Archived: Park House

Park House is a residential care home providing nursing and personal care to 39 people living with dementia and age-related care conditions at the time of the inspection. The service is registered to support up to 111 people. Care is provided across two separate units, each of which has separate adapted facilities.

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

Feedback we received from staff, people and relatives was very positive in regard to improvements that had been made in the areas we inspected and to the management of the home. The provider and registered manager was aware the improvements needed to be sustained and had made significant progress.

Improvements had been made to how medicines were managed, people’s needs were monitored, and how the service was managed.

We observed care being delivered in the home and saw this was done with care and in a patient manner. People were comfortable in the presence of staff and had developed positive relationships with care staff. One person told us, “They do ask me if I’m happy and they ask what they can do for me. I can talk to the staff; they do listen to me.” Relatives told us staff were kind and treated their relatives with dignity and respect. We were told, “They [the staff] give me peace of mind. They tell me nice stories about [person].”

Care plans and risk assessments reflected the needs of people. Medicines were managed safely and those staff who administered medication had had their competencies regularly checked. Staff attended meetings and said they felt well supported.

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 policies and systems in the service now support this practice as consent was sought and recorded in line with the principles of the Mental Capacity Act 2005.

Accidents and incidents were managed appropriately, and referrals were made to other professionals in a timely way. The registered manager notified CQC of significant incidents when it was appropriate. Additionally, the provider and management team had a new auditing system in place that helped drive improvement and ensure quality service for people living in the home.

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 26 March 2020) and there were multiple breaches of regulation. 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 and the provider was no longer in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

This service has been in Special Measures since16 April 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

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 the service can respond to coronavirus and other infection outbreaks effectively.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same. This is based on the findings at this inspection.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. We will work with the local authority to monitor progress. If we receive any concerning information we may inspect sooner.

Park House is a residential care home providing nursing and personal care to 54 people living with dementia and age-related care conditions at the time of the inspection. The service is registered to support up to 111 people, however recent changes mean care was only provided across two of the five separate units, each of which has separate adapted facilities.

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

At this inspection, we found that improvements were still needed regarding medication administration as well as reporting and recording with regards to people's care and well-being. As these issues were highlighted in the last three inspection reports, there were still significant concerns about safety and the poor governance of the service.

Feedback we received from people, their relatives and staff indicated that improvements continued to be made to the service being provided and the management of the home. We were told that the culture and atmosphere in the home had improved and this was observed by inspectors throughout the inspection.

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 supported this practice however the processes in the service where not always followed to support this practice.

Staff were recruited safely and received regular training, received supervisions, attended staff meetings and had regular practice checks. Staffing had improved and agency staff usage had reduced. However, feedback received from people and their relatives indicated staffing was still inconsistent and people did not always know the carers.

Complaints, accidents and incidents were managed appropriately, and referrals were made to other professionals in a timely manner when people living in the home were in need. Each person and visitor we spoke with had no complaints and commented on the improvements to the home.

People had care plans and risk assessments in place that gave guidance on how people were to be supported, however these were mainly task orientated and not person centred.

Rating at last inspection:

The last rating for this service was inadequate (published 11 December 2019). The service is now rated requires improvement. This service has been rated inadequate for the last three consecutive inspections. At this inspection enough improvement had not been sustained and the provider was still in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Enforcement

We have identified breaches in relation to medication management and governance.

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

Follow up

The overall rating for this service is ‘Requires improvement’. However, the service remains in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Park House is one adapted building across three floors that currently have two separate units, each of which have separate adapted facilities. At the time of the inspection there were 63 people using the service many of whom were living with dementia and age-related health conditions. The service is registered to provide care to 111 people. The service has recently changed the homes outlay to two units instead of the previous five units.

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

Feedback we received from people, their relatives and staff indicated that improvements had been made to the care being provided and the management of the home. We were told that the atmosphere had improved and this was noticed by inspectors during the three days of inspection.

At this inspection we found improvements in all areas however additional improvements were needed regarding medication, reporting and recording in regard to people’s well-being and governance. As these changes were very recent the provider and interim manager were aware that the improvements needed to be sustained.

We saw improvements had been made to the environment and this was ongoing. We saw the positive impact this had had on the living conditions for people living in the home. Improvements had been made to the management of health and safety issues; however, we saw access to a fire extinguisher was blocked. This meant we could not be certain about staff knowledge regarding fire safety processes.

Care plans and risk assessments were in place that reflected the needs of the people, however we identified that some information held in care plans was not always reflected in other documents which were for the guidance of the staff delivering the service.

The provider had implemented new systems that monitored the service and the electronic system in place was now being utilised appropriately by staff. This meant that the auditing systems were more robust and helped to improve the service. However, as we found continued breaches of regulation. We identified that the audits needed to be sustained.

Staff were recruited safely and received regular training, received supervisions, attended staff meetings and had regular practice checks.

Incident and accidents were analysed for patterns and trends. Risks to people were assessed safely and referrals were made to other professionals in a timely manner, when people living in the home were in need.

People received the support they needed to eat and drink and maintain a healthy and balanced diet. Staff we spoke with knew people's dietary needs and people told us they enjoyed the food available to them and were able to choose alternative meals if they did not like what was on the menu.

The provider had implemented new processes so the people living in the home were starting to access enjoyable and fulfilling activities.

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 inadequate (published 31 May 2019). The service remains rated inadequate. This service has been rated inadequate for the last two consecutive inspections. At this inspection enough improvement had not been made/ sustained and the provider was still in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Enforcement

We have identified continues breaches in relation to Regulation 12 (Safe care and treatment) in relation to medication, recording and reporting. Regulation 17 (Governance) in relation to the management of the service at this inspection.

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

Since the last inspection we recognised that the provider had not managed medicines safely, robustly monitor people’s well-being and have an effective governance process of the service. This was a breach of regulation. Full information about CQC’s regulatory response to this is added to reports after any representations and appeals have been concluded.

Follow up

This service has been in Special Measures since 31 May 2019. During this inspection the provider demonstrated that improvements have been made, however additional improvements are needed.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

People’s experience of using this service: People we spoke with told us that they felt safe living in the home however, during the course of the inspection we identified serious concerns with the service.

Complaints, accidents, incidents and safeguarding processes were inadequately managed and not reported by staff either through communication channels within the home or by using the provider’s electronic system. Audits of the service were ineffective and, in some cases, not carried out.

We identified that a lack of cohesive working and poor communication within the home had led to risks not being recognised and acted on.

Medicines were not managed safely and the monitoring information for people living in the home was not always completed fully. Risks were not always recognised by staff and acted on by the provider.

We saw recruitment and induction process into Park House for either permanent or agency staff was not robust. Staff had not attended training the provider required them to and there was no oversight of supervision, appraisal or induction by the provider. This placed people at risk of receiving inappropriate and unsafe care.

Parts of the internal and external environment posed a risk to people and infection control standards at the home required improvement.

People living at the home and their relatives indicated there were issues regarding staffing levels. We saw that there was a high use of agency staff and that this impacted on the quality of the care being delivered.

People told us that they felt staff respected them however, we observed behaviour that was not respectful and feedback from people living in the home was that there were few activities on offer. Confidentiality was significantly breached, this meant that the rights of people were not respected.

Rating at last inspection: The last inspection was carried out in September 2018 and was rated as Requires Improvement.

Why we inspected: This inspection was brought forward due to information of risk or concern in regard to staffing, moving and handling procedures and governance of the home.

Enforcement: The service met the characteristics of Inadequate in four key questions of safe, effective, responsive and well-led and Requires Improvement in caring. We are taking enforcement action and will report on this when it is completed.

Follow up: We will continue to monitor the service closely and discuss ongoing concerns with the local authority.

The overall rating for Park House is 'Inadequate'. This means that it has been placed into 'Special Measures' by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded. We will have contact with the provider following this report being published to discuss how they will make changes to ensure the service improves their rating to at least Good.

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

Park House is a 'care 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.

Park House accommodates up to 111 people in one adapted building across five separate units, each of which have separate adapted facilities. At the time of the inspection there were 93 people using the service many of whom were living with dementia and age-related health conditions.

This is the second time the service has been rated Requires Improvement.

At the last inspection in August 2017 we rated the service Requires Improvement overall. This was because the provider was in breach of Regulation 17 of Health and Social Care Act. There was no system to analyse complaints for themes and trends, the administration of medicines needed to improve and there were no systems to make sure that everyone had the opportunity to participate in customer satisfaction surveys. At this inspection we found that improvements had been made and the provider was meeting legal requirements.

The service has two registered managers one of whom was a registered nurse and was the clinical lead. 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.

Despite the improvements made we found the completion of some records, such as medication administration records and staff personnel records needed to improve. We also saw the mealtime experience and the opportunities for to participate in meaningful activities needed to improve to make sure they met the needs of everyone.

People and relatives told us they felt the service was safe. People were protected from the risk of abuse because staff understood how to identify and report it.

The provider had arrangements in place for the safe management of medicines. People were supported to get their medicine safely when they needed them. People were supported to maintain good health and had access to health care services.

Staff considered peoples capacity using the Mental Capacity Act 2005 (MCA). People's capacity to make decisions had been assessed. 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. The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).

People and their relatives felt staff were skilled to meet the needs of people and provide effective care. Staff were supported by management to undertake their roles and were given training updates, supervision and development opportunities.

People were encouraged to express their views and results of customer satisfaction surveys were positive. People and relatives felt listened to and any concerns or issues they raised had been addressed.

Staff supported people to participate in activities of their choice and trips to the local shops and tourist attractions had been organised.

People were supported to eat and drink sufficient amounts and they were given time to eat at their own pace. People's nutritional needs were met and people had a good choice of food and drink.

The service had a relaxed and homely feel. Everyone we spoke with commented positively on the caring and respectful attitude of the staff team which we observed throughout the inspection.

People's individual needs were assessed and care plans were developed to identify what care and support they required. Staff worked with other healthcare professionals to obtain specialist advice about people's care and treatment.

People, staff and relatives found the management team approachable and professional. The manager had notified the Care Quality Commission (CQC) of events and incidents that occurred in the home in accordance with our statutory notifications. The ratings from the previous inspection were on display in accordance with requirements.

Park House is registered to provide nursing and personal care for up to a maximum of 111 people. At the time of the inspection there were 83 people living there, most of whom were older people living with dementia or age related conditions and frailty. Some people were accommodated on short term respite basis. The service is provided in five 'units' over three floors which were accessed by way of a lift or stairs. Each of the units had a secure entry system to which people needed to use a key pad to gain entry.

Our last comprehensive inspection of this service took place on 17, 18 and 19 January 2017. The overall rating for the service at that time was ‘Inadequate’ During this inspection the service demonstrated to us that improvements have been made and is no longer rated as ‘Inadequate’ overall or in any of the key questions.

At the last inspection we found four breaches of the legal requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to medicines, risks to people’s health and safety, staffing levels, staff support, the need for consent to administer medicines covertly and the governance of the service. We asked the provider to take action to make improvements to the quality and safety of the service and the provider developed an action plan stating the steps they would take to meet the requirements of the law. During this inspection we found that improvements had been made but other improvements were required.

The service required a registered manager. 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 the time of this inspection the service was being managed by two managers. One of them was a nurse and took the clinical lead the other took the lead for the day to day running of the service. Although the service also had two registered managers, neither of them still worked for the provider. Processes were in place for applications to be submitted to remove them from the register and for the new managers to apply to become registered.

At the last inspection the quality assurance and monitoring systems in place were ineffective. Although the provider’s systems had identified some shortfalls, action had not always been taken to rectify them. The provider had lacked oversight of the quality of the service provided and had therefor missed the opportunity to raise standards and drive improvement. At this inspection, we saw that improvements had been made. Regular audits of records had been undertaken and action taken to address shortfalls identified. However improvements were required to ensure action plans to address areas they had identified as needing improvement were always in place.

At the last inspection we found that medicines were not always being managed safely. At this inspection we found significant improvements had been made. However further improvements are needed in relation to guidance for administering as and when needed (PRN) medication.

At the previous inspection we found there had not always been sufficient numbers of staff on duty. At this inspection improvements had been made. People and their relatives told us and we saw, there were enough staff employed to meet people’s needs.

Improvements had been made in relation to care records. Daily records had been maintained and care plans had been reviewed as needed.

At our inspection in January 2017 we found staff had not always received regular supervision or annual appraisals. At this inspection we found this had been addressed.

At this inspection we found improvements had been made in relation to the quantity of food provided. There was plenty food available at mealtimes and people could have additional helpings if they desired.

At the last inspection we found personal emergency evacuation plans (PEEPs) were not in place. At this inspection we found PEEPS had been introduced. Risk assessments were in place and these were appropriately updated. Accidents and incidents were recorded and monitored to ensure that appropriate action was taken to prevent further incidences.

Some people were provided the opportunity to engage in meaningful activities such as going out to the theatre. However items used to stimulate and engage people, had been put into storage. Management acknowledged these items needed to be reintroduced. This is an area of practice we identified as needing improvement.

Staff treated people with the dignity and respect they deserved and provided people with kind, caring and compassionate support. Staff were responsive to people’s care needs. Staff responded quickly to requests for support and people’s care needs were met.

Management and staff worked within the principles of the Mental Capacity Act (MCA). Staff asked permission before delivering care. One person told us “They always ask permission, they say is it ok if we come in to wash you and things like that”.

The home used safe systems for recruiting new staff. These included obtaining identify and security checks. There was an induction programme in place to introduce new staff to ensure they were competent before working unsupervised.

Over recent months the manager had informed the CQC of significant events in a timely manner. Prior to this there had been significant delays in the CQC being notified. This was an area of practice we identified as needing to be sustained and embedded into day to day practice.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

You can see what action we told the provider to take at the back of the full version of the report.

Park House is a large modern building on three floors, located in a quiet residential area of Birkenhead. It is part of the Four Seasons group of health care services. The home is registered to provide accommodation and care for up to 111 people. The building is split into four units. The ground floor unit is for people who do not require nursing and also has a respite unit attached. The middle floor unit is for people with dementia who may require nursing and the top floor unit is for more frail elderly people who may require nursing. At the time of our inspection, there were 107 people living in the home.

There was a registered manager in post; Park House has two registered managers, one who is the home manager and the other who is the clinical manager. 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.’

During this visit, we identified concerns with the safety and quality of the service. We found breaches in relation to Regulations 11, 12, 17 and 18 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.

The staffing levels were seen to be adequate on the days of this inspection; however the staffing levels in December 2016 and up to 16 January 2017 were not sufficient to meet the care and treatment requirements of the 107 people living there.

Senior staff told us they did feel supported by the registered managers however there were staff who told us they did not feel supported. Supervision meetings were taking place but not for all staff. Annual appraisals had not been provided to ensure staff were happy, competent and that their role at the home was meeting their aims and also the aims and philosophy of the organisation.

We found that medicines were not being managed consistently in the four units. There were issues with medicine room temperatures and medication fridges, PRN stocks and recording. There were inconsistencies on all units for the recording and the storage for a once controlled medicine. On one unit a controlled drug that was not being used was being stored. A person was receiving their medication covertly by staff and the provider had not followed the correct procedure as they were crushing tablets and adding to juice for administration. Records confirmed that people were receiving the medication prescribed by their doctor.

We requested the personal emergency evacuation plans (PEEPs) for the 107 people currently living at the home that contained personal information about their needs in an emergency situation. We were not provided with a PEEP’s and were told in a meeting with senior management they were not available.

People told us they felt safe with staff. The clinical manager who was the safeguarding lead had a good understanding of safeguarding. They had responded appropriately to allegations of abuse and had ensured reporting to the local authority and the CQC as required. However the CQC was concerned about the notifications sent through in relation to unwitnessed falls and the severity of the injuries sustained by two people.

People had a choice in the meals that they received and were ordered the day before however we were told that the units at times did not receive sufficient quantities of food and this caused issues. This was discussed with the chef on duty and management with an outcome that to ensure that communication took place from the staff in the units to the kitchen, this required monitoring as we were told extra food would always be prepared or alternatives available. People’s satisfaction with the menu options provided had been checked and 100% of people said they were happy with the food provided. Where people had lost weight this was recognised with appropriate action taken to meet the person’s nutritional needs.

We found that in the care plans and risk assessment monthly reviews records seven of the nine people’s records we looked at were all up to date however there were gaps in two people’s reviewed care plans. There was information recorded by staff that reflected the changes of people’s health in the monthly reviews.

Accidents and incidents were recorded and monitored to ensure that appropriate action was taken to prevent further incidences. Staff knew what to do if any difficulties arose whilst supporting somebody, or if an accident happened.

The home used safe systems for recruiting new staff. These included using DBS checks. They had an induction programme in place that included training staff to ensure they were competent in the role they were doing at the home.

People were having enough person centred group activities provided by the service to promote their wellbeing.

During our visit, we found the culture of the home to be warm, open and transparent. People who lived at the home and the relatives we spoke with during our visit told us staff were kind and caring. We observed interactions between staff and people who lived at the home that were pleasant, kind and compassionate. It was clear that people felt comfortable with the staff that supported them. Staff we spoke with spoke fondly of the people they cared for.

The home was not well led and the systems and processes in place to monitor the home had not identified the concerns found at this inspection.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.