Park House Care Home

Updated 16 May 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by an inspector, a specialist nursing adviser and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Park House Care Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Park House Care Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. A manager recently started in post and was in the process of submitting their application for registration.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority, NHS and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 6 people living in the service and 8 relatives about their experience of the care provided. We spoke with the operations manager, 2 regional support managers and the manager. We also spoke with 11 members of staff which included nurses along with care, office, housekeeping, domestic, kitchen and maintenance staff. We sent an email to request feedback from staff and received responses from 3 members of the team.

We looked at aspects of 5 people's care records and multiple medication records. We reviewed recruitment records for 3 staff. We looked at a range of other records including quality assurance checks, meeting minutes and training records.

Updated 16 May 2023

About the service

Park House Care Home is a residential and nursing care home providing personal and nursing care to 24 people at the time of our inspection. Park House Care Home accommodates up to 42 people in one purpose built building.

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

People’s care and support had been impacted by a sustained period of management instability including several changes of manager since the last inspection. All aspects of the running and oversight of the service had been affected. Communication by staff was not always effective internally and with other agencies, which impacted upon people's care and raised the risk of unsafe care. Gaps and inconsistencies in care records and quality assurance checks required improvements to be made, embedded and sustained over time.

People were at heightened risk of receiving inconsistent care or care which did not meet their needs when they showed distress as care planning processes and management oversight of records were not always effective. Some safety risks were not addressed promptly.

Staff were able to meet people’s basic care needs but deployment of staff was not always effective. We received a lot of feedback from staff that there were often not enough staff on shift. We have recommended the provider keeps staffing deployment and levels under regular review.

People and their relatives were not routinely involved in reviewing people's care to ensure they had choice and control as their needs and preferences changed. We have made a recommendation to the provider they implement best practice in care planning and review processes.

Information about people's eating and drinking needs was not always shared promptly with kitchen staff which raised the risk of unsafe care. Where required, people received physical assistance with their eating and drinking to ensure their dietary requirements were met.

Staff worked in partnership with health and social care professionals to maintain people's health, although sometimes arranging appointments was not always prompt. The service was spacious and clean, although the décor was tired and in need of renewal in some areas.

MCA assessments and best interest decisions were undertaken but not always reviewed. The provider was already aware of this and making improvements in this area. 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 and ongoing improvements to documentation were in progress.

Personalised care plans were in place but not always up to date. Staff knew people well and had built positive, professional relationships with them.

People's communication needs were not always well assessed and at times were not fully met. Throughout the inspection we saw staff communicate and interact warmly with people. Activities staff supported people do things they enjoyed.

End of life care planning was not always well considered during care planning processes. Staff received training in this aspect of care so people could receive compassionate support as they approach the end of their life.

People were cared for safely. Risk assessments were completed and reviewed regularly and as people’s needs changed. Staff understood safeguarding procedures. Safe recruitment practices were followed to ensure staff were suitable for their roles.

People were supported with their medicines and good infection control practices were followed.

Accidents, incidents and falls were recorded and followed up. Additional analysis to spot any themes or measures to reduce the risk of recurrence was going to be introduced.

Pre-assessments were completed before people moved into the service. Staff received training to meet people's needs. The provider was arranging training in further topics relevant to staff roles. Processes to ensure staff received one to one supervision to discuss their roles and development had been improved.

People were well treated and supported by staff. Staff were observed to be compassionate and caring in their interactions with people. Staff maintained people’s privacy and dignity. Consent was sought before care was delivered.

Meetings took place and surveys were used to gather feedback.

A new manager was in post and regional support managers also supported the staff team. The provider had a service improvement plan and was aware of all the key areas which required improvements.

The provider and staff worked in partnership with other health and social care professionals. They were supportive of the inspection process and working hard to make and sustain improvements.

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 24 March 2020) and there were breaches of regulation in the areas of safe care and treatment, dignity and respect, and governance arrangements. 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 to people receiving care with dignity and respect. We found a continued breach in relation to people's safe care and treatment, and good governance of the service.

Why we inspected

The inspection was prompted in part due to concerns received about people receiving poor care, and also due to a review of information we held about the service. A decision was made for us to complete a full inspection to look at all aspects of the service.

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.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Park House Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified a continued breach in relation to people's safe care and treatment, and governance arrangements in the service.

We have also made some recommendations to the provider. We have recommended they keep staffing levels under regular review and implement best practice in care planning and review processes.

Please see the action we have told the provider to take at the end of this report.

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.