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Archived: Parkfield House Care Home Requires improvement

Reports


Inspection carried out on 16 May 2017

During a routine inspection

This inspection took place on 16 May 2017 and was unannounced. The last inspection took place on 20 April 2016 and at that time we found the provider was in breach of Regulation 17; Good Governance. This inspection was carried out to see what improvements had been made since the last inspection. At this inspection we found the provider was in breach of Regulation 12; In safe care and treatment, Regulation 13; Safeguarding service users from abuse and improper treatment and Regulation 17; Good governance.

Parkfield House in Thwaites Brow, Keighley provides nursing care for up to 24 people aged over 65 years. It is a converted house which has 17 bedrooms comprising of eight doubles and nine singles. There are two lounges on the ground floor and one lounge upstairs. The home has a large conservatory overlooking tiered gardens and a patio area. There is a passenger lift for access to the upper level as well as stairs. All food is prepared on the premises and there is a laundry.

At the time of our inspection the service was without a registered manager. The previous manager left in April 2017. In the interim a manager from the provider’s other home is overseeing the service until a new manager can be appointed. 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.

People told us they felt the service was safe. Staff had a good understanding of safeguarding and knew how to report any concerns about people's safety and welfare. We found safeguarding concerns were being referred to the local safeguarding team and the Commission.

The provider followed a robust recruitment procedure to ensure new staff were suitable to work with vulnerable people. Staff training had improved and the majority of staff were up to date with training on safe working practices. However we found staff supervision was not regular or consistent and appraisals had not been completed this year.

Overall we found people's medicines were managed safely. Although records did not always show when creams and lotions known as ‘topical medicines’ were applied and how often; we were told this issue would be addressed by the interim manager during the inspection.

We found staff were not working in accordance with the Mental Capacity Act which meant people's rights were not always protected.

We found people’s health care needs were met and relevant referrals to health professionals were made when needed.

Although staff generally responded to people’s individual needs; this was not always reflected in people’s care records. People’s care plans and other records required improvement.

People had their nutritional needs met and were offered a choice at every meal time. People were offered a varied diet and were provided with sufficient drinks and snacks throughout the day. People with specific nutritional needs received support in line with their care plan.

A range of activities was offered for people to participate in and people told us they enjoyed these.

There were systems in place to ensure complaints and concerns were fully investigated. The provider had dealt appropriately with all complaints received.

We found some areas of the home would benefit from refurbishment. Equipment were appropriately maintained and we noted safety checks were carried out regularly.

People, relatives and staff spoken with had confidence in the service. We found there were systems to assess and monitor the quality of the service, which included feedback from people living in the home and their relatives.

Although there were quality monitoring systems in place they had not been effective in achieving the required improvements in the service. This showed us that further improvements were still required

Inspection carried out on 20 April 2016

During a routine inspection

This inspection took place on 20 April 2016 and was unannounced. At the last inspection on 17 and 19 November and 2 December 2015 we rated the service as ‘Inadequate’ and in ‘Special Measures’. We identified eleven breaches of the Health and Social Care Act 2008

(Regulated Activities) Regulations 2014. Following the inspection we took enforcement action. The commissioners at the Local Authority and Clinical Commissioning Group (CCG) were made aware of our concerns and placements at the home were suspended. Following the inspection the provider sent us an action plan which showed how the breaches would be addressed. This inspection was to check improvements had been made and to review the ratings.

Parkfield House Care Home provides nursing and personal care for up to 24 older people, some of who are living with dementia. There were 19 people using the service when we visited in Aril 2016. Accommodation is provided over two floors. There are nine single rooms and eight shared rooms. There is a large conservatory and lounge areas on the ground floor and a small sitting area on the first floor.

The home does not have a registered manager. The registered manager left in 2014 and the current manager is not registered with the commission. 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.

Overall we found significant improvements had been made in the home since our last inspection, although there were still areas where further improvement was required.

People told us they felt safe and we found there were enough staff on duty to meet people’s needs. Robust recruitment procedures were in place which helped ensure staff were suitable to work in the care service.

Staff understood how to identify abuse and were aware of the action to take if abuse was suspected or reported. We saw safeguarding procedures had been followed when incidents had occurred. Risks to people were assessed and managed to ensure people’s safety and well-being.

We found improvements in the way people’s medicines were managed which meant people received their medicines when they needed them. However, documentation relating to prescribed creams and ‘as required’ medicines needed to be more robust. We also found action had not been taken to ensure medicines kept in the fridge were at the correct temperature.

An ongoing refurbishment programme which was implemented following the last inspection meant the premises were brighter, cleaner and better maintained than when we last visited.

A significant amount of staff training had taken place however there were still gaps where staff had not received training or updates in certain areas such as first aid, infection control and food hygiene.

The home was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and acting within the legal framework of the Mental Capacity Act (MCA).

People told us they enjoyed the food. Lunchtime was a pleasant experience with people offered choices and given the support they required from staff. People's weights were monitored to ensure they received enough to eat and drink.

People and relatives praised the staff who they described as 'good’ and 'kind'. We saw staff treated people with respect and ensured their privacy and dignity was maintained.

We saw improvements in the care records which provide more detailed and up to date information about people's care needs, although we found some information was missing or required updating.

We saw in the last few months people had enjoyed activities, which included entertainers and a trip out to a 1940s café. We found activities were limited, however an activity co-ordinator was due to start in post at the end of April 2016 which should m

Inspection carried out on 17 & 19 November and 2 December 2015

During a routine inspection

This inspection took place on 17 and 19 November and 2 December 2015 and was unannounced. At the last inspection on 18 February 2014 we found the home was meeting the regulations.

Parkfield House Care Home provides nursing and personal care for up to 24 older people, some of who are living with dementia. There were 23 people using the service when we visited. Accommodation is provided over two floors. There are nine single rooms and eight shared rooms. There is a large conservatory and lounge areas on the ground floor and a small sitting area on the first floor.

The home does not have a registered manager. The registered manager left in 2014 and a new manager was appointed who was not registered with the Commission. This manager was absent when we carried out the inspection and has since resigned. 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.

We found people were not kept safe in the home. Staffing levels were insufficient to meet people’s needs. For example, during our inspection there were occasions when we had to find staff to help people and keep them safe. Although staffing was increased following the first day of our inspection this was only due to the feedback we provided. Risks to people were not managed well. For example, we found on three occasions people had gone missing from the home due to lapses in security and a lack of staff supervision. Safeguarding incidents were not always recognised, dealt with or reported appropriately.

Staff recruitment processes were not robust as full checks were not carried out to ensure staff’s suitability to work in care services. There was no evidence to show new staff had completed an induction. The training matrix showed many staff had not received up-to-date training in the providers identified mandatory subjects such as moving and handling, fire safety and safeguarding.

Maintenance works were not always identified or addressed promptly until we brought them to the provider’s attention. There were strong malodours in two bedrooms, although these had been addressed on the third day of our visit.

We found systems in place to manage medicines were not always safe which meant people were not always receiving their medicines when they needed them. Care records were not up-to-date or person-centred and lacked detail about the support people required which placed people at risk of receiving unsafe or inappropriate care.

People were not offered a choice of meals although this had improved by the third day of our inspection as a new cook had started. People’s nutritional needs and weight were not monitored or reviewed to make sure they were receiving sufficient to eat and drink.

Staff lacked understanding and knowledge of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Two people had DoLS authorisations, yet conditions applied to one of the authorisations had not been implemented.

We observed some kind, caring and sensitive interactions between staff and people who used the service. However, we found examples which showed people’s privacy and dignity was not always respected and there was no provision to meet people’s cultural preferences. Some activities were provided which we saw people enjoyed, yet there was no structured activity programme and people’s interests and hobbies had not been determined.

There was a lack of consistent and visible leadership which, coupled with poor communication systems, led to disorganised service provision. Quality assurance systems failed to identify or address risk to people’s health, safety and wellbeing or secure improvements in the service.

Following the second day of our inspection we contacted the provider to inform them of our concerns and requested action plans to show how these would be addressed. The action plans were provided and our visit on the third day showed some improvements had been made. We liaised with commissioners from the Local Authority and Clinical Commissioning Group, as well as the safeguarding team.

Overall, we found significant shortfalls in the care and service provided to people. We identified eleven breaches in regulations – regulation 18 (staffing), regulation 19 (recruitment), regulation 12 (safe care and treatment), regulation 15 (premises), regulation 13 (safeguarding), regulation 11 (consent), regulation 14 (nutrition), regulation 9 (person-centred care), regulation 10 (dignity and respect), regulation 16 (complaints) and regulation 17 (good governance). The Care Quality Commission is considering the appropriate regulatory response to resolve the problems we found.

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 that 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. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

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.

Inspection carried out on 18 February 2014

During an inspection to make sure that the improvements required had been made

People who used the service were protected against the risk of abuse. All members of staff were in the process of receiving training in abuse awareness and protecting children and vulnerable adults. The Operations Manager told us the policies and procedures in relation to safeguarding were in the process of being updated and they should be completed and available to all staff by the end of March 2014.

We observed people were cared for in a clean, hygienic environment. There were effective systems in place to reduce the risk and spread of infection.

People were treated by staff who were supported to deliver care safely and to an appropriate standard. Staff had a programme of on-going training, supervision and appraisal.

There were quality monitoring programmes in place, which included people giving feedback about their care, support and treatment. These were new to the service and a regular audit programme was due to start in March 2014. The audit programme would provide a good overview of the quality of the service�s provided.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

Inspection carried out on 14 November 2013

During a routine inspection

Before people received any care or treatment they were routinely asked for their consent. Members of staff told us they always explained all support and care to people. People had contributed their preferences and their experiences were taken into account in relation to how care and support was delivered. One person told us, �I can go out when I want.� Another person told us, �I can choose where I spend my time.�

On the day of our inspection we observed staff assisting people who used the service; staff were friendly, patient and polite. We saw people were dressed appropriately, looked clean and appeared well cared for. One person told us, �It�s alright now I have got used to it.� Another person told us, �I�m settled and I feel comfortable.� However, the care plans we looked at did not contain thorough and detailed information relating to all aspects of people�s care needs.

People we spoke with told us they felt safe and comfortable with staff. However, we found people who used the service were not protected from the risk of abuse because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We found that appropriate standards of cleanliness were not being maintained in some areas of the home.

People were treated by staff who were supported to deliver care safely and to an appropriate standard. However, staff did not have a full programme of on-going training, supervision and appraisal.

The Provider or the Manager had not monitored some important aspects of the service and checks were not always carried out. They had policies and procedures which identified what they should do to ensure effective and safe care was delivered but these were not always followed or updated.

Inspection carried out on 17 October 2012

During a routine inspection

During the inspection we saw staff supporting people in a kind and friendly way, they treated people with respect. One person told us "the staff are so kind" and "they are very good to me" whilst another person we spoke with told us "staff here are excellent, nobody can complain."

The service held clear records about peoples care to maintain their safety and wellbeing. They kept and administered medicines safely and these were prescribed and disposed of appropriately.

The people we spoke with told us they had no complaints but if they did they would talk to the manager who would sort it out.

Reports under our old system of regulation (including those from before CQC was created)