Parker House Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Risk assessments in place detailed risks, however some risk assessments needed more detail to ensure risks were clearly documented. People told us the management of some risks could be managed better. For example, ensuring people had easy access to moving and handling equipment. There were enough staff to support people with their needs. However, we observed not all people received support in a timely manner. Staff received relevant training to meet people’s needs. Staff received support through supervision. Managers made sure recruitment checks were undertaken on all staff to ensure only those individuals that were deemed suitable and fit, would be employed to support people at the service. The environment was monitored, and some action taken to ensure people were protected from risks relating to their environment. However, we found some environmental risks had not been identified prior to our assessment. The registered manager took immediate action following our feedback to protect people from the risk of harm. People told us they received their medicines safely. Staff received training in order to administer medicines safely and in line with the providers own policies. Audits in place were in their infancy and needed further embedding to ensure medicine administration processes were effective in keeping people safe. People told us the home was clean and tidy. Staff recognised some areas of the home required further refurbishment to ensure they could be cleaned effectively, and work was ongoing. People and those important to them were supported to understand safeguarding and how to raise concerns when they didn’t feel safe. Staff understood their duty to protect people from abuse and knew how and when to report any concerns they had to managers. When concerns had been raised, managers reported these promptly to the relevant agencies and worked proactively with them, to make sure timely action was taken to safeguard people from further risk.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they felt safe living at Parker House. People told us they felt the registered manager had created an open and honest culture and they implemented change when needed. People said they felt listened to and respected. For example, a relative we spoke with said, “I’ve found the manager to be very receptive if I suggest something.”

Processes in place meant lessons were not always learnt in a timely manner. For example, audits and meetings were still in the process of being development which meant there was limited evidence lessons had been learnt following our last inspection to embed the changes required. The registered manager advised us following our assessment these processes had been implemented and monitoring increased to ensure lessons were learnt to drive service improvement.

The registered manager recognised processes required further development to ensure lessons were learnt. The registered manager and staff discussed the changes made at the service following our last inspection including the implementation of new technology to monitor and improve the care planning processes. Staff told us the registered manager informed them of incidents and accidents during handovers and meetings to ensure incidents weren’t repeated. Staff completed training to support them to carry out their duties safely. The management team ensured staff completed refresher training as needed.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff understood how to respond to allegations of abuse. Staff told us that they had no concerns, but if they did, they were confident the registered manager would act appropriately. The registered manager understood how to respond to allegations of abuse. They had a process in place and investigated concerns when needed to keep people safe. Staff told us they completed safeguarding training and knew where to find the safeguarding policy. Staff understood what they needed to report and how they should report any concerns of abuse.

Safeguarding concerns were reported to the relevant authority and action was taken to reduce any ongoing risks to people whilst waiting for an outcome from the safeguarding team. If an allegation of abuse was made, there were policies in place to support the staff team. Records showed incidents were investigated and referred to the local authority safeguarding team if needed. We found action had been taken following a safeguarding concern to protect people from neglect or abuse. Staff received training in safeguarding and information relating to safeguarding was stored in a designated file which staff had access to. Safeguarding information was detailed in the service user guide for people and their families. This meant people had accurate information to report safeguarding concerns to if needed.

People told us they felt safe living at Parker House. People told us that there were no unlawful restrictions imposed on them. Staff gained consent before providing care and where needed provided care and support in people’s best interest. Some people would be at risk if they did not have continuous supervision and control. Where this was the case, we saw staff had applied the suitable Deprivation of Liberty Safeguards. These safeguards ensure people who cannot consent to their care arrangements in a care home or hospital are protected if those arrangements deprive them of their liberty.

We saw people and staff have positive relationships. We saw no evidence that people were at risk or fearful of the staff team. People appeared relaxed in staff’s company.

People had care plans in place. The registered manager had invested and implemented a new electronic system following our last inspection. This meant risk assessments could be monitored and updated in a timely manner. We found some people did not have clear risk assessments in place relating to bed rails, we fed this back to the registered manager who informed us they had updated all risk assessments relating to bed rails following our assessment. Other risks were assessed, and risk reduction measures detailed. For example, skin integrity and malnutrition risk assessments were in place. People also had falls risk assessments in place and mitigation documented. People had personal emergency evacuation plans in place. This meant staff and emergency services had accurate information in the event of an emergency. Newly developed clinical meetings had been introduced to ensure risks were managed and monitored. However, these were in their infancy therefore we were unable to assess whether these meetings were effective.

Risks were mostly managed safely, however we observed one person to be sat throughout our visit and did not have their personal care needs met. Whilst staff explained the person had become anxious when they attempted to support them, staff did not reattempt which meant their needs went unmet for a prolonged period of time. We fed this back to the registered manager who acted. We also observed people did not always have easy access to items to help with mobilising such as a Zimmer frame. This increased the risk of people mobilising unsafely. We observed high risk areas such as rooms storing hazardous products to be locked. This protected people living with dementia from potential harm. We observed risk reduction measures in place such as falls sensor mats and specialist moving and handling equipment in place for people. We also observed improvements had been to the flooring since our last inspection to reduce the risk of injury for people who were at an increased risk of falls. People were supported safely with any nutritional support, people who required physical support were supported according to their individual needs.

Staff told us they felt they were able to support people safely. Staff and the registered manager knew people and their families well. A staff member told us, “Ensuring that people are well treated and safely supported is paramount to me.” Staff knew how to access people’s care records and had received training in the new electronic system.

People told us most staff understood risks relating to their individual needs and offered support to keep them safe. However, some people told us whilst they were involved in decision making, they did not always have access to equipment they had been assessed as needing. For example, a person we spoke with said, “Staff do use the equipment to help me move but I do not have my own wheelchair which I could really do with.” Another person we spoke with also said they would prefer their own wheelchair but had to use the shared one. This meant people sometimes had to wait to use certain equipment. However, a relative we spoke with said, “My [relative] has their own bespoke chair and staff know them very well.” People also told us some staff communicated better others which impacted in how safe they felt.

During the assessment we found some areas of the home required attention. This had improved since our previous inspection. However, some issues remained. For example, we found a person’s bedroom to be unsafe due to the position of the bed and edges of the skirting board which were sharp. This meant if a person fell, they were at risk of injury. We discussed this with the registered manager during the assessment who was receptive to our feedback and after discussion with the person moved them to a different bedroom. This bedroom was then locked preventing people from accessing this room. We found other areas had seen improvements. For example, toilet rail handles had been fixed and new flooring had been fitted.

Processes in place meant that whilst issues had been identified they were not always addressed or rectified in a timely manner. For example, some issues relating to people’s bedrooms had been identified on the maintenance action plan, but timely action had not been taken to address these issues. Processes for monitoring the environment had not yet been embedded in the service and we found these were not consistently reviewed. Further work to embed processes was required to ensure the environment in which people lived remained safe.

The registered manager recognised some areas of the home needed work to ensure the environment remained safe for people living at Parker House. They told us of a programme of refurbishment works which had commenced but recognised further work was required. The registered manager told us, they had a maintenance action plan in place with areas listed for improvement. However, this had not been updated recently to demonstrate the progress. Staff told us the service was homely and did not feel clinical but did recognise some areas of the home needed improving. Staff we spoke with said, “The décor could be improved but I know that is ongoing.”

People told us they felt safe in their environment at Parker House. People said, they felt safe in their bedrooms as they had a call bell which they used to call for support when needed. People told us staff usually answered calls for support quickly which made them feel safe in their environment. People told us, if they wanted, they were able to lock their bedroom doors which helped them feel secure and safe in their personal space.

There were enough suitably trained staff providing care and support during our visit to Parker House. We observed most people to be supported in a timely manner. However, we did observe one person who was not supported in a timely manner. We fed this back to the registered manager. We also found when people were in communal lounges, they were often left alone for periods of time meaning if they needed help someone would need to shout for staff’s attention. Staff supported people kindly, although some staff communicated better with people than others. For example, most staff explained clearly what they were doing whereas others did not. Staff appeared to know people well, and we observed staff to anticipate people’s needs where they could not do this independently. We observed both people and their visitors to be relaxed in the company of staff.

People told us they were supported by kind staff who supported them safely. People said, “Staff are very kind and there’s nothing they won’t do for you”. People told us when they called for help staff attended quickly. A person we spoke said, “Staff come quite quickly if I ring.”

We spoke with 3 members of staff during the inspection and received feedback from 11 members of staff following our visit to Parker House. All of the staff we spoke with and received feedback from without exception gave positive feedback about working at Parker House. Staff told us there were always enough staff on duty and they received training to ensure they were competent to carry out their roles safely. Staff told us, “The environment is positive, we are trained, and I feel supported in my role.” The registered manager spoke with pride about the team and the positive impact they had on people living at Parker House.

Processes in place ensured there were enough suitably trained staff on duty. There was a dependency tool in place taking into account people’s individual needs. This determined how many staff were required each day in order to support people safely. Staff were recruited safely. Processes ensured necessary checks were completed prior to staff starting at Parker House. This included reference checks, proof of identity as well as Disclosure and Barring Service (DBS) checks. A DBS check is a way for employers to check an employee criminal record, to help decide whether they are a suitable person to work for them. This protected people from receiving support from unsuitable staff.

The home was clean and tidy. People’s bedrooms were clean and fresh. We found pressure relieving equipment and moving and handling equipment to be clean on the day of our assessment. Work to the environment was ongoing which meant there were still some areas which would be difficult to clean. However, many areas had been improved since our last inspection.

Staff understood their responsibility to protect people from the risk of infection. Staff told us they felt confident in the training they received. A staff member we spoke with said, “I’ve been trained to prevent infections at Parker House. And in my view, the place is really clean and tidy, which makes it safe for everyone who lives and works here.” The registered manager understood their role in keeping the home clean and tidy and was committed to ensuring infection control processes at Parker House continued to improve.

The registered manager had implemented a new audit process to identify any issues. A new mattress audit had been completed and action taken to replace any mattress that were unclean. An infection control audit was in place however this needed further development to ensure all areas were monitored. The registered manager was aware some audits required further work to ensure service improvement continued. The registered manager told us they were developing these further with the clinical lead and deputy manager. Staff received training in infection control to ensure people were protected from the spread of infection.

People and their relatives told us they were happy with the cleanliness of Parker House. A relative of a person we spoke with said, “It’s a very clean home and the laundry is great. They’ve done lots of decorating lately too.” People told us staff supported them with their hygiene needs to prevent any infections.

Processes in place needed strengthening to ensure people were protected from the risk of receiving their prescribed medicines unsafely. Audits had only recently been introduced and were not yet effective in highlighting errors. For example, we found gaps on one person’s medicines administration record which had not been picked up. We found the storage of prescribed thickeners were stored safely but audits had not picked up some were missing labels. We fed this back to the registered manager who increased their audits following our assessment to ensure medicines were administered and stored safely. People had medicine administration records in place which detailed how they like to take their medicines and what support they needed. This meant staff had accurate information in order to support people safely. We found topical medicines to have opening dates documented which meant staff knew they were safe to use. Controlled drugs were stored according to guidance. Staff completed regular checks for controlled drugs. Controlled drugs are subject to government restrictions due to the risk of harm and/or addiction. Completing regular stock checks of these medicines, provides assurances of management of these high-risk medicines.

Staff told us that they completed training to safely provide support to people with their medicines. Staff were able to describe safe systems for medicine management. Staff told us only registered nurses administered medicines and there was always a registered nurse on duty. All staff completed training in medicines to ensure when required staff could assist the registered nurse in checking high risk medicines such as certain pain relief medicines.

People told us they felt safe, and staff managed their medicines safely. People told us registered nursing staff supported them to obtain and take their medicines. People said, “I am aware what all my medicines are and they stand and wait while I take them. I can also ask for more pain relief if needed.” Relatives we spoke with were happy with how staff managed their loved one’s medicines and raised no concerns.