Parklands Lodge

We found the following examples of good practice.

An electronic ‘booking in’ procedure was in place for visitors to the home including, evidence of a negative lateral flow test and COVID-19 vaccination. This helped prevent visitors spreading infection on entering the premises.

The home facilitated face to face visits, in line with government guidance. Both the registered manager and provider implemented any changes in government guidance accordingly. Visitors were kept up to date through telephone and email communication.

The home had a designated visiting room which had its own entrance, meaning that visitors did not have to enter the home if so preferred. However, visits were also permitted in peoples' rooms. A marque had been installed to permit garden visits in the warmer weather. Alternatives to in-person visitation, such as virtual visits, were also supported, as and when necessary.

People and staff were tested regularly for COVID-19. Staff employed at the home had been vaccinated, to help keep people safe from the risk of infection. Some staff had received their COVID-19 booster vaccinations. In the event that a person refused to be tested, risk assessments were used to help minimise any risk of infection transmission.

The home was clean, hygienic and well maintained, full time domestic staff helped implement good infection control practices.

Infection control policies and procedures helped ensure that the home adopted best practice which complied with current guidance. Cleaning schedules and audits were in place to help maintain cleanliness and minimise the spread of infection. High touch point areas such as light switches and door key code pads were sanitised two hourly.

Staff were trained in how to put on and take off PPE. The registered manager conducted visual observations and assessments of this. The home had adequate supplies of appropriate PPE. Staff had a designated area of the home where they could change into their uniforms and put on PPE before each shift.

The registered manager maintained links with external health professionals to enable people to receive the care and intervention they needed.

Parklands Lodge is a purpose-built service and provides residential and nursing care to older people, including those living with dementia. The service was supporting 20 people at the time of the inspection.

People’s experience of using the service and what we found

We inspected the service following some concerns about the management of infection control following a recent outbreak of COVID-19 at the home. There had been progress made regarding the concerns raised. We found the service was following good practice guidance regarding the management of COVID-19 and maintaining standards of hygiene and infection control.

People reported good support regarding the management of their medicines and told us they got their medicines on time. The medications records supported best practice although we fed back some minor anomalies to make records clearer. Staff administering medicines were suitably trained and competent.

We found good ongoing checks of the environment helped ensure people were safe.

The home was staffed appropriately at the time of the inspection. Use of regular staff had improved following the recent infectious outbreak where there had been some reliance on agency staff. This helped to maintain a consistency of care for people. People and their relatives told us they felt safe living at Parklands Lodge.

Since the last comprehensive inspection there had been three changes of management. The current manager was providing leadership and was supported by a senior management team. There were a series of quality assurance processes and audits carried out internally and externally by the home manager and senior managers. The new manager for the service had ensured key management systems had been applied in the home although we fed back some improvements to be made to the auditing cycle to further ensure consistency and development of the service.

People's experience of using the service was positive. People received the care and support they needed when required. The feedback we received showed staff were helpful and kind and treated people with dignity and respect.

A relative commented, “Communication has been an issue as there have been a lot of managers; this has improved recently and [manager] is good.” A person we spoke with commented, “I’ve always felt safe; staff are there when I need them.”

Risks associated with people’s care were identified and managed to minimise harm. Supporting care records identified risks and there were plans in place to help keep people safe.

Rating at last inspection and update

The last rating for this service was Requires improvement (published 10 February 2021). The service remains rated requires improvement. This service has been rated requires improvement since the last comprehensive inspection in July 2019.

Why we inspected

The inspection was prompted due to concerns received about aspects of the overall management of the home including the outcome of a recent audit carried by the local infection control team following an outbreak of COVID-19 at Parklands Lodge. The Commission is aware that the provider disputes the content of the LA/CCG infection control audit.

A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe and well-led only.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained Requires improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Parklands Lodge on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

• People were admitted to the service safely. People were tested for COVID-19 prior to their arrival and were cared for in their own room for an initial period of ten days.

• A safe visiting procedure was in place and followed. Any visitors to the service had their temperature taken and completed a health screening questionnaire. Physical visits to the home were facilitated for people's relatives in times of exceptional circumstances, such as end of life care.

• The service was registered for regular testing to ensure people and staff were tested frequently. The service also carried out additional testing if people or staff presented with symptoms.

• Policies, procedures and equipment were in place to maintain infection control and support the needs of the people using the service. The service worked in partnership with external professionals such as Infection Control Teams to help implement best practices.

Further information is in the detailed findings below.

Parklands Lodge is a care home providing personal and nursing care to 37 people aged 65 and over at the time of the inspection. The service can support up to 70 people. The home is purpose built over four floors. All but one floor support people living with dementia.

People’s experience of using this service

Improvements had been made in accordance with the provider’s action plan and the breaches of regulations found at the last inspection had been met.

Risk in relation to; completion and maintenance of records, development of individualised care plans, and meeting the requirements regarding peoples consent to care, had been reduced.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems to support this had improved. There was still a need for managers and staff to fully evidence clear, consistent, assessments for individual key decisions for people who lacked the ability to consent to care.

We made a recommendation regarding this.

The managers and the staff that we spoke with demonstrated their commitment to providing high-quality, person-centred care. Comprehensive care records reflected an improvement to people’s level of individualised care. People’s feedback regarding care and their level of involvement also reflected this improvement.

The key parts of the provider’s action plan, developed following our last inspection, had been met; these included improved electronic care records and documentation. The recruitment of new staff had supported a more consistent level of care for people.

People living at Parklands Lodge, relatives and staff were informed of any changes and encouraged to contribute to discussions.

Rating at last inspection and update

The last rating for this service was requires improvement (published 30 September 2019). There was a breach of regulations relating to records and personal care. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service in May 2019. A breach of three legal requirements was found. We issued a notice for one of these breaches and told the provider to improve. The provider completed an action plan after the last inspection to show what they would do and by when to meet these statutory requirements and improve care and treatment.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Effective, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those Key Questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has not changed and remains Requires improvement.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Parklands Lodge on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service:

Parklands Lodge has experienced management and staffing changes over the past three months. There was no registered manager in place at the time of the inspection. An interim manager was managing the service.

Some improvements have been made to the service during this period but there was a need for further improvements to be made. Systems of governance and oversight were still not robust enough to have identified the issues we found in relation to records supporting care.

The electronic care records that supported people's care were confusing, difficult to access and incomplete. The assessment and planning of people’s care were not always individualised. Preferences and choices were not always considered and reflected within records and work was ongoing to improve the new electronic system.

There had been a lot of staff changes over the previous months. The home was not always staffed consistently. Staff could not always fully explain each person’s care needs.

Records did not always evidence people's consent to care, and this needed clarifying. When people were unable to consent, the principles of the Mental Capacity Act 2005 were not always followed consistently.

There were systems in place to monitor medication so that people received their medicines safely. This was an improvement from the last inspection as aspects of medication safety had been a reoccurring issue. Some records with respect to the administration of thickening agents for people with swallowing difficulties needed improving; these where actioned at the time.

Arrangements were in place for checking the environment to ensure it was safe. We found the environment safe and well maintained.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported.

Staff were safely recruited and received the training and support they needed to undertake their role.

People living in the home interacted freely and staff were seen to be caring and supportive.

We were given mixed feedback from the people we spoke with and their relatives. Most of the feedback was positive and evidenced people were being supported. There was some anxiety expressed about the consistency of staffing.

There was a range of opportunities for people to engage in activities and follow their hobbies and interests.

We saw people’s dietary needs were managed with reference to individual needs and choice.

More information is in the full report.

Rating at last inspection:

This service had previously been inspected in April 2018 and rated as Requires improvement. There had been two breaches of regulations with respect to medicines management and the management and governance of the service. The report was published on 30 May 2018.

Why we inspected:

This was a planned inspection based on the rating of the service at the last inspection. Before the inspection we had received some concerning information about medication administration, the management and governance of the service and staffing.

Following our inspection, the service continued to be rated as Requires improvement.

Enforcement:

We have identified breaches in relation to person-centred care, the need for consent, and good governance. Please see the action we have told the provider to take at the end of this report.

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

Follow up:

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Parklands Lodge is a purpose built ‘care home’ offering nursing and personal care for up to 70 People. The care home is located close to Southport town centre near Hesketh Park. Care is provided over four levels in different units depending on people’s level of individual need; Meadow Park, Bluebell unit, Daffodil Park and Tree Tops. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of the inspection there were 67 people living in the home.

This registered manager had recently submitted their notice and was no longer working at the service. 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. Suitable arrangements were in place to ensure the effective management of the service in the interim period through the oversight of the deputy manager and compliance and support manager for the organisation.

At the last inspection on 30 March 2017, we found that the registered provider was in breach of Regulation 12 (Safe care and treatment). Following the last inspection, we asked the registered provider to complete an action plan to tell us what they would do and by when to improve. We received an action plan dated 2 May 2017 that outlined what improvements the registered provider intended to make to improve the safety of the service. At this inspection, we found that registered provider remained in breach of Regulation 12 and we identified a further breach of Regulation 17 (Good Governance).

At the last inspection we identified concerns with the way medicines were managed at the service. This was because the recording of medicines was not always clear or consistent and the audit processes were insufficient to ensure anomalies were identified. At this inspection, we found that medicines were still not managed safely at the service and quality assurance procedures were not robust.

Records contained contradictory information regarding people who required thickened fluids. The guidance in respect of what consistency the person needed was unclear and staff spoken with gave conflicting information. Support plans in place regarding PRN (as needed) medication did not always include important information to guide staff on safe administration such as the recommended time intervals between administrations. Medication Administration Records were not always updated to document people’s current medication, such as homely remedies.

Audits in place to check the safety of medicines were not robust because they had not identified the issues we found during the inspection. In addition, when errors were identified through the internal audit system, there was no clear evidence of remedial action taken in response. This meant that processes in place to monitor the quality and safety of the service were not always effective.

We have made a recommendation about staffing. We received mixed feedback from people, their relatives and staff themselves about the staffing levels within the service. Some people told us they had to wait for support and staff reported, and were observed, to be stretched.

We have made a recommendation about staff training and supervision. Staff received training to assist them to be effective in their role and an annual appraisal. Staff we spoke with felt relatively well supported and thought they had the skills and knowledge to complete the jobs effectively. However, we identified gaps in the training and supervision schedule at the service, a recurrent theme from our last inspection.

The registered provider had a number of different systems in place to assess and monitor the quality of the service. This included regular audits of areas such as care plans, infection control, the environment and accident and incidents. However, we identified that these checks were not always effective because actions, such as maintenance and repairs, were not always addressed in a timely manner.

All of the people we spoke with who used the service told us they felt safe when receiving care and support from the staff at Parklands Lodge. Staff were recruited safely because pre-employment checks were completed to ensure they were suitable to work with vulnerable people. There was a safeguarding policy in place and staff were able to describe what course of action they would take if they felt someone was being harmed or mistreated.

Risk assessments were sufficiently detailed and contained information regarding how to manage risks appropriately. Procedures were in place to analyse accidents and incidents with a focus on future learning and prevention.

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 at the service supported this practice. People told us that consent was sought and staff offered them choice before providing care. DoLS applications had been made appropriately and included any restrictions in place and consent was sought in line with the principles of the Mental Capacity Act 2005.

People spoke positively about the food served at the service. People were supported with their nutrition and hydration intake when required. Staff made referrals to a variety of health and social care professionals when required to support people to maintain their health and well-being.

People told us they liked the permanent staff team who supported them. Staff were mindful of how to preserve people’s dignity when providing personal care. Staff explained the ways in which they supported people to be involved in everyday decision-making to encourage their autonomy and independence.

Care plans were sufficiently detailed and documented people's preferred routines and individual preferences. This enabled support to be provided in a person centred way. Care plans were reviewed on a monthly basis and any changes in support needs were clearly recorded.

People and their relatives had access to a complaints procedure and a suggestion box was available in the home to enable people to raise any concerns. A record of complaints was held and these had been responded to in accordance with the registered provider’s policy. People also had the opportunity to contribute to service delivery through resident and relative meetings and surveys.

The registered manager had notified the Care Quality Commission (CQC) of events and incidents that occurred within the service in accordance with our statutory requirements. This meant that CQC were able to monitor risks and information regarding Parklands Lodge care home.

The required improvements to the service identified at our last inspection in March 2017 had not been implemented. The registered provider remained in breach of regulation around medicine management and there continued to be a lack of effective audit systems and processes to check the quality and safety of the service.

You can see what action we told the registered provider to take at the back of the full version of the report.

This was an unannounced inspection which took place on 30-31 March 2017. This was the first inspection of the service since Parklands Lodge was registered in April 2016.

There was a registered manager in post. 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.

We found some anomalies with the way some medicines were being recorded and monitored. This meant there was a risk these medicines were not being administered consistently. We found the checking and auditing systems of medicines needed improving to ensure all anomalies were being identified.

You can see what action we told the provider to take at the back of the full version of this report.

The registered manager and senior managers for the provider were able to evidence a range of quality assurance processes and audits carried out at the home. We found some supporting management systems continued to be developed and key areas such as medicines management and overarching health and safety audits needed improving.

We found the home supported people to provide effective outcomes for their health and wellbeing. We saw there was effective referral and liaison with health care professionals when needed to support people.

We looked at how staff were recruited and the processes to ensure staff were suitable to work with vulnerable people. We saw required checks had been made to help ensure staff employed were ‘fit’ to work with vulnerable people.

We found there were sufficient staff on duty to meet people’s care needs.

Staff said they were supported through induction, appraisal and the home’s training programme. We identified some areas that needed further development and found that some of these had also been identified by the managers. We received reassurance after our inspection visit that some issues, such as formal supervision for staff, had now been updated.

Care was organised so any risks were assessed and plans put in place to maximise people’s independence whilst help ensure people’s safety.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. Training records confirmed staff had undertaken safeguarding training in-house. All of the staff we spoke with were clear about the need to report any concerns they had.

Arrangements were in place for checking the environment to ensure it was safe. For example, health and safety checks were completed on a regular basis so hazards could be identified. Planned development / maintenance was assessed and planned well so that people were living in a comfortable environment.

The home was clean and we there were systems in place to manage the control of infection.

Staff sought consent from people before providing support. When people were unable to consent, the principles of the Mental Capacity Act 2005 were followed in that an assessment of the person’s mental capacity was made.

When necessary, referrals had been made to support people on a Deprivation of Liberty [DoLS] authorisation. DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. The applications were being monitored by the registered manager of the home.

We saw people’s dietary needs were managed with reference to individual preferences and choice. Meal time was seen to be a relaxed and sociable occasion.

People we spoke with said they were happy living at Parklands Lodge. Staff interacted well with people living at the home and they showed a caring nature with appropriate interventions to support people. People told us their privacy was respected and staff were careful to ensure people’s dignity was maintained. Staff were able to explain each person’s care needs on an individual basis and how they communicated these needs.

People we spoke with and their relatives felt staff had the skills and approach needed to ensure people were receiving the right care.

People felt involved in their care and there was evidence in the care files to show how people had been included in key decisions.

Social activities were organised in the home. People told us they could take part in a variety of social events which were held.

We saw a complaints procedure was in place and people, including relatives, we spoke with were aware of how they could complain. We saw there were records of complaints made and the manager had provided a response to these.

The registered manager was aware of their responsibility to notify us [The CQC] of any notifiable incidents in the home.