Archived: Parkhill Nursing Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question inadequate. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 54 (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 did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

The home had received input from local authority teams to improve their documentation in relation to assessments of people’s needs and therefore, we noted improvements in this area. However, it was not clear in the documentation how people and their relatives had been facilitated to be fully involved in their assessments. Whilst a variety of risk assessments were completed it was not always clear these were updated in response to changes or reviewed sufficiently to ensure they remained accurate and up to date. Some individuals known to experience periods of distress lacked robust and detailed guidance in their care plans to help staff provide effective support.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

We found risk-based assessments were in place for people, such as Waterlow and MUST. Waterlow is used to assess people’s risk of developing pressure sores and MUST are used to assess people’s risk of malnutrition or obesity. However, we found limited evidence people and their relatives had been involved in these assessments.

We noted people in their rooms and communal areas did not always have access to drinks as they were not available or they were situated out of the person’s reach. We observed people were given a choice of orange or blackcurrant cordial only at mealtimes and hot drinks were served to people in the lounge areas, but these were served at set times. We found there was no facility throughout the home for people, visitors or staff to make a hot drink as and when they wanted. The only place to make a hot drink was in the kitchen, which was situated on the lower ground floor and not easily accessible to people living at the home. On the second day of inspection, there was a long period of time where no staff were present on the ground floor unit and one person was consistently shouting out to say they needed a drink. We were unable to find any staff to assist the person, and this resulted in one of the inspection team visiting the kitchen to ask kitchen staff to prepare a hot drink, with thickener, and we served the person their drink. We also had concerns about people’s access to drinks 8pm to 8am, when only 2 carers and 1 senior carer were on duty over 3 floors of units during the night shift, as this meant staff would need to leave the units to visit the lower ground floor kitchen to make a hot drink. This placed people at the risk of harm when areas of the home were left unattended by staff.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

We observed staff generally worked well together but were not always proactive at engaging with people and promoting independence and choice. This was because although interactions were kind, they were also task-led as there was not enough staff on duty and therefore, staff did not have quality time to spend with people. People and their visitors commented on staff being too busy to talk and one person told us, "They [staff] check on me sometimes, but not for a chat.” Another person told us, “They [staff] are busy all the time and there is no-one around at weekends.”

The deputy manager had been working closely with commissioners in the MAC process and the local authority and was working towards improvements with significant input from local authority improvement teams. This support with systems had improved records and information to guide staff; however, this had not always improved the delivery of care to people living at the home due to insufficient staffing levels.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

Opportunities for physical activity were limited due to the lack of outside accessible space. We found a very small number of people accessed the local community and opportunities to enjoy fresh air for everyone was not demonstrated. Further opportunities needed exploring taking into consideration people’s hobbies, interests and abilities.

People and visitors told us they mostly had access to support for healthier lives and they told us a doctor visited the home once per month. However, one person told us they had been trying to resolve a medical issue and they commented, “The doctor comes once a month or so, in between that it is difficult to get sorted. I have been trying to sort out some [medication] for a while now.”

People at risk of choking were assessed by speech and language therapists (SaLT), and their care plan was updated with any changes following the assessment. Kitchen staff were updated about any changes, and they held updated records to ensure people who required a modified diet and fluid intake received their food and drink in the correct way.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

People’s care plans did not include their goals or future aspirations, or any information about positive outcomes they wished to achieve. Although the provider had systems for oversight, these were not always being effectively used to review and improve people’s care, including risks associated with people’s specific needs, and to ensure appropriate action and learning was taken in response to incidents and falls. However, new processes being implemented by the deputy manager meant that improvements should be made in relation to improving outcomes for people.

We were not assured people were experiencing positive outcomes in their daily lives and were only having their basic needs met. There had not been enough staff resource or investment in improving the home and the day-to-day experiences of people. For example, there had been no daily activity programme for several weeks, most people were not accessing the community, there was no hairdresser visiting the home and people were not receiving sufficient personal care in relation to hygiene.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

Improvements had been made to people’s documentation since the last inspection in relation to consent to care. The home had been working intensively with the local authority improvement team to ensure care delivery was in line with The Mental Capacity Act (MCA). We now noted reference to consent throughout care plans. We saw evidence of best interest meetings and where people had a lasting power of attorney (LPA) this had been confirmed with records.

Where people were legally deprived of their liberty, we saw applications and authorisations were in place and these were monitored by the deputy manager by way of a tracker to ensure new applications were made when necessary. However, we found one person had conditions on their authorisation to deprive them of their liberty, and these conditions had not been met for several weeks as the activity co-ordinator had been absent and their post had not been backfilled. We reported our concerns to the provider.

We observed staff were kind when providing support but did not always ensure they obtained consent before delivering care. For example, throughout the inspection we saw instances where people had actions done to them before staff asked their opinion or consent, such as having a clothes protector placed on them; we observed this to be a blanket approach by staff where everyone wore a clothes protector but not everyone was asked if they wanted to wear one.