Background to this inspection
Updated
3 March 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This comprehensive inspection took place on 20 and 21 December 2017 and 4 and 10 January 2018 was unannounced. On day one, the inspection was carried out during the evening and the inspection team consisted of two adult social care inspectors. On day two, the inspection team consisted of two adult social care inspectors, an assistant inspector and an expert-by-experience who had experience of people living with dementia. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. On day three, the inspection consisted of two adult social care inspectors. On day four of the inspection the inspection team consisted of one adult social care inspector and an adult social care inspection manager.
On 20 and 21 December 2017 there were 20 people living at Park Grange Care Home and on 4 January 2018 there were 22 people living at Park Grange Care Home. We spoke with four people who used the service, four relatives, two friends, five care staff, the day care manager, five domestic and kitchen staff, the maintenance person, the registered manager and the registered provider. We also spoke with two healthcare professionals. We observed care interactions in the communal lounges and observed the lunchtime meal. We spent some time looking at the documents and records that related to people’s care and support and the management of the service. We looked at four people’s care plans in detail and a further seven care plans for specific information. We looked also looked at people’s medication administration records.
Before our inspections we usually ask the provider to send us provider information return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We did not ask the provider to complete a PIR prior to this inspection. We also reviewed all the information we held about the service. This included any statutory notifications that had been sent to us. We contacted the local authority commissioning and contracts department, safeguarding, infection control and Healthwatch to assist us in planning the inspection. We reviewed all the information we had been provided with from third parties to fully inform our approach to inspecting this service. We also received whistleblowing information prior to our inspection, which raised concerns regarding staffing levels, the administration of medicines during the evening and some environmental issues. This information formed part of our inspection planning and the areas of concerns were reviewed during our comprehensive inspection.
Updated
3 March 2018
The inspection took place on 20 and 21 December 2017 and 4 and 10 January 2018 was unannounced.
When we completed our previous inspection on 12 June 2017 we found the registered provider was not meeting the regulations relating to the updating and accuracy of care plans, the care plans did not contain decision specific mental capacity assessments or best interest decisions and recruitment procedures were not robust. We issued a warning notice for regulation 17 (good governance) as records were not accurate or contemporaneous which meant the registered manager did not appropriately manage risks relating to the health, welfare and safety of people who used the service. We asked the registered provider to complete an action plan to show what they would do and by when to improve the service. The purpose of this inspection was to see if significant improvements had been made and to review the quality of the service currently being provided for people. We also wanted to look at recent concerns raised by a whistle-blower. ‘Whistleblowing’ is when a worker reports suspected wrongdoing at work. At this inspection we found the home was still breaching these regulations. We also found additional areas of concern.
At the time of the last inspection the areas of concern were included under the key questions of Safe, Effective, Responsive and Well-led. We reviewed and refined our assessment framework and published the new assessment framework in October 2017. Under the new framework the area of concern from this inspection are included under the same key questions of Safe, Effective, Responsive and Well-led.
Park Grange Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Park Grange Care Home is registered to accommodate up to 30 people on three floors with a lift or stairs access to the upper floors. People had ensuite facilities in their bedrooms with communal bath and shower rooms located on each floor. On 20 and 21 December 2017 there were 20 people living at Park Grange Care Home and on 4 January 2018 there were 22 people living at Park Grange Care Home, providing care and support for people with residential needs including people who were living with dementia.
At the time of our inspection the home had a registered manager in place who had been registered since 18 March 2014. 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 registered provider and registered manager did not have effective oversight of the service. Quality management was not effective as the audits in place had not identified concerns we found during our inspection and improvements had not been made from our last inspection. Confidential and sensitive information was not kept securely and were accessible to people and visitors. Some staff members told us the management team would not be happy they were speaking with CQC.
Risks were not appropriately managed as some general risk assessments were not in place and individual risk assessments did not provide sufficient guidance for staff. Some areas of the premises were not fully maintained and did not comply with current health and safety guidance and were therefore, a safety risk to people who used the service. For example, the electrical wiring certificate was not up to date.
Some areas of medicines were not well managed, as some ‘when required’ medicine protocols were not in place and there was evidence of ‘pre-potting’ of people’s medicines. At our last inspection in June 2017, we recommended the management team review the process and procedures for the administration of topical medicines across the home and guidance for ‘when required’ medicines in line with the National Institute for Health and Clinical Excellence guidelines.
The registered manager did not use people’s levels of dependency to make sure staffing levels were appropriate to meet people's needs. We found the number of staff covering shifts did not always match the staffing levels quoted by the registered manager. Recruitment processes were not robust and checks were not completed before staff started working at the home.
People were happy with the support they received from the staff team. However, we saw people were not always treated with dignity and respect. We found people’s bedrooms had been personalised and communal areas were comfortably furnished. The registered manager told us they involved people and/or family members when carrying out care plan reviews, although, this was not reflected in care plans. Resident and relative meetings had taken place. Opportunity for people to be involved in activities within the home and the local community were limited.
People told us they were happy with the meals provided. We observed the dining experience was pleasant and people had choice and variety in their diet, although we noted people’s food and fluid intake was not accurately recorded. People had access to healthcare services to make sure their health care needs were met.
People were offered choice, however, the care plans we looked at did not contain decision specific mental capacity assessments. Care plans were not fully completed and did not contain sufficient information to help staff to provide person-centred care.
People told us they mostly felt safe living at Park Grange Care Home. The staff we spoke with knew what to do if abuse or harm happened or if they witnessed it. The home was found to be odour free and mostly clean and tidy.
The training record showed staff had completed training to ensure people received appropriate care, although we noted the training record was not up to date. Staff had the opportunity to attend regular supervision meetings. People's equality, diversity and human rights were respected.
People told us they would speak with a staff member if they had any concerns. At our last inspection in June 2017, the registered manager told us they did not record minor concerns and ‘niggles’ but would record these in the future. We looked at the complaints records and saw the registered manager had not recorded they had received any complaints since 2013; although, a family member told us they had recently raised a concern with the registered manager.
Notifications were not submitted to the CQC as required under the terms of the registered provider's registration. The registered provider had not ensured their rating from our last inspection was on display on their website or in the home, although this was displayed in the home on 4 January 2018. We dealt with this outside the inspection process.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. You can see the action we have told the provider to take at the end of this report.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service.
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.