Parkwood House

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 good. At this assessment the rating has remained good.

This meant people were safe and protected from avoidable harm.

The provider was in breach of legal regulation in relation to safe care and treatment and good governance.

This service scored 66 (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 a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated. Lessons were learnt to continually identify and embed good practice.

Incidents and safeguarding concerns were reviewed, actions were identified and lessons learnt were shared with staff to reduce the risk of recurrence. Staff told us they felt able to raise concerns and were supported to learn from events and near misses.

Relatives told us they felt comfortable speaking with staff and management if concerns arose. One relative told us, when an incident does take place, the staff are calm and reassuring. Governance records showed learning from incidents was discussed through meetings and action plans were developed to improve practice.

We identified issues that staff, management team and the provider did not identify which affected safety within the service. The registered manager acted on shortfalls quickly when they were raised.

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.

Systems were in place for hospital admissions, transfers and discharge planning. People's care records included information to support continuity of care, including treatment escalation plans and important clinical information. Staff shared information through handovers, multidisciplinary working and electronic care records.

Relatives told us they were kept informed about changes to people's care and supported to remain involved in decisions. Professionals described the service as responsive and proactive when people’s needs changed.

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.

Staff understood safeguarding processes and could explain how they would recognise and report concerns. Safeguarding investigations were completed appropriately and records showed leaders worked with external agencies when concerns were identified. Staff had received safeguarding training and understood whistleblowing procedures.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. When people receive care and treatment in their own homes, an application must be made to the Court of Protection for them to authorise people to be deprived of their liberty. We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. Appropriate applications had been made where people were deprived of their liberty and systems were in place to monitor these arrangements.

People and relatives consistently told us they felt safe living at the service. One relative said, “I trust the staff here implicitly.” Observations and feedback demonstrated people were supported in ways that promoted their safety while maintaining their rights and independence. Professionals raised no safeguarding concerns about the service.

The provider did not always ensure people were supported in line with assessed risks and needs.

Records did not always demonstrate people received care in line with their assessed needs. We found examples where prescribed barrier creams were not consistently recorded after episodes of incontinence. Records did not always evidence people were repositioned in accordance with their assessed schedules. These omissions increased the risk of skin damage for some people. Although managers were confident care was being delivered, records were not always accurate or complete in evidencing this.

Relatives told us staff knew people well and communicated changes effectively.

We also found some measures were in place to support people's safety. Risk assessments for nutrition and moving and handling had been completed, and staff demonstrated a good understanding of people's needs and the actions required to reduce the likelihood of harm.

The provider did not always detect and control potential risks in the care environment. They did not always make sure facilities supported the delivery of safe care.

We identified several concerns which increased risks to people. Some fire doors did not close effectively, weekly fire alarm tests had not been completed, and some windows did not have tamper-proof restrictors in line with recognised guidance. These issues increased the risk associated with fire safety and falls from height. We also found examples of where environmental audits had not identified these concerns.

Other environmental safety checks were completed, and we saw a generally clean, homely environment with suitable equipment available to support people.

Managers acted promptly following our feedback and started to implement measures to reduce identified risks, including arranging repairs and additional checks.

Relatives told us the service was well maintained, and equipment was available when needed.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Staffing was regularly reviewed according to people’s dependency needs and additional support, including one-to-one care, was provided where required.

Safe recruitment practices were being followed. Staff had references and Disclosure and Barring service (DBS) checks, as required. DBS checks provide information, including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

Relatives consistently described staffing levels as sufficient and told us staff were knowledgeable, experienced and knew people well. One relative told us, “There are always enough staff to ensure people get the care they need.”

Staff spoke positively about the support they received from managers and described a culture focused on development and learning.

Observations demonstrated staff responded to people promptly and interacted positively with them.

Staff received training and competency assessments. We saw records indicating some improvements were needed in relation to robust supervision processes, to ensure all staff received regular supervisions.

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.

The environment was clean and systems were in place to maintain hygiene standards and reduce the risk of infection. Cleaning schedules, audits and monitoring processes were completed regularly. Staff had received infection prevention and control training and understood the use of personal protective equipment. Safe food hygiene practices were in place and records relating to cleaning and food safety were consistently maintained. Leaders demonstrated awareness of current national guidance and there were systems to respond to outbreaks and emerging risks.

People and relatives described the home as clean. One relative told us, “It is very clean.” Observations confirmed staff followed infection prevention and control procedures, helping to protect people from avoidable infection risks.

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

We identified examples where prescribed medicines were unavailable and had not been reordered or escalated promptly, resulting in people not always receiving medicines as intended.

We also found medicines storage temperatures were exceeding 30 degrees, some liquid medicines were not dated when opened and some PRN protocols lacked person-centred guidance. Governance systems had not identified all these concerns. Following our feedback, the registered manager introduced additional monitoring and medication stock checks to reduce the risk of recurrence.

Relatives told us medication changes were communicated and most people received their medicines as prescribed.

Staff were knowledgeable and safe administration practices were observed.