The Care Quality Commission
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Archived: Park House

Overall: Requires improvement read more about inspection ratings

93 Park Road South, Claughton, Wirral, Merseyside, CH43 4UU (0151) 652 1021

Provided and run by:
Four Seasons (Emmanuel Christian Care Home) Limited

Important: The provider of this service changed. See new profile

All Inspections

20 January and 4 February 2016

During an inspection looking at part of the service

This inspection was unannounced and took place on 20 January and 4 February 2016. At our last inspection in July and August 2016, we had found a number of breaches of legal requirements, relating to dignity and respect, consent to treatment, safeguarding, the numbers of staff provided and failure to follow safe recruitment processes. We made requirement actions for these areas to be improved. We also found further serious concerns and issued warning notices in respect of failure to provide person centred care, safe care and treatment, nutrition and hydration and good governance. We rated the service ‘inadequate’ overall and in all domains and placed it in ‘special measures’.

The provider sent us an action plan and updated us regularly on their progress with their planned improvements. We also received information from the local authority quality monitoring team. At this inspection we found that the service had made significant improvements to the care and support of people and had met the requirement actions and the warning notices. The home has now been taken out of special measures.

One visitor told us, “There has been a massive improvement since the last inspection” and another said, “There have been lots of improvements”.

Park House is a large modern building on three floors, located in a quiet residential area of Birkenhead. It is part of the Four Seasons group of health care services. The home is registered to provide accommodation and care for up to 111 people. The building is split into three units. The ground floor unit is for people who do not require nursing. The middle floor unit is for people with dementia who may require nursing and the top floor unit is for more frail elderly people who may require nursing. At the time of our inspection, there were 80 people living in the home.

The home requires a registered manager. 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.

Since our last inspection, the previous manager had left the service and the provider had recruited two managers, one who was the home manager and the other who was the clinical manager. The home manager had submitted their application to become a registered manager with CQC and was waiting for this to be processed. The clinical manager told us she would also be applying to be similarly registered. During this inspection, the home manager and the regional manager were present.

We found the service to be generally safer and that staff recruitment had been safely completed. The home had recruited more staff and people and visitors had noticed the improvement in care they were able to deliver. Staff knew about abuse and how to prevent and report it. However, we found that the medication recording was not adequate and have made a recommendation about this.

Staff were supervised regularly, but the training needed to be improved and more staff needed to attend key training, such as person centred care. The training records were difficult to follow. The staff followed the principles of the Mental Capacity Act 2005 and we saw that appropriate applications had been made for Deprivation of Liberty Safeguards to the local authority. The home was pleasanter in most areas and was in the process of some refurbishment and the outside areas were tidy.

We found that staff were caring and respected people and their right to privacy. The people living in the home were happy with the care they received. People’s religious and cultural needs were met and staff had been trained in end of life care.

Most people were cared for in a person centred way but records did not reflect that their assessment had considered this. Peoples records were reviewed generally, well, but some review entries were sparse and not informative.

The home was benefitting from having two managers who had split the duties of running the home, between them. Records and auditing had improved but still required more work. The satisfaction with the home had improved and in January 2016, 100% of people who chose to complete a survey, recorded they would recommend it.

22, 23, 29 July 2015 and the 10 August 2015

During a routine inspection

We undertook this comprehensive inspection on the 22, 23, 29 July 2015 and the 10 August 2015. Our inspection visit was unannounced.

We last inspected Park House in June 2014 and they were found to compliant.

During this inspection we found breaches of Regulations, 9, 10, 11,12,14,17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Park House is a large building located in a quiet residential area of Birkenhead. It is part of the Four Seasons group of health care services. The home is registered to provide accommodation and care for up to 111 people, there were 97 people living at the home at the time of this inspection. The building is split into four units. The ground floor (Bidston unit) is for people who do not require nursing care. The middle floor (Central unit) is for people with dementia who may require nursing and the top floor separated into two (Conway units) were for more frail elderly people who may require nursing.

There was a registered manager of the home 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.

People told us they felt safe with staff and this was confirmed by some of their relatives. The registered manager had an understanding of safeguarding; however not all staff spoken with, were clear on the policy and procedures. The manager had responded appropriately to allegations of abuse with the support of the operation and clinical manager, ensuring reporting to the local authority and the CQC as required.

Accidents and incidents were recorded and monitored to ensure that appropriate action was taken to prevent further incidences.

We found concerns with regards to the management of medicines at the home. The administration and record keeping was unsafe. We saw that the provider did not have clear instructions available for staff to give ‘as required’ (PRN) medicines and prescribed nutrients. Where instructions were available these had not been correctly followed. This placed people at significant risk of harm.

People and their relatives told us the home was short staffed. Staff confirmed this view. We saw that staff were too busy tending to people’s personal care needs to interact socially with them or meet all of their assessed needs. This placed people’s health, welfare and safety at significant risk.

We looked at records relating to the safety of the premises and its equipment, which were correctly recorded. We spent time conducting a full tour of the home; the basement area was not safe as it was a storage space being used for any mattresses and equipment not being used. This area was also used for offices for activities staff, the cook and the maintenance person. The boiler room was also in the basement area.

The staff recruitment practices were not being followed safely. During this inspection we found that not all relevant checks were taking place.

Staff told us they did feel supported by the registered manager. They said they had not been sufficiently trained as the training was predominantly e-learning. We saw from staff files, that staff had not received appropriate appraisals and supervision. Records for staff training were not up to date and not all staff had not received the Mental Capacity Act 2005 training or understood the reason for its implementation in the home. The manager told us that staff were not fully competent in their roles and understood that the training programme was not up to date. We were informed that the learning programme had not been working effectively.

The provider had not complied with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and its associated codes of practice in the delivery of care. Suitable arrangements were not in place addressed the needs of all of the people living with dementia to ensure their consent to the care they received was appropriately obtained. Staff we spoke with had a limited understanding of what was their role was and their obligations were in order to maintain people’s rights.

People’s emotional needs were not appropriately assessed nor the support provided, adequately planned or delivered.

People received sufficient quantities of food and drink and had a choice in the meals that they received. Their satisfaction with the menu options provided however, had not been checked. Where people had lost weight this was not always recognised with appropriate action taken to meet their needs. Where people had special dietary requirements, the planning and delivery of care failed to provide sufficient information to ensure people’s special nutritional needs were met.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

Staff were observed to be caring, warm and positive in their interactions with people who lived at the home but had little time to chat to people. People’s privacy and dignity needs however were not always met in the delivery of care. For example, staff were not available at all times when people were in distress and required immediate assistance.

Care records did not adequately assess people’s needs or risks, or plan how to meet their needs. Care records were not up to date and people’s care had not been updated when reviewed. For example ‘thick and easy’, which was a thickener for fluids, to support people with swallowing difficulties, was not being provided appropriately or monitored by staff.

The service was not well led at all times as they did not have effective quality assurance and monitoring systems in place to identify the risks to people’s health, welfare and safety and failed to seek people’s views on the quality of the service they received. We discussed the issues we had identified at this inspection with the manager and operations manager and expressed our concerns.

We found a number of breaches of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014 in relation to Regulation 9, Person centred care, Regulation 10, Dignity and respect, Regulation 11, Need for Consent, Regulation 12, Safe care and treatment, Regulation 13, Safeguarding service users from abuse and improper treatment, Regulation 14, Meeting nutritional and hydration needs, Regulation 17, Good governance, Regulation 18, Staffing and Regulation 19, Fit and proper persons employed. You can see what action we have taken at the end of this report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in 'Special measures'. The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work at there.

23 June 2014

During a routine inspection

Our inspection team was made up of three inspectors. They helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found.If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff and people told us they felt safe.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made, and how to submit one. This meant that people's rights were safeguarded.

Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.

People's care needs were taken into account when making decisions about the numbers, qualifications, skills and experience of staff required. Occasionally staff were stretched due to unexpected sickness of colleagues, but people's needs were met and staffing levels were never unsafe.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

Is the service caring?

People's preferences, interests, aspirations and diverse needs had been recorded and care and support was provided in accordance with people's wishes.

We saw that care workers were kind, showed patience and gave encouragement when supporting people.

People commented: "It's a nice place to be"; "It's good here. I feel safe and they do everything for you"; "It's very good here, I have no problems at all, it's like home from home"; "This place is great, very personal and very caring"; "My mother has been here five years. I can't fault it, they look after her really well".

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

Is the service responsive?

People knew how to make a complaint if they were unhappy. Two people said that they had made a complaint and both were satisfied with the outcomes. We looked at the records of how the complaints were dealt with, and found that the responses had been open, thorough, and timely. People can therefore be assured that complaints are investigated and action is taken as necessary.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system and records seen by us showed that identified shortfalls were addressed promptly. People using the service, their relatives and friends completed an annual satisfaction survey.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes in place. This helped to ensure that people received a good quality service at all times.

20 February 2014

During an inspection looking at part of the service

We went back to Park House to follow up concerns identified at our last inspection on August 12, 2013. These concerns related to people's care and welfare and also to the amount of staff available to support people, particularly during the night. At this inspection we checked that people received the support they needed and we did this by reviewing their care records, speaking with them and their relatives and talking to staff. We spoke to five people who used the service, three relatives and seven members of staff. Comments from residents and relatives included: "I'm very happy with the staff here, they do everything they can to make sure I'm looked after" and "In general there are enough staff, but there could never be too many. I'm very happy with the care for my [family member] and I know all the staff now. They definitely do their best".

We reviewed five people's care records and found that care plans identified how staff should support them. We saw that reviews were carried out and changes were made when required. For example we saw that one person had recently received a new bed because their need had changed and a person had been moved to a different unit where their needs could be more appropriately managed. This assured us that people were cared for according to their needs at a specific time.

We spoke with the home manager who explained that staff were apportioned according to occupancy and dependency. This was established using a tool which was recognised by the Department of Health and the Royal College of Nursing. We found that according to the tool the home was overstaffed for the amount of people and their level of need. However, we found that one of the units was short staffed from 8am until 3pm because two care staff had telephoned in sick. We saw that nursing staff helped out during busy periods such as meal times to ensure that everyone's needs were met. We did not see a negative impact on the people in the unit, but staff told us they felt under pressure. We discussed this with the home manager who said they would make better use of staff on other units if this happened again in the future.

12 August 2013

During a routine inspection

We spoke with a total of eleven people who lived at the home, six relatives and thirteen staff. The majority of people we spoke with were very happy with the care provided. One person told us 'It's always been very nice here' and another said 'The staff are kind and helpful.' All of the relatives we spoke with confirmed they did not have any concerns about their relatives.

The home gained people's consent and had access to independent advocates when necessary.

We found some issues in relation to the care and welfare of people who used the service. Whilst we found people on the ground floor received care appropriate to their needs, we found issues regarding people's care and welfare on the other floors in respect of care plans we saw did not always reflect people's needs. For example, one person was losing weight but no action had been taken to address this.

The manager told us the home had previously had problems with the level of staff sickness causing staff shortages. Staff we spoke with told us the situation had generally improved but some still expressed concerns in particular about staffing at night on the top floor which resulted in people who used the service receiving their medication late on occassions. The home had put plans in place to address this issue but the interim arrangements had not always provided enough staff.

We found that the home had quality assurance systems in place. Records were kept appropriately.

14 November 2012

During an inspection looking at part of the service

We spoke with several people about their medicines and the way they were handled. Due to varying degrees of dementia some people could not express their experiences of the home. Nobody raised any direct concerns about the way their medicines were managed.

Comments included:

'Staff do my medicines I leave it to them'

'I am comfortable and happy here'

'Can ask for help if I need it'

'I can ask for painkillers when I need them'

'They make sure I have enough medicines, I have no problems'

Overall we found people were given their medicines safely.

7 August 2012

During a routine inspection

The expert by experience visited Bidston unit and reported:

'The service users I spoke to during the visit said that all the staff treat them with respect and they are involved with the services that they receive. During my visit I saw a service user being transferred to the bathroom from his room and his dignity was respected at all times. One person said that they were involved in compiling their care plan when they first arrived at the home.'

Another person told the expert that a member of staff had taken her to the betting shop to place a bet as she used to do this before moving into the home. A relative said that perhaps more outings could be arranged.

On Hamilton unit the inspector spoke with five people who were living at the home. Only one person said that they had been consulted about their care plan, however people said that the staff treated them with respect, offered choices, and explained what they were going to do before carrying out care. People were all happy with the care they received. One person said 'I like to have a shower every day and the staff make sure I get one'. Other comments included: 'I'm very happy here and get the care I need when I need it'. 'I couldn't ask for better care'. A relative told us 'He has settled here and says he wants to stay, so it must be alright because the last home he stayed in he hated it and insisted on going home.'

We spoke with a visiting professional who said she had visited the home several times. She said she had not had any concerns about the care and staff always followed her instructions.

One person on Hamilton unit said 'I go downstairs to get my hair done once a week, but other than that there are no activities. I don't go to the lounge because I'd be sat there on my own. There used to be games and exercise classes in the lounge, but there's nothing now. I like to go and sit in the garden when it's fine, but the staff never offer. I have to ask and sometimes they say they're too busy.' Another person said 'The staff take me out once a month shopping, to the cinema or to see a show'. Another said 'The staff will take me out shopping if I need anything.'

We received mixed comments from people regarding the standard of meals. Comments included 'The food's not great but sometimes it's alright', 'The food's divine', 'The food's fine', 'The meals are very good', 'The cheese on toast was tough'. Members of staff who we spoke with considered that the meals provided were not always appropriate for people living at the home.

People we spoke with told us 'The staff are very good' and 'I can't fault the staff, day or night, they've been wonderful with me and answer the bell promptly when I ring'. However another person, who liked to go into the garden, said 'They're regularly short staffed and can't take me into the garden. Sometimes you can wait half an hour for them to answer the call bell'. Another person said 'The staff say they are short staffed, but I always get the care I need.'

4 August 2011

During a routine inspection

During our visit to Park House, the two inspectors spoke with people living on each of the three units and a number of relatives who were visiting.

On the ground floor, one person told us 'the staff care absolutely, they leave no stone unturned, they are nice to my wife and she is safe here'. Another person said 'I would not be anywhere else, staff are great and respectful, they listen to me and I am happy with everything'. We observed staff spending time in the lounge with the residents and interacting with them. Other people were sitting in chairs in the corridor areas and staff took time to speak with them.

On the first floor one person was sitting in her room and said that she was 'not too bad'. She said that the staff are very respectful but she feels isolated and would like to be in the lounge as she does not see a lot of the staff. A visitor told us the staff are really good but they are overworked. There are not enough staff, more are needed. She said 'the staff respect my mum, she has been here three and a half years, I feel she is safe here, I am happy with the place and it is generally clean.

On the second floor we spoke with one person who told us that she has lived at Park House for five years. She gets around independently using an electric wheelchair and she said that she does not need any help from staff with personal care. She told us that she is waiting for a sheltered housing apartment. She said that she would be able to look after her own medicines but has not been asked about this. She can get up and go to bed when she wants to. The staff come quickly if she rings her call bell because they are surprised if she rings. There are a couple of other people who she can talk to but one is very deaf. She doesn't really join in activities but knows that there is Bingo on the ground floor but she doesn't like Bingo. She passes the time by reading and TV; she gets magazines delivered. There is a rail in her room with clothes hanging on it and covered with plastic. She said that there is not enough space in her wardrobe for all her clothes. She used to have two wardrobes but one was taken away. The staff are all very nice but she thinks the men are the best. She enjoys having a laugh with them. They occasionally have meetings for residents.

Another person we spoke with was being looked after in bed. She was calling out because she wanted someone to talk to. A poster on her door said that it will be her birthday on 6 March 2011. Her nails had been painted in a bright colour but the varnish was badly chipped. Her care plan stated 'prefers to have female carers', however two care staff, one male and one female, came to attend to her personal hygiene and she appeared very happy to have a male carer.

An activity programme is displayed on the notice-board. We asked the nurses about activities and they said that there are chair exercises once a week and a video once a week.

We observed that staff spoke in a friendly and respectful way to residents and there appeared to be good relationships between them.

On the second floor we spoke with three relatives who were visiting.

One person told us that her mother has been at Park House for four months. The home was recommended to the family. She told us 'It's fantastic, the nurse who is on is really brilliant, she seems to love all the patients.' Her mother is always kept clean and fresh. She is looked after in bed. Members of the family visit every day and they would be aware if anything was wrong. The staff are very caring and helpful. Mother needs a liquidised diet and she gets plenty to eat and drink. She is not able to join in any social activities but she used to go to the hairdresser and chiropodist. She has a visit from her doctor when needed. 'We couldn't wish for anything better for her.' They know about the home's complaints procedure.

Another visitor told us that her father has lived at Park House for 18 months. The family visit often. Most of the time he is well cared for and he is happy, but he is very easy going. All of the staff are quite nice. Staff are good at keeping them informed of any changes but they have never been invited to a review of his care. Most of the time he's fine but the staff are not very good at picking up when something is wrong. He has a catheter and this can get blocked but the staff do not seem to check this when there are signs that he is becoming unwell, for example he becomes confused. In general things have improved. They had a copy of the complaints procedure and they had a satisfaction survey through the post. They are aware that some relatives meetings are held, but not recently.

Another visitor asked to speak with us. Her sister is a resident at the home. She said that for the last two weeks staffing levels have been terrible. 'My heart went out to all the staff working here'. Her sister has been here seven years and the staff are good but the home has 'gone down' recently. It was unclear why her sister was being looked after in bed and the relative said that she was got up and dressed when she wanted to take her somewhere.

On the first floor we observed a resident in the lounge who was unsteady on her feet. An alarm went off every time she got up and the unit manager intervened twice and reassured her and led her back to her seat. The next time she got up a relative intervened but there was no response from staff. When staff did intervene they appeared calm and reassuring.

We spoke with relatives who said that their father was not able to communicate or respond much. They visit every three weeks and are happy with his care. He stays in his bedroom and they find that staff are encouraging and respectful. There is always a member of staff around but there are not always enough staff during the week. They are comfortable with the staff and feel able to approach them. Their father is safe living here and he never seems distressed. 'It is OK, it is the best place for him, the staff are friendly.'

We observed that one person had visitors and was clearly upset after they went home, saying that she wanted to leave Park House and go home. She was irritable with other residents and staff and became verbally abusive. There was no staff intervention for at least half an hour. She was left agitated despite her care plan stating that she should be supervised at all times.

At one time there were two call bells ringing and one was answered after five minutes but the other was not answered for a while longer.

One of the people living at the home said 'I like it here, staff are angels, meals are great, the lounge is marvellous, staff are lovely'.

One person we spoke with said that the food is 'not bad'. She is vegetarian and gets enough to eat but also buys some of her own food. She has a friend who takes her out shopping. She did not know what was to eat today and added that staff used to ask her what she wanted but don't any more.

We talked for a while about food with another person and when asked if anyone asks her what she would like to eat and she replied 'do they hell'.

The people we spoke with at the home said that they felt safe there.

A visitor and a member of staff who we spoke with said that there is never enough bedding available. The visitor said that she had spoken to the manager about this and was told it had been ordered. They also considered that there is a shortage of cutlery and that plastic beakers are stained and there are never enough lids.

People we spoke with told us: staff are really good, staff are overworked, not enough staff, more staff needed, staff respect my mum, staff are very caring and helpful.

Two of the relatives we spoke with said that they had received a copy of the customer satisfaction survey.