We carried out a review of the data available to us about Park House Residential Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Park House Residential Home, you can give feedback on this service.
Park House Residential Home is a residential care home providing personal care to up to 20 people in one adapted building over two floors. There were 13 people living at the home at the time of our inspection.
People’s experience of using this service and what we found
There was a positive and open culture in the home. People received person-centred care which was inclusive of their needs and preferences. Staff were clearly engaged in delivering this. The registered manager had developed a governance framework and checks and audits took place regularly. However, there was little evidence recorded of how the provider ensured they had oversight of the home.
We have made a recommendation for the provider to consider embedding clear and effective governance arrangements at all levels of the service.
The registered manager understood their regulatory requirements and responsibilities. People were involved in how the home was run. The home kept in regular contact with relatives and regular staff meetings took place. The service had an action plan which was used to continuously learn and improve. The home worked in partnership with health professionals, training agencies, and had worked closely with the Local Authority to drive improvements.
Systems were in place to protect people from abuse. Risks were monitored and managed. Appropriate checks of the environment and equipment took place. Staff were recruited safely and staffing rotas reflected people’s needs. Medicines were administered safely. Infection prevention and control best practices were followed. The registered manager had a process for analysing incidents and learning lessons from these.
People's needs and choices were recorded in detailed, person-centred care plans. Staff received appropriate training and supervisions and appraisals were planned and took place. Where people were at risk of malnutrition this was monitored and their food intake recorded. Staff were knowledgeable about people’s dietary requirements and preferences. Staff worked and supported each other as a team. Handovers took place and detailed information and observations about people's health needs were recorded. People received timely access to health professionals. The home was decorated to support people's choices and people were involved in this. Consent to care was recorded in line with legislation. Best interest decisions had taken place, where appropriate. People were supported to have maximum choice and control of their lives and staff them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
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 8 July 2021) and there were three breaches of regulation. 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.
This service has been in Special Measures since 31 January 2020. 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
We carried out an unannounced comprehensive inspection of this service on 13 May 2021. Three breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, staffing and good governance.
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 Safe, Effective 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 changed from requires improvement to good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Park House Residential Home on our website at www.cqc.org.uk.
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 COVID-19 and other infection outbreaks effectively.
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 Residential Home is a residential care home providing personal care to up to 20 people in one adapted building over two floors. There were 12 people living at the home at the time of our inspection.
People’s experience of using this service and what we found
There was a governance framework in place and some manager checks and audits had been undertaken, however the provider had not ensured these had been undertaken during the registered manager's absence. There was no evidence the provider had oversight of the service. Regulatory requirements, for example, the submission of change and absence notifications for registered persons had not been undertaken by the provider. People, relatives and staff all spoke highly of the acting manager and acting deputy manager. They found them open, approachable and responsive. The acting manager and acting deputy manager had identified and made some improvements.
Staffing levels were low. Not all maintenance checks on equipment had been completed as required. Infection prevention and control was well-managed, however the use of handwashing sinks in communal areas to clean commodes is not appropriate. There was no evidence incidents were monitored to learn lessons and implement improvements. Staff had received training on safeguarding and were aware of how to identify and raise concerns, however there was no record for tracking and monitoring safeguarding concerns.
We have made a recommendation about recording and monitoring safeguarding concerns.
Good systems and processes were in place for medicine administration. Staff were trained but had not had their competencies checked.
Regular refresher training had not been provided, although it was recognised that this had now been sourced. Not all kitchen staff were aware of the dietary needs of some people. People's needs and choices were appropriately assessed and recorded. There was a good level of detail in handovers and checks. Involvement had been sought from health professionals and their advice recorded. People had consented to their care. 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's rooms were personalised and appropriate signage to support people living with dementia was in place.
We have made a recommendation about reviewing and considering implementing guidance in relation to the environment for people living with dementia.
People told us they enjoyed living at Park House. People were treated with kindness, respect and compassion. Staff were able to explain how they involved people in their care and support needs however this involvement had not been recorded, for example, when undertaking care plan reviews. Staff respected people's dignity and privacy. People's independence was supported and encouraged.
Care plans recorded personalised care for each person. There had been no complaints, a complaints log was in place. People were appropriately and well-supported at the end of their life. Support had been sought to provide advanced care planning.
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 31 January 2020) and there were multiple breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. We undertook a targeted inspection (published 27 November 2020) to check what improvements had been made. We found the service was no longer in breach of regulations but was not able to provide a rating. This is because we only looked at the parts of the key question we had specific concerns about.
At this inspection enough improvement had not been made and the provider was still in breach of regulations.
This service has been in Special Measures since 31 January 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall but is rated inadequate in the key question of well-led.
Why we inspected
This was a planned inspection based on the previous rating.
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 COVID-19 and other infection outbreaks effectively.
We have found evidence that the provider needs to make improvements. Please see the safe, effective 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. The acting manager has already rectified some of the concerns we found.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Park House Residential Home 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 breaches in relation to safe care and treatment, staffing levels, 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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. 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 with the 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.
Special Measures
The overall rating for this service is ‘Requires improvement’. However, the service remains in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.
Park House Residential Home is a residential care home providing personal care to up to 20 people. There were 15 people living in the home at the time of our inspection visit. The home is a converted old hall with one room in an annex.
People’s experience of using this service and what we found
There was a process for recording concerns and complaints, and this was followed. There had been one complaint since our last inspection, which had been resolved appropriately, however relatives had not received any information about how to complain.
We have made a recommendation about complaints information.
People told us they felt safe. Systems were in place to safeguard people from abuse. Staff had received safeguarding training. Risk assessments were in place for each aspect of people’s care and support needs. These were reviewed on a monthly basis, and people had signed these to show their involvement.
Good systems were in place to ensure medicines were administered safely. Weekly checks and audits took place. Staff had the competency to administer medicines checked regularly and were observed to ensure their practice was safe. People chose how to receive their medicines when they were able to do so.
People’s needs and choices were assessed and their care and support was provided according to their preferences. Care plans contained detailed person-centred information about how to support people according to their likes and dislikes, and communication needs.
Staff had received training and their skills and competencies were checked regularly during direct observations.
People had consented to their care, and individual aspects of consent had been checked and recorded. 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 supported with dignity and respect. Their privacy and independence were encouraged and promoted.
There was a governance structure in place and regular audits about all aspects of the service took place. Performance and risk were measured and managed.
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 31 January 2020). 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
We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains Inadequate.
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.
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.
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.
Special Measures
The overall rating for this service is 'Inadequate' and the service therefore remains in 'special measures'. This means we will keep the service under review. We will re-inspect within 6 months to check for significant improvements.
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 key questions it will no longer be in special measures.
Park House residential care home is a residential care home that provides accommodation and personal care for older people and people living with dementia. The home can accommodate up to 20 people in one building over two floors. At the time of this inspection there were 15 people using the service.
People’s experience of using this service and what we found
People and their relatives were generally happy with the care and support they received. However, the combination of inconsistent leadership and ineffective systems which measured the quality and safety of services provided put people at risk. The provider was open about the difficulties the service faced before we came to inspect and recognised the service needed to make significant improvements. During and after the inspection the provider showed they were committed to addressing our concerns and sent a list to the CQC of actions they had planned to take.
Medication systems were in place however, these were not always followed. Risks associated with people’s care and support had been identified, however, from records and observations staff were not supporting people in line with their assessments. Therefore, risks were not managed safely. Staff had not had safeguarding training and were not aware of the action they needed to take to protect people from abuse. We identified safeguarding concerns had not been reported appropriately.
People told us they felt safe in the company of staff. However, practices which promoted people's safety were not always followed. For example, staff were not always safely recruited and appropriately supported by the management team to carry out the duties they were employed to perform.
People's needs were not always identified through a robust assessment of needs and care plans lacked detail, which meant staff did not have access to clear information about how to support people safely and meet their needs. People's health and safety risks were not consistently being identified by the service and measures to reduce such risks were not explored or implemented. People's care plans were not being regularly reviewed to ensure they reflected their changing needs. The care plans we saw did not contain advice from health care professionals to ensure people’s needs were met.
When staff engaged with people they were mostly kind and caring. However, we observed some staff did not engage when providing support and were task focused. Care was not always planned in a way that promoted people’s independence. On the days of our inspection we saw limited activities taking place. We found the home was clean and mostly odour free. Bedrooms had been personalised and communal areas were comfortably furnished. However, some areas of the service were not adapted to meet the needs of people living with dementia.
We have made a recommendation that the service considers current best practice guidance on dementia friendly environments.
Care plans were not person centred and lacked information about people’s wishes, preferences and choices. End of life care plans were very sparse and did not contain people’s preferences. From the care plans we looked at it was not possible to see if people were involved in their care planning. Staff we spoke with understood people’s needs however, did not always follow care plans to ensure they respected their choices. People were not supported to have maximum choice and control of their lives and staff supported 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.
Staff had not had the necessary supervision, appraisal and training as is necessary for their role. The provider had a range of audits in place to monitor the service delivery however these were not effective. Action was needed in response to the July 2018 fire risk assessment as issues identified had not been followed up. These actions were completed during and following this inspection. The system for recording complaints was ineffective. The provider did not always submit a notification to the CQC or the local safeguarding authority when an incident or untoward event had occurred.
Rating at last inspection
The last rating for this service was good (published 8 August 2018).
Why we inspected
The inspection was prompted in part due to concerns received from the local authority's' contracts and commissioners which highlighted many concerns about the safety of people using the service. The concerns were considered as part of the inspection. A decision was made for us to inspect and examine those risks.
Enforcement
We have identified breaches in relation to safe care and treatment, person centred care, staffing, need for consent, complaints, safeguarding and leadership and oversight at this inspection.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures.' This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.
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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner. Since our inspection we have been provided with a detailed action plan form the provider who is addressing the issues we identified at inspection.
At our last inspection we rated the service good with one breach of regulation of the Health and Social Care Act 2008 (Regulated Activities) 2014; regulation 17, Good Governance. This was because people living at the service had not been protected against the risks of inappropriate or unsafe care or treatment because the registered provider did not have effective systems to monitor the quality of service provision. At this inspection we found the registered provider was no longer in breach of regulations. 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.
Park House Residential Home is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as a 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 Residential Home is a care home providing accommodation and personal care up to 20 older people. There were 13 people living at Park House Residential Home at the time of this inspection.
There was a registered manager employed 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.
People spoken with were very positive about their experience of living at Park House Residential Home. They told us they were happy, felt safe and were respected.
Staff recruitment procedures were in place. The registered provider ensured pre-employment checks were carried out prior to new staff commencing employment to make sure they were safe to employ. We have made a recommendation about the completion of a risk assessment for one staff member employed at the service, to ensure they were of good character and promote people’s safety at the home.
Staff had the necessary skills and understanding to support people to evacuate safely in the event of a fire. We found the service’s fire risk assessment was five years old and therefore recommended the registered provider review the risk assessment, so that changes in legislation and guidance can be taken into account. After the inspection, we received confirmation from the registered provider that the fire risk assessment was to be reviewed by an external company specialising in fire safety.
People’s care records contained detailed information and reflected the care and support being given. We found some care reviews had been missed in records we checked. After the inspection, the registered provider submitted an action plan to the CQC to review everyone’s care records.
The registered provider had a complaints procedure and kept a record of any concerns received. We have made a recommendation about recording completed actions once a complaint is received, to evidence when they have followed their complaints procedure.
There were systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure full and safe procedures were adhered to. We have made a recommendation about the completion of infection control audits.
We found systems were in place to make sure people received their medicines safely so their health needs were met. Medicine protocols were in place to guide staff when to administer medicines prescribed on an ‘as and when’ basis to meet people’s health needs.
Staff were provided with relevant training, which gave them the skills they needed to undertake their role. Staff knew people well and positive, caring relationships had been developed. People were encouraged to express their views and they were involved in decisions about their care. People’s privacy and dignity was respected and promoted. Staff understood how to support people in a sensitive way.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the registered provider’s policies and systems supported this practice.
Park House Residential Home is an old stone built property adapted to provide accommodation and personal care for 20 older people.
There was a manager at the service who was registered with CQC. 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.
Our last inspection at Park House Residential Home took place on 11 March 2014. The home was found to be meeting the requirements of the regulations we inspected at that time.
This inspection took place on 12 January 2016 and was unannounced. This meant the staff who worked at Park House did not know we were coming. On the day of our inspection there were 15 people living at Park House.
People spoken with and their relatives were very positive about the experience of living at Park House and the staff who worked there. They told us they felt safe and staff were “second to none,” “lovely,” and “fantastic.”
Healthcare professionals spoken with had no concerns with the home and told us they found the staff to be caring. One professional told us, “The care is very good and staff are very responsive to residents.”
The interior and grounds of Park House were well maintained, clean and felt homely.
We found systems were in place to make sure people received their medication safely although the auditing of medicine records and systems does need to improve.
Staff recruitment procedures were thorough and ensured people’s safety was promoted.
Staff were provided with relevant training to make sure they had the right skills and knowledge for their role.
The service followed the requirements of the Mental Capacity Act 2005 (MCA) Code of practice and Deprivation of Liberty Safeguards (DoLS). This helped to protect the rights of people who may not be able to make important decisions themselves.
People had access to a range of healthcare professionals to help maintain their health. People told us a varied and nutritious diet was provided and their preferences were taken into account so their health was promoted and choices could be respected.
People said they could speak with the registered manager or senior staff if they had any worries or concerns and felt that they would be listened to.
We saw people participated in a range of daily activities both in and outside of the home which were meaningful and promoted independence.
Quality assurance systems were not fully in operation to assess, monitor and improve the quality of Park House.
We found a breach in one regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was a breach in; Regulation 17; Good governance.
You can see what action we told the provider to take at the back of the full version of the report.
We found there were effective recruitment and retention processes in place.
We found people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records had been maintained.
People told us 'the meals were very good'. One person said, 'meal times are a social occasion and the food here is excellent. What I find quite pleasing, is that on one's birthday, you get to choose the lunch and you can go to town. It's unlimited what you can choose. We have a very good cook.'
We found the provider worked in co-operation with other health and social care professionals to meet people's needs.
The environment was clean and people were protected from the risk of infection. They had access to surroundings that were conducive in supporting their health and welfare.
Safe recruitment practices were not being followed.
Records which are required to be kept in the management of the regulated activity were not all available when requested. There was a lack of proper information about people and staff, which meant people were not always protected for the risks associated with unsafe or inappropriate care.
People were positive about the care they received at Park House. One person described Park House as, 'very comfortable' and said that the home had, 'exceeded their expectations.' During our inspection we saw that the direct care provided at Park House was safe, appropriate and took people's individual needs into account.
We found that the majority of care plans at Park House were appropriate. We found some negative comments and words within the care plan of one person. This did not promote or portray a positive impression of this person and their specific needs.
We found that medication was administered safely. People told us that they received their medication on time and had never experienced any difficulties with it.
Our observations and conversations with staff and people who used the service demonstrated that there were enough staff to meet people's needs.
None of the people we spoke with during our inspection had any concerns about Park House. We saw that a complaints policy was in place and reviewed the two complaints within the homes complaints book. There was no documentation to acknowledge the second complaint and the action taken to resolve it.