Park House

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 requires improvement. At this assessment the rating has changed to good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 67 (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.

Care plans we reviewed were improved and gave staff the guidance they needed to support people. However, a care plan for a person living with diabetes was not personalised or detailed to show how their condition affected the person, their normal blood sugar ranges and when staff should check this.

Most people we spoke with felt their care needs were met, and staff we spoke with understood people well. However, some comments were made about agency staff not always being aware of a person’s care routine. Concerns were shared about staff not always having time to support people with shaving and not being receptive to a person’s needs,

One person said, “Some agency staff don’t always know what I need doing and I have to explain how to manage my catheter. I’d like my beard trimmed on my neck and have asked but no one offers to do it. All I get told is, ‘when we’ve got time’. I’d also like my fingernails trimmed too but staff haven’t offered.”

We reviewed staffing rotas and could see that the management team used a dependency tool to ensure staffing levels were adequate. Where any staff had been found not to uphold the high standards expected from the provider, this had been raised with the relevant staff and used for learning to improve care quality.

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

Although we found improvements in the review and updating of care records prior to the migration of these onto the electronic system, there was a lack of personalisation for some people. Some people and their relatives felt they had not always been involved in the assessments and reviews, so their views and opinions were not fully respected, listened to and implemented as part of their day-to-day support. Only one relative we spoke with could recall any involvement with care plans. No person with capacity had any awareness of their care plan or of being involved in any review.

Staff kept records on how they had supported people and at what time. However, we found a lack of consistency in the daily records for repositioning for some people. For example, where a person’s repositioning records showed the person had not been moved at 3 hourly intervals, as required. This impacted on staff being able to accurately and promptly review any changes required to a person’s skin management needs. The management team advised they have an ‘Alert’ section on their electronic care planning system. The management team monitor this regularly, throughout the day, checking any issues with staff any issues, any concerns would be brought to the regular flash meetings. Any persistent shortfalls involving a particular member of staff would result in a supervision and further escalation if needed. The operations manager audited these records on a monthly basis to check compliance.

People’s communication needs needed more effective recording to enable staff to effectively communicate with people. For example, care plans for people who had specific communication requirements lacked detail. Information for staff to support a person’s spiritual beliefs was lacking. There was no mention regarding speaking other languages or the use of accessible information in an alternative language.

A range of national assessment tools were used, to understand people’s needs and how best to support them. For example, the malnutrition universal screening tool (MUST) was used for the management of weight loss and nutritional intake.

The management team worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

People had clear admission documents in place, detailing their individual needs. The management team assessed their capacity to support people based on the overall dependency needs of the service.

The service worked well with external health and social care partners and implemented guidance from these teams to support people effectively. Feedback from partner agencies who have recently visited the service was positive, regarding their approach.

The service had a positive relationship with their covering GP practice, who visited regularly to carry out review of medicines or any changes in a person’s clinical conditions.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People told us they had received visits from their GP, had dressings changed by the community nurse, had access to a visiting chiropodist, the Speech and Language team (SALT) and occupational therapists for equipment. We saw guidance from these external teams was incorporated into people’s care plans. One person said, “The surgery nurse has been coming in twice a week, to redo my arm dressing. I got a sore patch that got worse. The ‘foot person’ comes in to do my toes.” A relative told us, “They got the SALT team in to assess my family member, and they have the chiropodist regularly. The nurses here do their feet dressings.”

We observed the lunch time experience for people, which had improved significantly since our last inspection. People were assisted by staff with their meals in a discreet way, where this was required. Feedback on the food provision was generally positive regarding the quality, menu choices and portion size. Special diet requests or food preferences had been respected. One person said, “It’s different choices every day and they’ll do you a sandwich if you don’t want the menu. It’s a good size portion for me.” Another person said, “I’m a fussy eater, so gravy or mashed potato is a no-no. They do my food to suit me so I can’t complain.” A relative gave positive feedback, they told us, “My family member loves Caribbean food but can’t eat pork, which they seem to serve a lot on the menu. They’ll do a vegetarian or no pork option for them instead. They have gained weight here and in the past month have been much better. I can eat with them too if I like, which is nice.”

People were supported to maintain good hydration. Everyone gave positive feedback around the frequency and availability of drinks. One person said, “I have a fresh jug of squash every day in my room. We get the trolley about 4 times from morning to evening or you can just ask for a coffee any time.” Another person said, “I’ve got my squash jug and my own lemonade too.” A relative spoke of the staff ensuring their family member had thickened fluids, due to a clinical condition, and staff encouraged the person to keep well hydrated.

The kitchen team had a clear record of people’s dietary needs, including modified diets and allergies. The Chef confirmed this was communicated to all staff when changes were made by external teams for people’s dietary requirements. The nursing team updated the information kept in the kitchen and handed this over effectively.

The provider routinely monitored people’s care and treatment to improve it. They ensured that outcomes were consistent, and that they met both clinical expectations and the expectations of people themselves.

People's needs were assessed and care and support was delivered in line with current standards. People were regularly monitored to ensure they could achieve effective outcomes.

Care plans detailed people’s skills, strengths and clinical needs. However, not all people and relatives we spoke with had been involved in regular reviews of their plans of care. One person said, “I’ve no recall of any discussions on my care here.”

People we spoke with were generally complimentary about staff kindness and approach towards them, and understanding of their needs. We observed some lovely interactions between staff and people during an activity, in the bar lounge and when visiting a bedroom to do observations or check on a person. One person said, “They’re good people and I get on with them all. If I’m looking fed up, they’ll listen to me and check I’m ok.” Another person said, “They look after us well here and are so kind. When a person is ill, they are well cared for.”

The service ensured the clinical staff team were knowledgeable about current best practice for specific clinical conditions. We saw the service had planned training booked, from an external health team. This was to ensure robust support for a person living with a specific type of endoscopic feeding tube.

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

People we spoke with all told us staff asked for their consent before delivering personal care. Nobody raised concerns about feeling unnecessarily restricted and they explained how their preferences were respected. One person said, “On the whole, they’re good and will check with me first if I’m ok to be changed or hoisted into a different position.” Another person said, “I find they’re quite good at asking first rather than just getting stuck in with helping me, as I’m in bed.”

People were supported to make choices about their day and night routines, with these preferences clearly recorded in their care plans. One person said, “I like to sit outside whenever I can. The staff let me choose what I want to wear, then I come and sit where I want.” Another person told us, “It’s quite up to me when I want to go to bed or wake up, as I can get myself up and dressed.”

We checked whether the service was working within the principles of the MCA, whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met. We found the service was working within the principles of the MCA and if needed, appropriate legal authorisations were in place to deprive a person of their liberty.