Archived: Park House

Park House is a care home providing accommodation and personal and nursing care to up to 50 people. Accommodation is provided across two floors in one adapted building. At the time of our inspection 27 people were living at the home.

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

The service was not always well-led. Systems were not always effective in monitoring quality and driving improvements across the service. Audits had not always been effective in identifying issues. Where an audit had identified shortfalls action plans had not always been implemented to deliver improvements. There were gaps in the records to evidence government guidance was followed in relation to testing for COVID-19.

Medicines were managed safely however; medicines records were not always accurately maintained. Accidents and incidents were documented. Trend analysis reviews had not always taken place to consider if any actions were necessary to improve outcomes for people.

There were sufficient staff deployed to meet the needs of people. Contingency plans were in place in the event of staffing shortages. Systems for the safe recruitment of staff were in place. However, employment gaps for potential employees had not always been considered in the recruitment process. We have made a recommendation about this.

Staff understood their safeguarding responsibilities and were aware of how to escalate any concerns if this was necessary. A range of risk assessments were in place to help ensure the safety of people and the environment.

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

Rating at last inspection

The last rating for this service was good (published 18 July 2019).

Why we inspected

We received concerns in relation to staffing, medicines, care delivery, management arrangements, testing for COVID-19, record keeping and the management of falls. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified one breach in relation to good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

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.

Park House is a care home providing personal and nursing care for up to 50 people, some of whom are living with a dementia related condition. There were 25 people living at the service at the time of our inspection.

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

People we spoke with were positive about the care and support they received. One person told us, “The food here is good. I can’t remember what I am having for lunch, but the food is always nice. I’m happy here. They do look after me.” We observed positive interactions between staff and people using the service throughout our visit. People looked relaxed in the company of staff and laughed and shared jokes.

Arrangements were in place to ensure safe infection control and prevention practices were followed. Policies and procedures followed government guidance and staff had received training in the appropriate use of PPE. When asked staff were able to explain the correct process for the putting on and taking off of PPE.

People received safe care and support which was person centred. Care and support plans were personalised and contained information on people’s preferences for how they wished to receive care.

Risks to people’s safety had been assessed and there was guidance in place to manage these risks appropriately. We spoke with one staff member who explained the measures in place to support one person to remain safe. This explanation corresponded with the risk assessments and guidance in the person's care plan.

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

Rating at last inspection

The last rating for this service was Good (published 18 July 2019).

Why we inspected

We undertook this targeted inspection to check specific concerns we had received about people not receiving person centred care and risks to people’s safety not being assessed. The overall rating for the service has not changed following this targeted inspection and remains good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

Park House is a care home providing personal and nursing care for up to 50 people. Some of whom have a dementia related condition. There were 22 people living at the service at the time of our inspection.

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

At our previous inspection we identified multiple breaches of the regulations. At this inspection, a new registered manager was in place and we found robust action had been taken to improve.

People, relatives , staff and health and social care professionals now spoke positively about the improvements the new registered manager had made. One relative said, “I would definitely recommend the home. I have seen what a bad home is – here, you’ve seen it at its worst. I would recommend it now and I thought I would never say that.”

Effective systems were now in place to ensure people's safety. Risks were assessed and monitored, sufficient staff were deployed and safe recruitment procedures were followed.

People were supported to have maximum 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 in the service supported this practice.

People were cared for by staff who were suitably trained and supported. Staff supported people to access healthcare services and receive ongoing healthcare support.

Staff spoke in a caring and respectful manner about the people they supported. They talked about caring for people like members of their family. Staff told us they would now be happy for a friend or relative to live at the home because of the standard of care provided.

People were supported at their end of life. A multi-disciplinary approach was followed to help ensure consistent and responsive care was provided to meet people's needs at this important time in their lives.

People were supported to continue their hobbies and interests both within the service and outside, in the local community.

At our previous inspection, some people, staff and relatives said there was a negative culture at the service. The new registered manager had now changed this to a very open culture where everyone was listened to. She encouraged everyone to participate in this new way of working which was beneficial to both people and staff. One relative said, “It’s a brighter, happier place – it’s spot on.”

Audits and checks were carried out to monitor the quality and safety of all aspects of the home. Our observations and findings confirmed there was now an effective quality monitoring system in place.

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

Rating at last inspection (and update)

The last rating for this service was inadequate (published 18 February 2019).

At our previous two inspections, we identified multiple breaches of the regulations. We placed conditions on the provider's registration to minimise the risk of people being exposed to harm. This included imposing a suspension of admissions to the home.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since our inspection in May 2018. During this inspection, the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating and enforcement action taken

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.

At the last inspection in May 2018 we rated the service overall inadequate. At that time, we identified multiple breaches of the regulations and placed the service into special measures. Services in special measures are kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, we inspect the service again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. This inspection did not change the rating of the service and the overall rating is ‘Inadequate.’ The service remains in ‘special measures.’

Following the last inspection, we met with the provider to discuss the concerns we had about the service. We asked the provider to complete an action plan to show what actions they were going to take to improve. At this inspection, we found that although some action had been taken to address the previous shortfalls; we found ongoing breaches of the regulations and identified new concerns and shortfalls.

This is the second inadequate inspection of Park House and third inspection where the provider has failed to maintain compliance with the legal requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Park House is a ‘care home’. 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. Park House can accommodate up to 50 people. At the time of the inspection there were 37 people living at the service, some of whom were living with a dementia.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 registered manager was a peripatetic manager employed by the provider. A peripatetic manager is a manager who works across a number of services ran by the provider. We were told a permanent manager had been recruited for the home who would register as the manager once they commenced working at the service.

People told us they felt safe living at the home. There were safeguarding and whistleblowing procedures in place. Training had been provided to staff on safeguarding and whistleblowing procedures. It was also a standard agenda item on staff meetings and daily flash meetings to help ensure staff were given the opportunity to raise any concerns and were aware of how to escalate these if they felt their concerns were not being listened to. Three staff told us however, that they had raised several concerns about staff conduct. It was not clear whether the issues raised were dealt with in line with the provider’s policies and procedures; since records of the concerns raised and action taken were not fully available at the time of the inspection.

There were shortfalls and omissions with the management of risk. Although staff had completed training in moving and handling, we received feedback from several staff, people and a health and social care professional, that moving and handling risk assessments were not always followed. In addition, care plans and risk assessments were not always updated when there was a change in need for people.

The home was clean and there were no strong odours. One staff member told us that timely action had not been taken to replace mattresses that had been repeatedly soiled. The provider told us that following an external mattress audit, nine mattresses had been replaced and action had been taken when further concerns about the mattresses were received.

Medicines were administered to people safely. However, we could not be sure that creams and ointments were given to people as prescribed. There were gaps in medicines records.

Safe recruitment procedures were not always followed.

We received mixed feedback from people, relatives and staff about whether there were sufficient staff deployed to meet people’s needs. Some stated that more staff would be appreciated. We observed there were sufficient staff deployed to meet people’s needs at the time of our inspection.

Observations between staff and people were mixed. We saw at times, staff treated people with warmth, kindness and compassion during their interactions. Other observations showed staff were focused on tasks and engaging with each other rather than with people.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The registered manager had submitted Deprivation of Liberty Safeguards [DoLS] applications in line with legal requirements.

There was an activity coordinator employed. However, we found that there was a lack of meaningful activities for people.

There were some gaps in training the provider had deemed necessary for staff. The provider explained there was a plan in place to ensure that improvements in staff training were attained and sustained. Staff told us they did not receive supervision or appraisals in line with the providers policy.

The provider had a gender related care policy included within their personal hygiene policy. We found however, that this was not always followed. People’s care plans did not always reflect their preferred support levels with personal care in relation to whether they had support from male or female care staff. In addition, people’s preferences to receive personal care support from a female member of staff were not always respected.

People knew how to complain. There were gaps in the recording of complaints which meant we could not be assured that all complaints had been investigated and responded to.

Concerns and shortfalls relating to the governance of the service remained. At this inspection, we found that improvements had been made in certain areas of the service, however; we found ongoing breaches of the regulations and identified new concerns and shortfalls.

We referred all of our concerns about the service to Newcastle local authority and Newcastle Clinical Commissioning Group. At the time of our inspection, the home remained in ‘organisational safeguarding’. This meant that the local authority was monitoring the whole home.

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

The service was last inspected in September 2017. At that time we identified two breaches of the regulations relating to safe care and treatment and good governance. We rated the service as requires improvement. We asked the provider to complete an action plan to show what actions they were going to take to improve. At this inspection, we found that although action had been taken to address the previous shortfalls; we identified new concerns and shortfalls.

Park House is a ‘care home’. 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. Park House is registered to provide accommodation for persons who require nursing or personal care and for treatment of disease, disorder or injury. Park House can accommodate up to 50 people. At the time of the inspection there were 46 people living at the service, some of whom were living with dementia.

A new manager had been appointed in October 2017. They had applied to register with CQC as a registered manager. However, they were not present during or following our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

During this inspection, concerns were highlighted about how people were treated. Several people raised safeguarding allegations of a physical and psychological nature. Two staff informed us of their concerns about how certain staff spoke with people. We passed this information to the regional manager who notified the local authority safeguarding adults team and the police. We found that the correct actions had not been taken with regards to several safeguarding allegations. They had not all been reported to the necessary authorities including CQC.

There were shortfalls and omissions with the management of risk. Staff did not always follow risk assessments in relation to moving and handling. Documented risk assessments were not always in place for identified risks such as choking.

People received their medicines as prescribed. Records relating to administered medicines were well kept and medicines were stored appropriately.

Timely action had not been taken to resolve the bathing and plumbing issues at the home. At the time of the inspection, there was only one bath in use to bathe all people on both floors because none of the showers or other baths were working. This was resolved by the third day of our inspection. Maintenance records showed that suitable water temperatures were not always maintained in people’s bedrooms. Some water temperatures were recorded at less than 30°C.

We received mixed feedback from people and staff about staff deployment. We considered that more direction from senior staff could help staff deployment. We have made a recommendation that staff deployment is kept under review to ensure sufficient staff are deployed at all times

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The manager had submitted Deprivation of Liberty Safeguards [DoLS] applications in line with legal requirements. We found however, that consent to care and treatment was not always sought in line with the Mental Capacity Act 2005 (MCA).

Training records were not well maintained. The training matrixes contained gaps against certain training courses. It was unclear which training staff had completed or needed to undertake.

An effective system to assess, manage and monitor people’s nutritional needs was not fully in place. People were supported with their health care needs. Care records contained details of referrals and input from health care professionals.

Observations of staff interactions with people were varied. We saw some staff were very friendly and chatted with people whilst they supported people. We observed that others spent time talking amongst themselves, rather than engaging with people. In addition, some of the language used by staff did not promote people’s dignity.

There were two activities coordinators employed. We found however that there was a lack of meaningful activities.

Complaints had not always been fully investigated and there had been a failure to link themes between complaints and safeguarding.

The provider had not carried out robust, thorough and questioning audits of the service capable of identifying areas for improvement. Audits did not demonstrate who was accountable for which task and action plans had not been completed.

The overall rating for this service has deteriorated from ‘requires improvement’ to ‘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 of 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 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.

Following the inspection, we wrote to the provider to request an action plan which listed what action they had taken or planned to take to address the concerns and shortfalls identified during the inspection. We also met with the chief operating officer and regional staff to discuss our concerns and the improvements required for this service to become compliant with the regulations.

We referred all of our concerns about the service to Newcastle local authority, Newcastle Clinical Commissioning Group and the police. At the time of our inspection, the local authority had placed the home into 'organisational safeguarding.' This meant that the local authority was monitoring the whole home. The provider had also agreed not to accept any new admissions to the home.

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During this inspection, we identified eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also identified a breach of the Care Quality Commission Registration Regulations 2009, Notification of other incidents. You can see what action we have told the provider to take at the back of the full version of the report.

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

Park House is a residential home which provides nursing and personal care for up to 50 people. At the time of our inspection there were 44 people living at the home, some of whom were living with dementia. 30 people required nursing care and 14 people required residential care.

A registered manager was in place at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 last inspected this service on 13 May 2015 when it was rated 'good.'

During this inspection we found breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because risks associated with people's care were not always identified and mitigated, and the provider did not have effective quality assurance processes to monitor the quality and safety of the service provided to ensure people received appropriate care and support.

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

People and most relatives spoke positively about the service and said it was a safe place to live.

Staff had received training in safeguarding and knew how to respond to any allegations of abuse. Safeguarding referrals had been made to the local authority appropriately, in line with set protocols. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who used the service.

The premises were clean and largely well-maintained although some walls and handrails needed repainting. The provider had not responded to repeated requests from the registered manager to address specific maintenance issues.

Medicines that are liable to misuse, called controlled drugs, were stored appropriately. Records relating to controlled drugs had been completed accurately.

Regular planned and preventative maintenance checks and repairs were carried out and other required inspections and services such as gas safety were up to date.

Accidents and incidents were recorded accurately and analysed regularly. Each person had an up to date personal emergency evacuation plan should they need to be evacuated in the event of an emergency.

Staff received regular supervisions and appraisals and told us they felt well supported by the manager.

People had 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.

People told us staff were kind and caring. People said their choices were respected and their dignity was upheld.

Each person who used the service was given information about how to make a complaint and how to access advocacy services. An advocate is someone who represents and acts on a person's behalf, and helps them make decisions.

People we spoke with knew how to make a complaint. They told us they would speak to a member of staff or the manager if they had any issues. Relatives had mixed views whether complaints they had raised had been dealt with appropriately.

Staff had a good understanding of people’s care preferences but care records did not always contain up to date and relevant information about people’s care needs.

People we spoke with knew who the registered manager was and said they liked them. Staff said the registered manager was approachable and supportive.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found-

Is the service safe?

People told us they felt safe and well-cared for in the home. People's prescribed medicines were safely stored and administered.

The provider had robust systems in place for making sure only appropriate people were employed in the home to look after vulnerable people. Visiting professionals said they had no concerns about people's safety in the home. They told us the staff were very good at asking for professional advice, when appropriate, and following any guidance given to them, to keep people safe.

Is the service effective?

People told us the food was very good in the home. People told us the staff knew their needs and preferences regarding their care. Most people we spoke with felt there were enough staff to meet their needs. Visiting professionals told us told us the staff were always 'very caring' and 'very responsive and helpful'. They told us the staff team was hard working, well trained and very professional. They also told us staff used the full range of community and specialist services available to them to provide effective care.

Is the service caring?

People said they were happy living in the home, because the staff were very caring, and treated them with respect. People's comments included, 'It's generally good. I'm well-treated'; and, 'I'm pleased with the home. There's lots of activities. We get good care and staff treat me with respect'. Relatives confirmed the staff were kind and attentive at all times. Visiting professionals told us were 'very caring' and 'particularly polite and courteous' to the people living in the home.

Is the service responsive?

Relatives and some of the people we spoke with said they were involved in planning their care, and told us their views were asked for and acted upon. People told us they felt able to speak to staff if they had any concerns, and that staff listened to them and responded appropriately. One person commented, 'The staff are very good. They listen to you. If I ask them to do anything, they do it for me. I can't think how the home could be improved.' People said they were happy living in the home. Visiting professionals told us staff were very responsive to advice and guidance, and were able to deal with complex cases and urgent situations appropriately and speedily. They told us the home worked well with other professionals. We saw any complaints were dealt with in a timely manner.

Is the service well-led?

Since the previous registered manager left in December 2013, the home had been managed by a number of acting and interim managers. We saw that standards of care had been maintained. We were told the deputy manager and the staff team had worked hard to maintain consistency of care during this period. Records showed, and visiting professionals and relatives confirmed, that people's needs had continued to be met. A new manager was in post at the time of this inspection, and feedback from staff and professionals was positive about her pro-active approach. She had written to people living in the home, their relatives and staff to introduce herself and ask for comments and feedback about the home.

People's care and treatment needs were assessed before any care was given, and these assessments were reviewed regularly, to make sure they continued to meet people's needs. We spoke with people living in the home, with their relatives and with visiting professionals about the standard of care in the home. All were very positive, and praised the manager and the staff highly for their care and compassion.

Improvements in policies and procedures for keeping people in the home safe had been made since the last inspection, and staff had also been given further training in recognising and responding to any suspicions of abuse. This meant that people's safety had been enhanced.

Staff were also being given better support, supervision and training. This meant they were able to better understand and meet the needs of those people living in the home.

Any complaints received by the home had been taken seriously and had been properly investigated. Where necessary, steps had been taken to either refer the problem to the appropriate authorities or to make changes in the home, to prevent further complaint being necessary.

People told us they were happy with their care and were very positive about the staff. Their comments included, 'We're well looked after, and the staff are nice'; and, 'They [the staff] are very kind'. People's needs and wishes had been properly assessed and their care was carefully planned. Relatives told us they were also satisfied with the quality of care. One relative told us, "The care is generally very good". Visiting health professionals agreed, one person saying the care was "excellent".

Staff were very caring and were aware of their responsibilities for protecting people. However, we found that records for the safeguarding of vulnerable adults were not clear and did not demonstrate that all necessary steps had always been taken to prevent abuse, or to respond appropriately to some allegations of abuse.

The systems in place to support staff in meeting people's needs were not working well. Staff training was not up to date, and staff had not received the necessary formal supervision or appraisal in recent months.

The home had generally effective systems for checking the quality of the service offered.