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Archived: The Park Residential and Nursing Home Good

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Reports


Inspection carried out on 25 March 2019

During a routine inspection

About the service:

The Park Residential & Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The Park Residential & Nursing Home accommodates up to 41 people in a purpose built building. At the time of the inspection there were 36 people in residence.

People’s experience of using this service:

¿ We found improvements had been made following the previous inspection of the service by the Care Quality Commission.

¿ We found The Park Residential and Nursing Home met the characteristics of a ‘Good’ service.

¿ People and family members were consistent in their praise for the service provided. A family member told us, “I would recommend it here, I have done. I feel positive about the place and have peace of mind, I have faith in their judgement and the care they give. If I have any concerns I can raise them, and I go to the appropriate people and I know they will listen.”

¿ People’s safety was promoted. We found there were sufficient staff to meet people’s needs who had undergone a robust recruitment process. Staff had a clear understanding as to how people’s safety was to be promoted as they had received and continued to receive training and guidance.

¿Staff followed the information within people’s records to reduce potential risk, promoting people’s health and wellbeing. People’s medicines were managed safely, and prescribed medicines were regularly reviewed by a health care professional.

¿ People lived within a clean and well-maintained environment which met their needs. The service was homely and welcoming and provided opportunities for people to socialise, both within the service and the garden. Equipment to promote people’s independence and meet their personal care needs was provided.

¿ People’s needs were regularly reviewed with their involvement or that of a family member and changes were acted upon, which included referrals being made to the relevant health care professional. The service had strong links with a local surgery who provided scheduled and regular visits by a health care professional, to support people’s health and welfare.

¿ People spoke positively about the meals provided, all meals and foods were homemade and met people’s dietary requirements. Food and drinks were in plentiful supply, with snacks and drinks being served throughout the day. Mealtimes were an important social event. Family members were encouraged to join their relatives for meals.

¿ People’s rights and choices were promoted on an ongoing basis. Where people were not able to make informed decisions, then decisions were made in their best interest. Family members were consulted about their relative’s health as part of best interest decisions.

¿ People and family members were consistent in their praise of all staff for their care, attitude and approach. People’s equality, diversity and individuality was understood and respected. Staff had developed caring and positive relationships with people and their family.

¿ People’s needs were regularly reviewed and updated with their involvement and that of a family member. People and family members understood how information was stored and maintained and the legislation that governed the sharing of personal information.

¿ Effective systems were in place for staff to share information about people, so they could respond to people in a timely and coordinated manner.

¿ People had opportunities to take part in activities within the service and the wider community, which were provided by staff and by external companies.

¿ People’s views and that of their family members were regularly sought and the registered manager implemented changes based on the feedback they received, which had had a positive impact on the quality of the service as commented upon by people and their family members.

¿ Staff, peo

Inspection carried out on 28 June 2017

During a routine inspection

This inspection took place on 28 June 2017 and was unannounced. At our previous inspection during July 2014 the provider was not meeting all the regulations we checked. The provider was required to make improvements under effective. At this inspection we found that improvements were still required under effective. Improvements were also identified under safe.

The Park Nursing Home is located close to Derby City Centre, and provides nursing and personal care for up to 41 older people. The service supports people living with dementia and or a physical disability. At the time of our inspection there were 39 people using the service. There are bedrooms on the ground and first floors. Access to the first floor is via a stairwell and a passenger lift. Communal areas were located on both floors.

There was 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.’

Most people and visitors felt that staffing levels were not always adequate. This did not ensure people’s needs could be met safely, due to staffing levels and staff deployment. The provider's arrangements for staff recruitment did not ensure that only suitable people were employed. We found that all the required pre-employment checks were not in place.

We found that the provider's quality assurance systems had not picked up the issues we identified at this inspection visit. This demonstrated that the management systems were not always effective in recognising areas which required improvements.

People felt that staff who looked after them knew them well and had the skills to support them. However some staff felt that the induction program was not detailed and did not provide them with the skills to carry out their roles effectively.

The Mental Capacity Act 2005 (MCA) helps to ensure that people are supported to make their own decisions wherever possible. Where people were identified as not having capacity there was no information to show the care and support provided was in the person’s best interests. Staff knowledge on the MCA varied.

People and relatives we spoke with felt people were safe at The Park Nursing Home. The provider had taken steps to protect people from harm. Staff had an understanding of potential abuse and their responsibility in keeping people safe. The provider had procedures in place for the management of medicine. This showed the provider could be confident that people were receiving their medicines as prescribed.

People were supported by staff that were kind and caring. People's choices and decisions were respected. Staff respected people's privacy and dignity. People were supported to maintain relationships which were important to them.

People were supported to maintain a diet that met their dietary needs. People were supported to use healthcare services.

There were processes in place for people and their relatives to express their views and opinions about the service provided. There were systems in place to monitor the quality of the service to enable the registered manager and provider to drive improvement.

People felt the management team at The Park Nursing Home were approachable and felt that if they had concerns they would be listened to. Staff felt supported by the registered manager.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 21 July 2014

During a routine inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

The Park Nursing Home provides accommodation and personal care for up to 41 older people who may have a dementia related condition. On the day of our inspection 35 people were using the service.

On 17 April 2013 our inspection found that the care provider breached Regulations relating to cleanliness and infection control, medication management, staff training and records. Following the inspection the provider had implemented an action plan recording how the service planned to make the required improvements. During this visit we looked to see if these improvements had been made.

The home had a manager who was registering with us. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law, as does the provider.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLs) and to report on what we find. Adults without capacity must receive the appropriate help and support to make decisions. We saw information that some best interest meetings had taken place where people lacked capacity but further assessments and applications were needed. Whilst there was a better range of staff training than before, and it was provided more often, we saw the learning was not always put into practice in relation to the Mental Capacity Act 2005. The staff knowledge was limited and in some cases was not up to date. This meant people without capacity may not receive support in there best interest or in the least restrictive way of their basic rights and freedoms.

The staff were kind and respectful to people when providing support. We saw staff smiling and laughing with people and joining in with hobbies and interests in the home. People received visitors throughout the day and we saw they were welcomed and participated in daily events. People told us they could visit at any time.

We found that people’s health care needs were assessed and care was delivered in a consistent manner. Risk assessments were in place and care was reviewed which meant people’s individual needs were being met and records were up to date. There were enough staff to support people safely and meet their needs. We saw new staff had been recruited correctly.

We observed medicine being administered and saw that suitable systems were in place.

People were supported to eat and drink enough to keep them healthy.

The home environment was safe and well maintained. Improvements had been made in relation to infection control and the cleanliness of the home. Further improvements were needed to ensure effective monitoring and suitable recording systems were in place.

The manager investigated and responded to people’s complaints according to the provider’s complaints procedure. People we spoke with knew how to make a complaint.

Records showed that we, the Care Quality Commission (CQC), had received notifications. A notification is information about important events which the service is required to send us by law.

We found the provider had one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 17 April 2013

During a routine inspection

People told us �It�s lovely here, they take good care of me�, and �If you want anything they will fetch it for you�. One person said �They do everything they can for me, I find it quite alright". We asked people if they knew about their care plans, and they did not.

We observed staff treating people with kindness and dignity. Staff were patient and encouraging when assisting people with their meals. Staff maintained eye contact with people and talked them through each stage of the assistance. People were offered a choice of meal, and alternatives were available. Catering staff had a good knowledge of people�s individual dietary needs.

Care records were not always specific about what moving and handling equipment to use. People�s capacity to make decisions was not always recorded. Care plans were reviewed monthly, although not always updated to reflect changes.

We saw staff supporting people to take their medication. Records did not support people always received their medication as prescribed.

Staff told us they received appropriate training and development. Not all staff were up to date with their moving and handling training. Staff were unclear as to whether they received supervision and how frequently this took place.

We saw records relating to health and safety checks of the building were up to date. We noted the building was not cleaned to a satisfactory standard and not all equipment was in a good state of repair.

Inspection carried out on 8 October 2012

During a themed inspection looking at Dignity and Nutrition

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by a practising professional.

We observed that when staff were supporting people when delivering care they treated people with respect and dignity. The registered nurses and care workers were polite and treated people in an appropriate manner. We saw staff were aware of people�s preferred names and used this name when speaking with people.

We saw that one of the registered nurses and the majority of care workers were not particularly attentive when they were supporting individual people with their meals. For instance talking with them whilst supporting them to eat or drink and explaining what food was on their plate.

Staff were not attentive to people's needs. They did not recognise how one person's behaviour at the dining table impacted on other people, or see that people could not reach their meals comfortably as they were sat too far away from the table.

We saw that people were not supported to have sufficient food and drink. Two people left the dining room after lunch having not been offered a drink with their meal. No one was offered an alternative meal or snack if they did not eat their main meal.

Relatives and people spoken with did not raise any concerns about living at The Park or about the care they received. Staff had a good understanding of the forms of abuse people would need protecting from. Staff told us what action they would take if they witnessed any abusive practices and would �always report incidents to the nurse in charge or the manager.�

We asked people if they thought there were enough staff to meet their needs. People did not raise any concerns that their needs were not responded to at any time. We spoke with three care workers about staffing levels.

They told us they felt the staffing levels were sufficient to meet people�s needs as long as everyone was doing their job properly. They explained that this meant not taking additional breaks during the shift. The registered nurses told us they felt that the staffing levels for care workers were not adequate, and they had raised their concerns regarding this.

People were asked if staff spoke with them about their care needs. They told us staff did not speak with them about their care needs and they had not seen their care plans. They did not express any concerns about this. One person told us they hadn�t seen their relative�s care plan but they weren�t concerned about this, as they knew what care was being delivered and were satisfied with this.

Care records and food and fluid diaries were not accurate and up to date. Several care records did not have up to date care plans and feeding regimes for people who required supporting with maintaining adequate nutrition.

Inspection carried out on 22 February 2012

During a routine inspection

We spoke with people who used the service and listened to what they had to say about their involvement in the care and support they received. We spoke with two people who told us they regularly go out into the community, either on their own or supported by care workers. We saw that care workers were attentive to people�s needs and feelings during our visit.

One person told us �This is the best place I have lived, and I�ve been in a few places.� Another said �I like it here, the staff are very good. I am very happy.�

People told us they were able to spend their day as they wished. One person told us they spend time sitting in the garden during the day, another person was involved in planting vegetables.

We asked people about the meals and people commented that the meals were good and they enjoyed them. We saw that people had been asked what choice they would like from the menu, and individual requests, such as �no gravy� were also recorded.

People told us about activities. They told us that a trip to the seaside was being organised, and that care workers also took different people into the city centre each week. They also told us that they could also arrange to go out individually with care workers. We saw information about activities was on display around the building.

People told us there was a religious service held once a month. A number of people continue to attend services at their own church, and representatives of the Roman Catholic church visit and provide communion.

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