Archived: Parklands Care Home

We have inspected this location on two previous occasions and found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This inspection on 30 January and 21 February 2017 was to check improvements had been made to meet the breaches of regulation. The inspection was unannounced. This meant the people who lived at Parklands and the staff who worked there did not know we were coming. We found sufficient improvements had not been made to meet regulations.

There was no registered manager in post at the time of the 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The manager who was running the home at the last inspection had left, a new manager had commenced employment.

Some families expressed they did not always feel their relative was safe at the service because of incidents that happened that had either harmed their relative or others. The number of incidents was supported through notifications submitted to the Care Quality Commission (CQC).

We found staffing levels were sufficient to meet people’s needs, but the recruitment of staff still required improvement to include all the relevant information and documents as required by the regulations.

Systems were in place to manage risks to individuals and the environment, but we found those systems were not always effective in practice to manage the risks identified.

Systems and processes were in place for the safe administration of medicines, but we continued to find the management of medicines required improvement.

There continued to be inconsistency where care plans and risk assessments did not fully reflect a person’s needs, concerns we had raised at previous inspections.

The majority of people received good support and choices at mealtimes, but this was not consistent for everyone who used the service, in particular people receiving their meal from a drinking beaker. For those people there were risks in regard to their nutritional needs, the presentation was not appealing and the people would not have been able to identify individual food by taste.

The premises had been improved to take account of ‘best practice’ in their design for people living with dementia, but further improvement was required. The registered provider had an action plan in place to address this.

Supervision of staff took place, but there was no information to demonstrate staff’s performance had been appraised yearly as stated in the service’s policies and procedures. All training was not up to date, or effective in practice, in particular, fire training.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. However, we found where decisions had been made in people’s best interest, some decisions lacked evidence to support the person lacked capacity in accordance with the Mental Capacity Act 2005.

People had access to a range of health care professionals to help maintain their health.

There were mixed responses from families about the care their relative received.

There were systems in place to assess and monitor the quality of service provided, but these had not been effective in achieving compliance with regulations.

The local authority and clinical commissioning authority were working with the service to drive the required improvements.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’.

Services in special measures 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.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.”

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

On 1 and 2 February 2016 the Care Quality Commission carried out an inspection and found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Warning notices were issued for two breaches of regulation and five requirement notices were issued for the further five breaches of regulation. At this inspection we checked that improvements had been made to meet the breaches of regulation. We found sufficient improvements had not been made to meet six of the seven previous breaches and a further breach was identified.

This inspection took place on 2 August 2016 and was unannounced. This meant the people who lived at Parklands and the staff who worked there did not know we were coming.

There was no registered manager in post at the time of the 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The manager who was running the home at the last inspection had left, a new manager had commenced employment, but was not present on the day of the inspection. Two of the registered provider’s regional service managers were supporting the service.

When we spoke with people who lived at the service they all told us they felt safe and this was supported by their family members.

We found staffing levels were sufficient to meet people’s needs, but recruitment of staff still required improvement to include all the relevant information and documents as required by the regulations.

Systems were in place to manage risks to individuals and the environment, but we found sufficient safeguards were not in place as identified in the fire risk assessment to keep people safe in the event of a fire.

Systems and processes were in place for the safe administration of medicines, but we found one medicine being used was beyond its use by date, a concern we had identified to the registered provider at the last inspection, when a warning notice was issued.

There continued to be inconsistency where care plans did not fully reflect whether a person had capacity to make decisions about their care and treatment and consent was not always sought in accordance with the Mental Capacity Act 2005, a concern we had raised at the previous inspection, when a warning notice was issued.

The majority of people received good support and choices at mealtimes, but this was not consistent for everyone using the service, meaning people’s dignity was not always maintained during the mealtime experience.

The premises had been improved to take account of ‘best practice’ in their design for people living with dementia, but further improvement was required. The registered provider had an action plan in place to address this. There had been improvements with the cleanliness of the home.

Staff received induction, training, supervision and appraisal relevant to their role and responsibilities, but induction training required review to accommodate new guidance, there were some staff who had either not received some training relevant to their role or it needed updating, there was inconsistency in the supervision and appraisal of staff.

People had access to a range of health care professionals to help maintain their health.

People and their relatives spoke positively about staff and said they were kind and caring.

There were systems in place to assess and monitor the quality of service provided, but these had not been effective in achieving compliance with regulations.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures 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.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

This was the first inspection for the new provider of Parklands. The service was registered with CQC in September 2015.

This inspection took place on 1 and 2 February 2016 and was unannounced. This meant the people who lived at Parklands and the staff who worked there did not know we were coming.

There was no registered manager in post at the time of the 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. A new home manager had commenced employment two months before the inspection and was being supported by the provider’s head of operations. The home manager confirmed they had submitted an application to CQC to commence the process to become the registered manager.

When we spoke with people who used the service they all told us they felt safe. Relatives spoken with did not raise any concerns about mistreatment or inappropriate care provision of their relative. Staff had received safeguarding training and were confident the manager would act on any concerns.

We found staffing levels were sufficient to meet people’s needs, but recruitment of staff needed to include all the relevant information and documents as required by the regulations.

Systems and processes were in place for the safe administration of medicines, but some improvements were needed surrounding the safe storage of medicines.

On one day of the inspection some areas of the home were not clean and free from odours that were offensive or unpleasant. More frequent cleaning is required.

Care plans did not fully reflect whether a person had capacity to make decisions about their care and treatment. Consent was not always sought in accordance with the Mental Capacity Act 2005.

People did not receive adequate support or choice at mealtimes.

The premises did not take account of ‘best practice’ in their design for people living with dementia.

People had access to a range of health care professionals to help maintain their health.

Staff received induction, training and supervision relevant to their role and responsibilities.

People were not always treated with dignity and respect whilst receiving care and treatment.

People and their relatives spoke positively about staff and said they were kind and caring.

People were not always supported in accordance with their needs and care provided was inconsistent. Staff did not fully understood people’s preferences and support needs.

There were systems in place to assess and monitor the quality of service provided, but these had not always identified improvements needed and ensured sufficient improvement to achieve compliance with regulations.

People and their relatives had been asked their opinion of the quality of the service by the regular meetings and availability of managers in the service.

We found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.