This unannounced inspection took place on 2 and 15 May 2018. South Park Residential Home is a ‘care home‘. People in care homes receive accommodation and personal care as a single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The home does not provide any nursing care and specialises in supporting older people living with dementia. The care home can accommodate up to 11 people on either a permanent or temporary 'respite' basis in one adapted building across two floors. At the time of our inspection there were ten people permanently residing at the home who were all living with dementia.
The service had a registered manager in post. A registered manager is a person who has registered with the CQC. Registered managers like registered providers 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.
At the last comprehensive inspection of this care home in February 2017 we continued to rate them 'Requires Improvement' overall and for the three key questions 'Is the care home safe', 'effective' and 'well-led?'. This was because we found the provider had failed to appropriately check the suitability and ‘fitness’ of new staff, ensure staff were suitably trained and supported to carry out their duties and effectively manage and scrutinise the quality and safety of the service people living in the home received.
We undertook a focussed inspection in July 2017 and found the provider had followed their action plan to improve and met their legal requirements. However, we continued to rate the service 'Requires Improvement' overall because we wanted to be sure they could maintain what they had achieved over a more sustained period of time. In addition, we identified issues with their fire safety arrangements. Specifically, we found fire safety equipment used in the home was not always appropriately maintained, staff did not routinely participate in fire evacuation drills and fire safety risks were not always identified and mitigated.
At this comprehensive inspection we found the service continued to improve. We saw the provider had taken appropriate action to resolve the fire safety issues we identified at their last inspection. Specifically, we saw fire safety risk assessments were in place, staff had completed their fire safety training and they routinely participated in fire evacuation drills. In addition, we found the provider continued to appropriately check the suitability and ‘fitness’ of new staff, ensured staff were appropriately trained and supported and operated effective governance systems. We have therefore improved the service’s overall rating from ‘Requires Improvement’ to ‘Good’ and for most of the key questions, ‘Is the service safe, effective, caring and well-led?’
However, the service’s rating for one key question, ‘Is the service responsive’, has deteriorated from 'Good' to 'Requires Improvement'. This is because people did not have sufficient opportunities to follow their social interests and take part in meaningful recreational activities inside the home or in the wider community. We received mixed feedback from people living in the home, their relatives, professional representatives and staff about the availability of fulfilling social activities in the home. People were not engaged in particularly meaningful activities throughout our inspection. We recommend the service seek advice and guidance from a reputable source, about developing a more structured and dementia friendly programme of social activities which is based on the interests of people living in the home.
In addition, although people when they were nearing the end of their life received compassionate and supportive care at the home, people’s care plans did not contain a section that people could complete if they wanted to record their wishes during illness or death and staff had not received any end of their life/palliative care training. We discussed these issues with the registered manager who agreed to support people living in the home make decisions about their preferences for their end of life care and arrange for all staff to complete end of life care training. Progress made by the service to achieve these stated aims will be assessed at our next inspection.
Finally, although we saw the provider continued to improve the interior décor of the home, there remained considerable room for further improvement of the home’s physical environment. We recommend the provider seeks the relevant guidance and research on the design of the environment for people living with dementia.
Improvements described above the service still needed to achieve notwithstanding, people living in the home and their relatives told us they remained happy with the standard of care provided at South Park Residential Home. We saw staff continued to look after people in a way which was kind and caring. Staff had built up caring and friendly relationships with people and their relatives. Our discussions with people living in the home, their relatives and community health and social care professionals supported this.
There continued to be robust procedures in place to safeguard people from harm and abuse. Staff were familiar with how to recognise and report abuse and neglect. The provider continued to identify and manage risks to people’s safety in a way that considered their individual needs. There remained enough staff to keep people safe. The environment continued to be kept hygienically clean for people and staff demonstrated good awareness of their role and responsibilities in relation to infection control and food hygiene. Medicines continued to be managed safely and people received them as prescribed.
People continued to be supported to eat and drink sufficient amounts to meet their dietary needs. The registered manager was aware of their duties under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff continued to seek people's consent before providing any care and support and followed legal requirements when people did not have the capacity to do so. They also received the support they needed to stay healthy and to access health care services.
Staff continued to treat people with dignity and respect. They ensured people’s privacy was maintained, particularly when being supported with their personal care needs. Staff communicated with people using their preferred methods of communication. This helped them to develop good awareness and understanding of people's needs, preferences and wishes. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.
People continued to receive person centred care and support which was tailored to their individual needs. Each person had an up to date and personalised care plan, which set out how their care and support needs should be met by staff. These were reviewed regularly. This meant people were supported by staff who knew them well and understood their needs, preferences and choices.
People felt comfortable raising any issues they might have about the home with registered manager and staff. The service had arrangements in place to deal with people’s concerns and complaints appropriately. The provider routinely gathered feedback from people living in the home, their relatives and staff. The provider also worked in close partnership with external health and social professionals and bodies.
The registered manager had a positive impact at the home and was highly regarded by people living there, relatives and staff. It was evident from the registered manager’s comments they understood their registration responsibilities particularly with regards to submission of statutory notifications about key events that occurred at the service.