Parkside Nursing Home Also known as Part of the abbey total care group ltd group of services

Parkside Nursing Home is a residential care home providing personal and nursing care to up to 34 people. The service provides support to older people and those who live with dementia. At the time of our inspection there were 26 people using the service.

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

There was a lack of robust management oversight of the service. Quality assurance processes were not effective in identifying and delivering required improvements to the service which meant people were at risk of not receiving a consistent or safe service in line with their needs.

Risk assessments for those with specific healthcare conditions did not always provide consistent information around the additional care needs associated with those conditions. We found that there was an inconsistent approach to good hygiene practices. Damage to the fabric of safety equipment meant they posed an infection risk to people. Some equipment was not tailored to one person’s needs and posed an injury risk to them. The environment did not meet the needs of people who lived with dementia. In addition, certain areas of the service were in need of refurbishment.

Some people told us the quality and provision of activities was inconsistent. At times, we observed minimal staff engagement with those who were more difficult to engage as well as with those who were cared for in their rooms. We made a recommendation that the provider explores ways in which to improve communication.

People and their relatives told us they felt safe. There was robust oversight of medicines management. There were appropriate systems for recruiting, training and supporting staff. The staff felt supported and valued. We observed that they appeared to know the people they were caring for and treated them with respect.

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.

Family members told us engagement with the home had improved and the manager was approachable and readily available to them. They also told us that staff were consistently respectful, kind and caring. We observed how staff engaged with people in a warm and friendly way. Staff told us they felt supported and valued.

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 this service was requires improvement (published 28 April 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 01 March 2022. Breaches of legal requirements were found. We served Warning Notices in relation to Regulation 11 (Consent to care) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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 identified continued breaches in relation to safe care and treatment, person centred care premises and equipment and good governance.

We have made a recommendation about improving communication with people.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Parkside Nursing Home is a residential care home providing personal and nursing care to 25 older people and those who live with dementia at the time of inspection. The service can support up to 34 people.

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

Risks associated with people's care were not always managed in a safe way, particularly in relation to the safe management of medicines and good infection prevention and control practice. However, people and their relatives told us they felt safe and the provider had systems in place to ensure safe recruitment of staff.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People’s consent to care was not always evidenced and application of the Mental Capacity Act 2005 was inconsistent. Staff training was not effective in ensuring consistent good practice within the service. People’s needs were assessed prior to moving into Parkside Nursing Home and they had regular access to healthcare professionals, and they complimented the quality of food provided.

We found that some of the language used by staff was not respectful and at times, aspects of people’s dining experience lacked dignity. Care plans were not always person centred and they lacked guidance around the needs of people. When people's needs changed, these were not always updated in their care plans.

People’s end of life care choices were not always clearly documented and people cared for in their rooms did not always have access to meaningful activities. People told us they were confident they would be listened to if they made complaint. At other times we found staff treated people with kindness and took time to make sure they were comfortable.

Quality assurance processes were not effective in identifying and delivering required improvements to the service which meant people were at risk of not receiving a consistent or safe service in line with their needs. There was a lack of robust management oversight of the service. However, people and staff spoke positively about improvements initiated by the recently appointed the manager.

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 this service was requires improvement (published 19 March 2019) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider had not made enough improvement and remained in breach of regulations. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This five key question inspection was prompted in part due to concerns received about infection control, medicines and nursing care. A decision was made for us to inspect and examine those risks. We also checked if they had followed their action plan and to confirm they now met legal requirements.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified breaches in relation to medicines administration, consent, staff support and training, person-centred care and governance of the service.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Parkside Nursing Home 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. Parkside Nursing Home accommodates up to 34 people in one adapted building across two floors. At the time of the inspection there were 18 people living in the service.

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.

When we last inspected the service it was rated Good however at this inspection we found that areas there were areas that required improvement.

Whilst we received positive feedback from people, relatives and staff we found consent was not always obtained in line with the Mental Capacity Act 2005. There were no decision specific capacity assessments in place for important decisions such as the use of bedrails. People told us permanent staff were competent in their roles. The service was using agency staff which people told us sometimes affected the quality of the care provided. The environment for people living with dementia needed to be updated to help people move around the service.

Whilst permanent staff knew people’s needs very well there was a risk that care delivery could be affected as care plans contained incomplete or contradictory information. This was an area that the registered manager and staff told us work was needed to improve. Activities were provided however people told us they felt these were not always enough to help stimulate them or keep them interested. Some of the required refresher training for staff had not been completed.

There was a system of auditing in place however this had not identified the issues we found. Where audits were completed these did not always state what action should be taken to address the findings or give a timescale for this to be completed by.

People told us there were enough staff to keep them safe and we saw people being supported when they needed. A number of staff had recently left and there were plans in place to recruit new staff to address this. People received their medicines when they needed them by trained nursing staff who explained what the medicines were for. All medicines were stored and disposed of appropriately. Where there were risks to people these had been identified and managed well to help keep them safe. The registered manager monitored accidents and incidents to identify any themes or patterns. Staff spoke confidently about the actions they would take if they had a safeguarding concern. The service was clean and staff followed safe infection control practices.

People told us they liked the food provided and their nutritional needs were met. Staff supported people at mealtimes which were calm and relaxed. People’s needs were assessed and their healthcare needs met, specialist support was provided and guidance followed to maintain good health.

People and relatives told us staff were kind and caring and treated them with respect and compassion. Where possible people were able to discuss the care they received and make decisions on how this should be provided. People’s privacy, dignity and independence was promoted and visitors welcomed.

People told us they would have no concerns making a complaint if necessary and were confident this would be acted upon by the registered manager and staff. There was an experienced and established staff team who worked well together and followed guidance given by external healthcare professionals. The atmosphere in the service was homely and the registered manager knew people well and was approachable to them. CQC was notified of important incidents and events.

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.

The inspection took place on 27 July 2016 and was unannounced.

There was positive feedback about the home and caring nature of staff from people who live here.

People were safe at Parkside Nursing Home.

Staff understood their duty should they suspect abuse was taking place, including the agencies that needed to be notified, such as the local authority safeguarding team, CQC or the police.

Risks of harm to people had been identified and clear plans and guidelines were in place to minimise these risks. Accidents and incidents were recorded and acted upon. In the event of an emergency people would be protected because there were clear procedures in place to evacuate the building.

There were sufficient staff on duty to meet the dependency needs and preferences of the people that lived there. The provider had carried out appropriate recruitment checks to ensure staff were suitable to support people in the home.

People received their medicines when they needed them. Staff managed the medicines in a safe way and were trained in the safe administration of medicines.

Staff were knowledgeable and received a comprehensive induction and ongoing training, tailored to the needs of the people they supported. They also received regular supervision.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people’s ability to make decisions for themselves had been completed. Throughout the inspection day staff were heard to ask people for their permission before they provided care.

Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected.

People had enough to eat and drink, and specialist diets either through medical requirements e.g. diabetic meals, or personal choices organic foods were provided.

People were supported to maintain good health as they had access to healthcare professionals when they needed them. When people’s health deteriorated staff responded quickly to help and made sure they received appropriate treatment.

The staff were kind and caring and treated people with dignity and respect. Good interactions were seen throughout the day of our inspection, such as staff talking with people and showing interest in what people were doing and comforting them in an appropriate manner.

People could have visitors from family and friends whenever they wanted and there were positive relationships between people and staff which allowed people to express their views.

Care plans were detailed and provided good guidance for staff to reference if they needed to know what support was required. People received the care and support that reflected their needs and preferences.

People told us they enjoyed the activities on offer. There was a range of activities that met their social needs.

People knew how to make a complaint if they needed to. Complaints had been effectively resolved in line with the complaint procedures.

People and relatives gave positive feedback about the management of the service and felt they could speak to the registered manager whenever they needed to.

Quality assurance checks were effective at identifying areas where the service could improve. We saw that the records and policies in the home provided an effective tool for the registered manager to gain an oversight into how well and effective the service was run.

The registered manager notified us appropriately of incidents in the service.

People told us they "Liked" living at Parkside. Comments included "I like it here", "Well the food is wonderful" and "They are really superb here".

We found that the service had appropriate procedures in place to ensure that people received the correct medication at the correct times.

People spoke highly of staff and described them as "Wonderful" and "Kind". However, we found concerns that there were not enough staff to meet the individual social needs for people who lived in the home.

Staff we spoke with told us they felt "Supported" and "Enjoyed" working in the home. They told us that they received good training opportunities which helped them in their role.

We found that the service had completed the appropriate checks in order to maintain a safe and suitable environment for people. We also saw that there were systems in place to monitor the quality and effectiveness of the care that people received.

People spoke highly of the staff and described them as "Caring" "Loving" and "Kind". Another person said "It has really improved recently and staff are happy".

All of the people we spoke to said they liked the food and they haD plenty to eat. One person told us "The cook makes me the food I ask for" and "The food here is lovely".

People told us they were able to get involved in different activities and were able to choose what they wanted to do. One person said "I really enjoy doing the exercises here" and "I've started to improve with doing the activities".

People told us they were involved in their care and support. Comments included "You can get involved as much as you want to" and "The staff talk to me and tell me why it will help me if I do things".

All of the people we spoke with told us the home was kept clean and tidy.