Archived: Park House

The service accommodates people in one adapted building, set over two floors with lifts to allow full accessibility for people. It has a large communal lounge and dining area for people, with access to a well-maintained accessible garden area with outdoor seating.

We found the following examples of good practice.

The provider was working effectively to implement the recommendations of an infection prevention and control audit conducted by an external health team in November 2021.

The service was clean with frequent cleaning of high touch areas. Best practice guidance was being followed and maintained by staff across the service in relation to infection prevention and control.

The provider had systems in place to effectively manage an outbreak of COVID-19. Staff were trained and followed safe infection prevention and control procedures, including the safe wearing and disposal of personal protective equipment (PPE) and regularly cleansing their hands.

The provider had ensured a sufficient stock of personal protective equipment (PPE) was available to staff. PPE stations were placed outside rooms when people were isolating and provided at PPE stations across the service, to ensure staff had access to this when it was required.

Staff were participating in the testing and vaccination programme. People using the service and their relatives or essential care givers had been supported to participate in the COVID-19 testing and vaccination programme. People's individual risks in relation to COVID-19 had been assessed. Care plans had been updated to reflect any individual risks related to COVID-19 for people.

Park House is a care home that can provide personal and nursing care to up to 68 people, some of whom live with dementia. The home is situated on the outskirts of Nottingham City. The accommodation for the designated scheme is in a purpose-built unit, Garden View, separate to the main building. This offers communal spaces and personalised en-suite bedrooms for up to 14 people. One of which was a double bedroom, to accommodate a couple or a relative if a person was receiving palliative care.

The building was observed to be in good decorative repair throughout, clean and appropriately furnished.

The service provided access to a small garden space for people, a communal lounge and dining area, with a range of books and board games for people during their stay.

Furniture was robust, fully wipeable, and placed at appropriately spaced distances to meet current guidance. Rooms allowed people to be isolated with appropriate support from staff when they required.

Consideration had been given as to how to reduce social isolation for people using the service and how they would be occupied, especially if they are feeling well. People had access to televisions in each bedroom, and in the communal areas.

The service had provision of various technologies and telephones to enable people to keep in touch with loved ones.

Each bedroom had a separate PPE station outside, with cleansing and disposal areas for staff. To ensure that people could be isolated, or barrier nursed effectively on their arrival from hospital.

The service has access to a range of equipment to meet people’s identified needs, including; manual handling equipment, continence products, mobility aids and pressure area support aids.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Park House is a care home that can provide personal and nursing care to up to 68 people, some of whom live with dementia. The home is situated on the outskirts of Nottingham city. The accommodation for the designated scheme is in a purpose-built unit, separate to the main building, offering communal spaces and personalised en-suite bedrooms for up to 14 people.

The unit is currently unoccupied, and is set over two floors, with three rooms on the lower level to accommodate people with the highest level of need, and 11 rooms upstairs. The unit is accessible by a wheelchair and stretcher accessible lift and ramp from an entrance which is separate from the main entrance to the building. The building has access to its own garden area.

We found the following examples of good practice.

¿ The compliance manager was responsible for ensuring staff followed best practice guidance in personal protective equipment (PPE) and infection control policy and procedures.

¿ Staff had received training in the appropriate use of PPE, and the provider had ensured they had sufficient supplies and suitable contingency plans.

¿ The location had been reviewed and assessed to ensure the required safety measures were followed at each stage to reduce the risks of cross infection.

¿ Staff were to be employed and contracted to work only in the designated scheme for the duration of their contract. They would be expected to follow the policies, protocols and standards of the provider.

¿ Staff were to take on lead responsibilities in relation to infection control, these linked into local and national guidance.

¿ Additional time had been allocated to ensure the home was cleaned on a rotational basis to minimise the risk of infection. Robust measures were in place for laundry transfer.

¿ Consideration had been given to enabling people to retain contact with loved ones during their stay, using electronic methods and the use of telephones. Bedrooms had access to televisions, to ensure people were provided with something to keep them occupied and stimulated.

¿ Risk assessments had been completed for the staff on site or returning after shielding or a period of isolation. These ensured measures were taken to minimise the risks, this included any additional risk for people in the Black, Asian, Minority, Ethnic or other high-risk groups.

¿ Any visitors would be risk assessed and arrangements would be in place to support rotational visits for larger families or for people who were receiving end of life care.

¿ The compliance manager showed robust leadership and expressed how positively the staff team had worked together. to ensure all measures were in place to reduce infection risks and continuously followed.

¿ Measures were in place to appropriately support people with a positive Covid 19 diagnosis. This was to ensure staff followed guidance to reduce the risk of transition to other parts of the service.

Further information is in the detailed findings below.

Park House is a residential care home providing personal and nursing care to 46 people (with three people inpatients in hospital on the dates of inspection) aged 59 and over at the time of the inspection. The service can support up to 68 people. Some people residing at the service were living with dementia or related conditions.

The care home accommodates people in one large well adapted building, set over two floors with lifts to allow full accessibility for people. It has a large communal lounge and a separate bright dining area for people, with access to a well-maintained accessible garden area with outdoor seating. Smaller lounges were provided for people to watch television or for having private meetings with their family or professional visitors.

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

People received caring and effective person-centred support from staff who were motivated and led to provide the best care they could. Staff supported people to make decisions for themselves and engaged with people about their wishes and preferences.

Staff were proactive in supporting people to maintain as much independence as possible. People were able to live healthy lives. People and relatives felt they were partners in their care and encouraged to make decisions about this.

The service's visions and values promoted people's rights to make choices and live a dignified and fulfilled life. 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.

The service was led by a registered manager and a dedicated staff team who were committed to delivering a service which improved the lives of the people.

The registered manager led a team of well trained staff to provide a high quality of care and support to people.

People received highly effective support with their health and social care requirements, through good diet and nutrition, and a multi disciplinary approach to all of their care and support needs.

The service was in the process of being refurbished by the committed provider to a high standard, which supported people to live well with dementia or sensory loss.

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

Rating at last inspection

The last rating for this service was Good (published 2 June 2017).

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.

The provider is registered to provide accommodation for up to 68 older people living with or without dementia in the home over two floors. There were 59 people using the service at the time of our inspection. The home provides nursing care for older people.

A registered manager was in post and was available throughout the inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff knew how to keep people safe and understood their responsibility to protect people from the risk of abuse. Risks were managed so that people were protected from avoidable harm and not unnecessarily restricted.

Sufficient staff were on duty to meet people’s needs and staff were recruited through safe recruitment practices. Safe medicines and infection control practices were followed by staff.

Staff received appropriate induction, training and supervision. People’s rights were protected under the Mental Capacity Act 2005.

People received sufficient to eat and drink. External professionals were involved in people’s care as appropriate and adaptations had been made to the design of the home to support people living with dementia.

People and their relatives were involved in decisions about their care. Advocacy information was made available to people.

People received care that respected their privacy and dignity and promoted their independence.

People received personalised care that was responsive to their needs. Care records contained information to support staff to meet people’s individual needs, though activities could be further improved so that more people could access activities outside the home.

Complaints were handled appropriately. A complaints process was in place and staff knew how to respond to complaints.

People and their relatives were involved or had opportunities to be involved in the development of the service. Staff told us they would be confident to raise any concerns with the management team and appropriate action would be taken.

The registered manager and provider were meeting their regulatory responsibilities. There were effective systems in place to monitor and improve the quality of the service provided.

Accommodation for up to 68 people is provided in the home over two floors. The service is designed to meet the needs of older people and has a separate unit for people living with dementia. There were 57 people using the service at the time of our inspection.

At the previous inspection on 3 and 4 June 2015, we asked the provider to take action to make improvements to the area of safe care and treatment, specifically medicines management. At this inspection we found that improvements had been made in this area.

A manager was in post but had not started the application process to become registered with the CQC. The service had not had a registered manager for over a year. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People felt safe in the home and staff knew how to identify potential signs of abuse. Systems were in place for staff to identify and manage risks and respond to accidents and incidents. The premises were well maintained. Sufficient numbers of staff were on duty to meet people’s needs. Staff were recruited through safe recruitment practices. Safe infection control and medicines practices were followed.

People’s rights were not fully protected under the Mental Capacity Act 2005. People received sufficient to eat and drink, but action had not been taken to ensure that a request for a dietician referral had been progressed for a person who had significant weight loss. Staff received appropriate induction, training, supervision and appraisal. External professionals were generally involved in people’s care as appropriate. People’s needs were met by the adaptation, design and decoration of the service; however, not all people could use the bath as equipment was not in place to support them to do this.

Staff were caring and treated people with dignity and respect. People and their relatives were involved in decisions about their care. Advocacy information was made available to people. People’s privacy was protected and they were encouraged to be as independent as they could be.

People’s needs were promptly responded to. Care records provided sufficient information for staff to provide personalised care. Activities were available in the home and plans were in place to improve them further. A complaints process was in place and staff knew how to respond to complaints.

People and their relatives were involved or had opportunity to be involved in the development of the service. Staff told us they would be confident raising any concerns with the management and that the management would take action. There were systems in place to monitor and improve the quality of the service provided.

We did not find any evidence that staff living in a part of the building (separated from the rest of the care home) were causing disruption to people who used the service.

We spoke with five people using the service. All of them told us they were happy with the care provided by the service. We spoke with two people specifically about the pressure area care they received. One person said, "They turn me now and again, I am comfortable resting in bed." Another person said, "They turn me over every two hours. I am kept comfortable.'

We spoke with two people who were using the service and asked about the quality and quantity of food and fluids they received. Both of them were satisfied with the food on offer and the amount they received. One person said, "I enjoyed my dinner it was very nice." Another person said, 'The food is good, there is plenty to eat."

We found that people experienced care, treatment and support that met their needs and were supported to be able to eat and drink sufficient amounts to meet their needs. We found that effective infection control practices were being followed and medicines were appropriately managed.

We found that the provider had an effective system to regularly assess and monitor the quality of service that people receive. We found that records were kept securely; however, records were not always accurate.

We spoke with a total of 16 people using the service during our inspection. However, people did not comment on every standard that we inspected.

We spoke with ten people regarding the care provided by the service. Almost all people we spoke with were happy with the care provided by the service. One person said, 'They [The staff] do what I ask them to do.' Another person said, 'They look after you.' Another person told us that they were looked after by the staff.

We spoke with 11 people who were using the service and asked about the quality and quantity of food and fluids they received. The majority of people were happy but some people were not.

Two people using the service told us that the home was clean and no people raised concerns about medication or the premises. People told us they had access to equipment when they needed it and there were enough staff on duty and they knew what they were doing.

We found that people did not always experience care, treatment and support that met their needs. We found that people were not always protected from the risks of inadequate nutrition and dehydration and effective infection control practices were not always being followed. We also found that medicines were not always appropriately stored or administered.

We found that people who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises and people were protected from unsafe or unsuitable equipment. We also found that there were sufficient staffing to meet people needs and staff were supported to deliver care and treatment safely and to an appropriate standard.

However, we also found that the provider did not have an effective system to regularly assess and monitor the quality of service that people receive and that records were not kept securely.

All people told us that the premises were clean and they received their medication when they needed it. They had no concerns with the safety of the premises and two of the three people we spoke with were happy with the levels of staff working at the service.

People were happy that they could raise any issues of concern and two of the three people were happy that their records were secure.

We found that people did not always experience care, treatment and support that met their needs and protected their rights. We found that people were safe but effective infection control practices were not always being followed and medicines were not always appropriately stored or administered.

We found that there were sufficient staff to meet people needs, the provider assessed the quality of the service provided and that records were fit for purpose and kept securely.