We carried out a review of the data available to us about Home Park Nursing 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 Home Park Nursing Home, you can give feedback on this service.
Home Park Nursing Home is a nursing home providing personal and nursing care for up to 35 people. At the time of our inspection there were 34 people using the service.
People’s experience of using this service and what we found
People were safeguarded from abuse by staff trained to protect them. People felt safe and regular servicing and maintenance ensured the premises were safe. Recruitment was safely completed, and agency staff were used to maintain safe staffing levels. Medicines were safely managed, and improvements had been made since we last inspected. We were assured the provider maintained good infection prevention.
People’s care records contained useful information to ensure they received the care they needed in a way they were happy with. Staff completed an induction on commencing in post and completed additional and refresher training to ensure they were familiar with current good practice. Kitchen staff were responsive to people’s needs and wishes and prepared meals people enjoyed. People were supported to remain active and as independent as possible. 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.
There were a wide range of plans addressing aspects of people’s health and well-being and daily activities. People were supported to access the local community and where possible and safe to do so they were encouraged to engage independently. The service was managed in a positive way and staff could access the management team when needed as they had an open-door policy. The provider understood their responsibilities under the duty of candour and informed CQC of significant events in the service. Regular meetings and surveys ensured the provider maintained good communications with staff, people and relatives.
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 good (published 22 June 2019) and was rated good. At this inspection we found the service remained good.
Why we inspected
The inspection was prompted in part due to concerns received about the quality of care and because we previously identified areas for improvement in well-led.
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.
The overall rating for the service has remained good.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Home Park Nursing Home is registered to provide accommodation for up to 35 older people living with dementia who require nursing or personal care. At the time of the inspection there were 28 people living at the home.
The home had 23 single rooms and six shared rooms located over two floors which are accessible via stairs or lifts. The home had a large communal area which opened out to a garden at the rear of the 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.
People’s experience of using this service:
• The providers evacuation list of people living at the home was not up to date and put people and the emergency services at risk of harm in the event of an evacuation of the building being necessary. This document was updated immediately on the first day of our inspection.
• Window restrictors on the first floor at the home were not robust or tamper proof and did not therefore reduce the risk of people falling from height. This was updated following our inspection and the provider sent us evidence it had been done.
• People received their medicines when they needed them and as prescribed.
• The service was person centred and assessed people’s needs and individual preferences.
• Staff told us that the training they attended was good and gave them the skills and knowledge they needed to support people. However not all self-employed staff had undertaken refresher training.
• Health care professionals such as community nurses, a GP, and community mental health team had been involved in people’s care.
• 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.
• People were supported to express their views and staff were knowledgeable about people’s preferred communication methods.
• Relatives and staff were very positive about the management of the service.
Why we inspected:
• We inspected the service as part of our inspection schedule methodology for ‘Good’ rated services.
Rating at last inspection:
• At the last inspection in December 2016 the service was rated Good.
• Rating from this inspection: Good
Follow up:
• We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.
There was a registered manager at the home. 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.
At our last inspection in July 2015, we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to make improvements in the areas of: ensuring peoples care plans reflected their most current needs, ensuring guidance for staff was clear to support people with their medicines, and taking steps to minimise risk to ensure a safe environment for people to live in. At this inspection we found that improvements had been made and provider had taken steps to meet the requirements of the regulations.
People received personalised care which was tailored to their needs. This included care plans that reflected peoples; dietary needs and preferences, personal care routines, people’s life history and medical conditions. People and their relatives were involved in the planning and reviewing of their care and told us the provider worked in partnership with them.
People’s care records were updated regularly to reflect their changing needs. The staff responded quickly to changes in people’s health and wellbeing. Staff were able to identify when people’s conditions changed and took appropriate action to ensure they were seen by healthcare professionals.
The provider had made adjustments to the environment to make it more suitable for people living with dementia or visual impairment. Environmental and individual risks to people were monitored and managed to ensure the risk to people coming to harm was minimised. The registered manager undertook regular checks and audits of the home environment to ensure it provided a safe and comfortable place for people to live in. Incidents were analysed to identify causes with measures put in place to reduce the risk and likelihood of reoccurrence.
People were cared for with kindness and compassion. Staff followed legislation designed to protect people’s rights and freedoms.
Staff knew people well and interacted with them positively when supporting them. They actively sought to uphold people’s choice, privacy and dignity. People had a range of activities available for them to participate in and were supported to maintain contact with people who were important to them.
People’s medicines were managed safely and people received their medicines as prescribed.
There was a clear management structure in place and sufficient staff that were suitably skilled and qualified to meet people’s needs. Staff felt supported in their role by the registered manager and received regular supervision and guidance. Staff were confident in identifying and acting upon safeguarding concerns about people.
The service had an open and transparent culture. The provider encouraged feedback from people, relatives and professionals and looked to make improvements from suggestions made. Complaints were dealt openly with the registered manager responding feeding back to people in a timely manner. The provider notified CQC about significant events that happened in the home.
The inspection took place on 14, 16 and 21 July 2015.
The home provides accommodation and care for up to 35 people. There were 34 people living at the home when we visited, all of whom were living with dementia.
There was 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 and associated Regulations about how the home is run.
At the last inspection on 30 and 31 October 2014, we asked the provider to take action to make improvements in the following areas: respecting and involving people; care and welfare; safeguarding people from abuse; cleanliness and infection control; recruitment procedures; staffing; medicines and assessing and monitoring the quality of the service provision. Action had been taken to make improvements in line with the provider’s action plan but during this inspection we found two continuing breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found one new breach. You can see what action we told the provider to take at the back of the full version of this report.
The home was clean but there were were areas of the home where risks had not been identified or action taken to minimise them. Care plans were not up to date and one person did not have a care plan in place. Medicines were stored safely but people did not always have effective care plans in place for medicines prescribed as ‘when needed’.
Staff were aware of risks to people, such as using the hoist to support people to move. They knew about people’s moving and handling care plans which detailed what equipment people needed to ensure they were supported to move safely.
Most people needed staff support to eat and drink and this was done in a patient and caring way. However, we saw two incidents where people were not getting the support they needed and the registered manager dealt with the incidents. Staff formed positive caring relationships with people and spoke about them in a caring and compassionate way. People’s dignity was respected when staff supported them with personal care. The provider employed an activities co-ordinator who used a range of techniques to interact with people.
New staff started work after satisfactory pre-employment checks had been completed. Staff completed a thorough programme of induction training as well as further training, relevant to their work. Staffing levels were calculated based on the number of people living in the home rather than on assessed needs and staff said most people needed support with eating and many needed two staff to support them with moving and personal care. However, staff did meet people’s needs. The registered manager was well thought of and ensured an open and positive culture within the home.
This inspection took place on the 30 and 31 October 2014 and was unannounced.
Home Park Nursing Home provides accommodation for up to 35 older people who require nursing, respite or end of life care. Many of the people being cared for at the home are also living with dementia which means their ability to understand and communicate their needs and wishes is limited. Most people were dependent on the staff to meet all of their care needs. At the time of our inspection, there were 34 people living at the home.
Home Park Nursing Home is an older style house set in large grounds in a rural location in Hampshire. The accommodation is arranged over two floors with a lift available for accessing the first floor. The home has 23 single rooms and six shared rooms.
A registered manager was in post. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
Staff deployment required improvement. People were not always adequately supervised and had to wait for support and assistance during key periods of the day such as at mealtimes. Staff did not have the time to provide meaningful interaction with people.
Cleanliness and hygiene standards in the home required improvement. We saw some poor infection control practices which placed people at risk of transferring or acquiring infections.
The management of medicines required improvement. Appropriate arrangements were not in place for checking the expiry date of medicines. We could not be assured that records contained sufficient information to ensure the consistent administration of ‘as required’ medicines to people. Arrangements were not in place to ensure staff had the competency and skills needed to safely administer medicines.
People were not consistently protected from the risk of abuse. A safeguarding incident had not been reported to the local authority safeguarding unit or to the Care Quality Commission (CQC). It was not clear to us that following the incident, the home had put in place a full range of preventative measures to prevent the risk of similar incidents occurring.
Recruitment procedures were in place to ensure that only suitable staff were employed. However these were not fully effective. Appropriate references had not always been obtained and checks had not been made to ensure that applicants were physically and mentally fit for work
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager had not always sought and acted in accordance with relevant guidance where people’s freedom was being restricted.
People were not supported to take part in a comprehensive range of meaningful activities. We observed people spent long periods of time without stimulation or meaningful interaction. We looked in five people’s records and found low numbers of recorded activities.
People did not always receive care which was dignified and respectful. People were not supported to eat their meals in a manner which respected their dignity. Some interactions appeared entirely task focused and we noted that some staff did not readily engage with the people they were supporting.
Improvements were needed in relation to how the provider and registered manager identified, assessed and managed risks relating to the safety of people and of the quality of the service. We identified concerns in a number of areas. These included dignity and respect, protecting people from harm, medicines management, cleanliness and hygiene and the recruitment procedures. These issues had not been identified by the provider or the registered manager before our visit, which showed that there was a lack of robust quality assurance systems in place.
Whilst overall, the care plans and records were of a good standard, there were some aspects that could be improved, for example, none of the records we viewed contained a care plan in relation to the person’s end of life wishes. People living with dementia did not have a detailed care plan which gave staff specific and personalised guidance about how they should meet the person’s care and support needs, although elements of this were contained within people’s other care plans such as their nutrition and hydration plans and their personal care plans.
People’s care plans did not always provide all of the necessary information to ensure staff were able to respond quickly to people’s changing needs.
The programme of training needed to be further developed to ensure that staff continued to receive all of the essential and relevant training required to carry out their roles and responsibilities effectively. For example, Mental Capacity Act and Deprivation of Liberty Safeguards training had yet to be rolled out to all staff.
The provider had policies and procedures in relation to the Mental Capacity Act (MCA) (2005) and a copy of the MCA code of practice was available within the home. Whilst staff had yet to receive formal training on the MCA, they were able to describe some of the basic principles of the Act.
The registered manager had developed effective working relationships with a number of healthcare professionals to ensure that people received co-ordinated care, treatment and support. The records confirmed that guidance and instructions from these professionals were acted upon.
The provider had a complaints procedures which was readily available to people and their relatives. We saw that complaints or concerns were used as an opportunity to learn and improve the care and support provided to people.
Most people living at Home Park Nursing Home were unable to tell us their views about the leadership of the home. One person did tell us they had no complaints about how the home was managed. A relative told us that they felt comfortable talking with the registered manager about any queries or concerns.
Staff told us that the home was well led and that the management team were supportive and approachable and that there was a culture of openness within the home which allowed them to make comments or suggestions about how the service might improve.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.
During our previous inspection on 1 May 2013, we found that the provider had not completed a mental capacity act assessment for all the people using the service, who required one. During our follow up inspection on 9 September we found that this had changed. Where people did not have the capacity to consent, the provider had acted in accordance with legal requirements. The deputy manager explained that most people who used the service did not have the capacity to consent. She told us that everyone using the service had a mental capacity act assessment included within their care plan.
Staff received appropriate training and support. We saw records which showed that all staff had had a supervision meeting during May, June or July 2013. The deputy manager told us that staff had a supervision meeting every three months or more often if the need arose. We saw supervision responsibilities displayed in the manager's office.
We observed people being spoken to kindly and staff responding to people's needs, offering support to make sure they were comfortable. Staff told us that they respected people's wishes if they did not want care. One relative told us they had overheard staff providing personal care for their relative, speaking to them kindly and with respect, explaining what they were doing and asking for consent to provide care. But we found that the requirements of the Mental Capacity Act 2005 were not always met, where people lacked capacity to consent.
We spoke with staff who demonstrated a good understanding of safeguarding vulnerable adults, so people were protected from the risk of abuse.
Current training records showed that the only fire safety and moving and handling training had been kept up to date. This meant that most staff had not received all the training they needed to provide a safe and efficient service.
Regular inspections of the quality of care were carried out by an independent consultant. Various aspects of care including privacy and dignity were reviewed and action points were raised.
We spoke with four members of staff who all demonstrated a good understanding of people's needs. Relatives we spoke with praised the staff for the care and support they gave to their family member. One person said: 'Nothing is too much trouble.' Another told us: 'I know they check things like weight and can always let me know if there is any change.'
The service had recently revised and updated both their safeguarding and whistle blowing policies. Local authority and safeguarding team contact details were available on the staff notice board. This meant that should there be an allegation of abuse staff would be able to make an appropriate referral in a timely way.
One member of staff told us: 'The use of agency staff has been reduced and the delegation of staff to help people eat is a lot better.' One of the relatives we spoke with commented on the way staff carried out their duties to be able to care for a wide range of needs: 'Staff are so well organised.'
During our inspection we used the Short Observational Framework for inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of those people who could not talk with us. We observed that not all staff interacted and communicated with people in an appropriate and respectful manner. Some meaningful interaction however was provided by some staff who obviously knew the people well and responded appropriately to people's needs.
We were able to speak with the relatives of five people who live at Home Park. Three of the five people told us that they thought there were not enough staff available. One person said, 'At lunchtime there are not enough staff available to support people.'
One relative was concerned that they had not seen any activities taking place in the home at weekends. 'Is there any stimulation?'
Most of the relatives we spoke with praised the staff for their friendliness and said they were very approachable. They felt that their family member was being well cared for and their day to day needs met. Two people commented that their relatives were always dressed nicely and their clothes clean.
One person we spoke with felt the home had not done enough to protect their relative against any risks to their safety.
The local social services quality improvement team have been involved in the service and, told us that following a recent review a quality improvement plan remains in progress with action to be reviewed in September regarding consent, risk assessments and training.