Parker House Nursing Home

People’s experience of using this service and what we found

Risks were not consistently managed or monitored. This placed people at an increased risk of avoidable harm. Risks relating to people's environment were inconsistently managed. Medicines were not always managed safely. People were not always protected from the risk of infection as staff were not consistently following safe infection prevention and control practices. People and their relatives told us they felt safe living at the service. Lessons were not always learnt following incidents. This meant there was an increased risk incidents could be repeated.

Staff were not always recruited safely, and we found the provider did not always ensure there were enough suitable staff to support people in a timely manner. The provider took immediate action to ensure safe staffing levels were in place. We have recommended the provider reviews their recruitment process to ensure all staff are safely recruited.

Internal quality assurance processes were not effective in monitoring the service. Health and safety audits were not always effective in monitoring safety and driving service improvement. People and their relatives were inconsistently involved in developing the service. The culture at the home was not always person centred. Relatives we spoke with told us they were informed when things went wrong. Staff worked in partnership with others.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 28 October 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We carried out a focused inspection to review the key questions safe and well led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well-led section of this full report. You can see what action we have asked the provider to take at the end of this full report.

During our inspection the provider took some action to address the concerns we found to mitigate risks. Risk reduction measures implemented during our inspection were found to be effective in managing some of the risks we identified.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Parker House Nursing Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to medicines, infection control, management of risk, the premises and quality monitoring of the service at this inspection. We have also recommended the provider reviews their recruitment process.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

At the time of the inspection there was an outbreak of an infection and the home was closed to visitors. Systems and processes were in place to promote safe visiting when the home is clear from COVID-19.

People who had tested positive for COVID-19 were asked to self-isolate in their own bedrooms. People who were unable to self-isolate, for example people who lived with dementia and liked to walk with purpose, were kept separated from others to reduce the spread of infection as much as this was practicable.

Enhanced cleaning of the home had been implemented. This included regular cleaning of high touch points such as handrails, door handles and light switches. Some areas of the home were showing signs of wear which made cleaning more difficult.

People were monitored for the symptoms of COVID-19. Checks on temperature and oxygen levels were undertaken daily to enable staff to quickly identify any changes in people’s health. Changes in people’s health were reported to the GP.

People and staff were taking part in regular testing for COVID-19. Staff were asked to complete Lateral Flow Device (LFD) test prior to coming to work, to ensure they were infection free.

The home had up to date policies and procedures about infection prevention and control which reflected the latest government guidance.

The service had a registered manager in place at the time of our inspection. 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 felt safe in the service and staff understood their responsibility to protect people from the risk of harm or abuse. The risks to people’s health and safety had been assessed and were kept under review to ensure that action taken to reduce risks was effective. There were sufficient numbers of staff to meet people’s needs in a timely manner and systems were in place to support people to take their medicines.

Staff received relevant training and felt supported. People were asked for their consent before support was provided and people who lacked capacity to make certain decisions were supported appropriately. Although information about the choice of food available to people was not always communicated clearly, people were supported to eat and drink enough. People were supported to maintain good health and referrals were made to health care professionals for support and guidance if people’s health changed.

People were supported by a caring staff team who interacted warmly and with compassion. Staff offered people explanations and provided them with information in order to promote choice and independence. Staff supported people to maintain their privacy and dignity.

People’s needs were responded to by staff who knew people well and respected their choices and preferences. Care plans were in place which provided detailed information about the care people required. The care that people received was recorded and some improvements were required to ensure this reflected the support provided. People felt confident to raise concerns and felt these would be acted on.

People and their relatives felt that management team were approachable and responsive. People’s views about the quality of the service they received were sought and records showed that suggestions about improvements had been acted upon. Effective systems were in place to monitor the quality and safety of the service.

The service had a registered manager in place at the time of our inspection. 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.

Although risks to people were identified and assessed and people were supported by sufficient numbers of staff, risks were not always minimised by staff following good practice in relation to equipment and moving and handling.

People received their medicines when they needed them but the management of medicines required further improvement.

People felt safe in the service and staff understood their responsibility to protect people from the risk of abuse. We found that the registered manager had shared information with the local authority when needed.

People were not consistently asked for their consent before support was provided. Where people lacked capacity to do so they were protected under the Mental Capacity Act 2005. People were not deprived of their liberty without the required authorisation being applied for.

People were not always provided with timely support in relation to eating and drinking. Referrals were made to health care professionals for additional support or guidance if people’s health changed.

People were cared for by staff who received training and support. We observed that staff were compassionate in their care and interactions with people who used the service.

People were encouraged to make choices about the care they received and people’s privacy and dignity were respected by staff.

People told us that they felt that activities at the service were limited and we observed this to be the case during our visit. Records did not always show that people received care when they needed it.

People, and their relatives, told us they would feel comfortable making a complaint to staff or the registered manager. Records showed that complaints were responded to appropriately.

There were systems in place to monitor the quality of the service however these were not always effective in identifying issues within the service and the appropriate action being taken.

People felt that the management team were approachable and responsive to any concerns. People’s views about the quality of the service they received were sought and staff felt they received a good level of support from the registered manager.

During our previous inspection visit on 18 and 19 April 2013, we found that people were not protected from the risk of infection because appropriate guidance had not been followed. During our inspection visit on 28 November 2013, we found that there were effective systems in place to reduce the risk and spread of infection.

On 18 and 19 April 2013, we found that the provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others. During our inspection visit on 28 November 2013, we found that the provider had taken appropriate steps to ensure they identified risks and took appropriate action to minimise potential risks to people who used the service and others.

We found people's needs were planned for and delivered appropriately. The people we spoke with said they were happy with the care they received and knew who to speak with if they wanted to raise a concern. People using the service spoke positively about the staff working in the home saying they were, 'Caring and kind' to them.

We were concerned about hygiene standards at the home and that quality monitoring systems had not identified this as a problem. Although quality monitoring systems have improved, they are not effective enough to identify, monitor and manage risks to people who use the service.

People told us they were treated with respect and dignity. One relative explained they were very pleased with the home and that care was delivered to a high standard. We were told, "They're lovely, you can't fault them."

One person said, "I am happy here."

We spent periods of time sitting with groups of people so that we were able to observe their experiences of living in the home and their interactions with each other and the staff.

Because some of the people we spoke with had dementia they were not always able to tell us about their experiences. We have therefore used a formal way to observe people in this inspection to help us understand. We call this the 'Short Observational Framework for Inspection (SOFI). This involved us observing five people who used the service for an hour and 15 minutes, recording their experiences at regular intervals. This included people's mood, and how they interacted with staff members, other people who use services, and the environment.

We found that people's privacy and dignity was not always respected and that the home could not provide sufficient evidence to demonstrate that they were fully assessing people's care needs.

We found that checks were not taking place to ensure the safety and comfort of the premises and some of the equipment in use to support people's care needs.

Appropriate levels of competent staff were not always in place to meet people's needs and the provider could not evidence how risks to the delivery of care were identified and managed.