The Park Residential and Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. The provider took actions so that lessons were learnt when things had gone wrong. People had been supported to settle into the service and were supported with any other health appointments. People were safeguarded from abuse and avoidable harm. Risks were managed well and people were not restricted; they felt the environment was safe and kept clean. People told us there were enough staff to provide them with safe care and they received their medicines when needed.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We spoke with 6 people using the service and 1 relative. People felt they could approach staff for help and staff were motivated to learn from incidents and wanted to make things better. People told us they had been, “Fully informed,” when an incident required their involvement and were, “Happy with the outcome,” when concluded. People felt they could approach staff and managers if they had any concerns. All of them felt able to raise concerns and had a staff member they could speak with if they were worried.

Leaders promoted a culture of learning and planned training to meet the needs of the service. This was monitored to ensure staff completed the required training. Learning from incidents across the provider’s locations were discussed so good practice could be identified and shared. Staff understood the reporting process for any accidents and incidents. Nursing staff understood their role in referring to relevant agencies if needed to help reduce risks to people.

Processes were implemented when incidents had occurred to help reduce further risks. We saw people’s care plans and risk assessments were updated and reviewed following incidents to ensure risks were mitigated and staff had the guidance to support people safely. The provider had a policy in place for the duty of candour that would be followed when needed. This would help to ensure open and honest investigations and any subsequent findings would be shared appropriately. Clinical supervision arrangements and learning from external audits and findings supported learning and improvement.

People were helped to settle and feel at home when they first moved in. They continued to access what other healthcare services they needed. This helped people experience smooth transitions when they moved to The Park Residential and Nursing Home.

Leaders told us they worked closely with relevant professionals to ensure continuity of care for people. This included working with the hospital discharge team and social workers as people moved into the service. Leaders explained when people moved to the service, they would book them a review with a GP who would review any medicines needed to help ensure these were effective for them. Nursing staff completed pre-admission and post-admission care plans. They explained they worked with relevant agencies, people and their families and care staff to ensure all necessary information was gathered to ensure a smooth transition into the service.

Feedback from partners was mixed. One partner told us they found care delivery had been inconsistent. They told us on one occasion they had needed to prompt staff to ensure the comfort and well-being of a person however, staff were receptive to their advice and were competent in providing further support. Other partners reported positive experiences. This included working positively to help develop transport options to get people to medical appointments, providing updates on people while they waited for an assessment and medicines being up to date.

Assessment processes were used for when people moved into the service to review initial information and care plans for people to ensure everything is suitable for them. Care plans showed that care and support was planned collaboratively with people and relevant professionals. Risk assessments allowed staff to identify risks and make referrals appropriately.

People told us they felt safe living at The Park Residential and Nursing Home. One person told us, “I do feel safe, mainly because the staff know you and your little quirks and I’m content with the way things are.” People were confident to speak with staff if they were worried about anything.

Leaders understood their responsibilities to keep people safe. Staff understood their responsibilities under safeguarding and confirmed they had received appropriate training. Staff gave an example of a recent safeguarding referral and the actions taken following this. Staff felt people using the service were safe from the risk of abuse. Ancillary staff were also confident in their responsibilities to be aware of potential abuse and report it to safeguarding. One told us, “I have no concerns about anyone that lives here, if I go in a room and think they look different I will tell a nurse. The carers are really good here. Everyone is very alert, it's a very alert home.”

We carried out a short observational framework inspection (SOFI) to help us understand the experiences of people using the service who may not be able to verbally share their feedback. The SOFI showed us people felt safe with staff and shared good relationships. Staff took time to speak with people and check how they were feeling. Our observations showed people were comfortable with staff. Staff were present in communal areas at all times and completed observations on people’s safety. Information was present in staff rooms to support staff in escalating any concerns.

Leaders explained there were systems in place to allow them to easily report, review and investigate safeguarding concerns. This included a monthly trend analysis. Leaders explained plans were in place to start accessing the NHS England’s Patient Safety Incident Response Framework. This is a new approach to responding to patient safety concerns. Care plans and risk assessments were reviewed and updated following any safeguarding activity to ensure people were protected from potential abuse. Safeguarding incidents were monitored and analysed to help inform whether any changes could help to promote people’s safety further. Processes were in place to monitor any Deprivation of Liberty Safeguards (DoLS) and to identify, monitor and refer to the local community mental health team should people have these needs. This helped to ensure people’s care remained safe and appropriate for them.

People felt involved in how risks were managed and that they were not restricted in what they wanted to do. People told us they had any equipment that they needed, such as a walking stick to help them mobilise safely. Another person told us they could, “Come and go as they pleased,” into the garden where they enjoyed spending their time.

Leaders explained that nurses were responsible for writing care plans in conjunction with people and their families. They said, "We make it personal to them." This was confirmed by nurses who told us they wrote care plans by including information from hospital discharge teams, care staff, families and people. Staff understood the risks relating to people using the service. Nursing staff were clear on their roles in relation to people’s clinical needs and risks. Staff were able to give examples of specific people’s needs and how they are supported which was in line with their care plans.

The SOFI showed us staff provided safe care and support which was in line with people's care plans. We observed people to have meals prepared for them in line with their dietary needs and recommendations. This included modified diets as per SALT guidance. Staff were observed to follow guidance within people’s care plans when supporting people’s risks. For example, when assisting people when they mobilised.

Risks associated with people’s health and care needs were identified and assessed. Care records identified and suitably assessed risks to people. For example, where people required a modified diet as per speech and language therapy recommendations this was accurately recorded within their care plans to support staff in meeting their needs. Specific clinical risks such as diabetes, or catheter care were suitably assessed. Care records provided guidance for staff on monitoring signs of deterioration, such as changes in a person’s diabetes. People and their relatives were involved in planning their care and support and this was reviewed on a monthly basis. A clinical meeting board showed staff had oversight of clinical risks for people. This included, amongst other areas, reviews of equipment used, people’s skin integrity, swallowing ability, use of catheters, and any nutrition and hydration needs.

People told us staff helped to make sure the environment was safe for them. For example, a person told us how staff made sure nothing was in their way so they could mobilise safely. Another person told us they felt the environment was safe and they had not personally had or observed any accidents whilst living there.

Leaders explained projects were underway to improve the home and gardens. They told us people were encouraged to be involved in making choices in the design of these projects. Environmental issues were reported to the maintenance team through a maintenance reporting book. Staff said these issues were resolved quickly. Maintenance staff explained the provider was efficient at arranging appropriate contractors and were quick to resolve any issues, particularly if there were any concerns about safety. Staff we spoke with knew how to report concerns within the environment and felt that issues were dealt with quickly.

The SOFI showed us people were cared for in an environment free from hazards and had access to equipment and aids they needed to keep safe. People were observed to have appropriate equipment and aids to support them safely during mealtimes.

Processes were in place to maintain a safe environment. For example, safety testing was undertaken for risks associated with fire, water, gas and electricity. Equipment such as the passenger lift and equipment people used to help them mobilise were checked and passed as safe to use. A business continuity plan was in place to endure staff had clear directions to follow in the event of a utility failure or other type of foreseeable event. Improvements to the environment were ongoing. These included recent changes to the lighting designed to help people, some who may be living with dementia, orientate to daytime and night-time. Staff had access to a training room and staff rest room. Work was underway to improve the environment of the medicines room and further work was scheduled to improve the kitchenette and lounge areas. The provider had ongoing plans to ensure the environment was maintained safely and was benefitted people and staff.

People thought there were enough staff to help them when needed. One person told us they needed staff to help them with certain aspects of their care and they would use the call bell to get help. They said, “It can vary how long [it takes, but] they come [and] they’re good, I can’t fault them.” Another person told us the care staff were quick to respond and, “‘I’ve never been left stranded, sometimes there’s a delay but by and large the care is first class’.” People told us they liked the staff and 1 person told us they appreciated that the staff were regular as this meant the person could more easily recognise them.

Leaders explained they considered trends from accidents and incidents, activity levels and staff skills when reviewing staffing levels. They explained there was flexibility to ensure that they could determine the right staffing levels for the service. Leaders said supervision meetings with staff were held quarterly including an appraisal of their performance. Staff training was closely monitored and staff training compliance was at 97%. Leaders told us they regularly discussed the training needs for the service. All training had a competency assessment at the end that required staff to achieve 100% pass score. Staff said they felt there were enough staff working each shift, including nurses. Staff confirmed they received ongoing support in the way of supervisions, and nurses confirmed they were supported with continual professional development and revalidation of their nursing registration. Staff spoke positively about the training at the service and told us any training they needed would be provided for them. Domestic staff confirmed there were enough staff to do the cleaning needed and they had received IPC training.

The SOFI showed us there were enough staff to meet people's needs and staff attended to people's requests for support promptly. Staff were not rushed and were available in communal areas to monitor people’s safety. There were enough staff to respond to people's needs during mealtimes, this included people who needed 1 to 1 support and for people who took their meals in their rooms. Staff were visible and monitored people’s safety in communal areas at all times. Staff practice showed they had received suitable training. A call bell system was in place, this was through a device which vibrated so staff were alerted to anyone who needed support without disrupting other service users through loud alarms. There were sufficient staff available to meet people’s needs.

Leaders had regularly reviewed staffing levels using a 'staffing ladder tool'. This was based on occupancy levels and people's dependency needs. It was updated as people’s needs changed and indicated the number of staff that would be needed to meet people’s needs. The provider recruited staff safely. Staff had completed training relevant to their job role and the provider maintained oversight of this to ensure staff renewed this training and remained compliant with the required training.

People told us they were happy with the cleanliness of their home. One person said, “Everything is nice and clean.” Another person told us their mattress and bedding were regularly cleaned.

Leaders told us they worked with the provider's hospitality manager to oversee infection prevention and control measures. Leaders explained, "We have an infection prevention and control champion now, so we have tighter oversight." They said they had worked to address improvements identified following external audits and this had included replacing mattresses, introducing scrubs as a uniform, and improving the checks completed. They explained there are daily infection prevention and control checks, handwashing competency observations and mealtime audits. Staff understood best infection prevention and control practice and completed daily, weekly and monthly cleaning tasks. They felt there were sufficient domestic staff to ensure the tasks were completed. Staff confirmed they had received infection prevention and control training. Staff explained cleaning schedules were routinely checked by senior leaders. Domestic staff told us the cleaning schedules ensured all areas within the home were routinely cleaned. Domestic staff were able to explain processes to reduce risks in the event of an infection outbreak. Domestic staff were clear on their roles and responsibilities in ensuring a clean home and minimising the risk of infection and had received relevant training. They explained in detail their daily, weekly and monthly tasks. They confirmed they had the products and equipment needed to do their roles and demonstrated an understanding of best infection prevention and control practices and what to do in the event of an infection outbreak.

The SOFI showed us staff followed best infection prevention and control practices which helped to keep people safe from the risk of infection. Staff wore appropriate items of personal protective equipment during mealtimes. The home was clean and well maintained. Domestic staff were observed cleaning the home throughout the day. Some areas within the home were not made from easily cleaned materials however, staff explained how they ensured these were cleaned effectively.

Processes were in place to monitor and improve infection prevention and control at the home. For example, actions had been taken to ensure staff had an improved understanding of the required documentation required for leaning and for recording temperatures for kitchen related processes. Audits had been taken where external monitoring identified improvements, for example new mattresses had been ordered. The providers own quarterly audit identified improvements staff could take to improve the overall effectiveness of infection prevention and control.

People confirmed they were happy with the care staff provided in relation to medicines. One person told us they received their medicine regularly in the morning and after dinner.

Leaders had a system in place to review any medicine errors. They were in the process of working with the pharmacy and GP to ensure improved communication and stock management at the service. Staff explained there had been some challenges with the supply of medicines from the local pharmacy which meant occasionally medicines were not delivered. Staff said they were in the process of changing to a new pharmacy which would resolve this issue. Staff told us they had annual medicine competency checks by the deputy manager, or if an error was made, they would have a medicines competency assessment. Staff felt confident using the electronic medicines administration record system and understood best practice relating to medicines administration and management. Staff were competent in explaining their roles in medicine management and explained they liaised with the GP and pharmacy to ensure people’s medicines were right and were effective and provided examples of this.

Overall medicines were managed safely, and people received their medicines as prescribed. We found one person’s medicine was out of stock on the day of our inspection. Staff told us there were ongoing issues with the pharmacy and they were in the process of getting this resolved. Medicines were stored, ordered and disposed of safely. Guidelines were in place for any ‘as and when required’ medicines. These described how people may present with pain if unable to verbally express they required this medicine. Relevant medicines risk assessments were in place where required. For example, for the risks associated with flammable topical creams. GP advice and recommendations were included in people’s care plans. Medicines policies were in place to ensure staff worked in line with good practice. Medicines audits were completed and identified any actions needed to help ensure medicines were managed safely and in line with the expected good practice.