The Park Beck

The Park Beck is a residential care home providing personal care to up to 37 people. The service provides support to people, some of whom were living with dementia. At the time of our inspection there were 14 people using the service.

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

We found improvements were needed to ensure risks to people, for example moving and handling, were managed safely. Care plans and records did not always contain all the information staff needed to support people. An audit system was in place, but this had not identified all the shortfalls we found. The registered manager and provider had oversight of the service and had implemented improvements which needed further time to be embedded into everyday practice. They were proactive in making the required improvements. One relative told us, “I appreciate changes are being made.”

There were enough staff who had been recruited safely to support people each day. Medicines were managed well, and recent improvements had taken place following a concern. Only staff who had received the appropriate training and been assessed as competent gave people their medicines. Systems were in place to ensure people were protected from the risk of abuse.

People had enough to eat and drink throughout the day. They were offered a choice of meals that suited their individual needs and choices. People were supported to maintain and improve their health through regular reviews with health and social care staff.

Staff received training which was regularly updated. When concerns were raised staff received extra training to remind and refresh their learning. Staff were supported and updated through regular staff meetings and supervisions.

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.

The home was clean and tidy throughout. There was an ongoing plan to improve the physical environment of the home through decoration and maintenance.

The registered manager had identified improvements were needed to the culture. Through observations and discussions, we identified a positive culture. Staff engaged well with people and each other.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection The last rating for this service was good (published 3 November 2022).

Why we inspected

The inspection was prompted in part due to concerns received about the management of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective, and well-led only.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, and good governance.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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

People were protected from the risks of harm, abuse or discrimination because staff knew what actions to take if they identified concerns. There were enough staff working to provide the care and support people needed. Staff received regular training and supervision which helped to ensure they had the knowledge and skills to look after people safely. The home was clean and tidy. Regular cleaning helped ensure people were protected against the risk of infection.

Staff knew people well and understood the risks associated with their support. Care plans and risk assessments provided guidance about individual and environmental risks. People received their medicines safely, when they needed them. Recruitment procedures ensured only suitable staff worked at the service.

There was evidence of continuous learning. Following any accident or incident there was discussions with staff to identify if there were any themes or trends and what could be done to prevent a reoccurrence.

The culture of the home was positive and staff worked hard to ensure people lived happy lives. The quality of the service was regularly monitored through audits, meetings and feedback surveys. Improvements were made where needed and there was an ongoing improvement program for the home.

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection The last rating for this service was good (published 7 August 2017).

Why we inspected

We received concerns in relation to the way in which an incident was managed. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We carried out an inspection of The Park Beck in July 2015 where we found the provider had not met Regulations 15 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had not ensured the home was properly maintained and suitable for the purpose for which it was being used. We imposed an additional condition on the provider’s registration which required them to identify all areas at the home where maintenance and repair was needed in order to keep people safe. Following this inspection, June 2017, this condition was removed.

We undertook a further inspection in September 2016 where we found continued breaches in relation to the maintenance of the home and the quality assurance. There was also a breach of regulation 9 because people did not always receive care that was person centred. An action plan was submitted by the provider that detailed how they would meet the legal requirements.

We followed our enforcement processes and issued a warning notice for the continued breach of Regulations 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we found improvements had been made and the provider was now meeting the regulations.

There was a quality assurance system in place which identified and addressed shortfalls. There was improved communication between the provider and registered manager and maintenance issues were now addressed in a timely way. There was ongoing maintenance and redecoration inside and outside the home to ensure improvements continued and were of a good standard. The registered manager had a good oversight of what was required to continue to drive improvements.

Staff had a good understanding of providing person-centred care. They knew and understood people as individuals and supported them to make their own choices and decisions. There was a range of meaningful activities taking place throughout the day. These included group and one to one activities designed to suit each individual person.

Risk assessments were in place and staff had a good understanding of the risks associated with the people they looked after. Medicines were stored, administered and disposed of safely by staff who had received appropriate training. Staff had a clear understanding of the procedures in place to safeguard people from abuse.

There were enough staff to meet the needs of people. Recruitment records showed there were systems in place to ensure staff were suitable to work at the home.

There was a training and supervision programme in place. This included observations of staff in practice and assessment of their competencies. Staff told us they felt supported by the registered manager and could discuss concerns with him.

People were given choices about what they wanted to eat and drink. A variety of food and drink was provided that met their individual needs and preferences

Staff knew people well, they communicated clearly with them in a caring and supportive manner and had developed good relationships with them. People were treated as individuals and staff respected their dignity and choices.

The registered manager and staff understood their responsibilities in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff asked people’s consent before they offered any care or support.

Visitors were always welcomed at the home and could visit whenever they wished. The registered manager was committed to developing an open culture where continuous learning could take place.

The home is a large Edwardian building and accommodation is provided over two floors. There was a passenger lift at the home and due to the layout of the home a chair lift was available to some of the first floor rooms which could not be accessed by the passenger lift.

We carried out an inspection of The Park Beck on 20 and 22 July 2015 where we found the provider had not met Regulations 15 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had not ensured the home was properly maintained and suitable for the purpose for which it was being used. We imposed an additional condition on the provider’s registration which required them to identify all areas at the home where maintenance and repair was needed in order to keep people safe. The provider was also required to supply CQC with a log of maintenance concerns, responses to them and dates for completion of each identified issue. The provider did not have an effective system to regularly assess and monitor the quality of service that people received.

An action plan was submitted by the provider that detailed how they would meet the legal requirements. At this inspection we found although some improvements had been made in relation to the maintenance of the home further improvements were required. Not all legal requirements had been met to ensure an effective system to regularly assess and monitor the quality of service that people received was in place and this was a continued breach of regulation. There were a number of action plans in place and the registered manager was working to address the outstanding issues.

There was ongoing maintenance taking place and improvements had been made. However, work was still required to ensure the home was properly maintained. We found areas of the home were not consistently clean. When areas for improvement, such as the garden had been identified action had not always taken place in a timely way. There was a lack of communication between the provider and the registered manager which meant the registered manager did not always have the information required about actions being taken at the home.

However, there was no information about who had the right to consent on behalf of a person who lacked capacity or whether the decisions should be as the result of a best interest meeting.

The registered manager understood their responsibilities in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People received care the care they needed in a way they liked it delivered. However, there was not enough for people to do throughout the day. There were not enough meaningful activities for individuals to take part in. We made a recommendation about this.

The registered manager was currently recruiting more staff to ensure people’s needs could be met safely. Staff who worked at the home had been appropriately recruited.

Staff had an understanding of the procedures to safeguard people from abuse. There was ongoing training to ensure all staff were aware of their individual responsibilities in ensuring safeguarding concerns were reported appropriately. There were systems in place to ensure that medicines were managed appropriately and people received the medicines they had been prescribed.

People were looked after by staff who knew them well. They had a good understanding of people’s individual care and support needs. Risk assessments were in place and staff had a good understanding of the risks associated with the people they looked after.

Staff were kind and caring, they had developed good relationships with people. They treated them with kindness, compassion and understanding. We observed a genuine warmth and friendship between people and staff. Staff supported people to enable them to remain as independent as possible. They communicated clearly with people in a caring and supportive manner.

Staff received appropriate training and support to enable them to meet people’s needs and had access to regular supervision.

People had a choice of meals and drinks received nutrition which met their individual needs and preferences. Mealtimes were unrushed and people were assisted according to their need. Staff monitored people’s nutritional needs and responded to them appropriately.

We found 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 this report.

Below is a summary of what we found. The summary describes what people using the service, visitors and staff told us, our observations during the inspection and the records we looked at. At this inspection we spoke with four people who lived at the service, one visitor and four care staff. We also spoke with the deputy manager. We returned to the service again on 4 August 2014 and spoke with the manager because they were not present when we originally inspected.

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

Is the service safe?

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People told us that they were satisfied with the support they received. Their comments included 'I am looked after perfectly well' and 'I am very happy here'.

We saw that care plans were sufficiently detailed to allow staff to deliver safe and effective care. They reflected people's assessed needs and responded to their changing needs. However, we found that some care plan information had not been reviewed when it should have been and we brought this to the attention of the manager.

Systems were in place to make sure that staff learnt from events such as accidents and incidents, complaints and concerns.

There were robust recruitment procedures in place and required pre-employment checks had been completed. This helped to ensure that staff employed to work at the service were suitable.

Staff rotas took account of people's care needs when making decisions about the numbers of staff required, their qualifications, skills and experience. This helped to ensure that there were enough staff on duty to safely meet people's needs. However, following feedback received from a visitor during our inspection, we spoke with deputy manager about the consistency of care the visitor's relative had received and their views about the quality and availability of staff at times within the service.

Staff we spoke with had a good understanding of their role in the service and told us that they felt supported by the manager.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). This is where restrictions may be placed on some people to help keep them safe. We found that suitable policies and procedures were in place and most staff had been trained to understand when a DoLS application should be made and how to submit one. We saw that a DoLS application had been made in the past when needed. This had been reviewed and was no longer necessary.

Is the service effective?

People told us that they were happy with the care delivered and that their needs had been met. Our observations and speaking with staff showed that they had a good understanding of people's care and support needs and that they knew them well. However, a visitor told us that they had raised a number of concerns about the care their relative had received commenting 'After I speak with the manager, the care improves for a few weeks then slides back'.

Is the service caring?

People told us that the staff were kind and attentive. Care records contained personalised information which helped staff to know the people they supported and how to meet their needs. We saw that care workers showed patience, encouragement and understood how to support people as individuals. One person told us 'I feel safe and happy here'. We observed that staff knew how to communicate effectively with people and we saw occasions when this helped to reduce people's anxiety and meet their needs.

Is the service responsive?

People's needs had been assessed before they moved to Park Beck. This meant the service had determined that they had the skills and facilities to meet people's identified needs from the outset. Records confirmed that people's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with their wishes. Where people's needs had changed or specialist advice was required, we saw that the service had responded appropriately.

Is the service well-led?

There were quality assurance processes in place to maintain standards in the service. Records showed that identified shortfalls were addressed promptly. This ensured that risks were identified and reviewed, which helped reduce risks to people and enabled the service to improve. We saw that staff and people who used the service were given opportunities to express their views. We found the manager had good knowledge and oversight of the running of the home.

People who could talk to us told us they enjoyed living at the home. They told us they felt well supported by staff. One person told us, 'they have really helped me through a difficult time.' People told us they were able to choose how they spent their day, we were told 'I go out most days, I can choose what I want to do.' We saw people being offered choices throughout the day, including what time they wanted to get up that morning.

People who lived at the home appeared to be happy and enjoying their day interacting with staff. Staff had a good understanding of infection control policies and procedures and were seen to use these appropriately.

There were enough staff on duty to ensure people received an appropriate level of care.