The inspection took place on 13 September 2016 and was unannounced. The inspection continued on 14 September 2016 and was announced. Day one was carried out by a single inspector. A specialist advisor in elderly nursing and dementia care was present on day two. Park House provides accommodation and personal care to up to 20 older adults with dementia and learning disabilities. The accommodation was split over two floors with a management office being situated on the second floor. There were six bedrooms on the ground floor and 14 on the first floor. A passenger lift supported people up and down the stairs. 19 bedrooms were ensuite and one was not. There were two bathrooms which both had assisted baths and one level access shower room. The home had a kitchen and a multipurpose room. There was a communal living area and a separate dining room for people to come together.
The service did not have a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. A new manager had been recently recruited and was in the process of applying for their registration. The new manager had an interview arranged for the following week with a registration inspector.
Staff had a good knowledge of people’s support needs and received regular e-learning training as well as some training specific to their roles for example, end of life, nutrition and dementia. Staff told us however that they had not received any training around learning disability and felt that this would support them to deliver an even better service to some people who lived at Park House. Staff were aware of the Mental Capacity Act however training records showed that they had not received training in this.
We have made a recommendation about staff training on the subject of learning disabilities.
Park House was not always responsive to people’s communication needs. We observed on several occasions staff relying on verbal communication to interact with everyone who lived at the home however we found that some people’s care files reflected that their communication needs included; visual prompts, pictures and facial expressions.
There was a system in place for recording complaints which captured the detail and evidenced steps taken to address them. We noted that there were no recorded complaints for the past 12 months. We checked with the management and asked if this was correct. We were told about feedback received from a family and actions which the service had taken to address this but it had not been recorded as a complaint.
People and staff told us that the service was safe. Staff were able to tell us how they would report and recognise signs of abuse and told us they had received safeguarding training. We reviewed the training records which confirmed this.
Care plans were in place which detailed the care and support people needed to remain safe whilst having control and making choices about how they lived their lives. Risk assessments were completed, regularly reviewed and up to date.
Medicines were managed safely, securely stored, correctly recorded and only administered by staff that were trained to give medicines. Medicine Administration Records reviewed showed no gaps. This told us that people were receiving their medicines as prescribed.
Staff told us they received regular supervisions which were carried out by management. We reviewed records which confirmed this. A staff member told us, “I receive regular supervisions and find them useful”.
The service completed capacity assessments and recorded best interest decisions. This ensured that people were not at risk of decisions being made which may not be in their best interest.
People were supported to maintain healthy balanced diets. Food was home cooked using fresh ingredients and people said that they enjoyed it. Food options reflected people’s likes, dislikes and dietary requirements.
People were supported to access healthcare appointments as and when required and staff followed GP and District Nurses advice when supporting people with ongoing care needs.
People told us that staff were caring. We observed positive interactions between staff and people throughout the inspection. This showed us that people felt comfortable with staff supporting them.
Staff treated people in a dignified manner. Staff had a good understanding of people’s likes, dislikes, interests and communication needs. Information was available to people. This meant that people were supported by staff who knew them well.
People had their care and support needs assessed before using the service and care packages reflected needs identified. We saw that these were regularly reviewed by the service with people, families and health professionals when available.
People, staff and relatives were encouraged to feedback. We reviewed the findings from quality feedback questionnaires which had been sent to people and family. We noted that it contained mainly positive feedback.
Staff had a good understanding of their roles and responsibilities. Information was shared with staff so that they had a good understanding of what was expected from them.
People and staff felt that the service was well led. The manager and others in the management team all encouraged an open working environment.
The service understood its reporting responsibilities to CQC and other regulatory bodies and provided information in a timely way.
Quality monitoring audits were completed by the management team. The deputy manager reviewed incident reports and analysed them to identify trends and/or learning which was then shared. This showed that there were good monitoring systems in place to ensure safe quality care and support was provided to people.