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

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question inadequate. At this assessment the rating has changed to good.

This meant people were safe and protected from avoidable harm.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had made improvements since the last inspection and had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Incidents and accidents, safeguarding concerns and complaints were recorded appropriately. These were reviewed, discussed and analysed to determine any underlying causes or trends and identify any actions required to improve the service.

Staff told us regular meetings were used to share information about any incidents along with any learning and we saw evidence of this. Staff knew how to report and document any incidents or accidents.

Healthcare professionals felt the staff team met people’s needs and were always willing to learn. Their comments included, “I do not have any concerns. As with any busy service there are always areas that can be improved, but concerns are listened to and acted upon. There appears to be a genuine willingness to learn and improve” and “The managers are accessible and responsive and appear to take concerns and feedback seriously.”

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People told us they felt safe living at Parkside Nursing Home. They told us the staff were available if they needed support. Relatives stated they were informed when their family members required support or treatment from different agencies.

The staff team and managers told us they worked well with other professionals to ensure continuity of care, including when people moved between different services or required temporary stays in hospital. The registered manager told us, “Depending on each case, but if they go to hospital, we send an escort with them. Sometimes the nurses go and assess people or I go. We then look at people’s needs and decide if we can meet these. We then liaise with the local authority, brokerage etc.”

Staff told us they were happy working at the home and felt supported and listened to. They said they received training that equipped them to do their job well and care for people who used the service. Documents we viewed confirmed this.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People said that in general they felt safe and protected from abuse. One person told us, “Very safe, I don’t worry.” A relative agreed and told us, “Absolutely, nothing to worry about as far as I’m concerned.”

Records showed that safeguarding concerns were reported appropriately. The service was working alongside the local authority safeguarding team to ensure processes to manage risks were in place and monitored. Staff received safeguarding training and demonstrated an understanding of the different types of safeguarding, reporting procedures and the whistle-blowing policy.

The provider acted in accordance with the Mental Capacity Act 2005 (MCA). People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). At the time of our inspection, nobody was being deprived of their liberty unlawfully.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe and supportive.

Although most people said staff knew their needs and met these safely, one person reported the night staff hurt their arm when supporting them. This was reported to the provider on the day of our visit and action was taken to investigate this. Another person reported male care workers were often ‘heavy handed’ and did not realise their own strength.

Although there were processes in place to help ensure risks to people were assessed and mitigated, these were not always effective enough. We observed one person’s toenails were excessively long and sharp. This increases the risk of skin tears. The person’s care plan stated ‘to arrange for chiropodist to care for toenails’. Although we were told the person had refused to be seen by the chiropodist, not enough had been done to support the person with this. The registered manager took appropriate action following the inspection.

Incidents and accidents were recorded and action followed up appropriately. However, a relative told us where their family member had sustained an injury whilst being transferred and did not feel it was dealt with well. They said, “The follow up was not good. It happened 2 or 3 months ago. It was not dealt with very well. It happened at night. Communication was not good. Nothing was explained.” We saw evidence, however, that appropriate actions had been taken following this incident.

Some people told us staff did not always support them in a timely manner. One relative told us, “I am very happy but the only problem is if [family member] soils [themselves], [they] have to wait ages as [they] need 2 staff.” We reported this to the registered manager who told us they would address this without delay. Another person reported they were experiencing severe stomach pains. We discussed this with the registered manager. Following the inspection, they told us new pain medicines had been prescribed for the person and they had started taking these.

Notwithstanding the above, we saw that risk assessments were completed and were comprehensive and regularly reviewed. They were accessible to staff in areas including mobility, nutrition, falls and specific health conditions. Where required, referrals were made to external professionals such as speech and language therapy, community mental health services and the district nursing team. Advice and guidance provided was followed to minimise risks to people’s safety.

Incidents and accidents were recorded and contained details such as a description of events leading up to the incident, action and response and post incident analysis. Each report also highlighted what has been put in place to prevent re-occurrence. Following the incident, an action plan was put in place and care plans and risk assessments were reviewed.

Personal emergency evacuation plans were in place for each person. These contained detailed information about each person and the support they required to safely evacuate the building in the event of a fire or other emergency.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Overall, the environment was safe and well maintained. However, we identified some exposed pipes in an area of the ground floor. This increased the risk of injury if someone fell on these. We also saw some of the tiles of the wall leading to the garden were broken. We discussed this with the registered manager who took prompt action and sent us evidence the pipes had been boxed in and the tiles repaired.

The management team and staff worked together to help ensure faulty equipment or trip hazards were identified and addressed promptly. There was no permanent maintenance person employed, but whenever anything required attention or repair, the service had access to maintenance staff who came and addressed concerns.

We saw that safety checks were completed daily and weekly in all areas of the home to ensure safe systems were in place. These included water temperatures, fire safety checks and kitchen equipment.

The environment was developed to meet the needs of people, including those living with dementia. This included contrasting coloured handrails, memory boxes and names and room numbers on most doors. There was signage to support people to find areas of the home such as bathrooms and toilets. The home was bright and airy, and bathrooms and toilets were large enough for people to access including those requiring hoisting or in a wheelchair.

There was a range of items displayed to aid people’s memory, such as an old-fashioned telephone box, a letter box (which was used as a suggestion box), and various photographs and posters of movie stars of the past.

People’s art was displayed in communal areas, demonstrating involvement in meaningful activities and helping to personalise shared spaces. An activity plan for the day was clearly displayed for people to see what was happening each day. Pictorial menus were also displayed for people to see. However, this was displayed in the dining area, which few people used.

Emergency procedures were well-documented and regularly reviewed. Equipment used to support people was suitable, well maintained and stored securely. The provider had an up-to-date emergency plan in place to help ensure people were supported in the event of an emergency.

People’s bedrooms were personalised with photographs and items belonging to them and were homely and clean.

The provider had systems in place to determine staffing levels and deploy staff according to people's assessed needs. However, some people told us they experienced delays when requesting support. Their comments included, “They’re short staffed. Getting up in the morning, sometimes I have to wait up to 2 hours. They come in and wake you up at 6am but don’t get you up until 8” and “I press my buzzer when I’m in my room and in here (lounge) when I need the toilet and they don’t come, they tell me to wait. I do have an accident and I can’t help it, it upsets me.” A relative echoed this and said, “The only thing is the staff shortage. We did point it out as with their conditions, it takes 2 staff and if someone kicks off. They have tried to recruit.”

The provider used a dependency tool to help ensure there were always enough staff to meet people’s needs. The staff rotas indicated they ensured the correct number of staff were deployed according to the tool. In addition, where people raised concerns about call bell response times, we looked at the call bell records which showed an average response to calls within 3 minutes. However, the registered manager told us they would address the concerns without delay.

The provider carried out checks on the suitability of staff before they started working at the service. Systems in place included checks on new staff’s identity, eligibility to work in the United Kingdom and Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. This information helps employers make safer recruitment decisions.

Staff told us they were happy working at the home, felt supported and listened to. They said they received training that equipped them to do their job well and care for people and regular refreshers to ensure their skills were updated. Staff told us they received regular supervision and appraisals to support them in their roles.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

People told us they felt safe from the risk of infection because premises and equipment were kept clean and hygienic, and relatives confirmed they did not have any issues with cleanliness of the service.

Cleaning staff followed a cleaning schedule and used appropriate personal protective equipment (PPE). Care staff wore PPE when supporting people to help protect people from cross infection. A care worker told us, “We have training for infection control, also we are checked for our handwashing techniques and competencies and wearing PPE at appropriate times like gloves and aprons.”

Appropriate systems were in place in relation to infection control. The provider ensured staff had access to PPE and were trained in the use of this. The provider’s infection prevention and control policy was up to date. Information about the risk of infection was shared appropriately with people using the service and visitors. The managers and senior staff carried out audits to ensure standards of cleanliness were good.

The provider did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

People’s medicines were not always managed safely. Whilst we saw that people generally received their medicines to meet their needs, the provider did not have effective processes to ensure people received their time critical medicines at the prescribed time. We saw that time critical medicines were routinely recorded as being given late to one person. This meant they were at greater risk of suffering from symptoms or adverse effects of their condition. Following the inspection, the registered manager told us they had reviewed the person’s needs with their doctor to ensure they were safe and taken action to improve the support given to people.

The service did not manage controlled drugs (CDs) safely. Whilst the service completed regular stock checks and controlled drugs were kept secure, we saw that out-of-date liquid CDs were being administered. Staff did not acknowledge revised dates of expiry when liquid controlled drugs were opened (some liquid medicines have limited shelf life once open). This meant that the medicines may not have been effective and put people at risk of pain.

The service had identified prior to the inspection that the CD records they kept were not in line with legislation. We saw the improvements they had made to ensure that records were concurrent and auditable.

The provider did not have effective processes for making changes to the electronic medicines administration record (eMAR) when directed to by prescribers. We saw for one person, their “when required” insulin regime for their diabetes had not been updated on the eMAR following an update from the local diabetes team whilst their regular dose had been updated. This meant that nurses could potentially administer insulin doses not intended for the person. This was raised with the registered manager to investigate and resolve with the diabetes team.

The service did not have effective processes for managing excess stock. We saw excessive amounts of medicines stock being wasted every month. The registered manager told us they would be arranging meetings with the local GP and pharmacy to address excessive stock and ordering.

Areas where medicines were kept were secure and accessible by only authorised staff. However, medicines cupboards were cluttered and there was limited space for storage. The registered manager informed us that they would be reviewing how medicines were stored, alongside ensuring they kept stock to a minimum.

However, we saw that people received regular medicines reviews from their GP. Where people were being administered their medicines covertly, we saw evidence this was managed in line with guidance and legislation.

There was no evidence people had been harmed in relation to the issues we identified. The provider took our feedback seriously and took immediate action to make the necessary improvements. Following the inspection, they provided evidence that all the areas of concerns had been addressed.