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Archived: Parklands House Care Home Inadequate

Reports


Inspection carried out on 27 and 28 October 2014

During a routine inspection

Parklands House provides nursing care for up to 57 people whose primary care needs are mental disorder or dementia care. Qualified nurses, supported by care assistants, provide 24-hour nursing care. At the time of our inspection there were 35 people living at the home.

This was an unannounced inspection carried out over two days, 27 and 28 October 2014. During this inspection we looked to see if outstanding breaches in regulation and the warning notice, issued on the 15 September 2014 had been met. We also looked at other areas of the service to check the provider was meeting the regulations.

The home has no 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.’

People’s safety was being put at risk as the medicine management system did not demonstrate people received their medication as prescribed. We found there was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Suitable arrangements to effectively maintain hygiene standards within the home and minimise the risk of cross infections were poor. We found there was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Where people’s freedom was being restricted the management team had sought appropriate advice and support so that decisions could be made in people’s ‘best interests’. This helped to ensure people were protected. Accurate records about the individual support needs of people were not maintained. Care records did not reflect how people were being restricted, how risks were managed or reflect their changing health needs. We found there was a breach of Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

People were not always able to tell staff if they needed help. People were reliant on staff to identify any change in their health and well-being and seek appropriate help and advice. We saw where people had lost a significant amount of weight loss, this had not been acted upon. This could result in people’s healthcare needs not being met. We found there was a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

People did not receive care and support that was delivered in a dignified and timely manner. Visitors to the service told us they had witnessed people having to wait for assistance and they looked unkempt. They said people were left without staff supervision and had to seek out staff when people needed assistance. We saw staff did not always provide meaningful interactions with people. We found there was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

People were not always supported by sufficient numbers of staff to keep them safe. Due to the turnover in staff there had been a reliance on agency staff to support people. We found these staff were not aware of the individual needs of people. We found there was a breach of Regulation 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Systems to monitor the quality of the service were not robust. Where audits had been completed and areas of improvement had been identified, the provider could not show us that appropriate action had been taken to improve the quality of service people received so that they were kept safe. This put people at risk of harm or injury. We found there was a breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Effective management arrangements providing clear leadership and support for staff were not in place. New staff spoke positively about working at the home and the support they had received from colleagues. However existing staff had not received updated training and support in areas specific to the needs of people living at Parklands House. We found there was a breach of Regulation 23 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Staff recruitment processes had improved however not all checks about the suitability of staff had been completed prior to them commencing work. This puts people at risk of being cared for by staff that are unsuitable to work with vulnerable people. We found there was a breach of Regulation 21 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

People told us they liked living at the home and liked the staff. They told us they enjoyed the food and maintained relationships with family and friends. Improvements were needed so that people were effectively supported or encouraged to take part in activities specific to their needs and abilities.

Inspection carried out on 5 August 2014

During an inspection in response to concerns

We carried out this inspection to check whether Parklands House Care Home had taken action to comply with the Warning Notices served on them in July 2014.

We found that robust records were not maintained, evidencing how important decisions had been made to safeguard people from harm or injury and ensure their rights were protected.

Where issues or concerns were identified the provider did not always ensure this was effectively communicated to the relevant authorities so that appropriate action could be taken in a timely manner to help keep people safe.

The manager of the home was not registered with the Care Quality Commission (CQC). An application had been made however had not yet been approved.

Care records did not fully reflect the current and changing needs of people. This meant staff were not clearly directed in the safe delivery of care ensuring people�s needs were appropriately met.

Improvements had been made with regards to the auditing and monitoring of the service. The manager was aware further improvements were needed across the service and was working with senior managers to address this.

Inspection carried out on 9 June 2014

During a routine inspection

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

� Is the service safe?

� Is the service effective?

� Is the service caring?

� Is the service responsive to people�s needs?

� Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service and their relatives, speaking with the staff supporting them, and from looking at records.

Is the service safe?

Suitable arrangements were not in place for obtaining people�s consent to their care and treatment where people lacked the capacity to make decisions for themselves. Where people were potentially being �deprived of their liberty�, the provider had not acted in accordance with legal requirement so that people�s rights were protected.

Systems to safeguarding people from the risk of unsafe care were not in place. Events affecting the well-being of people were not adequately recorded or reported so that people were protected.

The management and administration of people�s medication was safe.

Recruitment and selection procedures were not robust; necessary to ensure the suitability of applicants before being offered work at the home.

Hygiene standards within the home were poor and did not ensure people were protected against the risk of infection.

People were provided with a choice of suitable and nutritious food and drinks to ensure their nutritional needs were met. More appropriate cutlery and crockery was needed to promote people�s dignity and independence.

Is the service effective?

Not enough staff were provided to safely and effectively meet the needs of people.

Arrangements to clearly lead and support the staff team, including agency staff, were not in place. This meant people did not always receive the care and support they needed.

On-going redecoration and refurbishment of the home will ensure people are provided with comfortable, well maintained accommodation.

Is the service caring?

People were not always cared for in a way which maintained their dignity. People looked unkempt and had not been supported in addressing their personal care needs.

Whilst staff were seen to speak with people in a kind and sensitive manner, at times there was little or no communication or activity with people.

Care records contained enough information to show how people were to be supported and cared for. Information included details of people's needs, their life history and their routines.

Is the service responsive to people�s needs?

People had access to support in addressing their health needs. Records did not, however, always reflect how peoples changing needs were to be met or if additional health care support had been accessed to minimise the risks to people.

Incidents potentially affecting the well-being of people were not adequately recorded or reported to show that appropriate action had been taken when responding to the changing needs of people.

Is the service well-led?

We were aware there had been no registered manager at the home since June 2013. In this report the name of the 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. The present manager had made application to registered with Care Quality Commission (CQC).

Systems to monitor and review the quality of care and facilities, as well as opportunities for people to give their views about their experiences were not in place. This information would help to identify where improvements could be made within the home.

Servicing and checks had been completed to the equipment and facilities provided. Action identified to some areas had not been addressed. This puts the health and safety of people living and working at the home at risk of harm.

CQC had not always been notified about notifiable accidents and untoward incidents, as required by legislation. This helps us to monitor events within the home and check that appropriate action has been taken to keep people safe.

Inspection carried out on 9 October 2013

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

The purpose of this visit was to look at what improvements had been made since our inspection in June 2013. We had also received a number of concerns about the safety and suitability of the premises, staffing arrangements and the management and conduct of the service.

Opportunities to enhance people�s daily routines were being made. This included the appointment of therapeutic and recreational staff. People�s individual needs and preferences were being explored so that social and development opportunities could be offered.

From our observations we found staff to be very attentive and were aware of what care and support people using the service required. It was noted that arrangements in relation to pressure care could be improved so that the risk to people was minimised.

Work to improve the standard of accommodation had started. Completion of the work throughout the home will ensure that people are provided with a good standard of accommodation in which to live. Hygiene standards in some areas of the home also needed improving.

Suitable staffing arrangements were in place. Further recruitment had taken place to fill vacancies for both care, ancillary and therapeutic and recreational staff.

Staff spoke positively about the manager and work carried out since they joined the team at Parklands. Staff spoken with felt supported in their role. One staff member told us, �His [the manager] focus is very much on improving things for people who live at Parklands�.

Inspection carried out on 20 June 2013

During a routine inspection

As part of this inspection we looked at what progress had been made following our last inspection at the home. We also observed the care provided by staff and spoke with people who lived at the home and their visitors.

Some of the comments received varied about people�s experiences. One person living at Parklands told us, �Yes, it�s alright here� and �The foods good�. However in relation to daily routines they added, �There�s nothing to do� and �It�s boring�. A visitor told us; �I can visit at any time� and �my [relative] seems to have settled well�. They added, �Staff do the basics, clean, dress and help people with their meal but that�s it, they are not proactive, need pushing to do things�.

Improvements were found in the individual care records completed when assessing and planning people�s care so that staff knew how to meet people�s needs.

Suitable arrangements were in place with regards to meeting the nutritional needs of people. Further consideration was needed with regards to how people were supported with their meals to help provide a more sociable activity.

Refurbishment and redecoration of the home was required to improve the standard of accommodation provided.

Suitable arrangements were in place when recruiting new staff. Systems offering on-going training and support for staff had also been developed.

Systems were in place to monitor and review the quality of the service provided.

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