Parkhill Nursing Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

People’s needs were not always appropriately assessed and subject to regular review. People were not always having their assessed needs met and staff did not always work effectively within the home and with other stakeholders to ensure people’s needs were met. Information about people’s changing needs had not always been effectively communicated and updated within care plans and there was no provider oversight of these matters. The service was not working in line with the requirements of the Mental Capacity Act (MCA) and staff did not always ask for consent to provide care. The high use of agency staff was a concern and people felt there was a delay in how they received support, together with a lack of understanding how to provide good quality, safe and evidence based care.

This service scored 29 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s needs were not always effectively assessed, reveiwed and managed. People and families were not being consistently involved in the assessment and care planning process. Feedback from people and their families about how the service assessed and met people’s needs was mixed. We observed care being provided to people that did not met their needs. We found that staff were not clear on people’s needs, and stakeholders had raised concerns about whether staff were able to identify where needs were changing, for example when a person became poorly.

We received mixed feedback about communication of people’s needs from staff. Some staff told us that communication worked well and they were updated on people’s changing needs. However, other staff commented that communication was not always effective and other staff did not always know people’s needs. This was reflected in our observation.

Systems and processes were not being used effectively to ensure people’s needs were reviewed regularly or when things changed. Some people had care plans which had not been reviewed for several months, had not been updated to reflect changes in care needs, were often inconsistent or lacked detail and not all care plans and risk assessments were in place for everyone living at the home.

People had mixed views of the support given. Some people were generally happy with the support provided but also had numerous examples of where care had been poor. People were not consistently getting good levels of personal care or oral care and were not being repositioned in line with their assessed needs. Although people generally spoke positively about the food provided, they were not always getting the correct support including regarding the type of food provided and the level of support needed to eat and drink well.

Staff were not able to demonstrate that they had a good understanding of evidence based care. Most staff told us they had completed a range of training but their understanding of this training and its application in practice was limited. The training provided was not in line with best practice guidance to ensure staff had the knowledge and skills required to work in the health and social care field.

The service had relevant policies although these were not always detailed and specific to Parkhill Nursing Home. The provider did completed audits, but there was not sufficient oversight to ensure people had care and treatment which was in line with best practice and met their needs.

People spoke positively about some staff who were very helpful and supportive. However, this was felt not to be the case for all staff working at the service and delays in receiving support and ineffective communication were highlighted as significant areas of concern. We observed delays in how people were supported with continence care, supported to get up, and supported with eating and drinking.

Some staff told us they were working well together, however due to the high use of agency felt this was sometimes difficult. There was no clear leadership and oversight to ensure staff worked together effectively to meet people’s needs.

Feedback from stakeholders included concerns about the high use of agency staff and how it was ensured that they had the training and skills to meet people’s needs and were appropriately inducted to the service. Communication was noted to be an area which needed significant improvement to ensure staff and services were able to work together effectively to meet people’s needs.

The was not sufficient oversight to ensure staff were working well together to meet people’s needs. The lack of permanent management oversight was impacting upon this. Following our inspection the area manager moved the office to ensure their visibility within the service. The deputy manager and area manager were working to ensure that teams and services were working together to meet people’s needs. The service was engaging with partner agencies to support with aspects of an improvement plan.

People had access to the GP and felt confident medical care would be given. However other aspects to support healthy lives, such as access to drinks to promote hydration, frequent and regular snacks for people at risk of weight loss and regular repositioning were not evident. There were limited activities for some people to promote wellbeing, therefore people were bored and unstimulated and staff did not have sufficient time or the initiative to speak with people. One person commented “The residents need stimulating.”

Permanent staff were keen to support people well but felt there were limited opportunities and time to do this. Staff told us that they were focusing on ensuring people had better access to fluids. Kitchen staff were keen to ensure people had access to good quality food and keen to develop their menu and were working alongside other stakeholders in this area.

The service had limited oversight of health needs. Clinical audits were in place to ensure oversight of people’s weight loss risk, wounds and other needs. However, it was not clear that these were effective and led to people’s needs being met. These were not being completed robustly and had not always led to the required action being taken or embedded.

Feedback about people’s outcomes was missed. Some feedback was that people were putting on weight, receiving regular fluids and seemed to be improving although others raised significant concerns about how people were cared for. We found there was no clear oversight of day to day care such as personal care and repositioning, that people did not always have access to fluids and did not always receive a diet and support that was suitable to their nutritional needs. One person told us, “They write down everything we eat and keep an eye on it. In between breakfast and dinner, we are given tea, coffee or juice and biscuits.” Another person responded that, “That’s how it used to be, and all of a sudden it stopped. They’ve only just started putting it back on.”

Some staff were keen to improve outcomes for people and would escalate concerns when needed. However, it was not evident that all staff had a good understanding of people’s needs and were therefore unable to do this effectively.

The process in place to monitor and ensure people received good care was not being used effectively. Audits were being completed but this was not always done robustly and in a structured way and did not always lead to action being taken. Work to improve the provider oversight of the service had begun with the support of external stakeholders.

People did not raised concerns about how they were supported. However, we observed staff did not request consent before supporting people and did not knock on people’s bedrooms doors before entering. No consent to care and treatment records were in place meaning that we could not be certain that people had been involved in decisions and given consent to the care they received.

Staff were unable to demonstrate they had a good understanding of the Mental Capacity Act (MCA) or Deprivation of Liberties Safeguards (DoLS).

Care records did not demonstrate how people and families had been involved in care planning or consent to care and there was no evidence of processes to ensure effective oversight in this area. Processes to ensure accurate records of Lasting Powers of Attorney (LPA) and DoLS authorisations were not being maintained. There was limited oversight to ensure people’s capacity had been assessed and that when people were found to lack capacity best interests’ decisions with the relevant involvement were undertaken and documented. The service was not working in line the requirements of the MCA.