28 January 2016
During a routine inspection
At the last inspection in March 2015 we found the service required improvement in all the areas we inspect; safe, effective, caring, responsive and well-led. The issues related to management of behaviour which could be challenging for staff, infection control, training, maintaining dignity, activities and audits. We received a satisfactory action plan reassuring us that the service would address these issues in a timely way. In September 2015 we received concerns about inadequate staffing levels. The manager left the service at this time. We met with the provider and registered manager of their other care home, who was supporting a newly appointed manager for Parklands. We were assured that staffing levels were adequate and issues had been due to holiday and sickness and were now resolved. The new manager also left after three months. Therefore, at the time of this inspection, there was a new manager at Parklands who had been employed since December 2015.
We found during this inspection that all the areas identified in the last report and in the meeting with the provider had been addressed or were being addressed. However, we have noted that these improvements are very recent and although actions show that improvement has been made, we were not able to see sustained or embedded practice yet. For example, at the last inspection we found improvements were needed to make sure quality assurance systems were effective in identifying shortfalls in the service offered. At this inspection we found more robust quality monitoring had been put in place but it was too early to establish the effects of this over a period of time. The registered manager of the provider’s other service was working with the new manager and the deputy manager at Parklands to ensure that improvement continued in a timely way and they would inform us of their progress.
At present there is no registered manager who is responsible for the home at Parklands. The newly appointed manager said it was their intention to register in the near future. 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 and associated Regulations about how the service is run.
On the day of the inspection there was a calm and relaxed atmosphere in the home and we saw staff interacted with people in a friendly and respectful way. There were sufficient numbers of staff to meet people’s needs. During the period of concern about inadequate staffing levels the service had worked with the local council quality assurance team to ensure they were admitting and caring for people with less complex needs. At the time of this inspection, people’s dependency levels were relatively low, with only one person requiring a hoist to mobilise for example. People were encouraged and supported to maintain their independence. They made choices about their day to day lives which were respected by staff and their needs were met in a timely way.
People said the home was a safe place for them to live. Staff had received or were booked to receive training in how to recognise and report abuse. All were clear about how to report any concerns. Staff were confident that any allegations made would be fully investigated to ensure people were protected.
People said they would not hesitate in speaking with staff if they had any concerns. People knew how to make a formal complaint if they needed to but felt that issues would usually be resolved informally. One person said
People were well cared for and were involved in planning and reviewing their care. Care plans were person centred and reflected people’s care. A new activity co-ordinator was getting to know people so that stimulation and leisure activities met people’s preferences. People were provided with a variety of activities and trips. People could choose to take part if they wished. Records of activities were recorded under each activity although did not ensure staff could monitor each individual’s activity experiences activities. The new activities co-ordinator was arranging a meeting with staff to discuss future plans and how care staff could be more involved in activities. They were also starting individual records for each person rather than records based on the activity. Staff at the home had been able to start building links with the local community, such as the library.
There were regular reviews of people’s health and staff responded promptly to changes in need. The district nurse who visited regularly told us that they were impressed with the level of health care and that the service worked in partnership with them in a timely way. People were assisted to attend appointments with appropriate health and social care professionals to ensure they received treatment and support for their specific needs.
Staff had good knowledge of people including their needs and preferences. Staff had received recent training or were booked for training in a wide range of topics in the near future. There were good opportunities for on-going training and for obtaining additional qualifications. The new manager had previously been the service national vocational qualification assessor so had good knowledge of standards of care and training competencies.
People’s privacy was respected. Staff ensured people kept in touch with family and friends. Each relative we spoke with told us they were always made welcome and were able to visit at any time.
There was a new management structure in the home which provided clear lines of responsibility and accountability. The new manager was well supported by the registered manager of the provider’s other service and was keen to provide the best level of care possible. Staff said there had been a period of change and unrest but that the service was now more settled and things were a lot better. They showed care and respect for people and clearly were knowledgeable about who people were and how they liked to be cared for.
There were quality assurance processes in place to monitor care and plan ongoing improvements. These had not been kept up to date until recently during the period of change but the systems were now up and running and appeared to be effective. For example, falls risk audits had been completed and showed appropriate actions being taken to keep people safe. There were systems in place to share information and seek people’s views about the running of the home such as quality assurance surveys. These had just been started and responses were being collected.