Parton House

Parton House is being refurbished. It provides spacious communal areas including three lounges, a reception room, a dining room, a cinema, seating areas on each floor and accessible gardens. People’s rooms are individualised and some have en suite facilities. They also have access to shared toilets, showers and bathrooms.

This inspection took place on 20 and 21 February 2018. At the last comprehensive inspection in December 2016 the service was rated as Requires Improvement overall.

At this inspection we found the service had improved to Good overall.

There was a registered manager in place who had recently transferred from another of the provider’s homes. 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.

People were benefiting from sustained improvements to the service they received. Their care and support was individualised reflecting their preferences, routines and lifestyle choices. Staff understood people well anticipating their emotions, helping them to stay calm. People’s health and wellbeing were promoted. They had access to a range of healthcare professionals. Their medicines were safely administered at times to suit them. People’s dietary needs were considered when offering them a choice of meals, snacks and drinks. Fortified foods and drinks were provided to those at risk of malnutrition. People at risk of developing pressure ulcers were provided with equipment to protect their skin and staff followed strategies to prevent deterioration in their skin. People had discussed their end of life wishes which were respected. A relative said, “You all went the extra mile for her in her last few days, and [Name] and I are extremely grateful for your dedication.”

People’s care records were kept up to date with their changing needs. They and their relatives were involved in developing their care and support. Information was shared with other agencies and organisations, when needed, to ensure a smooth transition between services. People were kept safe from the risk of abuse. Staff had a good understanding of safeguarding procedures and were confident management would take the appropriate action. 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. People had access to a range of meaningful activities which included visits by people and children living in their local community. Visitors were made to feel welcome and arrangements could be made for private dining.

People were supported by staff who had been through a robust recruitment process before starting work. Staff had access to a range of training to equip them with the skills and knowledge they needed to meet people’s needs. Staff were supported to develop in their roles. Disciplinary procedures were in place should they be needed. The registered manager was open and accessible and understood the challenges of introducing change management. There were plans to recognise best practice and to introduce staff champions in key areas.

People, their relatives and staff had a variety of ways to express their views about the service. Their feedback was used to drive through improvements. Quality assurance processes were in place to monitor the standard of the service provided. Accidents, incidents and complaints were monitored. Lessons were learnt when things went wrong and action taken to prevent issues reoccurring. A relative commented, “I would not hesitate to recommend your services for your professionalism and compassion.”

The registered manager had been in post just under two months at the time of the inspection. She had been previously registered at another home owned by CTCH Limited. 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 inspection on 10 May 2015 the overall rating was requires improvement. We asked the provider to take action to make improvements to:

• the accuracy of people’s care records

• the way in which people were treated, ensuring dignity and respect at all times

• people having access to the appropriate diet and nutritional input

• staff recruitment procedures

and these actions had been completed.

Despite the action taken to address issues we identified and on-going positive changes to people’s experience of their care, there was still room for improvement. People’s dignity was not being promoted when they were assisted with moving and handling. Staff did not use blankets provided to cover them when being hoisted. A new range of quality assurance audits had been introduced which identified where further improvements were needed. However actions had not been recorded to evidence what was going to be done to address these issues, by whom and by when. Other quality assurance audits also failed to identify actions although the registered manager was able to evidence through other records these had been completed. We made a recommendation in relation to this.

People received individualised care which reflected any changes in their health and wellbeing. Improved communication by staff ensured their changing needs were addressed and they had access to health care professionals when needed and action had been taken to keep them safe and well. Accidents and incidents had been monitored and staff had looked for explanations of possible causes, taking action to minimise these where they could. People’s needs had been assessed and new care plans put in place which reflected their individual wishes and needs.

People were supported by staff who understood their needs. They had been appointed after all the necessary recruitment checks had been completed. They had access to training and support to develop in their roles and reported that morale had significantly improved and they felt valued in their roles. People’s rights were upheld and staff understood how to recognise and report suspected abuse. People were supported to make day to day decisions and were supported to make larger decisions in their best interests if they were unable to do this. When people had been restricted, the least restrictive option had been explored, and deprivation of liberty safeguards had been requested. There were enough staff with the right skill mix to meet their individual needs.

People had access to a range of meaningful activities reflecting their likes, interests and hobbies. They enjoyed entertainment by local choirs, schools and other services. Consideration was being given to the needs of people living with dementia, making their environment more accessible to them. Signs around the home helped them to find their way around and brightly coloured crockery helped them to eat and drink. There were plans to provide pictures and rummage draws which they could interact with.

The registered manager had plans to further improve people’s experience of care by refurbishing the home, increasing staff awareness of dementia and to develop a staff team with the skills and knowledge to enhance people’s wellbeing. Staff found her to be open, accessible and approachable. They reported an improvement in staff morale and were working as a team. People and their relatives would confidently raise concerns with the registered manager who one relative said was “a breath of fresh air”. The registered manager was supported by the provider to drive through changes to deliver a higher standard of care.

We undertook this focused inspection on 23 September 2016 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Parton House on our website at www.cqc.org.uk”

Parton House provides care to 36 older people with a physical and/or sensory disability. At the time of our inspection 24 people were living in the home. Accommodation was provided over two floors with shaft lifts to access the first floor. There were 36 bedrooms, each of which had en suite facilities and there were an additional bathrooms and shower rooms. People had access to three lounges and a dining room. There were pleasant grounds around the home which were accessible to people.

At the time of the inspection there was no 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. A representative of the provider was temporarily managing the home until a manager had been appointed.

At the inspection on 10 May 2015, we asked the provider to take action to make improvements to:

• the accuracy of people’s care records.

These actions still needed further improvement. You can see what action we told the provider to take at the back of the full version of the report.

At the inspection on 10 May 2015, we also asked the provider to take action to make improvements to:

• keeping people safe from harm or injury, by reducing risks and ensuring medicines were

administered appropriately

• records evidencing people’s capacity to consent to their care and support

• the quality assurance systems,

and these actions had been completed.

People had access to their call bells whether in their bedrooms or in the lounges. Any unexplained bruising or injuries had been reported and recorded. When necessary health care professionals had been contacted for their advice and support to help people to stay healthy and well. New arrangements had been put in place for the administration of medicines. Medicine administration records had been completed and people had their medicines when they needed them. Any errors had been followed up and the appropriate action taken. People’s capacity to consent to their care and support had been assessed and new records had been introduced to confirm when decisions would be made in their best interests. Quality assurance processes had been improved and evidenced any shortfalls and when improvements had been made.

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 and associated Regulations about how the service is run. The registered manager was on annual leave at the time of our inspection. A representative of the provider was present in their absence.

People received inconsistent care and support which impacted on their safety and well-being. Changes in people’s physical or mental well-being were not always responded to in a timely fashion. Staff were reactive rather than proactive and people’s health potentially suffered as a result. Risks to people had not always been explored or investigated to prevent them from reoccurring. This was not helped by poor record keeping and making sure care records and medicines administration records were accurate and up to date. People were not always treated with dignity and respect. They had access to a range of activities which were being reviewed to make sure they provided meaningful and individualised opportunities for people. When staff were appointed not all of the checks needed had been carried out to ensure they were fit to carry out their duties. Quality assurance audits were not robust and the service was not always well-led.

People and visitors were positive about the care and support they received. They were involved in planning and reviewing their care and support. Their concerns were listened to and action had been taken in response. People were supported by enough staff who understood them well. Staff were kind and compassionate and cared for people. They were supported to develop in their role and their training needs were monitored. A range of training had been provided and more was scheduled. Staff had individual meetings to help them reflect on their performance.

People and their relatives were able to express their views through residents and relatives meetings as well as annual surveys. As a result trips and outings had been arranged and there had been improvements to the laundry. A three year refurbishment of the home had reassured them about concerns about the environment. The provider recognised the issues raised at the inspection and confirmed action would be taken to improve the standards of care and support provided.

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 the report.

As part of this inspection we spoke with five people who use the service, the registered provider, four staff and other authorities. We also observed how people were being cared for. We reviewed records relating to the management of the service which included four care plans, daily care records, accident and incident records and staff training documents.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

People were safe because staff shared information on risks associated with their care, treatment and support. Accidents and incidents were analysed and actions were taken to keep people safe from the risk of further accidents or incidents.

People were safe because they received their medicines as prescribed because they were stored, administered and disposed of safely in line with current and relevant regulations and guidance. Systems were in place to make sure the administration and control of medicines was monitored and action taken to address any issues which might affect the wellbeing of people living in the home.

Is the service effective?

The service was effective because people were supported by care staff who had the necessary skills and knowledge to meet their assessed needs, preferences and choices. Staff had access to support, induction, one to one meetings, annual appraisals and training. People told us, "Staff are very gentle and kind", "Staff are lovely", "Staff are very good".

People received an effective service because when their needs changed, referrals were made quickly to relevant health services. Their care records were updated to make sure all staff were kept informed of any changes.

Is the service well led?

The service was well led because they monitored accidents and incidents. Systems were in place to continually review the incidence, type and timing of accidents and incidents. There was evidence the service learnt from incidents and accidents to prevent them happening again.

The service was well led because there were clear and transparent processes in place for staff to account for their decisions, actions, behaviours and performance. One to one and group meetings provided the opportunity for staff to discuss their roles and responsibilities and to reflect on their performance.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

The inspection was completed by two inspectors. We spoke with eight people living in the home and seven members of staff. This is a summary of what we found.

Is the service safe?

People said, 'Staff look after me very well', 'Staff treat me well', 'I am amazed at the kindness of staff'.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications needed to be submitted proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

On the whole there were enough staff on duty to meet the needs of people living at the home and a member of the management team was available on call in case of emergencies. At times staff felt additional support would be beneficial.

The medicines were not being managed so that people received them safely. Appropriate arrangements for the safe keeping, safe administration and management of medicines were not in place. This meant people were not being protected against the risks associated with the unsafe handling and management of medicines. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the management of medicines.

Monitoring of accidents and incidents was not robust. Trends were not responded to quickly enough to prevent further harm to people. Quality assurance audits highlighted actions to be taken to address any shortfalls but these were not being properly monitored or acted upon to make sure the changes were made. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the assessing and monitoring of the quality of service provision.

Is the service effective?

People were supported to be involved in the assessment of their needs. Their individual needs, choices and preferences were reflected in their care records. For people living with dementia their reactions to pain had been assessed. This meant staff were able to recognise when people living with dementia were distressed due to pain and able to take the appropriate action. Where people were at risk of falls they had been provided with equipment to minimise the risk of injury. People were supported to make arrangements for the end of their life reflecting their preferences and wishes.

Staff were not having support to take part in learning and development to make sure they were competent to carry out their role. Staff were not receiving the opportunities they needed to keep their skills and knowledge up to date. This meant staff were not being properly supported to provide care and support to people who lived in the home. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to supporting staff to receive appropriate training and professional development.

Is the service caring?

We observed staff treating people respectfully, sensitively and with shared humour. A visitor said, "Staff speak to her as a person. They are patient and lovely." Staff had a good understanding of people's needs. They were attentive and noted when people needed help or support. If people were observed not eating their meal they were offered an alternative.

A person told us, "I chose this home. My wife is able to visit me daily." Another person said, "Very lucky to be here". People told us they discussed their views about the home at resident's meetings. One person told us, "We have residents' meetings. Everything we ask for they have arranged by the next day."

Is the service responsive?

People's preferences, interests and diverse needs were recorded and we saw that their care was provided in accordance with their wishes. Activities were provided such as bingo, music, trips out and the home's cinema. Visitors were welcomed and people could meet with them in privacy if they wished.

People said they were able to give feedback about the service provided. A person told us they had asked for fresh fruit to be served at mealtimes. They said this was provided the following day. A visitor said, "The managers are approachable and I would talk to them if I had any concerns. I have none." People living in the home said they had no complaints.

There was a lack of consistency in the way people's changing needs were reflected in their care records. For some people this meant an inaccurate or incomplete record was being kept which could potentially lead to the incorrect care being provided. Some records were not being kept securely promoting people's right to confidentiality. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the maintenance of accurate records for people.

Is the service well led?

People had completed surveys as part of the annual quality assurance process. This resulted in improvements to the service such as a review of housekeeping and the laundry system. Visitors, other professionals and staff had also completed surveys to express their views about the service provided.

A range of quality assurance checks were in place to make sure the home was operating safely. Health and safety audits were completed at appropriate intervals. The provider had recognised the need to improve their quality assurance visits to the service. Their audits would be more frequent and look at the service as a whole rather than at individual areas such as care planning or medicines.

There was evidence the way the service was managed did not always anticipate risks and they did not have strategies to minimise them to ensure the smooth running of the service. This meant that the service was reactive rather than proactive in their response to accidents and incidents. This meant people were not being protected or safeguarded from the risk of further accidents or incidents.

We did not speak with people about this follow up inspection. We looked at schedules which identified when staff would receive supervisions and their annual appraisal. Training records confirmed that the training needs of staff were being monitored. Staff were having access to refresher training.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

For a complete overview of the outcomes for people at this location please also read the report for 2 October 2013.

People told us, "I wouldn't want to live anywhere else", "I couldn't fault staff, I am really happy here" and "I am well looked after". A visitor said they were really happy with the care provided and that staff were always friendly and welcoming.

People's care records identified their individual needs and reflected any changes to their health or wellbeing. People's wishes, preferences and routines were noted and respected.

People were protected from abuse or the risk of abuse. Safeguarding procedures were in place to identify and prevent abuse from happening.

Infection control measures ensured that people were protected against the risk of infection. Standards of cleanliness and hygiene were monitored and new systems were being put in place to make sure these were more robust.

Staff had access to training to keep their knowledge and skills up to date. Staff were not receiving supervision and appraisals to help them reflect on their roles and responsibilities.

People's personal records and other records were kept up to date and reviewed at appropriate intervals.