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 remained requires improvement. This meant people’s outcomes were not always consistently good, and people’s feedback confirmed this.

The provider was in breach of regulation related to person-centred care.

This service scored 54 (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.

The provider was in the process of transitioning onto an electronic care planning system. During this transition period, some people’s needs were not always clear from their care plans and risk assessments. This meant people did not always achieve positive outcomes. For example, people's needs were not being robustly reviewed or updated following an incident or hospital admission. We saw a person had received medical intervention following a fall. The increased observations and welfare check documents were not linked to their records, and the care plan and risk assessments had not been updated.

Staff had access to documents on how to support people and told us they understood people well. Staff we spoke with all understood the importance of falls management and risk factors for specific people they supported. One staff member said, “Falls risk time of day varies for different people. One person is more at risk in the morning but also this can be later in the day when people are tired or taking certain medication.” All of the staff we spoke with understood the post-falls management process and could describe how they should respond in line with the escalation process at the service.

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

Some people and relatives felt they could be more engaged in planning their care. One person said, “I am not aware of one, no one has said this is your care plan.” Whilst another person felt more involved and said, “I prefer to do this jointly with them, so we consider both sides and decisions.”

Staff kept records on how they had supported people and at what time. However, we found a lack of consistency in these daily records for repositioning, oral care and personal care for some people. This also impacted on staff being unable to accurately and promptly review any changes required to a person’s needs. For example, where a person’s oral health needs might require review by an external professional.

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.

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

The provider did not always support people to manage their health and wellbeing so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

People were not always encouraged to maintain their own personal cleanliness. We saw people with dirty fingernails which presented an infection risk to themselves and others. Where people had been identified as being resistant to support with personal care, there was a lack of positive engagement to encourage people to self-manage their daily personal care.

Some people and relatives spoke of the need for people to be more effectively supported at mealtimes. One relative told us, “The problem is that my family member needs food cutting up. Today they needed help, as they can’t see.” Another relative told us they visited daily at lunchtime, due to the support needs of their family member. Another relative told us, “We come in every day. My family member needs to have their food cut up; we have to come to help them eat. I come in the afternoon.” In relation to the challenges faced by staff during the dining experience, one staff member told us, “The temporary space makes it harder, it makes it more crazy at mealtimes. I do get why we have moved to the other lounge as there is a lot more room, and not all residents like to move out of their chairs.” One person felt positive about their mealtime support and said, “Yes, I get support to eat and drink and I can have snacks when I want.”

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 management team updated the information kept in the kitchen and handed this over effectively.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent or that they met both clinical expectations and the expectations of people themselves.

People's needs were not always assessed and care and support were not always being delivered in line with current standards. People did not always achieve effective outcomes.

Care plans were person-centred, and detailed people’s skills, life experience and strengths. However, not all people and relatives we spoke with had been involved in regular reviews of their plans of care. People and their relatives were largely positive regarding staff being hardworking and understanding of their needs. One person said, “My family come in and they help to do the care plan.” A relative gave positive feedback about the support in place and told us, “My family member is cared for very well, they could not be in a better place.”

The service 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 around feeling unnecessarily restricted and they explained how their preferences were respected. One person said, “I get showered myself, but the staff will always come and help if I need them. We have a hairdresser periodically and I shave myself daily. I can go out when I want to.” Another person told us, “Yes, the staff check with me when doing personal care. I get up about 10.00am. I am very independent.”

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.