We carried out this inspection to follow up on concerns we had identified at our last inspection of the home on 2 April 2014. These concerns related to the management of the home, care and welfare of people and the premises. On this inspection we saw that improvements had been made.This inspection was carried out by an adult social care inspector and an expert by experience. During the inspection we looked at the evidence to answer five key questions:
Is the service caring?
Is the service responsive?
Is the service safe?
Is the service effective?
Is the service well led?
We carried out this inspection to follow up on concerns we had identified at an inspection on 2 April 2014. On this inspection we found that improvements had been made.
Park House is a care home for up to twenty one older people, many but not all of whom were living with dementia or mental health needs. On the inspection we spoke with seven people who lived at the home about their experiences there. We also spoke with two relatives, three members of staff and the team leader on duty. We reviewed records relating to the management of the home which included four care plans in detail and observed the care and support people received.
Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.
Is the service caring?
We observed staff delivering care to people. We saw that they were relaxed, confident and supportive towards people even when they presented challenges or hard to manage behaviours.
People told us that the staff were kind, caring and supportive. One person told us 'The staff are good'they're kind and make me comfortable' they do everything for me'. A visitor told us their relative was 'contented here. I appreciate the place and how well she's looked after'.
Staff we spoke with understood people's needs, personalities and aspects of their lives before entering the home. People told us staff took their wishes into account when delivering care. One staff member told us they 'go with the flow' of people's day.
Is the service responsive?
We saw that the home responded to changes in people's needs. For example at the last inspection we had concerns that where people had lost weight, and this had been identified on their care plans and risk assessments, action had not been taken to refer the person to their GP or dietician for investigations. On this inspection we found that this had been done.
In another instance we saw that one person had been increasingly agitated and presented increased risks to others around them in the days prior to our inspection. We saw that action had been taken to contact the responsible clinicians and review the person's mental and physical health as well as trialling medication to manage their agitation. This told us the home responded well to support changes in people's well-being or mental health.
We also saw that when the questionnaires sent to relatives and people living at the home had been analysed the home had altered the menus. They had been made more seasonal and provided two hot options and a lighter cold option for each meal. This had led to greater choice for people and showed the home responded to comments made to improve the service.
Is the service safe?
People told us they had full confidence in the staff to support them and their care safely.
We saw that risk assessments had been improved since the last inspection, and where concerns were identified action plans were put in place to reduce risks. Some personal risk assessments were being improved to make them more person centred for the individual. However, some care plans we saw did not have detailed strategies for staff to support them in managing behaviours that were challenging in a consistent manner.
We saw that where improvements had been made following the last inspection to improve the control of infection these had been maintained.
Work was planned to improve the safety of the grounds so that people could spend more time outside.
Is the service effective?
We saw that the home had taken steps to help make the environment more dementia friendly for people. We saw for example that the home had put up signs to help people orientate themselves better around the home. We heard one person following the signs and saying to themselves 'This way to the toilet. That's what I want.' Staff told us the signs had been particularly effective for this person. This told us that these actions had helped increase this person's independence and sense of well-being.
We saw other instances where changes had been made that had improved the effectiveness of people's care. We saw for example that one person's nutritional risk assessment had indicated they were at high risk on admission due to a low Body Mass Index (BMI). We saw that the person had gained weight since admission and was now at lower risk. This had been achieved through a higher calorie diet and monitoring of their food intake. We looked at another person's file and saw that they had continued to lose weight despite having a higher calorie diet. We saw the person had been referred to their GP for a health evaluation as a result. This told us that the systems for monitoring people's care needs were effective in identifying risks to the person's health.
Is the service well led?
On this inspection the provider and manager were not available so the inspection was conducted with the team leader. We saw that they had a clear understanding of their role and the ethos of the home. They were able to explain management systems to us and locate records needed. This told us that information about the management of the home was understood by the staff who worked there.
A relative we had spoken with told us 'I wanted (my relative) to move from the previous home and I was given a choice of three. This was the best'It's clean and tidy and the staff are obliging and helpful.
There was evidence that learning from incidents and investigations took place and appropriate changes were implemented. We saw that since the last inspection the home had increased the number of audits that were being carried out. We also saw a new audit system for incidents, accidents and near misses. Falls were being audited every three months as an example. We saw evidence that people had been referred to the falls team for specialist advice as a result of this analysis.
We also saw the home had adopted targets for improvement on a monthly basis for staff to focus on. The team leader told us that the recent target had been for staff to have an increased awareness of the use of protective infection control equipment, such as gloves and aprons and improved hand washing techniques. There had been spot checks on staff including the use of ultra violet gels and lights to assess how well hands had been washed. This told us the home thought about ways of ensuring that staff were involved in understanding the need for improvement and quality at all levels.
We saw a new audit system was in place to assess complaints and concerns raised and identify actions required to prevent a re-occurrence. We saw that there had been a number of concerns or complaints raised about the home in 2014, many of which had been managed through safeguarding processes from the local authority. We saw that the home had acted quickly to protect people where concerns had been identified.