Park House

Park House is a ‘care home’ which provides accommodation and personal care for up to 13 people living with dementia and other physical health needs. At the time of the inspection 11 people were using the service.

The service also provides community support (domiciliary care) for people living in their own homes. At the time of the inspection 12 people received support. Support currently provided ranged from individuals receiving 1 or 2 hours a week from one member of staff, to people receiving 4 visits a day from two staff.

The registered manager oversees both services from the care home office. There are 2 separate staff rotas to cover the care home and the domiciliary care team. However, some staff, on duty in the care home, also cover some short visits to people in the community.

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

The environment was safe and there was equipment available to support staff in providing safe care and support. However, the internal environment required updating and attention, with some areas found to be neglected and in a poor state of repair. Carpets were heavily stained and threadbare. Lino in a bathroom had holes in it, making it difficult to clean which posed an infection control risk, and many items of furniture were old and dated. For example, armchairs were badly stained and bedroom furniture was worn and scuffed. We also found many areas of the service were cluttered and untidy. A lounge was being used to dry laundry and a new washing machine had been left in the room and there were several boxes of activity equipment. This meant the room was not a pleasant environment for people to spend their time in. Boxes of equipment were left in many areas of the service. Though unsightly they were not stored in thoroughfares and did not pose a risk to people. The registered manager told us this was due to the lack of storage space available in the service.

Areas of the premises were no longer adequate to meet the needs of the service. Shared lounges and the kitchen area were small, and corridors were narrow which could pose difficulties for people using wheelchairs. A lift was available to upper floors. There was no sluice room in place. Shared bathrooms were outdated.

Council of the Isles of Scilly, who owned the property, have put forward a business case to central government for an integrated building which would include a new care home. They are still waiting for an outcome and decision following a visit from central government. At present money had been made available to upgrade and update the current property and to bring it up to standard. This had not commenced partly due to difficulties identifying a contractor to carry out this work as well as problems associated with the pandemic. One professional commented; “Unfortunately the building is very dated.” A relative said; “The building is very run down. It is very dated and could do with a total revamp or better still be relocated somewhere on the island to a more suitable site that caters for modern day needs.”

Staff for both the care home and DCA were recruited safely, however both the registered manager and nominated individual agreed that they had been struggling to recruit staff on the island. The service used agency workers from the mainland to cover shifts and staff worked extra shifts to cover vacant posts. Limited local housing options meant it was difficult to source accommodation for staff from the mainland, including agency staff which the service was relying on heavily. One relative said; “They do a great job, though have the pressures of staffing and the conditions. Shame they have the pressure of that which can take focus away from what they are doing.” Another said; “Additional funding is needed to help recruitment linked to housing provision for staff.” While a staff member said; “Can be difficult with staffing.” One professional commented; “I’m aware that they were struggling to recruit staff.”

We have made a recommendation about staffing in the report.

Health and safety checks of the environment and equipment were in place. However, we found the audits for checking some areas including weekly room checks, sling checks and daily environment checks were not completed. The registered manager told us that due to staff shortages these had not been completed recently. However, we requested and received updated and completed forms to say these checks had been carried out.

People who were able to, told us they were happy with the care they received, and people said they felt safe living there. One person said; “I’m looked after very well” and a relative said; “She (their relative) is safe with them.” People looked relaxed, happy and comfortable with staff supporting them. Staff were caring and spent time chatting with people as they moved around the service. A professional said; “I have always seen and heard the staff interacting with residents in a most positive, caring manner. They all have a lovely approach, engaging in conversation, while listening and responding to their individual needs.”

A professional said of the care home and the domiciliary care service; “We receive feedback from members of the community about health and care services that they have experienced. We have not received any negative feedback about Park House and the service that they provide.”

Medicines were ordered, stored and disposed of safely within the care home. All medicines were held in individuals’ bedrooms. People who lived in the community received visits from staff to check people had taken their medicines as prescribed.

People were supported by staff who completed an induction, received appropriate training and support to enable them to carry out their role safely, including fire safety and manual handling training. There was time for people to have social interaction and staff carried out activities to assist people. Staff knew how to keep people safe from harm.

Records were accessible and up to date. The service used a computerised care planning system which held records for the care home and for the domiciliary care service. The management and staff knew people well and worked together to help ensure people received a good service.

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.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately.

Records of people's care were individualised and reflected each person’s needs and preferences. Risks were identified, and staff had guidance to help them support people to reduce the risk of avoidable harm. People’s communication needs were identified, and where they wanted, people had end of life wishes explored and recorded.

Staff told us the registered manager was available, assisted them daily and helped cover shifts when needed. They went onto say how the registered manager was approachable and listened when any concerns or ideas were raised. A staff member said; “Feel very supported (by staff and management) and everyone very friendly.” A professional said; “Particularly I have found the manager of Park House to conduct themselves in a professional, competent, caring manner with genuine desire to care for, support and meet the needs of each and every one of their clients.”

People and their families were provided with information about how to make a complaint and details of the complaint’s procedure were displayed at the service.

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

Rating at last inspection and update

The last rating for the service was good, (published 2 October 2018.)

Why we inspected

This inspection was prompted by a review of the information we held about this service and due to receiving information of concern about people’s care.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We have found breaches in relation to the environment and governance.

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

Notice of inspection

This inspection was unannounced.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Park House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Park House accommodated up to fourteen people, and nine people lived at the service at the time of the inspection.

The service also provides community support (domiciliary care) for people living in their own homes. At the time of the inspection seven people received support. Support currently provided ranged from individuals receiving one or two hours a week from one member of staff to people receiving four visits a day from two staff.

The service did not have a registered manager, although the current manager had submitted an application to be registered with the Care Quality 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.

The service was viewed by people we spoke with as very caring. We received positive comments about the service. For example we were told, “I could not ask for better,” and “(My relative) has only good things to say about the care.” An external professional said, “Park House (provides) a high level of care and support…in a warm and supportive environment,” and another said, “Park House has undergone a significant change in the last year or so and now appears to me to be a vibrant, friendly and safe facility.”

People told us they felt safe. The service had a suitable safeguarding policy, and staff had been appropriately trained to recognise and respond to signs of abuse.

People had suitable risk assessments to ensure any risks of them coming to harm were minimised, and these were regularly reviewed. Health and safety checks on the premises and equipment were carried out appropriately.

There were enough staff on duty to meet people’s needs. The service had an effective recruitment procedure, and appropriate checks were carried out on new staff to ensure they were suitable to work with vulnerable people. Staff were suitably trained. Staff received a comprehensive induction when they started to work at the service, and they received regular supervision to provide them with feedback and guidance about their work. Overall staff had received appropriate training although some staff members still needed to complete some training required by law.

People in the community, who we contacted, said they were happy with staffing provided. The care people received was provided by a small group of staff, who they knew well. Staff arrived on time, stayed to assist them the correct amount of time, and did not leave out any assistance which they were required to give. People said staff had not missed any visits. One person said if there was any lateness, there was usually good reason, for example the carer had been delayed at a previous call. The person said staff were never late by more than 25 minutes. People said they did not receive personal care from someone from the opposite gender if they did not want this.

The medicines’ system was well managed, medicines were stored securely, and comprehensive records were kept regarding receipt, administration, and disposal of medicines. Staff who administered medicines received suitable training.

The service was clean and hygienic. The building was suitable to meet the needs of the people who lived there. There has been some decoration and improvement to the home’s environment.

There were suitable assessment processes in place before someone moved into the service. These assisted in helping staff to develop detailed care plans. The managers and staff consulted with people, and their relatives, about their care plans. Care plans were regularly reviewed.

People enjoyed the food and were provided with regular drinks throughout the day. Support people received at meal times was to a good standard. Comments about food included: “The food is very good,” “Excellent,” and, “Pretty good really.”

The service had well established links with external professionals such as GP’s, Community Psychiatric Nurses, District Nurses, and social workers.

Some people lacked capacity due to their dementia. Where necessary suitable measures had been taken to minimise restrictions. Where people needed to be restricted, to protect themselves, and/or others, suitable legal measures had been taken. No physical restraint techniques were used at the service. Staff had received suitable training about mental capacity.

Everyone we saw looked well cared for. People were clean and well dressed. The service provided some activities. We were told, “We play scrabble,” and we were told there were singsongs. We were also told the service made a lot of effort to celebrate community events, such as ‘May Day,’ and the manager said there had been a dinner where the wider community was invited to the service to encourage links with them. An external professional said, “I often see them [people using the service] out and about for walks or to visit local parks / fete / events.” The manager said some people liked to go out, so people would be assisted to go to the sea front, or to go out to have an ice cream. Activities provision was however currently being reviewed so a wider variety of opportunities could be provided.

The manager, and the management team were well respected by people, relatives, staff and external professionals. External professionals said managers were, “Supportive and helpful,“ and the manager had “Brought a refreshing stimulus to Park House with her welcoming personality.” Staff also said team working at the service was good, and team members were supportive and communicated well with each other.

There was a suitable quality assurance system in place. The managers had a hands on approach, and had a comprehensive system of checks and audits in place.

Park House is a care home which offers care and support for up to 12 predominantly older people. At the time of the inspection there were nine people living at the service, one of which was staying for a period of rehabilitation prior to going back home. Some of these people were living with dementia. The service occupies a detatched building over two floors. The service has a lift to support people who require assistance to access the upper floor.

The service also supported a domiciliary care service for 13 people who lived on St Mary's and the off islands. The staff who provided this care were provided with care plans and support out of hours by the social work team of the council.

The service had a registered manager in post. 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. However, the registered manager had resigned and would leave at the end of October 2016.

We walked around the service which was comfortable and personalised to reflect people’s individual tastes. People were treated with kindness, compassion and respect.

At the previous inspection in 2015 we found concerns with the medicines management and processes used by the staff. We found gaps in the medicine records which meant it was not always possible to establish if a person had received their prescribed medicines. Staff did not always record when they had applied prescribed creams and given eye drops. Medicines were not always stored at the correct temperature with the medicine cupboard reading a temperature of over 25 degrees centigrade. The temperature of the medicine refrigerator was not being recorded in a way that could ensure the safe storage of medicines within. Medicines which required stricter guidelines were not stored securely in accordance with good practice guidelines. Staff were administering medicines from a variety of difference packaging, including blister packs, dossett boxes and original packaging. This meant medicines could not be effectively audited to ensure people always received their prescribed medicines appropriately.

At this inspection we found there were only occasional gaps in the medicine administration records (MAR). Handwritten entries on to the MAR following verbal advice from medical practitioners were signed by two staff to help ensure the risk of any errors was reduced. Regular medicines audits were consistently identifying if errors occurred and these were being addressed with specific staff. Prescribed creams were mostly recorded by staff when applied. The medicine cupboard was recorded at 25 degrees. The staff told us there was a plan to vent the door to this cupboard to ensure that the cupboard did not exceed this temperature. The temperature of the medicine fridge was checked daily and was ensuring the safe storage of medicines that required cold storage. All medicines administered at Park House were given from original packaging. The service was planning to move to a system of blister packs and discussions with the local pharmacy were ongoing to arrange this. Staff regularly audited the medicines at Park House and errors had greatly reduced. Any errors found were now being addressed with specific staff through supervision. Medicines that required stricter controls were being stored securely. This meant that the service was now meeting the legal requirement for the safe and effective management of medicines.

The service had identified the minimum numbers of staff required to meet people’s needs and these were being met. The service did have three vacant posts and were covering these with agency staff. The islands were experiencing a great challenge in finding suitable accommodation for new staff once they had been offered a position. We were told of suitable applicants being offered posts who could then not accept the post as they could not find anywhere to live. An action plan had been completed to help address the critical staffing issues, raising the potential risk to safe care continuing to be provided at Park House.

Staff were supported by a system of induction training, supervision and appraisals. Staff received training relevant for their role and there were good opportunities for on-going training and support and development. More specialised training specific to the needs of people using the service was being provided. For example, dementia care training.

Staff meetings were held regularly. These allowed staff to air any concerns or suggestions they had regarding the running of the service. Staff felt well supported by the registered and deputy managers.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff supported people with their meals and drinks. Staff were provided with all meals when on duty and ate their meals together with people living at the service. This led to a relaxed sociable atmosphere where people chatted together throughout the meal.

Care plans were well organised and contained accurate and up to date information. Care planning was reviewed regularly and people’s changing needs recorded. It was not possible to establish if people, or where appropriate their relatives, had been given the opportunity to see their own care plan and sign in agreement with the contents.

Activities were provided by staff and volunteers from the local community. People took part in a variety of activity and also went out in to the local area regularly. However, some families told us they felt that their family member was left to sleep most of the time.

The registered manager was supported by a deputy manager and the local social work team.

We spoke with two people who received a care service in their own homes. We were told staff were kind and polite. We also spoke with the relative of one person. They all expressed satisfaction with the service delivered by Park House and told us the carers were reliable, dependable and provided good care. Additional comments were made including 'they are excellent I could not ask for a better service' and 'they come at the same time each day, rain or shine and will do anything extra I need'.

Staff were appropriately supervised and a training programme was in place to support them to carry out their roles effectively.

The confidential records belong to people who used the service and the staff were stored securely. Documentation regarding people's care needs was due to be updated using new templates that had been prepared.

Staff and people who used the service were satisfied with the staffing levels and competencies of staff both in Park House and when providing care to people in their own homes.

We spoke with two people who received a care service in their own homes. We were told staff were kind and polite. Both people said the service they received from their main carers was very good, reliable and dependable. Comments they made about their main carers included; 'wonderful', 'very very good' and 'looks after me so well'. They said this changed when their main carer was on leave. One person said the visits could be up to two hours late and they were not informed of who was visiting or if the appointment was going to be at a later time.

People who used the service were safeguarded against abuse as the home had provided guidance and training to the staff regarding the action they would take if they became aware of any safeguarding issues. There was insufficient staff in place to meet people's preferred and assessed care needs when they received a service in their own home.

Staff were not supervised, although training was available to support them to carry out their roles effectively.

Not all personal records were not stored securely, some records could not be located promptly and we found records were not consistently up to date or accurate.

One person gave us examples of how the staff supported them to make choices on how they spent their day. They told us 'I like to stay in my room, I am not bothered about going to the lounge. I choose what I do and the staff always help me to do things'.

We saw the privacy and dignity of people was respected by the staff as prior to entering a bedroom, toilet or bathroom they knocked on the door. We observed the care staff were kind and caring in their approach and when communicating with people who used the service.

The home had, since our last inspection, appointed an activities coordinator, who organised activities three times a week.

We found that while action had been taken to keep people safe from abuse, the correct reporting procedures had not been followed for one issue that had arisen.

The training programme for staff had been reviewed and developed and steps taken to ensure a training schedule was in place for staff to complete. Not all staff had completed the relevant training to ensure they were trained and competent to meet the care needs of people who used the services of Park House.

All of the people we spoke with in the home, told us they liked living at Park House. One person who used the service told us 'the staff are very good and always very polite and kind to me'. Another person said 'it is paradise here and I am very lucky to be here as everything is top class'.

We observed interactions between staff and people who lived at Park House and saw they communicated with people in a polite, friendly and respectful manner. The atmosphere in the home was warm and homely.

People did not consistently experience support that met their needs as there were limited activities available in the home, particularly for people who required dementia care. The care and treatment provided to people met their needs but staff did not receive full guidance or instruction in people's own care plans.

Staff were not provided with sufficient training, policies or procedures to ensure that people who used the services were protected from abuse.

Records were not available to demonstrate that an effective recruitment procedure was in place to ensure that people's needs were met safely by appropriate staff.