Park House

We found the following examples of good practice.

• The home had a dedicated infection control champion who was also their head housekeeper. With the management, they monitored staff practices to ensure the correct procedures were being followed. All staff were monitored to ensure they adhered to national guidance and maintained the strictest of infection prevention and control standards throughout the home. Enhanced cleaning schedules were in place.

• Systems were in place to manage and prevent people, staff and essential visitors from catching and spreading infections. The home supported staff and people with social distancing. Community Nursing teams visited the home regularly to provide care and support to people and staff.

• Staff were observed to be wearing appropriate personal protective equipment (PPE) at all times. Suitable supplies of PPE were available. Staff had undertaken training in putting on and taking off PPE, hand hygiene and other Covid-19 related training. Clean signage and information was in place throughout the home to remind staff of their responsibilities.

• The home ensured people isolating or presenting with any symptoms were supported safely in accordance with national guidance. People were cared for by a dedicated staff team who provided a support bubble to meet all of their needs and reduce any feelings of isolation and loneliness. People were supported to keep in contact with friends and relatives through telephone calls and use of social media. At the time of inspection, all visiting had ceased, in line with national guidance.

• The home was participating in the whole home Covid testing programme. All staff and residents were in the process of having their Covid vaccinations.

• Infection control audits and checks were carried out. The registered manager and community nursing teams spoke highly about the hard work and dedication which staff had shown throughout the pandemic. This had helped to minimise the impact the pandemic restrictions had placed on people’s health and wellbeing.

Park house is a residential care home in Guisborough. It is a purpose built building which provides care and support for up to 56 people over three floors. At the time of the inspection 55 people were using he service.

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

People, relatives and professionals were extremely positive about their experiences in this home. Comments included, “The home is beautiful and staff are wonderful. [Person] is well looked after.” And, “I love the home. Staff are always helpful. There is always someone available to talk to. On every floor staff know the patients. It’s just fab and nothing is hard work. There is always something going on [for people]. It’s welcoming and comfortable.”

The care which people received kept them safe from harm. Professionals were involved when people needed extra support to keep them well. Comments included, “There is good two-way communication for advice and informal discussions. Staff are happy to ask questions. They have always done what they need to do to reduce risk before they contact us. The right steps have been followed and recommendations have been completed.”

People were encouraged to take positive risks, which led to them being as independent as they could be. Staff were responsive to risk and staff continually monitored them. Resources to manage risk were in place. There were always enough staff on duty and they were supported in their roles.

People received very good person-centred care from staff who knew their needs well. The care which people received led to positive outcomes for them and they were able to lead fulfilled lives. Comments included, “I get looked after. Staff are brilliant. They are so friendly. It’s like a hotel.” And, “The girls [staff] can’t do enough for you.”

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.

Leadership was effective. Continued improvements had taken place since the last inspection and staff worked together to embed these changes. Feedback from everyone involved in the service was used to drive improvement. Checks in place to monitor the quality of the service demonstrated the service was very good.

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 requires improvement (published 20 December 2018) and there were two breaches of regulation relating to medicines and quality assurance. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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 care home is an established care home, however was newly registered under HC one This is the first rating of the service since registering with us on 25 January 2017.

Park House Care Home 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.

The home accommodates up to 56 people in one adapted building across three floors. At the time of inspection, there were 54 people using the service.

The service had a registered manager. A registered manager is a person who has registered with the 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. The registered manager at the home had been in post since May 2018 and had extensive experience of working in the social care sector.

A programme of audits were carried out by the registered manager. However, these were not always effective as we found issues with medicines that were not identified in audits.

Medicines were not always, stored or managed safely we found issues with the cleanliness of the medicine treatment rooms and administration equipment. Records were not in place for all topical medicines (creams) and there were some stock control issues.

Dietary requirements for people where not always clear and communication between care staff and kitchen staff was not always consistent. Menus on display didn’t reflect the food on offer for people.

People were supported to have a positive dining experience. However, we received mixed feedback about the range of food on offer and we found little or no choice for people who needed their food prepared differently for dietary needs.

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, this wasn’t always observed at meal times.

Communication systems were in place for staff. Staff used handover notes to pass on important information between shifts and held regular meetings. However, messages between kitchen staff and carers was not always consistent.

People’s nutrition and hydration needs were met and they were supported to maintain a healthy diet. Where needed, records to support this were detailed.

Partnership working was in place with other professionals, including health care professionals and community nurses. Specialist consultants were involved in people’s care as and when this was needed and staff supported people with any appointments. Feedback from the community team was excellent.

Accidents and incidents including falls were managed and recorded robustly they were analysed and lessons were learned.

People’s personal risks had been identified and more detailed risk assessments had been written to give staff the necessary guidance on how to keep people safe.

Staff training was up to date and reflected people’s needs. Staff gave us positive feedback about their training.

People were now supported by sufficient numbers of staff to meet their needs. Rotas’ showed there were consistent numbers of staff on duty each day to meet people’s needs.

People were supported to access information in a variety of formats to suit their needs and adaptations could be made to suit individual needs.

During our inspection lots of valued activities took place with people and feedback from people and their relatives about the activities was extremely positive.

The home was clean, tidy, well presented and infection control was carried out to a good standard. However, we found cleanliness issues in the treatment rooms that were addressed.

People were supported by kind and caring staff. We observed positive interactions between people and staff. The feedback from people and their relatives was positive about the staff attitude and their caring nature.

Staff were employed safely and pre-employment checks were carried out on staff before they began working in the service. Staff were supported through an induction period. They received training and supervision from the registered manager together with an annual appraisal.

People were supported to maintain their independence by staff who understood and valued the importance of this.

Care plans were person centred regarding people’s preferences and were personalised. Person centred means that a person’s preferences are respected and valued when planning and delivering their care and support.

People were supported by person centred approaches and the service had a three wishes project that supported people to achieve personal goals.

People could complain if they wished to and procedures were in place to support this.

No-one was receiving end of life are at the time of our inspection however, arrangements were in place for people.

Notifications of significant events were submitted to us in a timely manner by the registered manager.

We found two breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These relate to safe care and treatment and the management of medicines and good governance. You can see what action we told the provider to take at the back of the full version of this report.

Park House provides care and accommodation to a maximum number of 56 older people, some of whom were living with a dementia. Park House is a three storey purpose built facility. There are three units within the service. Grace unit can accommodate 23 people living with a dementia. The ground floor unit can accommodate 21 people who need personal care. The lower ground floor can accommodate 12 people who need help with personal care. There are communal lounges and dining facilities on each floor. Bedrooms are for single occupancy and have en-suite facilities which comprise of a toilet, hand wash basin and shower. The home is close to shops, pubs and public transport. At the time of the inspection there were 54 people who used the service.

The home had a registered manager in place. 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. The registered manager displayed exceptional leadership qualities, drive and enthusiasm. They empowered staff to provide outstanding care that was tailored to individual’s needs. Without exception people, their relatives and professionals told us they experienced and we observed compassionate care from staff who strove for excellence. This ensured the service was run in the best interest of people who used the service.

There were robust systems and processes in place to protect people from the risk of harm. Staff were able to describe in detail different types of abuse and what their responsibilities were in protecting people. This ensured the welfare of vulnerable people was protected through the rigorous whistle blowing and safeguarding procedures.

There were meticulous control measures in place to make sure safe care was delivered at all times and this was in a safe environment. This included comprehensive and detailed individual and collective risk assessments covering health and environmental issues. This meant that staff were enabled staff to help people to remain safe.

Staff displayed enthusiasm and pride in their work. We saw the registered manager provided comprehensive levels of supervision and appraisal for staff. This resulted in a talented and motivated workforce. The management team recognised potential and invested in their staff. This empowered staff to support the people who used the service effectively.

People using the service were involved in the recruitment process. The robust recruitment and selection process ensured the safety of individuals who lived at Park House.

Staff were enthusiastic and proud to work at the service. Staff had been trained and had the skills and knowledge to provide support to the people they cared for. The management team encouraged staff and gave excellent support to enable staff to develop their knowledge and skills further. The management team recognised potential and invested in their staff. This meant they could support the people who used the service more effectively. People and relatives told us that there were enough staff on duty to meet people’s needs. Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions.

We found a stimulating environment with a warm and welcoming atmosphere. People, staff and relatives had developed strong and mutually respectful relationships. Feedback we received about the service was unswervingly high. We saw positive interactions between people and staff and staff treated people with dignity and respect, anticipating their needs.

We saw that staff had been creative in their introduction of social experiences for people; an example was a twilight dining experience, introduced at tea time on Grace Unit. A restful and tranquil atmosphere was created with background music and flameless candles. Staff minimised distractions to ensure people relaxed and were able to concentrate on the dining experience and people were content to sit at the table. The registered manager told us that since introducing this experience people’s appetites had increased resulting in better nutrition. Staff told us that because of the enormous success of this experience they were to introduce it to other units.

We saw that people were provided with a choice of nourishing food and drinks which helped to ensure that their nutritional needs were met. Nutritional screening had been used to identify specific risks to people’s nutrition and this helped staff to make sure people’s dietary needs were tailored to each individual. The registered provider had a genuine interest in developing and resourcing new ways to enhance and improve people's nutrition. Innovative products were sourced to enable pureed food to be fortified, given texture and moulded to resemble the original shapes of meat and vegetables. This meant the dining experience for those people who needed a soft or pureed diet was greatly enhanced and their dignity maintained as they could use a knife and fork to eat, rather than a spoon. Another product used was a powder that could be added to a variety of drinks, using an air pump, to create bubbles and foam. This provided a refreshing substitute to conventional mouth rinses where oral care was required.

There was a strong presence of health care professional involvement at the service where people had access to all healthcare professionals and services. Professionals who visited the service during the inspection told us the service was outstanding. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments.

Assessments were undertaken to identify people’s care, health and support needs. There was a strong emphasis on person centred care. People and their families were at the centre of decision making whilst working alongside professionals to get the best outcome possible. Care plans were developed with people who used the service and relatives to identify how they wanted to be supported.

People’s independence was actively encouraged. The registered manager and staff displayed clear resolve to make a positive difference to people's lives. Activities were invigorating, outings and events were well thought through, varied and in plentiful supply. Staff encouraged and supported people to access activities within the community. The registered provider had initiated a 'Three wishes campaign’. People who used the service were asked to write down things they wanted to accomplish over the coming year. Staff then worked hard to make sure at least one of their wishes comes true. People who used the service told us this had happened and their wishes had been granted. There were meaningful activities for people living with a dementia and thought had been given to the layout of Grace Unit to ensure it enhanced the life of people who used the service. Themed areas had been created in corridors which encouraged people to stop, look and interact with the surroundings and others. Meticulous thought had been given to sensory stimulation such as beads and fluffy throws.

The registered provider had a system in place for responding to people’s concerns and complaints. People and relatives told us they knew how to complain and felt assured that staff would respond and take action to support them. People and relatives we spoke with did not raise any complaints or concerns about the service.

The management team sought feedback from staff, people, relatives and external partners on a regular basis. There was a culture of continuous learning and improvement. Survey responses were analysed and shared with all stakeholders. The registered manager had regularly completed a wide range of audits to maintain people’s safety and welfare at the service. Staff told us that the home had an open, inclusive and optimistic culture.

The inspection team was made up of one adult social care inspector and an expert by experience. The expert by experience spoke with people who used the service, relatives and staff. The inspector spoke with people who used the service, a relative, the manager, the operations manager, the activity co-ordinator and with care staff.

We set out to answer our five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us that their rights and dignity were respected.

Care plans and risk assessments were in place and were updated on a regular basis.

We found that care plans were not person centred and did not detail what the person could do independently or the assistance needed from staff. This meant that people may not receive care and support in the way they want it to be delivered.

Staff we spoke with during the inspection were very knowledgeable about the people they cared for. Staff we spoke with were aware of risk management plans that had been written for people with particular needs.

We found that nutritional screening had been carried out for people who used the service. This meant that people received timely and appropriate intervention if they lost weight. People were supported to have adequate nutrition and hydration.

Systems were in place to make sure that the manager and staff learnt from events such as accidents and incidents, concerns, complaints, whistleblowing and investigations. This helped to reduce the risk of harm and ensured that lessons were learnt from mistakes.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The home had proper policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and there was evidence to show that these had been followed appropriately. Staff had received training in relations to these topics along with the safeguarding of vulnerable adults and had an understanding of the actions to take. This meant that people were safeguarded as required.

Is the service effective?

People's health and care needs were assessed and where possible people and their relatives were involved in writing the plan of care. Specialist dietary and mobility needs had been identified in care plans. Care and support plans were reviewed and updated on a regular basis.

The records we looked at also showed that people's needs were regularly reviewed. For example, people' weight was monitored and action had been taken when there was concern about someone's nutritional wellbeing. For example, staff fortifying their food and involving the doctor or dietician.

Is the service caring?

People were supported by kind and attentive staff. We saw that care staff showed patience and gave encouragement when supporting people.

People who used the service, their relatives and friends were regularly asked for their views on the care and service provided. Where shortfalls or concerns were raised, however small, these were taken on board and dealt with.

Is the service responsive?

People knew how to make a complaint if they were unhappy. Discussion with the manager and operations manager during the inspection confirmed that any concerns or complaints were taken seriously. We looked at the complaints record which confirmed that complaints had been investigated thoroughly and in line with the complaints policy.

People took part in a range of activities both in and out of the home. This helped to keep people involved in their local community.

Is the service well led?

The home had a registered manager, who was supported by the provider and administrative systems. The manager and staff had a good understanding of quality assurance processes and records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving. There was also regular input from the provider, including visits to the service.

Staff told us that they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and all senior staff understood and shared the responsibility of quality assurance processes. This helped to ensure that people received a good quality service at all times.

What people told us.

During the inspection we spoke with 22 people who used the service and three relatives. We also spoke with the manager, the operations manager, the activity co-ordinator and with care staff.

People who used the service told us that they were very happy with the care and service received. One person said, 'I like being here, people are kind and I can get everything I need.' Another person said, 'They are all kind and ever so helpful.'

People told us that they were happy with the food that was provided. One person said, 'The food here is excellent, always hot and there is plenty of it.'

Staff told us that they received lots of training and an annual appraisal. They said that they felt well supported by the manager. One person said, 'The training is non stop.'

We used a number of different methods to help us understand the experiences of people who used the service, because some people had complex needs which meant they were not able to tell us their experiences. A relative spoken with said, 'I feel that he/she is well looked after and is safe and secure.' Another relative said, 'The staff are really kind, friendly and helpful.'

We were able to observe the experiences of people who used the service. We saw that staff treated people with dignity and respect. We saw that people had their needs assessed and that care plans were in place.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to safely manage them.

We saw that people lived in safe, accessible surroundings that promoted their wellbeing.

We saw that the service had appropriate equipment. We saw that regular checks and servicing of equipment was undertaken to ensure that it was safe.

We found there was an effective complaints system in place at the home.

During the inspection we spoke with three staff and they told us that people who used the service were able to make choices about what time they went to bed and got up on a morning. We found that care records reflected people's choices regarding their sleeping routines and preferences. We were unable to speak to people who used the service during the inspection as people were in still in their rooms.

We observed that people's views were taken into account in the assessment and care planning process.

We found that staffing levels reflected the needs of people living at Park House at the time of the inspection and steps had been taken to increase the flexibility of staffing .

CQC is aware that the details of the Registered Manager (RM) included in this report are not correct. The process to remove these RM details and register the new Manager at Park House is in progress.