Parkgate Manor

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment, and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question requires improvement. At this assessment, the rating has changed to good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

At our last assessment, the provider was in breach of legal regulations in relation to people’s health appointments. Improvements were found during this assessment and the provider was no longer in breach of this regulation.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing, and communication needs with them. Management told us of their pre-assessment process and how they used the information to create care plans and risk assessments.A staff member said, “Management starts the assessment and then we get updates by memo if there are any changes. The care plan is written before the person moves in. There are usually 2-3 trial visits and once the person has moved in, they are reassessed once they have found their feet.” A professional said, “Parkgate Manor has a thorough pre-assessment process, and they will always ensure compatibility with the other people living there.” We viewed pre-assessment paperwork which demonstrated how staff gathered information both directly from people and indirectly through observations. When required, the provider made appropriate referrals to specialist services to ensure guidelines were in place for staff to support people effectively. People had a one-page profile which set out the most important information that staff needed to know about them to be able to support them in the right way.Staff were knowledgeable about people’s support needs and how to support their physical and emotional wellbeing. When people were admitted to hospital, management ensured they reassessed the person before they were discharged back to the service. The manager said, “I won't have anyone back from hospital unless I've been there and assessed them. I will go in and check on the person, their skin integrity or if their medicines have changed.”

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. For example, bowel charts were used to monitor constipation for people who needed this support. Staff were concerned a person’s current interventions were not effective and sought advice from a healthcare professional to ensure a good outcome for that person. The provider had guidance for staff to support people who found it difficult to communicate their anxieties.Where interventions were not working, staff sought advice and support from specialist services to ensure people were supported effectively. We observed staff supporting people appropriately at mealtimes. Where appropriate, the local speech and language team (SaLT) had provided specialist advice and guidance for people who had difficulty swallowing. All guidelines had been incorporated into people’s care plans. Staff had a good understanding of people’s dietary needs and information was displayed in the kitchen. Specialist guidance was also in place to support people who required enteral feeding (feeding directly into the stomach via a tube) and staff had received appropriate training.

The provider worked well across teams and services to support people. Staff worked with a wide range of health and care professionals including community learning disability nurses, speech, and language therapists, advocates, and epilepsy nurses. People had hospital passports. These are documents that contain vital information about a person’s health, wellbeing, and communication needs. They are used if a person is admitted to hospital so that hospital staff can meet the person’s needs appropriately. The manager told us that one person needed to have an imaging test using large equipment at a hospital. They said staff worked with the person using easy read guidance of the procedure to help the person understand and prepare for the test. The person was able to have the test successfully. Feedback from professionals was positive. Comments included, “Staff have been very supportive of 1 person’s assessment and were responsive to the recommendations. Staff contributed to the discussions and had the person at the centre of those discussions. They have had all the information we need to hand and completed detailed recording when we requested it. Another professional told us, “The service appears to be run well. They have a good staff team and provide consistency, using 2-3 regular agency staff. They all work well together and have established good partnerships with health professionals.”

The provider supported people to manage their health to maximise their independence, choice, and control. Staff supported people to live healthier lives. People accessed healthcare when they needed it and were supported by staff who knew them well. A professional said, “Staff are reporting concerns to us appropriately about people and flagging additional concerns if the person's presentation worsens.” Where people were at risk of malnutrition, they were supported to have fortified meals and drinks to prevent further weight loss. Equally, where people had gained weight, staff supported them to choose healthier food options. The manager said, “There are different menu choices every day. The kitchen assistant goes around with pictures so people can choose what they would like. Everything is brought in fresh.” Staff supported people to go on walks or relax in different garden spaces to aid their wellbeing.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. People and relatives did not always have an opportunity to give their feedback or share views. Although care plans contained information about people’s goals, it was not always evident these were reviewed to check they were still relevant or were being actively worked towards. The provider had been open to feedback about this and had taken immediate actions to make service improvements. People accessed healthcare services for their physical and mental wellbeing. Relatives told us staff informed them if people required clinical treatment. A relative said, “[Person] was in hospital several times with various health conditions.” They told us treatment received had brought about a reduction in their epilepsy and reduced the [person’s] aspiration risk.” In relation to another person, the manager told us, “We monitored a person closely as they kept getting chest infections and were at risk of aspiration. We did the referrals and worked with the specialist team [and implemented their advice]. The person has not had a chest infection for months now.” People received routine support in relation to chiropody and eye tests.

Staff understood the importance of gaining people’s consent, but capacity assessments had not been consistently undertaken.

Where people could not give informed consent, mental capacity assessments were not always consistently undertaken or documented. Some decisions had been recorded without demonstrating that an assessment had been carried out to determine if people could understand, retain, and weigh up the information to communicate their decision.Records did not always show the names of those who made decisions, in people’s best interest. For potentially restrictive practices such as using lap belts on wheelchairs or giving medicines covertly, mental capacity assessments had not been completed to ensure these measures were the least restrictive. The provider had been open to feedback and took immediate actions to make service improvements. However, this now needs to be fully embedded and sustained.

We also observed good practices. People chose where they wanted to have their meals, where they wanted to relax, and what activities they wanted to do. A staff member told us, “We give some people simple choices. For example, two different options for drinks. Other people can take in more information and make more complex decisions.”

Where people had to make complex decisions around clinical procedures or end of life wishes, best interest forms were completed. Where needed, people had access to independent advocates. For example, one person had a serious health condition which required treatment in hospital. The provider worked with an independent mental capacity advocate (IMCA) to ensure the person’s wishes, feelings and rights were considered in the decision-making process.