Parkmanor Care Home

Parkmanor Care Home is a residential care home providing personal and nursing care to up to 40 people aged 65 and over. At the time of our inspection there were 34 people using the service.

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

Infection prevention and control (IPC) procedures were not always effective. We saw the environment was not always clean and some equipment was not fit for purpose. However, these issues were rectified immediately following our inspection.

Quality control systems were not always effective in identifying issues within the service. However, when issues were identified during audits, the provider developed effective action plans to improve care and drive continuous learning.

People’s individual risks were managed in a safe way and environmental risk assessments were completed appropriately.

People were supported by a staff group who had been trained in safeguarding and understood how to safeguard vulnerable adults from abuse and neglect.

The provider had enough staff with the right skills deployed to provide people with their commissioned care.

Medicines were safely managed. Medicines administration record (MAR) charts were accurately completed, medicines were safely administrated and when people received their medicines ‘as and when required’ the correct protocols were in place.

The provider demonstrated they learnt lessons when things went wrong and they encouraged continuous improvements.

Care records were person-centred and contained sufficient information about people’s preferences, specific routines, their life history and interests.

People and their relatives were involved in developing and reviewing their care plans and risk assessments. People’s relatives and staff felt they were able to contribute to the development of the service.

The provider and management team had good links with the local communities within which people lived.

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 31 December 2019).

Why we inspected

We undertook a targeted infection prevention and control inspection in line with our current regulatory approach.

We inspected and found there was a concern with the cleanliness of the service, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Parkmanor Care Home is a registered care service providing personal and nursing care to 35 people aged 65 and over at the time of the inspection. The service can support up to 40 people. Parkmanor is purpose-built and provides care over two floors. The ground floor is for general nursing care and the first floor specialises in providing nursing care to people living with dementia. There are dining rooms and lounges on both floors and all rooms are single accommodation.

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

People were protected from the risk of abuse and avoidable harm by trained staff who understood how to identify and report concerns. People felt safe living at the service. Risks to people were identified and were well managed. Processes were in place to manage the administration of medicines safely. People were protected from the risk of infection as preventative measures were in place.

People’s needs were holistically assessed. Care and support plans were developed with people and their families to include their histories, preferences and routines. People had nutritious food and options at every meal. Staff received an induction, competency checks and supervision with managers. 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.

People told us staff were caring and treated them with kindness. People were treated with dignity and respect. People’s privacy was respected by staff. People were supported to maintain relationships important to them. People were encouraged to express their views, be involved in their care and to maintain their independence where possible. Advocacy information and services were made available to people who required them.

People’s care was person-centred and responsive to their individual needs. People’s communication needs were assessed and included in care plans. This meant staff knew how best to communicate with people in a meaningful way. People had choice in the activities on offer at the service and suggestions for activities were acted upon. People and their families were aware of how to complain and complaints were handled promptly by the management team.

The registered manager was committed to providing a high quality of care. Staff told us the service had good leadership, good practical support and had a positive culture. The registered manager was aware of their regulatory responsibilities. The registered manager conducted regular audits and checks which ensured the safety and quality of the service. People, their families and staff had opportunities to give feedback and offer suggestions. The management team worked closely with medical professionals and others to ensure good outcomes for people.

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

Parkmanor Care Home is a registered care service providing personal care, nursing care and support for up to 40 older people. There were 37 people using the service when we visited and some were living with dementia.

There was a manager in place who was in the process of applying to become the registered manager. It is a requirement that the service has 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.

Staff knew their responsibilities to help keep people safe from harm and abuse. The manager took action where an accident or incident occurred to try to prevent a reoccurrence. Risks to people’s health and well-being were assessed and monitored so that staff had guidance on how to help people to remain safe. The provider had safely recruited a suitable number of staff to provide care and support to people.

People received their medicines when they required them by staff who had received training to administer them safely.

People received care and support from staff members with the necessary skills and knowledge. Staff received good support and they knew their responsibilities. They received training in areas such as medicines, dementia care and specific health conditions that people were living with.

People were asked for their consent before care and support was undertaken. Staff knew the importance of doing this and gave people additional information where this was required to aid their understanding.

People were supported in line with the Mental Capacity Act 2005. People’s mental capacity had been assessed for specific decisions. Any decision made in a person’s best interest involved important people in their life. The provider had made applications to the appropriate body where they had sought to deprive some people using the service of their liberties to make sure this was agreeable. Staff understood the requirements under the Act.

People were satisfied with the food and drink available to them. Staff knew people’s dietary requirements and where there were concerns about a person’s eating and drinking, specialist advice was sought.

People were supported to maintain their health and close observation occurred where this was required. People had access to healthcare professionals such as to a doctor, optician and district nursing services.

People’s dignity and privacy was protected and staff offered their support in caring and compassionate ways. People’s friends and family could visit without undue restriction.

People’s histories and things that mattered to them were known by staff. Their independence was maintained for as long as possible by staff who offered encouragement.

People received care and support based on their preferences and routines that were important to them. People and their relatives contributed to the planning and review of their care wherever possible. Staff had guidance available to them about people’s preferences and care requirements.

People were mainly satisfied with the activities available to them. We received feedback that some people preferred to be reminded about daily activities. The manager said they would make sure this occurred.

The provider had made available to people and their visitors a complaints procedure that was used. Action was taken by the provider where improvements were required.

The service was well-led and it had an open approach to sharing information with other agencies. The provider learnt from mistakes and events that had occurred. There were opportunities for staff, people and their families to offer suggestions for how the service could improve. The provider and manager listened and took action based on the feedback received.

The manager was aware of their responsibilities. The provider and manager carried out quality checks of the service to make sure that it was of a high standard.

We carried out an unannounced comprehensive inspection of this service on 25 April 2016. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to a breach of Regulation 11; need for consent and a breach of Regulation 17; good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Parkmanor Care Home on our website at www.cqc.org.uk.

At the last inspection we carried out on 25 April 2016 we found that where people lacked the capacity to consent to their care and treatment the provider had failed to act in accordance with the provisions of the Mental Capacity Act 2005 (MCA). At this inspection we found the provider had made the required improvements. We also found that the provider did not have quality checks in place to assess, monitor and improve the quality and safety of the service. The provider did not always maintain an accurate and complete record in respect of each person including a record of the care and treatment provided. At this inspection we found the provider had made the required improvements.

Parkmanor Care Home provides care and support for up to 40 older people. At the time of our inspection 33 people were using the service and many were living with dementia or similar conditions. The accommodation is offered over two floors accessible by a passenger lift and stairs. There is a large accessible garden for people to use should they wish to.

At the time of our inspection there was a manager in place who was in the process of registering to become the registered manager. It is a requirement that the service has 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.

The provider had a range of systems in place to identify and drive improvement. The provider took action where necessary.

The provider maintained accurate care records for each person who used the service so staff had the information required to support people in a way that met their individual needs.

People were supported in line with the Mental Capacity Act 2005 (MCA). People were asked for their consent before staff carried out care and support. Where people’s capacity to make decisions required assessment, the provider had assessed people’s mental capacity and decisions were made in people’s best interests. Staff understood their responsibilities under the Act. The provider had made applications to the appropriate body where they had sought to deprive a person of their liberties.

People and their relatives felt safe with the support offered to them. Staff understood their duties to protect people from abuse and avoidable harm and to remain safe. The provider managed accidents and incidents appropriately and looked at ways to minimise these wherever possible. Risks to people’s health and well-being were regularly assessed. For example, where people were at risk of falling, staff followed guidance the provider had made available to them.

People received their prescribed medicines in a safe way. Staff followed national guidance when handling medicines and received regular training and guidance to understand their responsibilities. People’s medicine records were accurate and complete.

The provider had a suitable recruitment process in place for prospective staff. This included checks on the suitability of staff to work in the caring profession. People and their relatives had mixed views about the number of staff available to offer care and support. On the day of our visit we found that staffing levels were suitable to help people to remain safe.

People received care and support from staff with the appropriate knowledge and skills. Staff received regular training such as assisting people to move. Staff received a comprehensive induction and had regular meetings with a manager so that they could receive feedback and guidance on their work.

People were involved in decisions about what they ate and drank and were supported to eat and drink where this was required. People’s care records were complete where their nutrition was monitored. The provider had sought the advice from specialist healthcare professionals where there were concerns about people’s health and well-being. People had access to healthcare services such as to their GP.

The manager knew their responsibilities and informed the relevant authorities about significant incidents that occurred at the home. Staff felt supported and knew their responsibilities. Staff knew how to report the inappropriate or unsafe practice of their colleagues should they have needed to.

People, their relatives and staff had opportunities to give feedback to the provider. Relatives and staff told us that improvements were taking place at the home.

At the last inspection on 21 and 26 November 2014 we asked the provider to take action to make improvements. We asked them to improve their practices in relation to obtaining people’s consent to their care. We also asked the provider to improve their practices in relation to their arrangements for monitoring the quality of the service. Following that inspection the provider sent us an action plan detailing what improvements they were going to make.

During this inspection we found that some improvements had been made. However, we were still concerned that people’s consent had not been obtained in line with the Mental Capacity Act (MCA) 2005. We were also concerned that people’s capacity to make specific decisions had not always been assessed. We still had concerns that checks by the provider on the quality of the service provided had failed to identify concerns found at this visit and therefore necessary action had not been taken.

Parkmanor Care Home is a registered care service providing care for up to 40 older people. At the time of our inspection 38 people were using the service, a significant number of whom had dementia. The service is offered over two floors accessible via the stairs or passenger lift. There are two lounges and two dining areas for people to use and all bedrooms are single occupancy. There is also access to a garden area for people to use should they wish to.

The service had a registered manager. It is a requirement that the home has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider had not always consistently managed or assessed risks that people were vulnerable to. For example, where people were at risk of skin damage this risk had not been carefully considered and documented. Staff members had recorded accidents and incidents but the registered manager had not analysed ways to prevent them from reoccurring.

The provider did not always have safe systems and processes for managing people’s medicines. For example, the storage and recording of people’s medicines was not always robust. Staff supported people to take their medicines in a safe way.

The provider had carried out regular checks on the equipment people used and the premises.

There were not always plans available to staff to support people to keep them safe during emergencies. For example, where people needed individual support to evacuate the home, the plans were not thorough.

People did not have concerns about their safety and staff knew how to protect them from abuse and avoidable harm.

People and their relatives had mixed views about the amount of staff available but we found there were enough staff to meet people’s basic care needs. The provider’s recruitment process was robust and included checking prospective staff before they started to work at the home. This helped the provider to make safer recruitment decisions.

Staff understood the requirements of the MCA 2005 and could describe how to obtain people’s consent before they offered care and support. Where people may have lacked the capacity to make their own decisions, the provider had not always followed the requirements of the MCA. For example, how the provider had assessed people’s capacity to make decisions was not always clear.

People were supported by staff that had received regular training. However, the regular checking of staff’s knowledge and skills had not always been recorded. Staff did not always receive regular support from their supervisor.

People were not always aware what food choices were available to them but food and drink was available to them throughout the day. However, daily records to monitor people’s nutrition lacked details of what people had actually eaten and drunk.

People had access to healthcare professionals to maintain good health.

People had mixed views about the caring approach of staff. Staff did not always show compassion and kindness to people although we saw some staff being warm and friendly towards them.

People were supported to maintain relationships with people that were important to them. People’s dignity and privacy was not always being maintained because staff were not always aware of people’s preferences.

Staff knew about people’s communication needs which meant they were able to respond to them effectively.

People’s personal information was mainly being kept secure.

Where people could, they had not always been involved in and contributed to the planning and reviewing of their care and support. Where this had not been possible, people’s representatives or their relatives had not always been included. People’s support plans were not always individual to them and lacked detail that staff could refer to about how they wanted to be supported.

The provider had adapted parts of the home for people with dementia. However, these were not always maintained. For example, some rooms were cluttered and may have confused people.

People’s preferences, backgrounds and things that were important to them were not always known by the staff team as these had not always been recorded in people’s care plans. People were not offered a full range of activities and interests to meet their preferences and interests.

People did not have access to independent advocacy services information available to them to help them to speak up if they had required this support. Feedback about the quality of the service had been sought but the results had not always been shared with people or their relatives. People and their relatives knew how to make a complaint.

The provider had carried out quality checks of the service but these had not been effective in identifying the concerns that we found during our visit. Records of people’s care were not always in place or were incomplete.

The registered manager largely understood the requirements of their role but not all statutory notifications had been submitted to CQC. People and staff did not always have opportunities to give feedback to them.

Staff enjoyed working at the home and were able to describe the vision of the service such as offering dignified care. Staff had been made aware of their responsibilities.

We found breaches of the Health and Social care Act (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.

People lived in an environment that was safe, comfortable and adequately maintained. One person said: 'I have my own private bathroom and you can also have shower or a bath anytime.' Another person who was asked for their view about Parkmanor Care Home said: 'It's perfect.' Risks were assessed and suitable equipment was provided to ensure people's needs could be met safely. Arrangements were in place to ensure staff were trained; the premises and equipment were adequately maintained.

People were supported by staff that underwent a robust recruitment process to ensure they were suitable and qualified to work with vulnerable people. All staff received induction and regular mandatory training so that people could be confident that their needs were met by trained staff.

People had opportunity to take part in social activities and seasonal events organised by staff. People received personalised support that promoted their rights and independence.

People told us they were treated with respect and their care needs were met safely. People had a range of assessments and care plans in place that detailed the care and treatment they needed. Records showed people's health and care needs were monitored and reviewed regularly. People had their prescribed medicines on time and saw health care professionals when needed. Arrangements were in place to support people safely and to deal with foreseeable emergencies.

People's health and care needs were met by qualified nurses and care staff. The provider increased the staffing levels in response to our findings on the day and assured us staffing levels would be reviewed in response to people's needs.

People had opportunities to make comment about the service and had information about how to make a complaint. They said they were confident to raise concerns with the registered manager. One person said 'We all have little grumbles which they do sort out quickly.'