Archived: Parkfields Nursing Home

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered provider, 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.

We previously inspected Parkfields Nursing Home on 28 and 29 June 2016. At the time of our previous inspection we found improvement had been made and two breaches of legal requirement highlighted in the earlier report were met and we rated the service as requires improvement.

People and their relatives we spoke with were confident improvements had taken place within the home which had resulted in the delivery of better care and support.

Staff told us how they would recognise concerns to people’s safety and were aware of the action they would need to take if people were at risk of harm or abuse. People were supported to remain as independent as possible. Staff were mindful to support people in a way which maintained their dignity and upheld their right to privacy.

Staff had undertaken training relevant to their role and in order to meet the needs of people. Staff were confident they had the skills needed and felt supported by the management team. There were sufficient staff on duty to meet the needs of people who lived at the home.

Risks associated to the care and support of people were assessed and staff were aware of these risks. The registered manager had introduced new systems to ensure accurate records were maintained and was aware further improvement was needed with these

Improvements had been made in the recruitment of staff and the measures taken to ensure staff were suitable to work with people living at the home. We found improvement to the systems in place for the safe management of medicines. The registered manager introduced additional systems to ensure people always received their medicines as prescribed during the inspection process.

People were supported by staff in a kind and caring way. People were involved in planning their care and how they spent their day. Staff were aware of people’s interests and sought to engage people in these to stimulate them. The cultural needs of people were respected and met. Staff sought permission from people before care and support was provided. The registered manager and staff were aware of the importance of gaining consent and were aware of the need to involve other relevant people if looking at people’s best interests. People were confident they could raise concerns if they had any with the management team. Staff spoke highly of the management and of the changes they had brought about.

At our previous inspection of the service on 18, 19 November 2015 and 12 January 2016 we identified two breaches of legal requirements. This was because the provider’s systems for minimising and mitigating risk had not been effective, and systems were not robust enough to ensure risks relating to the health, safety and welfare of people were responded to. The overall rating after the previous inspection was inadequate and the location had been in Special Measures since August 2015. We found the provider had met the regulations at this latest inspection, and the overall rating had changed to Requires Improvement this meaning we have taken the decision to take the service out of Special Measures.

Parkfields Nursing Home provides care and treatment for up to 49 older people that may have a physical disability. The home provides nursing care, which means qualified nursing staff are always available. There were 25 people living at Parkfields Nursing Home when we inspected.

The service had a registered manager at the time of our inspection. 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.

Staff knew how to protect people and reduce risks but this information was not always reflected in people’s assessments. Staff were confident in escalating any allegations of abuse, so these would be investigated, and people protected. People said there was sufficient staff to ensure they were safe and received assistance when required. People were satisfied with how their medicines were managed. There were not always records in place to show pre-employment checks for new staff were carried out.

People’s consent was sought, but assessments to establish if people had capacity to make decisions were not always accurate and did not show how staff gained people’s consent in accordance with their rights. People felt staff were skilled and competent. The training staff needed had been identified and was been prioritised, so that more important areas of learning were provided first. People had a choice of food and drink available to them and said they enjoyed these. People’s health care was promoted, and risks to their health escalated to appropriate external health care professionals.

People said they were treated well by staff who were kind and caring. People’s privacy was respected and they were able to make choices before and during the care staff provided to them. People’s independence was promoted.

People did not always have access to pastimes they enjoyed and found meaningful. People had involvement in the care and support they received. Staff were knowledgeable about people’s individual likes and dislikes, although this information not always captured in people’s records. People felt able to complain and were confident any issues would be addressed.

People had confidence the provider was improving the service they received. The provider had made improvements to ensure risks to people’s safety were identified and minimised. The registered manager recognised further improvements were required to improve people’s experiences. People were able to approach staff and felt listened to. Staff were well supported and happy in their work.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who used the service, their relatives, the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

Some people told us they felt safe and we found that staff were knowledgeable and trained about safeguarding procedures so that they understood their role in safeguarding the people they supported.

There were some improvements since our previous inspection in August 2013 that showed that the manager and staff learnt from some events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. The provider responded to the specific concerns that were identified from these and our previous inspection. They were not able to demonstrate how they would routinely identify and assess risks and put systems in place to minimise these risks as a matter of routine practice though. This meant there was an increased danger that the risk of harm to people may not always be identified and there may be a failure to ensure that lessons are learned from mistakes.

We found that there were times where people's needs were not always met appropriately by staff, with staff focusing on the task they needed to do but not engaging with people when they provided care and supported them. We were concerned that staff seemed less able to respond to people's needs during the morning period, with observation showing us that people had later breakfasts as staff did not get them up until mid-morning. We asked the manager about what sort of tools they used to measure people's dependency so they were able to plan how many staff were needed and how they should be deployed. They told us that they did not use one. This raised concerns as to whether there was sufficient staff, or whether they were deployed appropriately, so that people's needs were met and they were kept safe.

We looked at staff training records and saw that the provision of training to staff had improved in mandatory areas. Staff we spoke with presented as having better knowledge in some areas related to people's safety. There was still scope for improvement in areas relating to staff awareness of, for example, how to ensure people's dignity was consistently respected and the Mental Capacity Act.

We asked staff about people who may have a restriction agreed through a Deprivation of Liberty Safeguard (DoLS) (a restriction agreed with social services that is in the person's best interests), and there was a lack of understanding about one person's DoLS having ceased. Discussion with the same staff showed that the restriction was not being applied though, as these were not needed to promote the person's safety. Although this meant that restrictions were not applied inappropriately following the cessation of this DoLS it is important that staff are aware of the status of any DoLS in place to ensure that any restriction is not used unlawfully.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to learning from incidents and events, and ensuring there is sufficient staff available to ensure people's needs are met in an appropriate and timely manner .

Is the service effective?

People's health and care needs were usually assessed with them present, but they were not always involved in writing their care plans. Some people were not aware of what was in their care plans. Specialist dietary needs were assessed and included. We saw improvement in that all the care plans we looked at had been reviewed since our last inspection. Care plans identified people's health and care needs and staff showed an understanding of these. This meant that information was available to staff to allow them to offer support consistently to meet people's needs.

People's mobility and other needs were not always taken into account in ensuring people had equipment available to them to ensure they could be independent and be enabled to move around freely and safely.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to involving people in planning their care and promoting their dignity, privacy and independence.

Is the service caring?

People were not consistently supported by kind and attentive staff. We saw that although some care workers showed patience and gave encouragement when supporting people, others did not. People commented, 'They allow me to have a bath on my own. They just support me getting in and out, also in and out of my bed'. Another person said, 'Staff are always too busy to talk to me. I have to wait for staff to take me (to the toilet) and now they move me in a wheelchair'. A relative said, 'I'm not totally happy with the care in this home. Today (my relative's) shirt is all crumpled and scruffy and my relative has still got their pyjama bottoms on.'

People who used the service, their relatives, friends and other professionals involved with the service were able to complete satisfaction surveys. There were some shortfalls, and concerns had been raised by relatives. The registered manager was able to tell us what actions they have taken to address some of these shortfalls. Some people told us they would complain to the manager if they were not happy with the care, but one person told us they did not know how too, another that they were not confident in raising concerns. People were at risk of not having their concerns and needs properly taken into account.

People's preferences, interests, aspirations and diverse needs were recorded, although what we saw showed that care and support was not always provided in accordance with people's wishes, for example the times that people received their meals.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to involving people in planning their care.

Is the service responsive?

We looked at how the service worked with other health care professionals to ensure people's health care needs were addressed. We did see improvement in how the staff had responded to people's changing health needs to ensure appropriate health professionals were involved as and when needed. We saw that there was more regular assessment and review of people's care needs in place.

Is the service well-led?

All of the staff we spoke with said that if they witnessed poor practice they would report their concerns.

The service did not have a robust quality assurance system. Not all of the shortfalls identified by us at our previous inspection had been addressed. We saw that the provider had responded to some of the specific issues we identified during our previous inspection but had not identified other issues of concern that we observed during this inspection. This meant issues of concern were not routinely identified and responded to by the provider through continuous monitoring of the service.

The manager told us that the service worked in partnership with key organisations, including the local authority and safeguarding teams, to identify any concerns about care provision. The manager had informed us of any concerns about people's safety where this indicated potential abuse.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to developing their assessment and monitoring of the quality of the service so as to ensure they can learn from this.

We found that people's dignity was not always maintained. Some people we spoke with told us they were not involved in their care planning. One person said, "I am not sure if I have a care plan."

People did not consistently receive care that met their needs. We found that there was lack of stimulation and interaction. One person told us, 'I'm content here, I have to be but I can't say I'm happy.'

Some improvements had been made around protecting people from harm. However, we found that not all staff were aware of how to protect people.

There were not enough staff to look after people throughout the day. One person told us, 'The staff are really busy they don't have time to sit and talk to me, how do they know what I might want.' We observed that some people did not receive appropriate care and support.

Systems were not in place to ensure that the quality of the service was monitored so that improvements could be made. People we spoke with told us they were not happy with some aspects of their care. One person told us, No point in asking for anything, they don't listen.'

We found that records were not fit for purpose, accurate or up to date in some instances which would put people at risk of inconsistent care.

People told us that the care they received was as they expected. People told us that 'Its better than a hotel", 'It's alright, well catered for' and 'Couldn't' expect anything better if I was the queen, they have been brilliant to me'.

People told us they had choices about their daily routines. We saw staff interact positively with people but there were some occasions where people's dignity was compromised.

People told us that they felt able to raise concerns about the service, some saying they felt safe. We spoke with staff and they told us that they would report concerns they noticed. One person said that they did not like having to go to their room when they challenged staff.

We saw that the home had systems in place to promote effective infection control; this reflected by a building that we saw was clean.

We saw that people were able to manage their own medication safely but there was one occasion where a drugs trolley was left unlocked out of the view of a nurse.

We heard that staff usually responded to people in a reasonable time when they needed assistance meaning that there was sufficient staff available.

We heard that people knew about the homes complaints procedures which were available in a range of languages. People told us they were confident that staff would listen to any complaints they raised. One person said that they had "No complaints about the care".