with the registered manager after the inspection.

We previously carried out an unannounced comprehensive inspection of this service on 19 and 20 October 2016. Breaches of regulations were found. We issued requirement notices relating to staffing levels, safe care and treatment, medicines management, consent and good governance. We asked the provider to take action. The registered manager sent us an action plan telling us what action they would take to meet legal requirements in relation to the breaches. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. We found some improvements had been made but there were continued breaches of the regulations.

At the previous inspection there was a lack of management oversight by the provider to check delegated duties had been carried out effectively. The quality monitoring systems included reviews of people's care plans, health and safety checks and checks on medicines management. These checks and systems were not regularly reviewed and completed so it was difficult for the provider to be confident people received a safe service. At this inspection improvements had been made in some of these areas but shortfalls were still found. Some checks and audits had not been completed and some were not effective as they had not identified the shortfalls found at this inspection. Records were not always detailed to ensure that staff had the guidance to provide safe care. This was a continued breach of the regulations.

There were systems in place to receive feedback from people, relatives and staff. Feedback received had not been analysed and acted on to improve the service. Accidents and incidents were recorded and were reviewed to identify if there were any patterns or if lessons could be learned to support people more effectively. However, when patterns had been identified the required action to reduce re-occurrence had not been implemented.

The culture at the service was outdated and not in line with current good practice guidelines which did not support people's individual development.

There was open communication between staff and the management team. Staff told us they were able to give honest views and had regular staff meetings to discuss any concerns. People said they could go to the management team and said they would be listened to and get the support that they needed. They thought the service was well-led.

The registered manager and staff had knowledge of their responsibilities in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). When people lacked capacity, they received support in making more complex decisions, such as decisions around medical procedures, finances or where they wanted to live. However, people were not fully involved in their MCA assessments and in some cases people were being restricted when it was not the least restrictive option. There were restrictions in place at the service which did not promote openness and transparency that enhanced inclusiveness and empowerment for people. We have made a recommendation to improve this shortfall.

At the previous inspection risks had been identified to people's health and welfare but these were not always effectively managed. At this inspection improvements had been made but full guidance to make sure all staff knew what action to take to keep people safe and manage risks was not always available. This left people at risk of not receiving the support they needed to keep them as safe as possible. This was a continued breach of the regulations.

The registered manager and staff carried out environmental and health and safety checks to ensure that the environment was safe and that equipment was in good working order, but some checks and audits had not been completed. When shortfalls had been identified action had not been taken to reduce risks.

Emergency plans were in place so if an emergency happened, like a fire, staff knew what to do. There were regular fire drills. However, not everyone’s people's personal evacuation emergency plans (PEEPS) contained the all the information to explain what individual support people needed to leave the building safely. Staff had not received training on how to use specialist equipment needed for some people in the event of having to leave the building in an emergency.

There was a lack of supervision, appraisal and regular training for staff. Staff had completed induction training when they first started to work at the service but all staff had not received all the training and updates they needed to carry out their roles effectively and safely.

Improvements had been made to make sure people received their medicines safely and when they needed them. There were areas that needed further improvement. We made a recommendation to address the shortfalls.

On the whole people were supported by staff that were kind, caring and respectful and knew them well. However, we observed a few occasions when staff were not as caring and respectful as they should have been. We have made a recommendation that this issue is addressed.

People received a personalised service but people were not fully involved in planning their care. People's care was kept under review and the service was flexible and responsive to their individual needs. People were not consistently encouraged and supported to keep occupied. People were not always offered the choice of activities.

People’s privacy was respected. The atmosphere at Deer Park was relaxed and calm. People appeared content in the company of each other and staff. Staff promoted people's privacy and dignity. People's confidentiality was respected and their records were stored securely.

There were enough staff to support people safely. Recruitment procedures ensured that only staff of a suitable character to care for people were employed.

The staff monitored people's health needs and sought professional advice when it was required. If people were unwell or their health was deteriorating staff contacted their doctors or specialist services

People were supported to eat and drink food that met their dietary requirements and that they enjoyed. Staff were familiar with people's likes and dislikes, such as how they liked their food and drinks and the activities they enjoyed. People were given individual support to carry out their preferred hobbies and interests.

People felt safe using the service and were protected from the risk of abuse because staff knew the possible signs of abuse and how to alert the registered manager or the local authority safeguarding team. There was a complaints policy in place and people said they knew how to complain if they needed.

The registered manager had submitted notifications to CQC in an appropriate and timely manner in line with CQC guidelines

We found continuous breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

Deer Park Care Home is a residential home which provides care to older people including people who have a diagnosed mental health illness. Deer Park Care Home is registered to provide care for up to 38 people. At the time of our inspection there were 36 people living at the home, however two people were in hospital. Accommodation is arranged over two floors and not all of the rooms had en-suite facilities. One part of the home supported people living with dementia and the main part of the home, supported people who had a diagnosed mental health condition.

This service was last inspected on 5 June 2014 when we found the provider was compliant with the essential standards described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

There was a registered manager 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.

There was a lack of management oversight by the provider to check delegated duties had been carried out effectively. The quality monitoring systems included reviews of people’s care plans, health and safety checks and checks on medicines management. These checks and systems were not regularly reviewed and completed so it was difficult for the provider to be confident people received a safe service. Accidents and incident analysis was completed but it did not provide an overall picture to prevent further incidents from happening.

There were not enough staff on duty to respond to people’s health needs and to keep people safe and protected from risk. The registered manager could not be confident there were sufficient numbers of staff to keep people safe because there was no effective formula that calculated what safe staffing levels should be. The registered manager and deputy manager regularly supported staff on shift which meant some quality checks and improvement actions were not always identified and resolved. This affected the quality of service people received.

Risks to people’s health and welfare were identified but not always effectively managed. Where people were at risk of harm, actions had not always been taken to keep people safe. Care plans provided information for staff that identified people’s support needs and associated risks.

People said staff provided the care they needed. Care was planned to meet people’s individual needs and abilities. Care plans were reviewed although some information about people’s mental capacity required updating to ensure staff had the necessary information to support people as their needs changed. Some people’s physical and mental stimulation was limited because they were not proactively supported to pursue their own hobbies and interests because staffing levels did not always allow time for this.

The registered manager and staff had limited knowledge of their responsibilities in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity, staff’s knowledge and people’s records did not always ensure people received consistent support when they were involved in making more complex decisions, such as decisions around medical procedures, finances or where they wanted to live.

Before providing care, staff sought consent from people and gave them time to respond. They respected people as individuals and supported them to make their own choices as far as possible.

Staff were trained and knew how to keep people safe from the risk of abuse although staffing levels made it difficult to prevent people becoming agitated with one another and staff. People told us they felt safe living at Deer Park because they had support 24 hours a day, seven days a week.

People felt cared for by staff who had the skills and experience to care for them. Staff understood people’s needs and abilities and received updated information at shift handovers. Staff training was completed and there was an effective system to identify which staff required training updates.

People were offered meals that were suitable for their individual dietary needs and preferences. People were supported to eat and drink according to their needs, which minimised risks of malnutrition and dehydration.

Staff ensured people obtained advice and support from other health professionals to maintain and their health and wellbeing.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Following the inspection the provider took action to address the fire safety and other issues, We will follow this up at the next inspection.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service and a visiting relative, the staff and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

The service was safe?

Practices in the service generally protected people, staff and visitors from the risk of harm.

Systems were in place to make sure that managers and staff learned from accidents and incidents, concerns, complaints, whistleblowing and investigations. This reduced the risks to people and helped the service continually improve.

Appropriate arrangements were in place in relation to obtaining medicine. The system was straightforward and all medicine was checked into the service and recorded appropriately to ensure people's safety.

Each person had a care plan detailing their support and care needs. We saw that there was guidance for staff to follow to reduce risks and strategies implemented to make sure people were as safe as possible.

CQC monitors the operation of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLs) which applies to care homes. The provider may wish to note that care documentation viewed did not show that mental capacity had been considered. Where people lacked capacity and decisions were made on people's behalf the documentation did not show that the service had consulted with relatives / friends or advocates. This was needed to show that the service had acted in people's best interest and that people's human rights and rights of choice were not compromised. DOL's (Depravation of liberty safeguards) assessments had not been considered for any of the people using the service. This was needed as locks were fitted to external doors. This meant that people's human rights may not be fully protected.

Is the service effective?

The service was effective overall. People told us that they were happy with the care that they received and that their care needs were met. One person we spoke with told us, 'I am very happy here I have no concerns'. A relative said " Staff treat my Father well. I am happy he is here". We saw that staff were attentive to people using the service and responded promptly when needed.

People's health and care needs were assessed with them and /or their representatives where possible. However we found that care plans were not always regularly reviewed to reflect any changes in a person's needs.

Is the service caring?

The service was caring. People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people. People we spoke with said they felt staff respected their privacy and dignity and staff were polite and caring.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We reviewed and discussed with staff the care records of five people who lived within the service. These had sufficient detail and guidelines about the support needed to meet the people's needs.

Is the service responsive?

The service was responsive. People told us that they were happy with the service. It was clear from observations and from speaking with staff that they had a good understanding of people's care and support needs.

We found that the manager and staff were approachable and encouraged people to voice any concerns or ideas for change. People were consulted and were given the opportunity to contribute towards the running of the service. We noted evidence of regular meetings which enabled people to air their views.

We found that people were supported to attend health appointments, such as, doctors or dentists. We saw records to show that the service worked closely with health and social care professionals to maintain and improve people's health and well-being.

Is the service well-led?

Staff we spoke with had a good understanding of the different policies and procedures. They knew where to access them and where they get further advice from. Staff told us that they felt well supported and were given the information they needed to support the people who lived in the service.

The manager took an active role in the running of the home and met with staff and people who lived in the service to listen to what they had to say. We saw minutes of regular staff meetings where changes or issues with peoples' care were discussed. In addition, we saw evidence of meetings with people who used the service to ensure they were consulted and encouraged to contribute their ideas about running the service.

We saw that the people who used the service were making choices about their lives and were part of the decision making process. People had their own individual routines which were respected. One person who used the service said "Staff are very good. I have no concerns". Another person said 'Food is great, lovely choices and plenty of it'. Another person said "If I was unhappy I would talk to the manager. Staff look after me well. I have no concerns".

We had the opportunity to speak with a visiting Mental Health Nurse and discuss the care and treatment provided at the service. She was very complimentary of the staff and manager and said that the level of communication was good and the manager and staff were proactive in following through her practice recommendations. She had no concerns about the quality of care.

During the inspection process we identified that training had lapsed and that staff did not have the required mandatory training to fully meet people's needs. We have made a compliance action and will consider enforcement action in future should this outcome continue not to be met.

This inspection focused on Outcome 8 Cleanliness and infection control and Outcome 10 Safety and suitability of premises. We spoke with several people who use the service about these outcomes. All those spoken with did not have any concerns in these areas and did not pass comment.

We found the service to be none compliant with regard to cleanliness and infection control and safety and suitability of premises as the provider had failed to ensure that it was meeting the regulations as detailed within this report.

Whilst bedrooms were generally well maintained with fresh paint other parts of the service were not so well maintained. The flooring in some areas was worn and dirty. General paintwork within parts of the service were faded and chipped posing a possible infection control risk as it prevented effective cleaning.

The outside fabric of the building was in need of general maintenance in that many wooden windows were rotting and falling into disrepair. Paint was peeling with broken roof tiles and broken plastic down pipes needing attention.