Archived: Green Park Nursing*

This inspection took place on 14 January 2015 and was unannounced. Green Park is registered to care for up to 30 older people with nursing needs. There is a passenger lift to assist people to the upper floors and the home is located close to a pleasant park area and transport links.

The home did not have a registered manager in place. The home had been without a registered manager since 7 May 2014. An acting manager without clinical expertise was overseeing the care at Green Park but was the registered manager for another service. 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.

People told us they felt safe at the home. Risks to people were assessed and acted upon though there was not always sufficient emphasis on how to maximise freedom. Staff were trained in safeguarding and understood how to recognise and report any abuse.

Staffing levels were not always sufficient to care for people safely or to enable all people to pursue interests of their choice. You can see what action we told the provider to take at the back of the full version of the report.

Staff were not supervised effectively or frequently enough for them to feel supported or to develop professionally. You can see what action we told the provider to take at the back of the full version of the report.

The acting manager, provider and staff were clear about their responsibilities around the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). However, people who required a mental capacity assessment did not have one recorded, which meant it was not clear how people’s capacity to make decisions was supported or promoted. You can see what action we told the provider to take at the back of the full version of the report.

Staff told us they sometimes used pictorial prompts as an aid to communication. However, people’s needs related to dementia care were not always clearly addressed. There was little in the environment to support people with a dementia related illness, although staff told us that a number of people had needs relating to this area. You can see what action we told the provider to take at the back of the full version of the report.

The provider had identified a number of shortfalls and had a plan in place to address these; however, there were insufficient systems in place for monitoring the quality of service. This meant that required improvements to care and practice may not be identified or put into place. You can see what action we told the provider to take at the back of the full version of the report.

Medicines were handled safely, however, because the medicines took a long time to administer people did not always get them on time.

People told us that staff understood their individual care needs. We found that people were supported by staff who were well trained. All staff received mandatory training in addition to specific training they may need and a plan was in place for updates to this.

The home had links with specialists and professional advisors and we saw evidence that the home sought their advice and acted on it.

People’s nutritional needs were met and they received the health care support they required. However, choice at mealtimes was not promoted. An observed mealtime was relaxed and people received respectful attention, however, nobody had the opportunity to use the dining room which may have enhanced the social dining experience.

Staff had developed positive, respectful relationships with people and were kind and caring in their approach.

Care plans had a detailed clinical basis, however, they did not emphasise people’s interests, who and what was important to them or their priorities for care. This meant that people could not be sure that they received personalised care.

People were not sufficiently assisted to take part in activities and daily occupations which they found meaningful or fulfilling. People were at risk of being bored and under stimulated. We did not see any staff use aids to assist people who had a cognitive impairment to make choices.

If people raised concerns or complaints these were usually dealt with promptly and recorded with actions.

Staff and people who lived at the home told us that management was not as visible as it should be. The acting manager shared their time between the service they were registered for and Green Park. Communication was not clear between the acting manager and the staff team, which meant that updates to care and new information may be missed. This in turn could lead to people receiving inappropriate care.

Staff understood their roles and responsibilities but were aware that they did not always have time to fulfil them properly so that people had quality care. People and staff were not actively involved in developing the service. People were happy with the level of influence they had over their lives however there was insufficient evidence that they were consulted over the way the service was run.