Parklands

Parklands is a residential care home providing personal care to 18 people aged 65 and over at the

time of the inspection. The service can support up to 18 people. Parklands is a large premises, located on the edge of a rural village, set over two floors accessed by a lift, ramp and stair lift. At the time of the inspection there were 13 people living there.

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

A new experienced management team and staff group had been employed immediately following the previous inspection as a prompt response to the last inspection findings. They carried out regular audits to monitor the quality of care with the provider visiting weekly and supporting the new team. They and their staff team had worked hard to ensure the breaches found at the previous inspection had been addressed and robust systems embedded into practice. We saw examples of how the positive improvements had impacted on ensuring people’s needs were well met and the culture of the service was focussed on person centred care. The provider was responsive and supportive and there had been substantial investment to further promote good quality care at Parklands.

People were safe at the service. Staff had been trained to safeguard people from abuse and understood how to manage risks to people to keep them safe. There were enough staff to support people with staffing levels regularly reviewed and increased in relation to peoples’ dependency levels. The staff worked well as a team and were clear about what they needed to do. Recruitment checks had been undertaken to make sure staff were suitable to support people.

People had a choice of comfortable spaces to spend time in at the service and we saw these being used as people wished. The provider had reviewed all areas and adapted the premises when needed to meet people's needs, for example creating a homely library area, pretty decked outside spaces, auditing and improving décor and/or flooring in all rooms and refreshing the exterior. The premises were clean and tidy. Staff followed current hygiene practice to reduce the risk of infections with new effective systems in place, including a designated laundry person. Visitors to the service were given information to help them reduce the risk of catching and spreading infection. Health and safety checks of the premises and equipment were carried out at regular intervals.

People's’ care and support needs were assessed prior to them using the service. Care was taken to ensure staff could meet peoples’ needs before admission and we saw that people had spent time at the home before choosing to move in. One person with close personal links to the home and told us they were very happy. Peoples’ care plans set out for staff in detail how these needs should be met. Staff understood people's’ needs and how they should be supported with these. They received relevant training to help them to do this. Staff were supported by the manager to continuously improve their working practices to help people achieve positive outcomes and there were regular competency checks.

Staff were calm, kind and respectful of people. They knew them well. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported to stay healthy and well. Staff helped people eat and drink enough to meet their needs, to take their prescribed medicines and to manage their healthcare conditions. People and staff's feedback indicated that since the previous inspection there had been great improvement in the way the service was run. Staff approached us throughout the inspection to tell us how much the service had changed for the better.

People and relatives were satisfied with the quality of care and support they received. The manager reviewed accidents, incidents and complaints to identify how the service could improve further and had taken action based on peoples’ views. People were encouraged to have their say about how the service could improve.

The service worked with other agencies and healthcare professionals. We received positive feedback from two visiting health professionals. The provider and management team acted on their recommendations to improve the quality and safety of the service for people.

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 the service under the previous legal entity was Inadequate, published on 10 November 2021. We identified breaches in relation to safeguarding, risk management, person centred care, dignity and privacy, choice and consent, staffing levels, training and competency, premises and good governance. We also made two recommendations in relation to meeting peoples' social and leisure needs and improving dementia care. This service has been in Special Measures since 10 November 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating. We undertook this inspection to check they had followed their action plan and to confirm they now met legal requirements. We also looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Follow up

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

Oak Wood House is a residential care home providing personal care to 18 people aged 65 and over at the time of the inspection. The service can support up to 18 people. Oak Wood House is a large premises, located on the edge of a rural village, set over two floors accessed by a lift, ramp and stair lift.

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

Although peoples’ and relatives’ feedback was predominantly positive, we found people were not receiving timely, person centred care that met their needs and kept them safe.

People were not safe at Oak Wood House. There was not an effective system to identify and manage risks associated with people's care. Risks were identified and recorded in people’s care plans but actions for staff to take to keep people safe were not recorded meaning that people’s risks were not well managed. For example, risks relating to falls, moving and handling, behaviours which could be challenging for others and skin pressure damage and integrity.

Staff did not demonstrate a good knowledge of how to protect people from harm. They did not know how to manage behaviours that could be challenging, or monitor or report unexplained bruises appropriately to keep people safe.

Health needs were difficult to follow up within the computer system in relation to monitoring and outcomes. This included when health professionals had been contacted and actions taken. For example, in relation to identifying deterioration in health, reduction in mobility, infection and medication reviews. However, this was not consistent.

Although there was a cleaning regime in place to support good infection prevention and control, lack of good continence management had resulted in a large number of continence accidents requiring additional deep cleaning. This meant that some carpets and furniture was very soiled and odorous and did not promote good infection prevention practice. Environmental and health and safety audits were carried out regularly, but they had not picked up these issues. The home was otherwise very clean and there were no odours permeating throughout the communal spaces.

People were not supported by enough staff who were trained to meet their needs. Staff knew people well and were caring, however their interactions with people were task related. However, there were not enough staff to meet people’s needs in a timely way, engage with people meaningfully or provide individualised care and support with person centred care. Staff did not all understand person centred care and were not supported by the provider and seniors team to promote this culture.

People were able to attend activities in the week with the activities co-ordinator but there were minimal activities at the weekend. There were no activity audits to ensure individuals were able to engage regularly with each other, and staff, or ensure they could pursue their interests.

There were no robust audit systems in place to identify any areas which required improvement and ensure action was taken to develop practice if needed. Audits were completed but did not translate to actions being taken or monitored in practice. Most of the concerns we raised during this inspection had been raised by staff already with no actions taken. There was no documentation of provider insight or oversight.

People were not involved in decision making about their care or able to make meaningful decisions and choices. For example, about when to rise and go to bed or where to spend their time due to the staff workload and routine. People and relatives were given opportunities to give feedback on their care and told us they felt comfortable in doing so but the survey results had not addressed all their comments.

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

People’s medicines were administered safely in the way prescribed for them. However, we found areas for improvement for some aspects of the way medicines were managed. The provider discussed with us their plans to make the necessary improvements.

Mealtimes were a social event in a pleasant setting and people were able to enjoy food they liked in a way that met their needs.

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 the service under the previous provider Oak House (Exeter) Ltd was rated Good, published on 4 March 2020. This service was registered with us on 21 June 2021 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels, cleanliness, continence management, eating and drinking, medicines, skin pressure care and skin integrity management and leadership. A decision was made for us to inspect and examine those risks.

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

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

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 safeguarding, risk management, person centred care, dignity and privacy, choice and consent, staffing levels, training and competency, premises and good governance.

We also made two recommendations in relation to meeting peoples’ social and leisure needs and improving dementia care.

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 and 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.

Special Measures:

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

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

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