Archived: Parklands

Parklands care home is a large converted Victorian mansion set in its own grounds. It provides up to 36 places for older people and older people with dementia care needs. There is an additional extension which is connected to the original part of the building by a bridge. Two people had chosen to live in this extension. At the time of our inspection there were 22 people using the service.

At the last inspection on 31 March and 1 April 2016 we found improvements were required. The provider had not made arrangements to ensure people received their prescribed topical medicines in a safe manner. Care plan documents which outlined the needs of people who used the service needed to be improved. Also action was needed to ensure the records were accurate and provided contemporaneous information.

We found the service in breach of regulations 12 (Safe care and treatment) and 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We rated the service as ‘Requires Improvement’ overall and three domains required improvement.

Following our last inspection the provider sent us information, in the form of an action plan, which detailed the action they would take to make improvements at the service.

At this inspection we found that the team had worked collaboratively to ensure all of the previous breaches of regulation were addressed.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like 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 and relatives we spoke with told us they felt the service was safe. Risks to people using the service were assessed and plans put in place to reduce the chances of them occurring.

Safeguarding and whistleblowing procedures were in place to protect people from the types of abuse that can occur in care settings. People’s medicines were managed safely. There were enough staff deployed to keep people safe. The provider’s recruitment processes minimised the risk of unsuitable staff being employed.

Staff received mandatory training in a number of areas, which assisted them to support people effectively, and were supported with regular supervisions and appraisals. People’s rights under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) were protected.

People were supported to maintain a healthy diet and to access external professionals to monitor and promote their health.

People and their relatives spoke positively about the staff at the service, describing them as kind and caring. Staff treated people with dignity and respect. Staff knew the people they were supporting well, and throughout our inspection we saw staff having friendly and meaningful conversations with people. People were supported to be as independent as possible and had access to advocacy services where needed.

People and their relatives told us staff at the service provided personalised care. Care plans were person centred and regularly reviewed to ensure they reflected people’s current needs and preferences. People were supported to access activities they enjoyed. Procedures were in place to investigate and respond to complaints.

People and staff spoke positively about the registered manager, saying she supported them and included them in the running of the service. The registered manager and provider carried out a number of quality assurance checks to monitor and improve standards at the service.

The registered manager had informed CQC of significant events in a timely way by submitting the required notifications. This meant we could check that appropriate action had been taken.

We last carried out an inspection of this home in September 2014 when we found the registered provider met our regulatory requirements.

Parklands care home is a large converted Victorian mansion set in its own grounds. It provides up to 36 places for older people and older people with dementia care needs. There is an additional extension which is connected to the original part of the building by a bridge. Two people had chosen to live in this extension. At the time of our inspection there were 22 people using the service.

There was a registered manager 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service had in place robust checking procedures to ensure staff who were recruited to the service were safe to work with vulnerable people.

Staff had recently undertaken training on nutrition to ensure people who used the service were not at risk of malnutrition. Staff had also been training in other topics to enable them to provide support and care to people. These included health and safety, moving and handling and the Mental Capacity Act.

Monthly medication audits were undertaken by the registered manager and actions were put in place to improve the service. Staff who administered peoples’ medicines had been assessed as competent by the registered manager to carry out this task.

The registered manager had used a disciplinary policy and taken actions against staff to protect people in the service.

People and their relatives were very positive about the standards of care provided in the home. We observed staff treated people with kindness and respect. We found staff ensured people were wearing their glasses and hearing aids, and had easy access to their walking aids.

We observed a potential altercation between two service users in the main lounge when one person felt that another person was sitting in their chair. Staff intervened swiftly and calmly to de-escalate the situation with a positive outcome. We saw there were enough staff on duty to meet peoples’ needs.

We observed the registered manager carrying out a number of tasks which could have been completed by an administrator leaving the registered manager free to for example ensure records were up to date. The registered manager told us the administrator had left and they had yet to be replaced.

The manager had investigated peoples’ complaints and provided complainant with an outcome. This meant peoples’ complaints had been taken seriously.

We found the registered manager was open and accountable in their practices and were able to demonstrate to us what actions they had taken when issues had been raised with them.

During our inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Since the last inspection the provider made the decision to close the nursing unit, which has been done. However, at the time of the inspection our register was in the process of being updated. This meant that the report still showed, in the section 'details about this location', that it provided nursing.

This inspection was carried out by two inspectors. We met with five people who used the service and observed their experiences of care to support our inspection. We also spoke with the team leader and five staff.

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?

Below is a summary of what we found. If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

People were cared for in an environment that was clean and hygienic. People were supported to remain independent as safely as possible.

Appropriate risk assessments were in place, and the registered manager had suitable arrangements to safeguard people from foreseeable emergencies.

At the time of the inspection, there were four people at the home subject to an authorisation made under the Deprivation of Liberty Safeguards.

There were regular quality checks and audits completed to make sure people lived safely at the home.

Is the service effective?

Staff had received training to meet the needs of the people who lived at the home.

Many people living at the home had gained weight in a positive way since moving into the home.

Is the service caring?

Observations during the visit showed staff were compassionate and caring to the people they supported. During the day we found positive interactions taking place and staff responding in a thoughtful and kind manner to people who lived at the home.

Is the service responsive?

Regular reviews were carried out with the people who used the service and their representatives to make sure the person's care and support needs had not changed. This helped ensure staff supplied the correct amount of care and treatment.

Information collected by the service also gave staff an insight into the interests, likes and dislikes and areas of importance to the people in their care. This meant that it helped staff to provide social activities that people could choose to be involved with.

Regular meetings took place with staff to discuss the running of the service and to ensure the service was responsive in meeting the changing needs of people who used the service.

People who lived at the home were encouraged to give their views.

Is the service well-led?

There was a registered manager in post at the home, however, at the time of the inspection they were not at work.

People who used the service had regular contact from the registered manager and other senior staff to check their wellbeing. The quality of service provided by care givers was monitored and this was done through quality audits.

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

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

Is the service safe?

People we spoke with told us they were happy living at the home, however we were unable to obtain the views of many people who used the service due to their health care needs.

Some of the staff working in the home were unaware of their responsibilities in relation to reporting incidents at the home and were not aware of how to report safeguarding concerns.

We saw the accident and incident book which related to people who received nursing care did not contain information about all the accidents and incidents that had occurred.

The provider had a recruitment policy in place and this was reviewed annually but we saw this was not being followed so was not safe.

The registered manager provided us with staff rotas. The staffing levels for people who required nursing care did not reflect the individual needs of those being cared for and did not allow for unforeseen circumstances.

Is the service effective?

People's care needs were assessed before going to live at the home. Where people needed help with their personal care needs, we saw they were involved with the planning of their care and the level of assistance the wanted.

Where people required nursing care their pre-admission assessments were not always carried out by a trained nurse. This meant the provider and registered manager could not be sure they were able to provide the correct level of care.

Is the service caring?

People who received help with personal care were treated kindly and with respect. People were happy with the care staff and we saw people's preferences being taken into account in ways like what they wanted to do during the day, what they wanted to eat and also if they wanted to spend time with visitors in private.

People who required nursing care were looked after by care staff that had not been appropriately trained for the role they were carrying out meaning they were unable to give the correct level of care and support to people who needed it.

Is the service responsive?

People who lived in the home were encouraged to participate in a variety of activities. Unfortunately those who required nursing care had very little stimulation and there were no cognitive activities for them to engage in.

Is the service well lead?

The home worked with other professionals like dentists, chiropodists and GPs to ensure people's wider health needs were met.

We asked the provider and manager to show us the operational systems in place to ensure people received care which was safe and appropriate. Both the Provider and manager told us they had no such system and this was something which required attention. Failing to have an operational system meant that people were at risk of receiving care which was not appropriate or safe.

We received an action plan on 30 May 2013.

During our recent visit we saw the provider had clear guidelines on the type of references that would be accepted and this was clearly shown on the application form. Where people had previously been in employment they were required to give the name of their previous employer as a referee. Where people had not worked before they were asked to provide two character references. These references had to be from professional people, for example school head teachers or GPs.

We saw people who were employed by the service had Disclosure and Barring Service (DBS) checks carried out. Disclosure and Barring Service (DBS) previously Criminal Records Bureau (CRB) checks identified whether a person had been convicted of any criminal offences, to enable the provider to determine whether the person was suitable for the job role.

At this inspection we found improvements had been made. We found people were treated with dignity and respect. For example, we watched care staff lower themselves to people's height when communicating with them about private matters. We found the atmosphere to be relaxed with care staff smiling and giving people good eye contact.

We found care and treatment was planned and delivered in a way which ensured people's safety and welfare. For example, we saw people who had been assessed at risk at mealtimes were not left unsupervised.

We spoke with several people who used the service. They told us 'I'm very happy with the care' and 'I'm content here, the staff are always laughing.'

At this inspection we found the provider had taken steps to remove dangers so care was provided in an environment that was safe for service users, staff and visitors.

We spoke with staff who were able to give examples of how they treated people with dignity and respect. We saw this was not always evident in practice.

We saw the provider had effective processes in place for the management of medicines.

We saw that people who used services, their family and representatives were encouraged to give their views on the service and how it is run.

We found the provider had failed to carry out suitable recruitment processes and that employment histories were not always completed. There was also evidence that references were not always checked.