Parklands Court Care Home

Parklands Court Care Home is a residential care home providing personal and nursing care to up to 163 people. The service provides support to older people, some of whom are living with dementia, people with a physical disability and younger adults. At the time of our inspection there were 55 people using the service.

Parklands Court Care Home consists of 3 purpose-built single storey buildings called Collins, Samuel and Marlborough. Each unit has access to a garden. There were several other self-contained units on the same site, but these were not in use at the time of the inspection.

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

Systems used for the management of medicines were not always safe. Some people experienced delays in their care and support due to staffing not being available when they needed them. There were systems in place to try and promote learning from incidents and events, however these were not always effective.

Governance processes and quality audits had failed to drive significant improvement and the home had been rated requires improvement at the last 4 inspections. People, relatives, and staff felt communication from the provider was poor and this had negatively affected their view of the home.

Staff knew how to escalate concerns for people’s safety and risks were assessed and managed to reduce the risk of harm. Improvements had been made to infection control, the home was visibly clean, and staff followed guidance to reduce the risk of cross infection.

Staff sought consent before providing care. 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 a new management team in place who were open about the improvements required and were developing a plan to raise the standard of care people received.

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 6 January 2023). 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 although some improvements had been made the provider remained in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last 6 consecutive inspections.

Why we inspected

We received concerns in relation to staffing levels and poor-quality care. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe 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 Parklands Court Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to the management of the service at this inspection.

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 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Parklands Court Care Home provides personal and nursing care for up to 163 people, including older people and people with dementia. At the time of our inspection 108 people were living at the service.

Parklands Court Care Home consists of 4 purpose-built single storey buildings named Collins, Samuel, Harrison and Marlborough. Each unit has access to a garden.

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

The provider’s governance and quality assurance systems were not effective in enabling them to assess, monitor and improve the quality and safety of people’s care. Staff recruitment checks needed to be improved to ensure people were supported by suitable staff. Infection control practices did not fully protect people from the risk of infections.

Improvement was needed to ensure all staff who administered medication were assessed as competent. The mealtime experience was disorganised. Staff displayed caring qualities; however, some practices did not protect people's dignity. There was a lack of activities available for people to participate in.

People were protected from the risk of abuse. People had person centred care plans and risk assessments which provided guidance for staff to follow to support them safely. Medication was managed safely and there were protocols in place to ensure people received their medication as prescribed.

People were offered choices. Staff sought consent before carrying out tasks.

Staff knew people well and knew how to communicate with people. People had end of life plans in place.

Lessons were learned following incidents and accidents and this learning was shared with staff. The registered manager took on board feedback and was proactive in addressing concerns identified during the inspection.

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 14 April 2021) and there was a breach 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 the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about poor nutrition and hydration, poor personal care, staff conduct, neglect of people and poor management. A decision was made for us to inspect and examine those risks.

We have found some evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive 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.

Enforcement and Recommendations

We have identified breaches in relation to infection control practices and governance 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Parklands Court care home provides personal and nursing care for up to 163 people, including older people and people who may live with dementia. At the time of our inspection 87 people were living at the service.

Parklands Court care home is purpose built and consists of six separate, single storey buildings named Collins, Samuel, Harrison, Marlborough, Elmore and Clarendon. Each unit has access to a garden. The Clarendon unit has not been used by the Provider for a number of years and was closed at the time of our inspection.

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

At our last inspection we found the provider's governance system required improvement. At this inspection we found improvements had been made but some concerns were still found in relation to the quality and safety of the care provided. Systems had been ineffective to reduce risks following an incident and address a repeated concern when medicines were administered via a patch. Some improvement was required to recruitment records and to ensure current COVID 19 government guidance was followed when people needed to isolate.

At our last inspection we found concerns in relation to how safeguarding was recognised and reported. At this inspection we found improvements and staff felt confident to raise concerns. People and relatives told us they felt safe and staff knew their needs well. Staff told us there was enough staff but the use of agency staff could impact on how people’s needs were met.

The provider had worked with partner agencies to improve their medicine ordering system and this had improved care and reduced errors. There were systems in place to analyse incidents and learn lessons to improve care, but this needed further embedding to ensure this was done consistently.

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 24 October 2020) and there were breaches of regulation. At this inspection we found some improvements had been made, however further improvement was required 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 four consecutive inspections.

Why we inspected

We carried out an announced focused inspection of this service on 08 September 2020. Breaches of legal requirements were found. We undertook this focused inspection to confirm if 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, 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 Parklands Court 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 a breach in relation to regulation 17, good governance 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 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.

Parklands Court care home provides personal and nursing care for up to 163 people, including older people and people who may live with dementia. At the time of our inspection 100 people were living at the service.

Parklands Court care home is purpose built and consists of six separate, single storey buildings named Collins, Samuel, Harrison, Marlborough, Elmore and Clarendon. Each unit has access to a garden. The Clarendon unit has not been used by the Provider for a number of years and was closed at the time of our inspection.

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

Safeguarding concerns were not always recognised and reported to the relevant authority. Where people displayed behaviours that could cause harm to others, risks were not adequately assessed, monitored or reviewed. Some people and most staff felt there wasn’t enough staff to meet people’s needs, and people had to wait to receive their care, although we did not see this on inspection. Where people received their medicines via a medicinal patch, guidance was not always followed. People and relatives told us they felt safe.

Audits were carried out by the management team and the provider, but they failed to ensure risks were consistently addressed and safeguarding’s were recognised and reported. There were inefficient systems to ensure monitoring records were accurate and completed in line with people’s assessed needs. People and relatives felt able to raise concerns with the management team and were generally positive about the care they received.

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 12 June 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about the safety and care provided to people in relation to medicines, staffing and increased safeguarding referrals. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 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 remains the same. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Parklands Court 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 regulation 13, safeguarding and regulation 17 governance at this inspection.

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 continue to monitor the service. We will work alongside the provider and local authority to monitor progress.

Parklands Court is purpose built and consists of six separate, single storey buildings: Collins, Samuel, Harrison, Marlborough, Elmore and Clarendon. The Clarendon unit was closed at the time our visit.

People’s experience of using this service: There were occasions where we saw there was not always enough staff in some units at lunch times, and this did have some impact on the quality of meal provision. The registered manager took some action to address this during our inspection. People told us they were happy with how they received their medicines. We found some areas where there was scope to make medicines management safer and the registered manager took immediate action during our inspection to address these issues. There was also a need to address some outstanding actions identified by infection control audits within the refurbishment of the service.

People looked comfortable and relaxed with staff and their relatives told us they were safe. Staff told us how they kept people safe and minimised risks.

People were supported by staff who were caring and expressed empathy and compassion towards people who lived at Parklands Court. We saw staff respected people and promoted their privacy, dignity and independence.

People received effective person-centred care and support based on their individual needs and preferences. Staff were knowledgeable about people’s needs and preferences and we staff fostered good relationships with people.

People were supported by care staff who had a range of skills and knowledge to meet their needs. Staff understood their role, felt confident and well supported. Formal staff supervision had now commenced. People's health was supported as staff worked with other health care providers to ensure their health needs were met.

People were supported to have choices, and the provider’s policies supported this practice. There were some occasions where the provider’s policies were not consistently followed to ensure decisions about people’s care were in their best interests.

People's care plans reflected people’s needs and preferences and staff and the registered manager could explain any recent changes to people’s care. We saw staff responded to people’s needs effectively and their preferences were respected.

People and their representatives knew how to complain. Relatives and staff knew how to identify and respond if people were unhappy with the service. People were able to communicate how they felt to staff, and said staff were approachable and listened to what they had to say. Relatives told us when they had raised concerns these had been addressed appropriately.

Most people, relatives and staff gave a positive picture as to the quality of care people received and said the registered manager and other staff were approachable.

Quality monitoring systems were in place, and the provider had made improvements since our previous inspection, although these improvements still needed to be embedded. The registered manager and provider demonstrated they were responding to findings from the quality monitoring system so that lessons were learnt and outcomes for people improved.

Rating at last inspection: The rating for the service at our last inspection was ‘requires improvement’ (Published on 28 August 2018). This is the second time this service has been rated requires improvement with the current provider.

Why we inspected: This was a planned comprehensive inspection that was due based on our scheduling targets. We had issued a warning notice to the provider following our previous inspection regarding breaches we identified in respect of governance of the service and we found the provider had addressed these.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

Parklands Court 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.

Parklands Court is purpose built and consists of six separate, single storey buildings: Collins, Samuel, Harrison, Marlborough, Elmore and Clarendon. The Clarendon unit was closed at the time our visit. The service is registered to accommodate up to 163 people providing nursing care to older people living with dementia and people who require rehabilitation and palliative care. At the time of our inspection there were 104 people using the service. Parklands Court is currently subject to a restriction on admissions imposed by the local authority and clinical commissioning group. This was imposed prior the registration of the new provider but has remained in place.

The home manager was not yet registered with CQC but told us it was their intention to apply. 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.

It was recognised the service is undergoing a major transformation. The governance systems had only just started to be implemented and had not been consistently effective at ensuring good working practices were constant across all the units. They were not always effective in ensuring all people received a good quality of service. The manager had worked closely with partner agencies to monitor and improve the quality of the service and where shortfalls had been identified, they were investigated thoroughly and appropriate action plans put into place to reduce risk of reoccurrences. People who used the service, most relatives and staff were confident in the new leadership of the service.

Full information about CQC's regulatory response to issues and concerns found during inspections are added to this report after any representations and appeals have been concluded.

Risks to people had been assessed and processes were in place to reduce the risk of avoidable harm. However, staff members’ working practices were not consistent across the service because we saw unsafe techniques were used to move people. Where risks were identified, we found that staff members were not always provided with the relevant information in people’s risk assessments to keep people safe. Risks associated with peoples’ nutrition were not always managed effectively. People told us they received their medicines appropriately, but some people did not receive timely pain relief because the staff had not identified that people were in discomfort.

People told us they felt safe and staff understood their responsibility to raise concerns regarding potential abuse. There were processes in place to ensure the premises and equipment was checked to maintain people’s safety. People were protected from the risk of infection. There were systems in place to investigate incidents and share learning when things went wrong.

There were not consistently sufficient numbers of staff employed to meet people's needs across the service. Employment checks had been undertaken on staff to ensure they were suitable for their roles. Staff received limited supervision and appraisals, but told us they felt supported by the management team to carry out their roles. Staff members were aware of the provider's policies to prevent discrimination and promote equality and diversity at the service.

Where people lacked the mental capacity to make informed decisions about their care, relatives, friends and relevant professionals were involved in best interest's decision making. Mental capacity assessments and best interest’s decisions were applied to show what decisions people were being supported or asked to make in relation to their care. Applications had been submitted to deprive people of their liberty, in their best interests. People were offered choices and staff sought people's consent for care and treatment. People were supported to make as many decisions themselves as practicably possible.

People received sufficient amounts of food and drinks they enjoyed and their nutritional needs were met. We saw evidence that people were being supported to access healthcare professionals when required. Relatives told us the communication from the service was good at keeping them informed about their family member’s care.

People received care and support from staff that had received training but their working practices and knowledge demonstrated that the training provided was not always effective. Some staff members were attentive and supported people promptly but this was not consistently practised across the all units with some staff lacking the skills and knowledge to support people who lived with dementia. The units were not suitably tailored to meet the needs of people living with dementia. This had already been recognised by the new provider and work was in progress to address this. Plans were being drawn up to modernise and re-develop the service to meet the specific needs of people who lived with dementia.

People told us that the staff members were kind and caring. We saw many positive interactions but this was not constantly practised by all staff across the service. People were generally supported by staff that respected their privacy and dignity and promoted their independence.

There were dedicated staff members to support people to participate in social activities and in things they liked to do. People and relatives were confident any concerns or complaints would be appropriately responded to. There were processes in place to ensure people would receive appropriate care at the end of their lives.