Park House Nursing Care Centre

Park House Nursing Care Centre is a residential care home providing personal and nursing care to up to 30 people. The service provides support to people who may be living with dementia and physical disabilities. At the time of our inspection there were 24 people using the service.

People were supported in an extended Grade II building with accommodation over two floors. People had access to communal areas consisting of a lounge, dining room, courtyard, community room and well-tended gardens.

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

People were at risk of poor care and support because governance systems were not effective and needed strengthening. Although audits were taking place they had failed to identify and address the issues we found during our inspection, in relation to care planning, infection prevention and control (IPC) and medicines.

People’s medicines were not always managed safely. We identified concerns relating to storage, stock levels and medicines records.

We found no evidence people had been harmed. However, risk management of ‘high risk’ medicines required further development.

The provider did not have effective safeguarding systems in place to help protect people from the risk of abuse.

The registered manager had not ensured safe recruitment practices were being followed.

Staff training records showed gaps in essential training. And there was no evidence to show that staff had completed training to meet people’s specialist care needs. For example, Motor Neurone Disease.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Care plan quality was inconsistent and required further development.

There were enough staff to meet people’s care and support needs. Staffing levels were increased if people required additional care.

People were protected from the risks of infection. We saw staff wearing personal protective equipment (PPE) to reduce the risk of spreading infections.

People’s needs had been assessed before they started using the service; and people told us they were involved in making decisions about their care.

Staff treated people with respect and upheld their privacy and dignity. Staff knew people well and encouraged them to be as independent as possible.

The service worked with a wide range of key organisations who were also involved in people’s care.

People and staff were positive about the registered manager and nominated individual. Staff said they were both approachable.

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 11 December 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Enforcement and Recommendations

We have identified breaches in relation to people’s safe care and treatment, staff training and support and the overall governance of the service at this inspection.

We have also made a recommendation the provider considers current guidance in relation to safeguarding processes, recruitment of new staff and supporting people to make their own decisions in line with consent to care and treatment.

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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

We spoke to four relatives during our inspection to understand their visiting experience. One relative told us they had not been able to visit as expected, however, three relatives told us they were satisfied with the visiting and communication arrangements. People could nominate three named visitors, and the essential care giver role was available in addition to this. The essential care giver role included enhanced COVID-19 testing.

Relatives told us they were required to produce a negative rapid COVID-19 test prior to visiting their family member. Personal protective equipment (PPE) was supplied, and guidance for PPE usage was displayed at the care home.

External health and social care professionals, and visitors, evidenced COVID-19 vaccination status, and had to produce a negative rapid COVID-19 test before entering the care home. Additionally, health declaration and temperature checks were completed. The only exception to this was for emergency workers, to ensure no delay of their review and care for people.

During the pandemic, the registered manager had introduced uniforms for staff to enhance their response to infection control. A log cabin had been built to support additional visiting options, and a safety screen was available should it be required. An air purifier had been installed in the log cabin, and an additional transportable air purifier was available within the care home.

The care home was clean and hygienic. Frequently touched areas, such as door handles, handrails and computer equipment received enhanced cleaning. Staff told us they had access to the required cleaning products and equipment to maintain a safe environment.

Park House Nursing Care Centre provides care and support for up to 34 elderly people, some of who may be living with dementia. At the time of our inspection 28 people were using the service. It is an extended Grade II listed building with accommodation over two floors.

We found the following examples of good practice.

The provider had purchased a Perspex screen for use at French windows to enable visiting to continue. In addition, a summer house had also been identified for use by visitors, and a booking system had been implemented to allow cleaning to take place in-between visits.

Where people were living on the first floor or were in receipt of End of Life care, the provider had implemented visiting guidelines. These guidelines included visiting by appointment only, provision of PPE and was for one nominated person for a period of 30 mins. All visitors were escorted directly to people's rooms and were requested to use the call bell for an escort at the end of the visit

Further information is in the detailed findings below.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

People using the service felt safe. Staff had received training to enable them to recognise signs and symptoms of abuse and they felt confident in how to report these types of concerns. People had risk assessments in place to enable them to be as independent as they could be in a safe manner. Staff knew how to manage risks to promote people’s safety, and balanced these against people’s rights to take risks and remain independent.

There were sufficient staff with the correct skill mix on duty to support people with their required needs. Effective recruitment processes were in place and followed by the service. Staff were not offered employment until satisfactory checks had been completed.

Medicines were managed safely. The processes in place ensured that the administration and handling of medicines was suitable for the people who used the service. Effective infection control measures were in place to protect people.

People were supported to make decisions about all aspects of their life; this was underpinned by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff were knowledgeable of this guidance and correct processes were in place to protect people. Staff gained consent before supporting people. 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.

Staff received an induction process and on-going training. They had attended a variety of training to ensure that they were able to provide care based on current practice when supporting people. They were also supported with regular supervisions and observed practice.

People were able to make choices about the food and drink they had, and staff gave support if and when required to enable people to access a balanced diet.

People were supported to access a variety of health professionals when required, including opticians and doctors to make sure that people received additional healthcare to meet their needs.

Staff provided care and support in a caring and meaningful way. They knew the people who used the service well. People and relatives, where appropriate, were involved in the planning of their care and support.

People’s privacy and dignity was maintained at all times. Care plans were written in a person-centred way and were responsive to people’s needs. People were supported to follow their interests and join in activities.

People knew how to complain. There was a complaints procedure in place and accessible to all. Complaints had been responded to appropriately.

Quality monitoring systems were in place. A variety of audits were carried out and used to drive improvement.

Further information is in the detailed findings below

Park House Nursing Centre is registered with the Care Quality Commission to provide care and accommodation for up to 30 people. Some people may require nursing care and people living at the home may have dementia. At the time of our inspection there were 28 people living at the home.

The home had a registered manager in post 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.

People received their medicines as they had been prescribed. An electronic system had been introduced with the aim of improving medicines administration. However the system required further development to enable it to address all situations that could occur in the administration of people’s medicines. During this inspection we Identified that there were some inconsistencies in the stocks of medicines held. Following our inspection the registered manager identified that these were down to errors within the system and introduced manual checks of medicines to identify and resolve any discrepancy speedily.

Staff were aware of the safeguarding process. Personalised risk assessments were in place to reduce the risk of harm to people, as were risk assessments connected to the running of the home, and these were reviewed regularly. Accidents and incidents were recorded and the causes of these analysed so that preventative action could be taken to reduce the number of occurrences.

There were enough skilled, qualified staff to provide for people’s needs. The necessary recruitment and selection processes were in place and the provider had taken steps to ensure that staff were suitable to work with people who lived at the home. They received training to ensure that they had the necessary skills to care for and support the people who lived at the home and were supported by way of supervisions and appraisals.

People’s needs had been assessed before they moved into the home and they had been involved in determining their care needs and the way in which their care was to be delivered. Their consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards were met.

People had a variety of nutritious food and drink available to them. There were freshly made, home cooked meals from a menu that had been devised using people’s likes and dislikes. The cook made regular checks that people were happy with the meals and choices provided. Snacks and fruit were available to people throughout the day.

Staff were kind and caring and protected people’s dignity. Staff treated people with respect and supported people in a way that allowed them to be as independent as possible.

There was an effective complaints system in place. Information was available to people about how they could make a complaint should they need to and the services provided at the home. People were assisted to access other healthcare professionals to maintain their health and well-being.

People and staff were encouraged to attend meetings with the registered manager at which they could discuss aspects of the service and care delivery. People were asked for feedback about the service to enable improvements to be made. There was an effective quality assurance system in place and the provider was an active participant in the day to day running of the service. .

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

We found that the home was meeting all areas.

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

We considered our inspection findings to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found

Is the service safe?

People had been cared for in an environment that was safe, clean and hygienic. The home had been well maintained. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was always available to provide support to staff. Staff told us that they were 'able to get things done' with the support of management.

Is the service effective?

People told us that they were happy with the care that had been delivered and that it was, 'A good home' and 'Staff made it as comfortable as possible'. People told us that their needs had been met. From a review of care documents and discussions with staff we saw that they had a good understanding of the people's care and support needs. Staff told us that they received handovers three times during the day which were recorded and discussed; this ensured staff were always kept informed of day to day changes. One person told us that, 'Staff are available when you need them', and that 'You can always talk to them'.

Is the service caring?

People were supported by kind and attentive staff. We were told that staff, 'Are always cheerful'. We saw that care staff were patient with people and always consulted people before carrying out any care. People told us they were given choices on what they wanted to do in the day and the food they wanted to eat. One person told us that they, 'Can't fault the staff'. Staff we spoke to told us that they all, 'Work together' to provide person centred care to people.

Is the service responsive?

People's needs had been assessed before they moved into the home and care plans had been created and were regularly reviewed and updated to support people in the care that they had been provided with. We saw that staff were aware of people's needs and preferences and acted in accordance with their wishes.

Is the service well-led?

Staff told us that they enjoyed caring for the people who lived in the home and that they worked hard to make the home a, 'Happy place' for the people to live. Previously the home did not have robust quality assurance processes in place. We saw that the manager had now put in place processes that ensured the quality was regularly monitored. People had recently completed a customer satisfaction survey and we saw that the results of the survey showed that people were generally happy with the service being provided. Staff told us they were clear about their roles and responsibilities and that management was 'Very supportive and approachable'.

We saw that the staff cared for people in a respectful way and had been provided with the necessary training to ensure they had the experience to meet people's assessed needs. Staff told us what they would do if they felt people were not being cared for correctly. People who use the service told us they felt safe living at Park House Nursing Care Centre. One person said, 'Everyone is lovely.' Another said, "I like some of the staff more than others, but everyone of them is kind."

Everyone we spoke with was complimentary about the standard of food in the home. One person said, "I like everything but if I didn't the cook would come up with something special for me." We observed breakfast and lunch. Breakfast was provided to people as they wanted it and lunch was served at 12.15. We were told a meal could be kept if someone did not want it at this time.