Archived: Park House

We last inspected the service on 5 and 7 July 2016 and rated the service as Requires Improvement. At that inspection we found breaches of the Health and Social Care Act 2008 in relation to consent, maintaining the premises and governance of the service. The service sent an action plan to the Commission stating how they would meet outstanding regulations. At this inspection we found the service had met these breaches of regulation had improved to Good.

Park House is a seven bedded service that provides personal care and support to people with mental health issues and learning disabilities, and support to moderate or manage alcohol or substance misuse. 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. At the time of our inspection there were five people using the service.

The service had a registered manager in place who had been registered since June 2017. 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.

We saw that people’s consent had been recorded, appropriate assessments of people’s capacity had been undertaken and staff had received training in the Mental Capacity Act [MCA] and Deprivation of Liberty Safeguards [DoLS].

Leadership at the service had improved and the new registered manager showed us the improvement in relation to records, staff supervision and training they had undertaken. Staff and people spoke positively of the support and changes by the registered manager.

Issues in relation to the environment highlighted at out last inspection had been addressed but décor in some areas of the home looked tired and scruffy.

We saw that people received their medicines at the correct times and people were supported to manage their own medicines following assessment. We saw medicines were stored safely and were usually administered by staff who were trained and competent. One person administered their own medicines following an assessment. We saw “as and when required” medicines were in place for some people and there were no accompanying protocol records to ensure staff were clear on when and why these medicines should be administered. We discussed this with the manager who stated they would seek guidance regarding these protocols and implement them without delay.

Staff and the management team understood their responsibilities with regard to safeguarding and had been trained in safeguarding vulnerable adults. People we spoke with told us they felt safe at the home.

Accidents and incidents had been appropriately recorded and monitored and risk assessments were in place for people who used the service and staff.

Care records showed that people’s needs were assessed before they started using the service and they were supported to transition to the service as smoothly as possible.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Staff were suitably trained and training was arranged for any due refresher training. Staff received regular supervisions and appraisals and told us they felt supported.

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 were supported to make choices about what they had to eat and we saw these were respected. People’s likes, dislikes and preferences were reflected in their care plans.

We received good feedback about the caring and dedicated nature of the staff. People clearly felt very comfortable with staff members and there was a warm and positive atmosphere in the service and people were very relaxed. We saw people being treated with dignity and respect and people told us that staff were kind and professional.

People who used the service told us they were aware of how to make a complaint.

The service regularly used community services and facilities and had links with other local organisations. Staff told us they felt very supported by the registered manager and were comfortable raising any concerns. People who used the service and staff were regularly consulted about the quality of the service.

The service had a range of audits in place to check the quality and safety of the service and equipment at Park House and actions plans and lessons learnt were part of their on-going quality review of the service.

Park House is a seven bed care home that provides personal care and support to people with mental health issues and learning disabilities, and support to moderate or manage alcohol or substance misuse. There were six people living there at the time of our inspection.

There was a registered manager in post but they were not managing this service on a day to day basis. There was a new manager who had been managing the service since a few weeks prior to the inspection. They told us they intended to transfer their registration and replace the existing registered manager. They were registered as a manager for the provider at another location. 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.

The provider had made sustained improvements since our last inspection in areas including, keeping people safe from possible harm or abuse. However there remained areas where improvements had not been completed to the required standard and leadership had not always been in place to support the service.

We found that the provider did not have a clear and robust contingency plan, which staff knew how to implement, to support the service. Some care plans and records had been improved by the new manager to ensure they were up to date and set clear guidelines for staff; however these were not always maintained by staff or used consistently.

People told us that the service was a safer place and they felt happy with the care and support they received. We saw that staff were supported and trained to meet people’s needs and that external professional assistance had been sought to help people with mental and physical healthcare. Medicines were not stored at the correct temperatures. Improvements had been made to the homes décor and environment, but some of this work was still incomplete and one bedroom did not have a lock for a period of time. People did not have a secure storage area in their bedroom.

Some people’s consent and involvement had been sought as part of recent care reviews, but the staff did not display a clear knowledge of the principles of the Mental Capacity Act. It was not always clear if staff had considered the use of these principles when consulting on and designing new care plans when they were reviewed.

Staff training had been improved and we saw that regular supervision and appraisal processes were now in place for staff. Training needs highlighted at the last inspection had been acted upon and a clear process was in place to ensure that staff had update or refresher training.

People told us that the staff cared for them in a manner of their choosing, and that they felt the team were effective at meeting their needs. The new manager was open to developing ways to gain peoples involvement in the improvement of the service. Whilst the new manager had improved support plans for people, not all recording and learning from incidents was effective. Staff use of records was inconsistent and this had not been picked up at reviews or improved.

Activities was a regular issue that people and staff identified as needing improvement and the new manager planned to use the house forum to make improvements. People told us they felt involved by the new manager and the staff team, but some people’s involvement was minimal and limited action had been taken to seek their views.

There had been significant improvement in the service, however inconsistent leadership of the service over the last year meant there were still issues that had not been improved as expected following our last inspection. The new manager was clear about issues they had to address, but not all quality assurance processes were fully in place so improvements had been inconsistent and were not yet fully embedded.

We found breaches of regulation relating to consent, maintaining the premises and governance of the service. You can see what action we told the provider to take at the back of the full version of the report.

The environment was not adequately maintained, in that many areas were in need of redecoration and new carpets.

People were supported by staff who were checked and vetted to make sure they were suitable to be employed.

People's personal records, and other records held at the service, were accurate and fit for purpose.

We found care was planned in a person centred way and provided by sufficient skilled staff to meet people's needs and promote their independence. Risks to people's welfare were appropriately managed, including safe arrangements for handling medication.

People understood how to make a complaint and told us they had no concerns about the service or the individual support they received.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.