Archived: Park Grange Care Home

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.

Park Grange is registered to provide accommodation and personal care for up to 30 older people. The home occupies a central position in Kendray, near Barnsley, close to local shops and other amenities.

At the time of this inspection the home had 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.

Recruitment procedures were not robust. Relevant background checks had not been completed to ensure staff were of good character and fit to care for vulnerable people. The administration of medicine was mostly well managed, but the process and procedures for the administration of topical medications and guidance for PRN medicines needed further work.

People told us they felt safe in the home and we saw there were systems and processes in place to protect people from the risk of harm. People told us they felt safe at the home and staff had a good understanding of safeguarding vulnerable adults and knew what to do to keep people safe. Risks to people’s safety were assessed and acted on, however, some peoples risk assessments and personal emergency evacuation plans required strengthening.

People were protected by sufficient staff, all of whom had the skills and experience to offer appropriate care and were well deployed within the home. Staff received the training to meet people’s needs and attended regular supervision meetings.

Staff we spoke with could tell us how they supported people to make decisions and they always offered choice. The care plans we looked at did not contain appropriate decision specific mental capacity assessments. Some best interest’s discussion and decisions had not taken place. We found the service was meeting the legal requirements relating to Deprivation of Liberty Safeguards (DoLS).

People’s nutritional needs were mostly met and people had access to healthcare services to make sure their health care needs were met. People valued their relationships with the staff team and felt they were well cared for. However, we saw two people had limited interaction from staff. Staff respected people’s privacy and dignity and this was evident in the way they dealt with personal care needs in a sensitive and discreet manner. Although, when we looked at care plans we noted the use of disrespectful language.

We found the home was well maintained, bedrooms had been personalised and communal areas were comfortably furnished. People reported little interest in joining in with activities but there was a range of activities available within the home.

Staff had a good knowledge and understanding of people’s needs and worked together as a team. However, people’s care plans did not always contain sufficient and relevant information to provide consistent, care and support.

Complaints were welcomed and were investigated and responded to appropriately.

We found quality assurance systems were not working well, and needed to be improved to ensure people receive a consistent quality service. Staff reported communication with the registered manager had improved and the atmosphere in the home was a lot better.

People and staff had opportunity to comment on the quality of service and influence service delivery.

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.

It is a condition of registration with the Care Quality Commission that the service has 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. There was a manager at the service who was registered with CQC.

Park Grange was last inspected on 27 May 2014. The home was found to be meeting the requirements of the regulations we inspected at that time.

This inspection took place on 6 June 2016 and was unannounced. This meant the people who lived at Park Grange and the staff who worked there did not know we were coming. On the day of our inspection there were 15 people living at Park Grange.

When we spoke with people who used the service they all told us they felt safe. Relatives spoken with did not raise any concerns about mistreatment or inappropriate care provision of their relative. Staff had received safeguarding training and were confident the registered manager would act on any concerns.

We found staffing levels were sufficient to meet people’s needs, but recruitment checks of staff did not include all the relevant information and documents.

Systems and processes were in place for the safe administration of medicines.

Some staff did not receive regular supervisions or appraisal.

Staff were provided with relevant induction and training to make sure they had the right skills and knowledge for their role.

The service followed the requirements of the Mental Capacity Act 2005 (MCA) Code of practice and Deprivation of Liberty Safeguards (DoLS). This helped to protect the rights of people who lack capacity to make important decisions themselves.

People felt staff were caring and respected their privacy and dignity.

People had access to a range of health care professionals to help maintain their health.

People’s care plans contained information on the support needed and risks to the person so that important information was provided to ensure people’s identified needs could be met.

Some people said they participated in daily activities both in and outside of the home. We saw evidence of some activities taking place during the inspection.

People living at the home, and their relatives said they could speak with staff or the registered manager if they had any worries or concerns and they would be listened to.

There were some systems in place to monitor and improve the quality of the service provided.

The majority of staff spoken with said that communication was not good in the home, staff morale was poor and they were unable to share their views or approach the registered manager.

We found three breaches of the Health and Social Care Act 2008 (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.

At the time of this inspection twenty one people were living at Park Grange. We spoke with eight people living at the home and two of their relatives to obtain their views of the support provided. In addition, we spoke with the registered manager, senior care assistant, three care staff, activity coordinator, the cooks and domestic staff about their roles and responsibilities.

We gathered evidence against the outcomes we inspected to help answer our five key questions; is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found.

Is the service safe?

People told us they felt safe. They said 'no worries at all, the girls (care staff) are very nice.' Relatives said, 'we have confidence in the staff, no worries whatsoever.'

Relatives told us they felt their loved ones dignity was respected. They said, 'their dignity is still there, staff make sure they are always clean and well dressed.'

We did see one staff interaction that did not uphold the person's privacy and dignity.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, relevant policies and procedures were in place. Appropriate staff had been trained to understand when an application should be made, and how to submit one.

We found that risk assessments had been undertaken to identify any potential risk and the actions required to manage the risk. This meant people were not put at unnecessary risk but also had access to choice and remained in control of decisions about their care and lives.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

There were effective recruitment and selection processes in place. We checked staff files and found the provider had maintained a satisfactory recruitment processes.

Is the service effective?

Staff were provided with training to ensure they had the skills to meet people's needs.

People and relatives told us they were happy with the care and support staff provided and people's needs were met. Staff had a good understanding of people's care and support needs and they knew how to meet them and avoid unnecessary risks.

Other professionals and individuals were involved in regular meetings and reviews with each individual to ensure their care and support was still appropriate.

Is the service caring?

During our inspection we saw people were very comfortable in the presence of staff. We observed staff giving support to people throughout the inspection and, in the main, this was carried out with respect and staff treated people in a friendly and supportive way.

We spoke with eight people and they all confirmed that they were happy with the care provided. They said, 'it is very nice here, I'm happy', 'the staff are smashing, the girls (staff) are really friendly' and 'It's a lovely place.'

We spoke with two relatives, they said they were very happy with the care and support their loved one received, comments included, 'the staff are all very nice' and 'we are very happy with everything, staff are always around, there are things happening, they (relative) particularly enjoy the singing and join in.'

People's preferences and interests had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People were able to join in with a range of activities. We observed staff treating people with kindness and helping them with their daily activities such as personal care and social activities. We saw staff spending time with people on a one to one basis and it was very evident that people enjoyed this.

People and relatives knew how to make a complaint if they were unhappy and said they would tell the manager. They commented, "If we were unhappy we would soon go and see the manager but we have no worries whatsoever.'

Is the service well-led?

The provider had some systems in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

People and staff said the provider visited the service at least once each week. The visits by the provider were not recorded and there had been no recent satisfaction survey carried out. Therefore the provider could not evidence that people's views were adequately sought or acted upon.

People said they had taken part in some 'residents meetings' where issues for the running of the home were discussed, these included food and activity choices. There was evidence that people's opinions had been acted upon such as changes made to the menu.

Staff told us they were clear about their roles and responsibilities. They said they were supported by the manager. Staff said there had not been a recent staff meeting. They said they had regular supervision sessions with either the home manager or senior care staff and were kept updated about any information they needed to know about the service. This helped to maintain consistency in the running of the service and to ensure staff were aware of relevant information.

We visited the service on 29 April 2013 as part of our scheduled inspection programme and also to check the service had become compliant with their action plan. We found Park Grange had acheived compliance with each outcome area checked.

At this inspection we spoke with seven people and two visiting relatives. They all spoke very positively about Park Grange. They told us they were happy with care at the home, liked all the staff who looked after them, thought the service was kept clean and enjoyed their food. Some people's comments captured included, 'I'm very well looked after in here', 'all the care staff are lovely', 'I'm one satisfied customer' and 'I've no problems at all with this place.'

People using the service said they felt 'safe' living in the home.

We found that a complaints policy and procedure was in place. All of the people and their relatives we spoke with said they had no complaints or concerns about the home.

We saw that staff treated people with respect and spoke with people in a kind manner. People told us that they were happy living at the home. Their comments included: "They do pretty well the staff." "They're great, they are all pretty fair."

People were not protected from the risks of infection because the appropriate standards of cleanliness and hygiene in relation to the premises, bedding and towels had not been maintained. The service was non compliant with this outcome area.

People were not protected against the risk from the use of unsafe equipment because the home had not ensured that all the equipment was properly maintained. The service was non compliant with this outcome area.

People were not being protected from the risk associated with unsafe or unsuitable premises because there was no heating in some areas of the home. The service was non compliant with this outcome area.

People benefited from sufficient staff to meet their needs but we saw that some staff worked very long hours.

People told us that they felt "safe" but the home did not have an effective complaints system in place. The service was non compliant with this outcome area.

We judged this had a minor impact on people using the service' where we have identified non-compliance.