Archived: Hemsworth Park

Hemsworth Park is a residential care home providing personal care to 62 people at the time of the inspection. The service is registered to provide personal and nursing care for a maximum of 93 people. It is split into four separate units within one building. One unit was not being used at the time of our inspection.

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

People and relatives said care staff supported them safely. Staffing levels were sufficient to ensure people received prompt support and staff attention overall, although some people did not feel they had enough choice over how they spent their time. People enjoyed the additional interaction by the service’s activities ‘magic moments’ team. Staff were recruited safely, although there were some minor recording matters which were addressed. Staff felt they had sufficient training to support people safely. Staff had appropriate knowledge of safeguarding people from abuse and were confident to raise concerns with management or local authority safeguarding team.

Infection, prevention and control processes were in place. Staff mostly worked in line with good guidance, although at times, staff adjusted their face masks without regard to IPC procedures. Most areas were clean and well maintained, although some items were need of more thorough cleaning, such as dining room chair arms, pressure cushion covers and a carpet on one unit. Proof of lateral flow testing was not requested from inspectors on the first day of the inspection, although this was promptly addressed.

Care plans were informative, although some information was conflicting at times, or of variable quality, such as for oral care, end of life care, specific health conditions and equipment needed to support individuals.

People were supported with regular drinks and additional supplies were encouraged throughout the heatwave. Staff monitored people’s fluid intake, although the amounts recorded needed to be more accurate. We had some initial concerns around how drinks containing thickening agent were prepared, although the provider addressed these immediately. The provider said training would be carried out as soon as this was available.

Equipment was checked for safety and staff knew what people needed to support their safe moving and handling. Where equipment was identified as being unsuitable for people, the provider took action to ensure this was addressed.

People felt they received safe support with their medicines overall. Some people said they had to be woken at night time to have medicines if the staff were running late. The provider was considering ways in which guidance for staff could be improved for people who needed ' as required' medicine. The provider responded promptly where recording issues were identified.

Quality assurance systems were in place and there were regular checks carried out. Where audits identified actions to improve, communication about this was shared with staff. Not all quality checks were robust enough to identify issues found on inspection. The registered manager gave assurance they would consider how these could be make more thorough. There was a lack of attention to important detail on some recording of people’s care, such as dates, times, and frequency of repositioning. Recording of care and support needed to be more detailed and meaningful in places. For example, people’s personal evacuation plans were all very similar, yet there were specific factors, such as if a person smoked, or had poor eyesight, that were not detailed. The provider promptly took action to address this.

Equipment was checked for safety and staff knew what people needed to support their safe moving and handling. Where equipment was identified as being unsuitable for people, the provider took action to ensure this was addressed.

Staff roles and responsibilities were clear. Staff understood the lines of accountability and knew who to refer to with any queries or concerns. Staff said the management team were very approachable and they were confident in their teamwork. People and relatives were confident in how the service was run overall. They found the registered manager to be visible and welcoming and they felt involved and included in the delivery of care.

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 February 2020) and there were breaches of regulations. 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 and the provider was no longer in breach of regulations. However, there were some areas still in need of improvement, not identified by the provider, which they addressed promptly.

The service remains rated requires improvement. This service has not been rated more than requires improvement for the last six rated inspections.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 see what action we have asked the provider to take at the end of this full report.

The provider took prompt action to address the matters raised at the inspection, and made some immediate improvements.

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 report.

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

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 found the following examples of good practice.

The provider had a process in place to enable relatives to visit their family members in a safe way and in line with government guidance. Visits were booked in advance and were spaced out, to help with maintaining social distancing. People were also supported to keep in touch with their relatives by social media, video and telephone calls.

Infection prevention and control measures were in place and staff understood how to prevent the spread of infection. Staff wore personal protective equipment (PPE) in line with current guidance. Staff completed training in infection control, hand hygiene and the correct way to put on and take off PPE.

The home was clean and high touch areas such as door handles and light switches were cleaned regularly.

We found the following examples of good practice.

The home looked and smelled clean, and was uncluttered. Staff were seen to be wearing appropriate PPE and were careful to maintain social distancing where possible, to help minimise the risk of spreading the virus.

Staff helped people to stay in touch with their family and friends by phone and face to face chats on-line.

The provider learned lessons and responded positively to address shortfalls and improve the service. We saw evidence that best practice feedback had recently been provided by a visiting infection control specialist nurse and, as a result, changes had been implemented quickly and effectively.

Hemsworth Park is a residential care home providing personal care to 60 people at the time of the inspection. The service is registered to provide personal and nursing care for a maximum of 93 people. It is split into four separate units within one building. One unit was not being used at the time of our inspection.

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

People told us they felt safe at the home, however we found there was an inconsistent approach to the management of risk. Some incidents between people were not well managed and the quality of risk assessments associated with people’s care was variable. There were systems in place to help learn from incidents which had occurred in the home. Medicines were well managed, staff were recruited safely and the building was clean.

There was an inconsistent approach to the support provided when people lacked capacity to make their own decisions, and some aspects of monitoring of DoLS needed improvement. People had choice at mealtimes, and most people said they enjoyed the food. Staff had the training and support they needed to provide effective care.

People were not always fully involved in writing and reviewing their care plans. We have made a recommendation about improving this. There were some improvements needed to supporting people to maintain or improve their independence, particularly on the unit for younger people. People and staff mostly got on well, and there was evidence of appropriate adaptation to some areas of the building.

Some care plans lacked information needed to provide responsive support. We have made a recommendation about reviewing care plans to improve this. There were systems in place to make sure complaints were responded to, and information could be adapted to make it more accessible if needed.

Although there were systems in place to monitor quality in the service, these had not always identified issued we found at our inspection. A new manager started at the home during our inspection, and they planned to register with us. People and staff were involved in the running of the home in appropriate ways, and there was some good feedback about leadership.

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 10 October 2018). We did not identify any breaches of regulation.

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.

Enforcement

We have identified breaches in relation to the safety of care and treatment of people using the service and the approach to monitoring quality and consistency in the service.

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

At our last inspection on 31 January and 16 February 2018 we rated the service as ‘Inadequate’ and identified nine breaches which related to dignity and respect, receiving and acting upon complaints, person centred care, meeting nutritional and hydration needs, staffing, safeguarding service users from abuse and improper treatment, safe care and treatment, need for consent and good governance. 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.

Hemsworth Park 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. The service is arranged into three units, people living with dementia (Vale View), Younger People's Rehabilitation (Bailey) and Residential (Lake View). The service can accommodate up to 93 people. At the time of inspection, the service was not providing nursing care and were in the process of removing this from their registration. On the day of inspection 48 people were using the service.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. On the day of inspection, the registered manager was on annual leave. On the second day we spoke to the registered manager to give feedback only.

We found the provider; registered manager and staff had worked hard to build on the improvements we had found at the last inspection. We found improvements in all areas.

We found medicine management had improved since the last inspection, however there were still improvements to be made in relation to labelling of medication and excessive stock. The management team told us on day two they had already arranged a meeting with the local practice manager at the GP surgery to look at the overall medication process and excess stock moving forward and how to improve performance.

Accident and incidents were acted upon and reported accordingly to the relevant professionals.

People, relatives and staff told us they felt there was enough staff to support them. We observed throughout the inspection staff were visible in communal areas.

We saw people were receiving appropriate pressure relief care and the care plans reflected these changes.

We saw improvements to the supervision process were more effective and gave staff opportunities to discuss training and any support needs which had been identified. We saw training had been implemented in the home and this was an ongoing process.

We found consent was sought with people, relatives and outside professionals who worked together to provide effective outcomes for people.

We saw mealtime experience had improved throughout the home. People were given choices and the service gained feedback from people on what they would like on the menu. We saw accurate records of people’s nutrition and hydration needs in care plans. People were encouraged to make their own drinks where appropriate and we saw relevant risk assessments in place for these people.

People told us staff were caring and kind towards them. We saw staff were genuinely caring and spoke in a compassionate way to people and their relatives. We observed staff promoting privacy and dignity by knocking on people’s doors before entering. People looked well and we saw documentation of people accessing their preferred choice of bathing.

We saw the provider had completed a complaints log and this was up to date on the system.

At our last inspection we rated the service as ‘requires improvement’ and identified five breaches of regulation. These were in relation to;

Safe Care and Treatment. This was a repeated breach. We found information in care plans and associated documentation was not always accurate or up to date, and we saw a lack of guidance for staff to show how risks could be minimised. We observed a number of incidents which showed risk was not always managed robustly.

Dignity and respect: This was a repeated breach. We found there was an on-going lack of support for service users who did not speak English. This had a negative impact on their experience of care and support at the service.

Need for Consent: We found consent was not recorded in line with the requirements of the Mental Capacity Act 2005. Staff routinely signed consent documentation rather than the person using the service or their representative.

Good Governance: We found governance systems were in place but had failed to identify some issues which we saw at inspection. Insufficient action had been taken to ensure breaches of regulation identified at our previous inspection were rectified.

Staffing: We found our observations and some feedback from people and staff identified staffing levels were not always adequate to meet people's care and support needs in an effective way. We also saw staff did not always receive supervision in a manner which supported them to remain

effective in their roles.

Following the last inspection, we met with the provider to confirm what they would do and by when to improve the key questions ‘safe’, ‘effective’, ‘responsive’, ‘caring’ and ‘well-led’ to at least good.

At this inspection we found improvements only in terms of the support for people whose first language was not English. The remaining breaches were not resolved and the provider was still not meeting these regulations.

Hemsworth Park 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. The service is arranged into four units, for nursing (Creighton), people living with dementia (Vale View), Younger People’s Rehabilitation (Bailey) and Residential (Lake View). The service can accommodate up to 93 people. At the time of our second day of inspection there were 81 people using the service.

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.

Staff were recruited safely, however we found they were not always deployed in sufficient numbers to provide safe and timely care. They could not always minimise risks appropriately as they did not always have access to up to date or detailed information in care plans. Care plans were not always updated in response to changes in people’s needs. We observed a number of occasions where people were not assisted with appropriate moving and handling support.

Medicines were not always managed safely, and we saw a number of occasions where people were without medicines because re-ordering systems had not been robust. Secure recording and ordering of controlled medicines was not always in place.

Although staff said they understood how to report concerns about potential abuse, we found systems in place to manage this were not sufficiently strong. Several incidents were reported to the safeguarding teams at our request during the inspection. Staff had access to personal protective equipment (PPE) but we found some areas of the home to be malodorous and not always clean.

Care of wounds and pressure areas was not always safe or effective, and controls put in place after the first day of our inspection had not improved the monitoring of this sufficiently. We concluded there was a lack of strong clinical oversight of the nursing unit in particular.

Staff had access to training, however individual support and performance review was still weak. The registered manager responded by putting new plans in place between the first and second days of our inspection.

The approach to assessing and documenting people’s capacity to make decisions was still not always effective. People were not always appropriately involved in decisions about their care. Conditions placed on people’s Deprivation of Liberty Safeguards (DoLS) were not well managed, and we found evidence the provider was not always meeting these.

People gave mixed, though mostly negative feedback about the meals served to them. We observed some people had very poor support in this area of their care, and records were not kept in an appropriate way. We found there were differences in the food available to people depending on their needs and which unit they lived in.

Staff did not routinely engage in conversation with people, and we observed very poor approach to care and interaction, particularly on the dementia and nursing units. There were a number of times when staff were not respectful or caring in their language and actions. People’s opportunities to shower or bathe were infrequent or non-existent, and we saw personal care was not always given.

Some improvement had been made to the experience of people whose first language was not English, some people told us they had been supported with their faith, and we were told information could be made available in accessible formats where needed. We found that there were inconsistencies in people’s experience of and access to care, and preferences were not always respected.

There were no records of complaints or concerns. The registered manager told us there had been no complaints, however this was not true. We had asked for them to record feedback from a family member as a complaint and record and manage it as such. They had not done this. Other people told us about complaints and concerns they had raised.

People living at Hemsworth Park had infrequent opportunity to engage in meaningful activities and spent much of their days with little to no stimulus.

Feedback about leadership and management in the home was mixed although mainly negative. We found evidence of insufficiently robust leadership in the home and at provider level. Audit activity had been conducted and reviewed, however had failed to identify the shortfalls in care and quality identified in our inspection.

We identified nine breaches of regulation connected with safe care and treatment, safeguarding, staffing, consent, nutrition and hydration, dignity and respect, acting on complaints, person centred care and governance.

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

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 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.

At our last inspection we identified five breaches of regulations. These related to dignity, safe care and treatment in relation to medicines management, nutrition and hydration, staffing levels and support and governance systems. At our recent inspection we found action had been taken to ensure improvements had been made in relation to medicines management and nutrition and hydration. The provider remained in breach of regulations relating to staff, dignity and governance. We also identified two further breaches of regulations relating to safe care and treatment and consent.

Hemsworth Park provides residential and nursing care for older adults, some of whom are living with dementia, and younger people with disabilities. It is arranged into four units, with communal living and dining facilities in each unit. There is a terraced outdoor area which some people could use. The home can accommodate a maximum of 93 people, and at the time of our inspection there were 82 people using the service.

There was not a registered manager in post when we inspected. 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 manager in post who was still in their induction period. They were planning to register with the CQC.

People told us they felt safe living at Hemsworth Park, and we saw the provider ensured maintenance was attended to, including regular checks to fire, gas and electrical installations. Risks associated with people’s care and support were not always well documented, and we saw some instances of poor risk management. We identified this as a breach of regulations relating to safe care and treatment.

Improvements in relation to the storage of medicines which we asked to be made had been actioned. We identified one medicines storage room and fridge had been regularly above the temperature recommended for the storage of medicines, and the provider took action on the day of our inspection to rectify this. Medicines administration was managed safely, with records kept fully up to date.

We saw recruitment was managed safely, with appropriate checks to ensure new staff were not barred from working with vulnerable people. However, we identified concerns with the numbers of staff on duty, and saw staff did not always get the support they needed to remain effective in their roles. These examples contributed to a repeated breach of regulations relating to staffing.

Staff had access to training which gave them the skills and experience needed to be effective in their roles, and people told us they had confidence in the staff’s ability to care for them. The provider was undertaking work to improve training, knowledge and environments relating to people living with dementia. Staff received an annual appraisal at which performance was discussed.

The provider was recognising when applications for Deprivation of Liberty Safeguards (DoLS) were needed, and we saw applications for renewals were being made in a timely way. People told us they felt able to make choices, and we found staff had received training which had given them an understanding of the requirements of the Mental Capacity Act 2005. However, we found consent documentation was not always completed appropriately, and concluded the provider was in breach of regulations relating to consent.

Feedback about meals served was generally positive from people who used the service, and less favourable from staff. We saw the provider had met with the catering supplier to discuss quality. We found the chef was knowledgeable about people’s dietary needs, and some people who needed a specialised diet for health or cultural reasons told us they received this. People generally had good access to drinks when they needed them, which was an area we had told the provider to improve after our last inspection. On one unit we needed to ask staff to provide drinks for people who had been up for some time but had to wait for the breakfast service.

People were supported to access health professionals when they needed, although some referrals had not been followed up in a timely way. Records of visits were kept in people’s care plans, and visiting health professionals gave good feedback about their experience with the service.

At our last inspection we saw one person who did not speak English did not receive adequate support, and asked the provider to take action. At this inspection we found there were two people who did not speak English, and little improvement had been made to ensure their care and support were effective and caring. We concluded the provider remained in breach of regulations relating to dignity.

People told us they had good relationships with staff who protected their privacy and dignity. We observed pleasant and patient interactions throughout out inspection. Staff had a good knowledge about the people they supported.

There was no one receiving end of life care at the time of our inspection, however we saw a lack of records relating to people’s wishes in their care plans.

We saw care plans were reviewed regularly and staff told us they received updates when people’s care and support needs changed. We found changes were not always immediately obvious in care plans, however.

People gave generally positive feedback about activities in the home, however staff told us more could be done in this area. Although there was information about people’s interests and hobbies in some care plans, we did not see this followed up to ensure people were supported to maintain these interests.

There were systems in place to ensure complaints were responded to appropriately. People could give feedback about the home online, however staff told us they felt this was not effective in capturing people’s opinions of the quality of the service.

We received positive feedback about the manager, although some staff said they had not had the opportunity to meet her at the time we inspected. Staff were occasionally critical of the culture in the home, and told us they felt they were blamed for things which were not in their control. Staff did not have regular meetings, however the manager told us they would be addressing this.

There were governance systems in place, however they had not always identified issues which were picked up during our inspection. In addition the provider had not taken sufficient action to address breaches identified at our last inspection. We identified a continuing breach of regulations relating to governance.

We identified three continuing breaches and two new breaches of legislation during this inspection. You can see what action we have told the provider to take at the end of the full version of this report.

At the time of our inspection there were 61 people living at the home, split across four units. The ground floor had a nursing unit and a younger adults’ unit. The first floor had a residential unit and a unit for people who were living with dementia.

There was a registered manager in post at the time of our 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.

We found that the care plans which were in place for most of the people living at the service were not person centred and were not clear in terms of the needs of the person and what care they required from staff to meet their needs. However the provider had introduced a new format for care plans which was person centred and addressed the issue of not being able to find the most important information for each person quickly. The registered manager told us and we saw that the staff were being trained to complete these new documents and that they were in the process of replacing everyone’s care plans, however we found that the progress on this had been very slow with only a handful of care plans having been updated since August 2015.

We saw that there were activities coordinators within the service, and there were activities provided to occupy people, however there were not enough activities coordinators at the time of our inspection to ensure that the people on each unit had activities every day which would interest and engage them.

There were not enough staff on the nursing unit in particular; the lounge area on this unit was out of action as it was being redecorated as part of the refurbishment, which meant that people were spending more time in their rooms. This meant that staff were with people in their rooms over this period and were not visible or available to people who were calling for assistance.

This was a breach of Regulation 18 (1) and (2) staffing of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The management of medicines had improved however there were still some errors occurring and we saw that there had been an incident where over the counter medicines had been given to a person who used the service.

This was a breach of Regulation 12 (2) (g) Safe care and treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Staff had a good understanding of the Mental Capacity Act (MCA) 2005, the Deprivation of Liberty Safeguards (DoLS) and safeguarding and were able to demonstrate to us that they knew what they needed to look out for and understood who to report this to and what action should be taken if there needed to be any escalation of a matter.

We saw that there were do not attempt cardio pulmonary resuscitation orders (DNACPR) in place which were not completed in line with the legal requirements set out for these documents as there was no documented evidence to show people or their representatives had been consulted.

People who lived at the home were clean and well-presented throughout our inspection and people told us that they received regular support to bathe and shower.

People told us that whilst the food had not been good over recent months that there had been a new catering provider engaged from Monday of the week we inspected. All the people we spoke with reported that there was a marked improvement in the quality of the food they had received so far. We also found that whilst some people had good access to drinks, others who were not mobile did not. We saw examples of people being served food which was not put within their reach.

This was a breach of Regulation 14 (1) Meeting nutritional and hydration needs of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The unit for people living with dementia was the first area to undergo a refurbishment, and the unit was pleasant and well run. There was lots of evidence that thought had been given to help people living with dementia to get around the unit and to find the rooms they were looking for.

We found that there were some people who used the service who had particular diversity needs which were not being met and that they were being discriminated against as a result of this.

This was a breach of Regulation 10 (1) Dignity and respect of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There was auditing and oversight of the service however this was not effective as it had not picked up the issues which we found during inspection. The standard checks which were prescribed by the registered provider across all their services were superficial and did not have the level of detail necessary to give useful oversight of such a large service.

This was a breach of Regulation 17 (1) Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We saw that there was a recruitment process in place which included pre-employment checks on all potential employees, we found that there were instances where people had supplied references which were not appropriate and these had been accepted by the service.

This was a breach of Regulation 19 (1) fit and proper persons employed of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The service had made improvements since our last inspection. However we found there were areas still in need of improvement.

We saw examples of good quality and compassionate care being provided in the home. For instance, we observed gentle and reassuring interactions taking place between staff and residents, and saw staff responded in a timely manner to residents' needs. We observed residents to be generally well presented and dressed appropriately.

We received mixed feedback from residents regarding the care which was provided at Hemsworth Park. Positive comments include:

"Everyone is nice to me. I like it here. I don't want to go home, I feel safe here."

"There's nothing I don't like about this place - thumbs up!"

"I would recommend this home to other people."

Less favourable feedback we received includes:

"It's not brilliant here but it's okay."

"Some staff look after me better than others, but some could have a better attitude."

"Some of the carers are not very nice. They don't always talk to me nicely. I don't know if I'd recommend this place to anyone."

We saw care assessments, care plans and care reviews had been carried out. This helped to protect residents from the risks associated with inappropriate and unsafe care. We also found examples, however, of when care had not been delivered in accordance with the care plans. We saw some occasions in the care records when there was conflicting information about residents' needs. This conflicting information meant there was a risk of inappropriate and potentially unsafe care being delivered.

Whilst we saw evidence of some meaningful activities taking place to help stimulate and occupy residents, we saw a number of residents who appeared to be bored. Some of the comments we received about this confirmed what we saw. For example:

"There's not much activities. So I go for a laydown."

"It's always the same, nothing to do. I sit here in the chair all day. They don't take us out."

"I wouldn't recommend this place, it's the same every day."

We found significant improvements had taken place regarding how the home managed medications. We saw numerous examples of personalised medication care plans, and medication records were both up to date and clear. A range of checks were being carried out by the home to make sure medicines management was both effective and appropriate.

We saw care records were being held securely and found care related information could be promptly located by staff.

It should be noted that in this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We received positive comments from residents we spoke with about their experiences living at Hemsworth Park. Examples of comments residents made include:

- "It's ok here"

- "Staff are ok"

- "It's nice to live here"

- "I feel well looked after here"

All relatives we spoke with also gave positive feedback; examples of comments made about Hemsworth Park include:

- "Absolutely terrific"

- "Very good"

-" Can't fault it"

One relative, however, felt the home could be more proactive in advocating for its residents with external agencies and professionals.

Despite the positive comments we received from residents and relatives, and the progress which the home had made since our previous inspection in April 2013, we found ongoing concerns regarding some aspects of care which was being delivered. We had particular concern regarding some of the care plans/records which contained contradictory information. This was a concern because opposing pieces of information regarding a resident poses a risk of inappropriate, or unsafe, care being provided. We found an ongoing lack of meaningful, purposeful activity for some residents to become engaged in; some residents made comments that they were bored.

We were particularly concerned that not all staff members felt able to recommend Hemsworth Park to their own family/loved ones.

We found staff had an appropriate knowledge and understanding of safeguarding issues. We saw records showing staff had received safeguarding training. Staff we spoke with were aware of whistleblowing procedures to help keep residents safe.

We identified ongoing issues regarding the management and administration of medications. Such concerns included some medication being inappropriately stored, and an instance of out of date medication having been used/given. We saw examples of medicines being given together when they should not have been. We saw staff not following correct procedure when dealing with controlled drugs. We were concerned to find ongoing issues regarding the management of medicine given that enforcement action was taken against the home, regarding medication, following our previous inspection in April 2013.

We found improvements had been made in the home regarding how complaints were managed and recorded.

Similarly, we saw improvements had been made regarding the home's care records. However, despite such improvements, we continued to find some of the care records difficult to follow. Staff gave us mixed feedback regarding how easy they found the care records to use.

Service users gave a range of feedback. One person said staff were 'pleasant'. Another person told us some staff were 'marvellous' but others were 'rubbish'. One person described the care they received as being 'good' but another person said it was 'passable'.

All three relatives we spoke with had good things to say about the home. One relative said 'I can't fault them, everything is fine' and another told us they had 'no concerns'.

During our inspection, we found a lack of activity for those living at the home which meant there was a lack of stimulation. Some service users complained to us about the length of time it took for staff to answer their call bells. We saw that call buttons were not always in easy reach of service users.

Care plans were not always followed. This resulted in, at times, unsafe care having been delivered. A number of medication related problems were found. Despite staff having had safeguarding training, we had concerns that service users were not always being fully protected from the risk of abuse, and their human rights were not always being promoted.

We found some good practice of dealing with complaints but a consistent audit trail was not found to show lessons were learnt and improvements made. Records were not easy to use and care related information was not always easily located.