Mersey Parks Care Home

Mersey Parks Care Home is a residential care and nursing home providing personal and nursing care to 102 people aged 65 and over at the time of the inspection. The service can support up to 120 people. The care home is set across four separate single floor units and an office block. One unit provides nursing care, two units provide residential care for people living with dementia and the fourth unit provides residential care.

Each unit comprises of various communal areas, including living and dining areas, adapted bathrooms and single bedrooms with ensuite facilities.

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

We have made a recommendation with regards to the recording of medicines administration. People told us they felt safe and happy living at Mersey parks. One person said, “The staff make me feel safe.” Staff were recruited safely. Incidents and accidents were appropriately recorded and analysed for patterns and trends. Risks to people’s health and well-being were assessed and reviewed appropriately. Safety checks on the environment were in place and robust. Staff could clearly describe the course of action they would take if they felt someone was being harmed or abused. Our observations showed there were enough staff deployed to ensure people were kept safe, and call bells were answered in a timely manner.

We have made a recommendation with regards to the information in some people’s care records. People were supported to eat a balanced diet. We did receive some mixed feedback regarding the food which we fed back to the registered manager. People were supported to have maximum choice and control over 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. Staff were appropriately trained and supervised to enable them to carry out their roles.

All people, without exception, knew who the registered manager was. Staff told us the registered manager had been a positive influence in the home. The registered manager welcomed feedback and was clearly proud of their achievements up to now at the home, however acknowledged there were still some areas they would like to improve further. All notifications had been sent to CQC, and the registered manager understood what was expected of them. Staff told us they enjoyed working at the home and the ethos was better and more relaxed. Staff felt they could approach the registered manager to help them develop further in their roles or if they had any concerns.

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 29 March 2021) and there were 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.

During this inspection we carried out a separate thematic probe, which asked questions of the provider, people and their relatives, about the quality of oral health care support and access to dentists, for people living in the care home. This was to follow up on the findings and recommendations from our national report on oral healthcare in care homes that was published in 2019 called ‘Smiling Matters’. We will publish a follow up report to the 2019 'Smiling Matters' report, with up to date findings and recommendations about oral health, in due course.

Why we inspected

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.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements and to check whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

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 remained requires improvement. This service has been rated requires improvement for the last four consecutive inspections under this provider. 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 Mersey Parks 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.

Mersey Parks Care Home is a residential care and nursing home providing personal and nursing care to 99 people aged 65 and over at the time of the inspection. The service can support up to 120 people. The care home is set across four separate single floor units and an office block. One unit provides nursing care, two units provide residential care for people living with dementia and the fourth unit provides residential care. Each unit comprises of various communal areas, including living and dining areas and adapted bathrooms, and single bedrooms with ensuite facilities.

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

Since our last inspection the provider had made limited progress in addressing the concerns found. Although they had appointed a new manager, measures had not been implemented in an effective and robust manner or evaluated to ensure they were effective in driving improvement. We found continued and new breaches of regulation during this inspection. People and relatives generally spoke positively about the staff and care provided but had mixed feedback about communication from the service.

We found that there were not always enough staff to meet people’s needs in a timely way. People’s prescribed creams were not always securely stored in line with best practice. Individual and environmental risk assessments were in place, but these were not always detailed or accessible to help staff reduce risk as much as possible. Health and safety checks were completed but did not identify shortfalls such as damaged furniture, which we found during the inspection. People were supported when they had been involved in accidents or incidents. However, it was not always clear that lessons had be learnt and sufficient steps had been taken to reduce future risk.

People’s needs were assessed, and referrals made to health care services when needed. Care plans were not always updated to clearly reflect people’s changing needs. People had care plans in relation to eating and drinking but we observed that staff were not always able to provide the support and encouragement that people needed to eat and drink enough. Not all staff had up to date training or regular supervision, but the new manager was working to address this. Records did not always demonstrate how people were supported to have maximum choice and control of their lives. We observed staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice but were not always robustly applied.

Rating at last inspection

The last rating for this service was requires improvement (published 9 August 2019) and there were 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 not enough improvement had been made or sustained and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections under this provider.

Why we inspected

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 coronavirus and other infection outbreaks effectively.

We received concerns in relation to staffing, training, and management oversight. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well-Led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the Safe, Effective and Well Led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the planning and delivery of individualised care; the management of risk; the management and suitability of the environment and equipment; the arrangements for oversight to ensure good care is delivered and drive improvement; and staffing levels, and training and support provided to staff.

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.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Mersey Parks Care Home is a residential care and nursing home providing personal and nursing care to 109 people aged 65 and over at the time of the inspection. The service can support up to 120 people. The care home is set out across four single-floor units and one office block. Three units provided residential care for people, including those living with dementia. One unit provided general nursing care.

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

People’s experience of using the service varied. Staffing had been planned but not always deployed effectively to ensure people’s safety, dignity and person-centred care. Aspects of the service’s record-keeping, person-centred planning and governance were not always robust. Many staff had worked at the service for a long time, felt they were overall well supported by line managers and worked together effectively as a team. However there had been a period of unsettlement with regards to the management of the service and changes. This, together with staffing level concerns, had contributed to an at times very low staff morale. An interim manager had recently started at the service to help provide stability, support staff engagement and drive outstanding improvements.

People using the service felt safe living at Mersey Park and together with their relatives overall spoke well of the staff team. Staff were knowledgeable about people’s needs and spoke with dedication about their work. We identified however that person-centred knowledge at times needed to be shared better, to ensure people were safely, effectively and well cared for. We observed overall kind, respectful interactions between people. Activities were on offer and continued to be developed, to help involve, engage and stimulate people using the service.

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; however, we found at times the policies and systems in the service needed to be used more consistently to support this practice.

The provider had invested into a complete refurbishment of the service, to make it brighter and more inviting. Staff support through regular training and supervision had been addressed by the provider, with some improvements made. The service worked with a variety of other professionals to help promote people’s health, wellbeing and positive outcomes.

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 requires improvement (published 9 October 2018). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating. We brought the inspection forward in part due to concerns we had received about people's safety, this included through notifcations sent by the service. These concerns continued to be under investigation at the time of our visit and we have not reviewed or reflected details within this report.

Enforcement

We have identified breaches in relation to ensuring sufficient staff planning and deployment, as well as the effectiveness of governance systems and record-keeping at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider and meet with them to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Mersey Parks Care Home 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.

The home is registered to provide accommodation and care including nursing, for 150 people. The site comprises four accommodation units and an administration block. Each of the units accommodates about 30 people. Two units specialise in residential care for people with dementia, a third provides general nursing care and the fourth provides general residential care. At the time of our inspection, there were 100 people living in the home permanently and two people were there for periods of respite care. The home is purpose built and is situated near good public transport links and is surrounded by a garden area.

The service requires 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, there was a registered manager who had been with the service for some time, both for the previous provider and the current provider.

We inspected medication storage and administration procedures in the home. These were varied, as some of the documentation was incomplete and storage was not consistently good. We found evidence that some medicines administered did not have the correct or consistent documentation to show how decisions had been made about how to administer them.

There were approximately 140 staff, comprising registered nurses, carers, maintenance, domestic, kitchen and laundry staff and administrative staff. Many of the staff had been with the service for over 10 years. There were unit managers for each unit and a clinical services support manager. However, staff and some people and visitors felt there were not enough staff on duty. Staff and visitors told us there were insufficient staff. We have recommended that the service reviews staffing numbers.

Many staff had been trained by the previous provider, but the training schedule for this year was only a third completed. We have recommended that the service regularly reviews its training schedule.

The service was in the middle of moving all its paperwork and its policies and procedures over to those of the new provider. The documentation was in either the old providers or the new providers format, but it was not consistent throughout the home and many of the old care files were disorganised. We felt that insufficient resources were being used to enable care plan reviews and updates to happen. The registered manager told us the provider would address this immediately. We saw that risk assessments had been completed which had identified risks to people’s safety and well-being and these were being updated. We have made a recommendation that this process be speeded up.

The registered nurses who were employed in the home had all had their PIN number checked each month to ensure it was current. A PIN number was issued by the nursing and midwifery regulator, the Nursing and Midwifery Council, when registered staff were considered to have the skills, knowledge, good health and good character to do their job safely and effectively; this was also known as being, ‘fit to practice’.

The registered manager had a good knowledge of the Mental Capacity Act and its associated Deprivation of Liberties Safeguards, but some staff told us they had not received recent training in this. Staff training showed generally poor take up, but we saw plans in place for much training to take place in the next few months. We also saw that there was little training available in dementia care. We found that some staff training was not up to date and that formal supervision of staff was erratic. We have made a recommendation about staff training and support.

The ‘Accessible Information Standard 2016’ requires that people with a disability or sensory loss are given information in a way they can understand. Part of the information the service provided was accessible, however other parts were not. We have recommended that the service reviews the way it communicates with people.

The registered manager was approachable and accountable and met the registration requirements of the home. However, audits had not always been completed satisfactorily or actions taken when they had. We have made a recommendation about quality assurance processes and audits.

We saw and were told by people and their relatives and visitors, that staff were kind and caring and they treated people with dignity and respect. There was good communication between staff and the people living at Mersey Parks Care Home.

The cleanliness and hygiene of the premises was good; all areas were seen to be clean on the day of the inspection. We saw that all the checks on such things as legionella, water temperatures, gas and electrical installations had been done regularly and were up to date and within safe limits. There were smoke and fire detectors throughout the home, with the necessary firefighting equipment placed around the home. These were also checked and serviced regularly. There were appropriate fire alarm checks and fire drills and the home had evacuation plans, should there be an emergency. We saw that individual personal emergency evacuation plans (PEEPs) had been recorded for staff to use in an emergency.

The kitchen was large and tidy and the kitchen and the equipment in it, was clean. The fridge and freezer temperature checks were completed twice a day and the food temperature checks as and when necessary. All were recorded as being within safe limits.

There was a full activity programme over the seven days but people said there were gaps in the week with nothing taking place. People told us they had choice about how they spent their day and that they knew how to complain if they needed to. The units used security keypads, which helped ensure that only people with permitted access could come and go and sensors were in use where necessary, to alarm staff if people were in danger.