Gorton Parks Care Home

Gorton Parks is a nursing home registered to accommodate up to 120 people across four separate bungalows. At the time of our inspection there were 112 people living at the service.

Each bungalow specialises in either nursing or residential care, Sunnybrow, Abbey Hey, Melland and Debdale. Some of the people living at Gorton Park live with dementia. Each of the bungalows has a lounge, dining area, a conservatory, and a kitchenette. All bedrooms are single with no en-suite facilities. Accessible toilets and bathrooms are located near to bedrooms and living rooms.

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

The management team were committed to making improvements across the service. Current priorities focused on staff recruitment and retention, with increased pay incentives, and medication management, working in partnership with the GP and supplying pharmacist.

Additional management appointments had been made, offering better support for the registered manager and across the service. Each had delegated responsibilities including audits and checks providing oversight of the service. A comprehensive action plan was in place to help drive improvement.

Suitable arrangements were in place for the management of people’s prescribed medicines. Regular audits were carried out to check a safe system was in place. Recent issues in the ordering and supplies of medication had been addressed with the GP and supplying pharmacist.

Areas of risk, such as behaviours, pressure care or poor nutrition, were identified and planned for. Additional records were completed to help monitor people’s changing needs and behaviours. Gaps in some records were noted. These shortfalls had been identified and acted upon following internal audits carried out the management team.

We found areas within the home were tired and needed enhancing, for example, carpets, redecoration and replacement of worn furniture. A comprehensive plan had been drawn up to address the work required. Relevant internal and external safety checks were carried out to help keep the premises and equipment safe.

Sufficient numbers of staff were available to meet the needs of people. Relevant information and checks were carried out to ensure new staff were safely recruited. Opportunities for staff training and development were made available. Following feedback from staff, leadership training was to be introduced helping to further enhance staff skills.

Systems were in place with regards to consent and capacity. 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.

People told us they were happy living at Gorton Park. People were engaged in activities and interaction between people and staff were kind and respectful.

Suitable arrangements were in place with regards to infection control procedures and safeguarding, to help keep people safe.

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 15 June 2021).

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. At our last inspection we also recommended improvements in medication records, improvements to risk management plans and the introduction of staff supervisions. At this inspection we found action had been taken, further improvements were being made in relation to the frequency of supervision.

Why we inspected

We carried out an unannounced focused inspection of this service in May 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve good governance and safe care and treatment.

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.

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 changed from requires improvement to good. 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 Gorton Park Care Home 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.

Three units specialise in either nursing or residential care (Sunnybrow, Abbey Hey and Melland). Part of Debdale is a nursing unit. The other half of Debdale and Delamere are 'intermediate' care beds which provide reablement services for people discharged from hospital. The care staff were employed by Advinia, with the NHS providing the nurses, physiotherapists and occupational therapists. All units come under the Gorton Parks regulation with the CQC.

Each unit has a lounge, dining area, a conservatory, and a kitchenette. All bedrooms are single with no ensuite facilities. Accessible toilets and bathrooms are located near to bedrooms and living rooms.

We found the following examples of good practice.

We visited the units and found the environment was clean throughout. The provider had a cleaning regime in place and communal areas were well spaced.

A robust screening process was in place for all essential visitors to the home. This included completion of a temperature check, evidence of a recent lateral flow test and a vaccination check for visiting professionals.

Staff had access to supplies of PPE and had received training to ensure they used this correctly. All staff and people living at the service had regular testing for COVID-19, and all had received their vaccinations.

The registered manager sought support and advice from external agencies including the local health protection team and CQC and was open to all advice and guidance offered.

The provider had policies and procedures in place which showed they were operating in line with government guidance.

Gorton Parks is a nursing home registered to accommodate up to 148 people across five separate units. At the time of our inspection there were 140 people living at the service.

Three units specialise in either nursing or residential care (Sunnybrow, Abbey Hey and Melland). Part of Debdale is a nursing unit. The other half of Debdale and Delamere are ‘intermediate’ care beds which provide reablement services for people discharged from hospital. The care staff were employed by Advinia, with the NHS providing the nurses, physiotherapists and occupational therapists. All units come under the Gorton Parks regulation with the CQC.

Each unit has a lounge, dining area, a conservatory, and a kitchenette. All bedrooms are single with no ensuite facilities. Accessible toilets and bathrooms are located near to bedrooms and living rooms.

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

Improvements had been made since our last inspection in the management of medicines. An electronic medicines system was now used which prompted which medicines were to be administered during each medicines round. Staff had received training in dementia and positive behaviour support. Staff were positive about the training and felt positive about the support they received.

However further improvements were required. Support plans for people who may become agitated were not detailed in the distraction techniques to be used and when the use of medicines may be appropriate. Records were not kept following incidents of distressed behaviour. Some daily records, for example the application of topical creams and when thickeners had been added to drinks were not fully completed. These issues had been identified in the provider audits but were still found during our inspection.

Risks were identified and plans in place to manage these known risks. Incidents were recorded on the providers computerised system and reviewed by the unit and registered managers to ensure appropriate actions had been completed. Staffing levels were sufficient to meet people’s needs and staff continued to be safely recruited.

People were supported to maintain their health and wellbeing. 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.

There was mixed feedback from relatives about their involvement in their relative’s care plans and communication with the home. Some relatives had difficulty getting their phone calls answered as staff were busy supporting people. The provider was looking into changing the phone system to address this issue.

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 22 July 2019). There were three breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. We also met with the provider to monitor the progress against the action plan.

At this inspection not enough improvement had been made and the provider was still in breach of one regulation. The service remains rated requires improvement. This service has been rated requires improvement for the last five consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 10 and 1 June 2019. Three breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, good governance and staffing.

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, Effective 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 as requires improvement This is based on the findings at this inspection.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Gorton 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 monitor the service.

We have identified breaches in relation to the quality assurance at the home in relation to the recording of incidents for people who may become agitated, the application of topical creams and the use of thickeners to manage the risk of choking.

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 and meet with the provider following this report being published 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.

Gorton Parks is a purpose-built ‘care home’, situated within a quiet residential area of Manchester, with good links into Manchester city centre.

Gorton Parks has five separate ‘units’; three units are dedicated to nursing or residential care. One and a half units are dedicated to intermediate care, these provide beds to people who are being discharged from hospital and half of one unit is dedicated solely to nursing care. The service can accommodate up to 148 people. At the time of the inspection, there were 139 people living at the home.

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

At this targeted inspection we found that there were safe, comprehensive and robust systems in place to ensure people received a safe level of care.

People received sufficient provisions and we were informed by chef manager as well as laundry and domestic staff that the ordering and supply system in place worked well.

People were living in a safe, comfortable and clean environment. Environmental risk assessments and management procedures meant that people’s level of safety was a priority and never compromised.

We received positive comments about staffing levels at Gorton Parks. A recent recruitment drive meant that the use of agency staff had reduced, and the home was generally being supported by regular Gorton Parks staff.

We checked that there were sufficient cleaning products in place and infection prevention control procedures were complied with. The home was clean, hygienic and odour free and staff told us that effective cleaning schedules were completed on a daily basis.

An on-line digital platform ensured that all accident and incidents were recorded, monitored and analysed. Local and regional managers maintained a good level of insight in relation to all accidents and incidents and the level of risk was safely managed.

Rating at last inspection:

The service was rated ‘requires improvement’ at the last inspection (report published 23 July 2019). We found breaches of regulation in relation to safe care and treatment, good governance and staffing (training). The registered provider was requested to submit an action plan which identified how they would follow up on the concerns we identified.

Why we inspected:

The inspection was prompted due to concerns received about the provision of care people received. We undertook this targeted inspection to ensure that the service was meeting legal requirements. To do this we examined risks relating to systems and processes, areas of risk management and safety monitoring and provisions that were in place to ensure people were living in a safe and well-maintained environment.

A decision was made for us to inspect and examine those risks. This targeted inspection only focused on specific concerns and did not cover all key lines of enquiry, as a result the ratings for this service have not been changed. The ratings for this service will be reviewed as part of our next comprehensive inspection.

We found no evidence during this targeted inspection that people were at risk of additional harm from the concerns we had received since we last inspected.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Gorton Parks on our website at www.cqc.org.uk.

Follow up:

We will continue to monitor intelligence we receive about the service until we return as per inspection programme. If any concerning information is received, we may inspect sooner.

Gorton Parks is registered to accommodate up to 148 people across five separate units. At the time of our inspection there were 133 people living at the service.

Three units specialise in either nursing or residential care (Sunnybrow, Abbey Hey and Melland). Delamere and part of Debdale are ‘intermediate’ care beds which provide reablement services for people discharged from hospital. The care staff were employed by Advinia, with the NHS providing the nurses, physiotherapists and occupational therapists. The other half of Debdale is a nursing unit run by Advinia.

Each unit has a lounge, dining area, a conservatory, and a kitchenette. All bedrooms are single with no ensuite facilities. Accessible toilets and bathrooms are located near to bedrooms and living rooms.

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

People living in Abbey Hey did not always receive their medicines as prescribed. Written guidance for medicines not routinely administered were not in place for the NHS units and did not explain when the medicine should be administered. Medicines records were not always fully completed.

Staff received training to support them in their role and were positive about the training they had. However, staff supporting people living with dementia had not completed training in dementia awareness or managing challenging behaviours.

The quality management system was better organised than at our last inspection, with audits being completed as scheduled. However, the medicines audits for Abbey Hey had consistently shown 80% compliance until June 2019 when the audit was 64%. Audits had not picked up the other medicines issues we identified. Training audits had not identified the gaps in training for staff working with people living with dementia.

Incidents and accidents were recorded and reviewed by the registered and clinical services managers. We have made a recommendation about ensuring all incidents are reported.

People and relatives said they felt safe living at Gorton Parks and were positive about the care staff. Staff knew people and their needs and explained how they maintained people’s privacy and independence.

There were sufficient staff on duty to meet people’s assessed needs, although they were seen to be busy. An activity coordinator team arranged activities for people or engaged in individual chats with people. Two of the five coordinators had started work on the first day of our inspection. We did not observe staff having the time to engage people in activities on the households as they were busy supporting people.

Staff were positive about working at Gorton Parks. They felt supported and that the management team were approachable and would listen to their concerns or ideas.

The home was visibly clean, however there was an odour in the lounge area of Abbey Hey. Equipment was checked, maintained and serviced in line with regulations and guidelines.

Risk assessments and care plans were in place and reflected people’s needs. The majority of care plans had been re-written on Advinia paperwork. The remaining care plans were on track to be transferred. People and their relatives had been involved in agreeing their care plans.

People’s end of life wishes were recorded.

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.

People were supported to maintain their health. Referrals were made to medical professionals appropriately.

People received support to maintain their food and fluid intake. People’s weights were monitored, and fortified foods offered to those at risk of losing weight.

People’s cultural needs were recorded and were being met. A range of culturally appropriate meals were available. People’s communication needs were recorded, and staff knew how they communicated and made decisions.

The service had a formal complaints procedure in place. Complaints had been responded to appropriately. People and relatives said they would speak directly to the staff and unit manager 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 22 January 2019). 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 in the areas identified at the last inspection; however, other issues were found, and the provider is still in breach of regulations.

This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

This inspection was brought forward due to overall concerns with the providers performance.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of the full report.

Enforcement

We have identified breaches in relation to medicines management, the lack of staff training in dementia awareness and managing challenging behaviours and the good governance of the home at this inspection.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Gorton Parks 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.

Gorton Parks is registered to accommodate up to 148 people across five separate houses. Three houses specialise in either nursing or residential care (Sunnybrow, Abbey Hey and Melland). Delamere and part of Debdale are ‘intermediate’ care beds which provide re-ablement services for people discharged from hospital. The care staff in these houses are employed by Advinia, with the NHS providing the nurses, physiotherapists and occupational therapists. The other half of Debdale is a nursing unit run by Advinia.

Each house has a lounge, dining area, a conservatory, and a kitchenette. All bedrooms are single with no ensuite facilities. Accessible toilets and bathrooms are located near to bedrooms and living rooms.

There was a registered manager at Gorton Parks. 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 our last inspection in July 2017 we identified three breaches of Regulations because medicines were not safely managed, activities were not organised to stimulate people, there were insufficient staff to meet people’s needs at meal times and quality assurance audits had not been sufficiently robust.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, caring, responsive and well led to at least good. At this inspection we found some improvements had been made.

We found improvements had been made and medicines were now managed safely and four activity co-coordinators had been recruited and people were positive about the activities now being organised on each household.

However there continued to be a breach in regulations as staffing levels on Sunnybrow household, especially during mealtimes due to the number of people who needed support to eat their food, were insufficient. Feedback about staffing levels for the other units was positive.

We also identified a breach in regulations because two care plans on Sunnybrow were not reflective of people’s current needs. The care plans we viewed on the other units reflected people’s identified needs and were reviewed each month. Risks had been identified and steps taken to reduce the likelihood of the identified risk occurring. Where people might have behaviour that challenges, care plans gave details of potential triggers and behaviours.

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

Improvements had been made to the quality assurance system, although these were still bedding in at the time of our inspection. Actions identified from the audits were completed for the specific care plan or medicines plan reviewed but were not applied across all plans on the household. The home planned to increase the number of care plans audited each month as the newly appointed CSM settled into their role.

All falls, incidents, weights and pressure area sores were recorded and reviewed each month. A monthly report was sent to the Advinia regional manager.

People, their relatives and the staff we spoke with were positive about the changes introduced by the new registered manager. The new registered manager was much more visible and approachable, conducting daily visits to each house.

The registered manager was more responsive to requests for additional items or equipment to be purchased. For example, pressure relieving mattresses were bought for people at risk of developing pressure sores, rather than waiting until an issue with the person’s skin developed.

Staff told us morale at the home had improved. Care staff had a monthly meeting with the registered manager where they were updated about the company and home and were able to ask questions or raise any ideas or concerns they had.

The home had recruited more staff resulting in fewer agency staff being used. Registered Mental Health Nurses (RMNs) had also been recruited to work in the houses specialising in supporting people with dementia. A safe recruitment procedure was in place.

Checks on lifting equipment had not been completed within the six month timeframe, household emergency files did not contain all everyone’s personal emergency evacuation plans and some emergency light bulbs had not been working for a period of ten months. The emergency lighting system was replaced shortly after our inspection. We have made a recommendation that best practice guidelines for health and safety in care homes are followed.

People living at Gorton Parks felt safe. We received positive feedback from people and their relatives about the care staff and the support they provided. Staff knew how to report any concerns they had about possible abuse.

All incidents, accidents and complaints were reviewed and investigated. Appropriate action was taken where required.

Staff received the training and support to carry out their role. On line training had been introduced, which had been received positively by staff.

Staff we spoke with knew people and their support needs. Staff said they received information about people’s support needs before they moved to the care home.

People said the food was good and they had a choice of meals. Culturally appropriate meals were available. People’s nutritional needs were being met, their dietary requirements were known and catered for.

People’s health needs were also being met. Referrals were made to GPs and other medical professionals as appropriate.

People’s end of live wishes were recorded, including any cultural requirements they may want.

The home was working within the principles of the Mental Capacity Act (2005). People’s capacity to make decisions was assessed and where they lacked capacity applications for Deprivation of Liberty Safeguards were made.

Gorton Parks had a complaints policy in place. We saw all issues raised had been looked into and responses provided to address the issues raised.