Park Grove

Park Grove is a residential care home providing personal and nursing care to up to 32 people older people in one adapted building. There was 16 people living in the service at the time of the inspection.

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

People told us they felt safe and systems were in place to support safeguarding investigations. Environmental and individual risk assessments had been completed. The service was clean and tidy and systems had been developed to manage the COVID-19 pandemic. Medicines were being managed safely.

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. Meals were provided to people and their choices were considered. Professionals were involved in the care and support as required. The service was homely and people’s bedrooms had been personalised with their own possessions.

People received good care, and people and relatives were positive about the care they received. People’s choices were considered, and they were included in decisions about their care.

Care files had been developed and supported people with person centred care, people were able to access an activities programme. No complaints had been received however, guidance was available to support staff to deal with any concerns.

A range of audits and monitoring was taking place. Policies had been developed to support the operation and management of the service. Meetings were being held with the staff team and people who used the service. Questionnaires had been obtained from staff, professionals and people who used the service.

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 3 January 2020). 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.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Follow up

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

We found the following examples of good practice.

¿ The provider had been proactive in identifying the risks from COVID-19. They had taken prompt steps to protect people. This had included the early introduction of restrictions on visitors to the service. They had also purchased additional personal protective equipment, (PPE), before the national disruption of supplies.

¿ The home had set up an infection control (IPC) station in entrance so all visitors could be monitored and risk assessed. This included a declaration to confirm they were well and a digital temperature check.

¿ The home had rearranged communal areas so the most vulnerable groups were protected by having dedicated staff teams. The upstairs area was a separate cohort of staff and meals were sent up in the lifts. This was to reduce the movement of care and kitchen staff around the home.

¿ People were supported to maintain safe distances when in the lounges, for example by placing a coffee table between people. The home had decluttered to ensure robust cleaning regimes in the event of an outbreak. This included removal of heavy lounge and dining room curtains.

¿ A staff sleep over area had been developed in the event of an outbreak in the home so staff had the option not to go home and put their families at risk.

¿ Each person had a COVID-19 care plan and risk assessment that included measures of what to do if a person refused a test. This set out the Mental Capacity Act process and how a best interest decision was to be made.

Further information is in the detailed findings below.

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Park Grove is a residential care home providing personal and nursing care to 26 people aged 65 and over at the time of the inspection. The service can support up to 32 people in one adapted building.

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

There were processes in place to protect people from the risk of avoidable harm however, these were not always consistently used. Lessons learnt after an accident or incident were not consistently actioned or recorded. We could not be sure people always received their medicines as prescribed because medicine management practices were not consistently safe. Staff understood how to protect people from abuse or unfair treatment. Staff were not always recruited in a safe way. We made a recommendation about improving quality assurance of recruitment processes. Some staff told us staffing levels were insufficient to meet the needs of people who lived at the service however, the provider acted on our feedback and immediately increased staffing levels. We made a recommendation about gaining people's feedback to ensure staffing levels are sufficient.

People were not always supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests; however, the policies and systems in the service did not support this practice.

Staff had received theory-based training however, the provider had not checked their competency and understanding in relation to important subjects such as moving and handling and first aid. Staff told us they felt supported and listened to. People's physical, mental health and social needs were assessed and they were involved in the care planning process. People had access to a wide range of nutritious and good quality food.

People consistently told us they were supported in a kind and caring way. Staff had formed trusting relationships with people they supported.

Staff did not always update people's care plans as their needs changed with person-centred information. People told us staff supported them in a person-centred way and encouraged them to remain independent. Staff encouraged people to maintain relationships with their friends and family. At the time of the inspection the provider was in the process of recruiting an activity worker. Staff were responsive to people’s requests. People had access to the complaints procedure and told us they felt confident to raise any concerns.

Since the last inspection quality assurance systems had improved however were inconsistently used and not always effective. The new manager had been in post for eight weeks and had already identified the shortfalls found at the inspection, they had an ongoing improvement plan. People and staff told us they felt confident in the management team and involved in decisions made about the service.

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 30 November 2018). The service remains rated requires improvement. This is the second time the service has consecutively been rated requires improvement. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safe care and treatment, governance and consent 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.

Park Grove 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.

Park Grove is registered to provide accommodation for up to 32 people who require nursing or personal care. All accommodation at the service is provided on a single room basis, although there is one double room available for a couple or anyone who wishes to share. Facilities at the service include several communal lounge areas, a dining room and safe accessible garden areas. There were 25 people who lived at the service at the time of the inspection.

There was a new manager who had applied to become a registered manager. The previous registered manager de-registered in September 2018 after terminating their employment at Park Grove in August 2018. 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.

During this inspection we found shortfalls in relation to environment safety, seeking consent, staff training and supervision and arrangements for checking the quality of the care. These were breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to: safe care and treatment, need for consent, staffing and good governance. We also found one breach of the Care Quality Commission (Registration) Regulations 2009, in relation to notification of other incidents. You can see what action we told the provider to take at the back of the full version of the report.

Our last inspection of Park Grove was carried out 06 January 2016. At that time, we rated the service as overall 'good' with the responsive domain being 'requires improvement'. There were no breaches of the regulations at that time. At this inspection the rating had deteriorated to overall 'requires improvement'.

We found that the service had procedures in place for protecting people from abuse, neglect and discrimination. However, we also found that staff had not received training in safeguarding adults that was in line with the local safeguarding authority alert processes. This meant that the provider had not made sure staff understood how make a safeguarding alert and kept them up to date with changing legislation and best practice principles.

The provider followed safe recruitment processes to ensure that new staff were of good character before employed.

We looked at accident and incident records and found that people were not always safeguarded following an unwitnessed fall. The manager showed us a new system they were introducing for identification, review and monitoring of accidents and incidents.

We found that people who lived at the service were accurately risk assessed and care plans had been formulated to show how people would be protected against identified risk. The service was adequately staffed and people told us that they felt safe and well supported.

We looked at the environmental risk assessments and maintenance records and found a clear audit trail had not been sustained. We discussed this with the provider who told us that improved record keeping would be immediately introduced. We saw that the environment was safe and clean. We checked how the provider protected people from the risk of exposure to fire and how they planned contingency strategies in the event of an emergency evacuation. Our checks showed that the provider did not have robust planning in place for emergency evacuation and some routine fire prevention checks had not been recorded.

We found that people received their medicines in a safe and proper way. We identified shortfalls in relation to medicine storage temperature record keeping, this meant that medicines might not have been stored at a safe temperature and this could cause a change in the effectiveness of the medicines. We found good examples of record keeping in relation to the administration of medicines, however we discussed with the provider the need for improving information around ‘as and when required’ medicines and topical medicines.

People who lived at the service told us they were supported by skilled and experienced staff. We looked at staff training records and found shortfalls in mandatory training. This meant the provider had not ensured staff were trained and competent to provide safe and correct care for people who lived at the service.

We checked whether the service was working within the principles of the Mental Capacity Act (MCA) 2005, and whether any conditions on authorisations to deprive a person of their liberty had the appropriate legal authority and were being met. We found the provider had failed to train staff in relation to the MCA, 2005. Care records did not demonstrate assessment of a person’s capacity, consent to care and treatment and appropriate DoLS standards.

We found that people were encouraged to maintain their independence and given choice and control of their lives. People were supported to live healthier lives, had access to healthcare services and received ongoing healthcare support. We found some examples of good practice throughout the six care files we looked at. People had been referred to external health care professionals and their advice was recorded and followed by staff.

We received positive feedback about the standard of meals and snacks provided and saw people enjoy their meals during the inspection. The service assessed people in relation to the risk of malnutrition and other nutritional risks.

People who lived at the service expressed positive feedback about the care and attention they received. We observed staff interact with people in a kind and compassionate way. People received personal care in a dignified manner and external health care professionals told us Park Grove is a desired location for short and long term care placement.

From our observations it was clear that people who lived at the service had formed trusted relationships with staff and senior management. We saw people actively engaged in recreational activities and group activities were planned daily. People who lived at Park Grove were encouraged to maintain an independent lifestyle and we saw people had formed meaningful friendships.

We found the service supported people to express their views and be actively involved in service provision, however due to the recent instability in management oversight, people who lived at the service and their representatives, had not been invited to attend regular meetings. We also found gaps in staff meetings.

We found a lack of consistency in management oversight and this had impacted negatively on the staff team causing staff to feel unsupported. The new manager had formed positive relationships with staff and people that lived at the service. They showed us how they intended to move the service forward. Staff and people who lived at the service told us that the owners were approachable and regularly accessible.

We found the service did not demonstrate how it continually assessed outcomes for people. We discussed this with the provider and new manager and we were assured that action would be taken.

We found that the provider did not always inform us of incidents that are notifiable.

We reviewed how the service continually learnt, improved and developed. Whilst gaps were found in record keeping throughout the last 12 months, we however found an improvement since the new manager had started. We looked at examples of lessons learnt, and action taken and found a good standard of evidence to show how improvements would be made.

The last inspection of the service took place on 25 July 2013. At this inspection the provider was found to be compliant with all the areas we assessed.

This inspection took place on 6 January 2016 and was unannounced.

We were assisted throughout the inspection by the providers and manager. At the time of the inspection the manager of the service was going through the process of registration with the Commission. 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.

We found that people were cared for in a safe manner. Any risks to their health or wellbeing were identified and addressed through risk assessment and care planning processes. People’s health care needs were carefully monitored and addressed in partnership with community health care professionals. Peeps (Personal Emergency Evacuation Plans) were completed for each person but not located in a central location. We made a recommendation about this.

The manager demonstrated a good understanding of the Mental Capacity Act 2005 (MCA) and associated Deprivation of Liberty Safeguards (DoLS) legislation. The manager was aware of the procedures to be followed in the event that a person may not be able to consent to some aspects of their care to help ensure their legal rights were protected. However, staff understanding of this area was variable. We discussed this with the manager who was able to provide evidence that training for all staff was arranged in the near future. We made a recommendation about this.

People expressed satisfaction with daily life at the home and were complimentary about the meals provided. People’s views about the activities programme were mixed. Some told us they would like to see more variety. We made a recommendation about this.

We received very positive feedback about the service provided at Park Grove, from people who used the service, their relatives and community professionals. People described a safe, effective service and told us they were confident staff had the skills to meet their needs. People told us the staff team were kind and compassionate and cared for people in a manner that promoted their privacy and dignity. The management team, including the providers, were described as responsive and approachable.

There was an effective system in place to manage people’s medicines safely. Medicines were appropriately stored and staff worked in accordance with clear guidance to ensure people received their medicines as prescribed.

Managers and care staff demonstrated a good understanding of safeguarding procedures and the action to be taken in the event that any safeguarding concerns were identified. In addition, staff were very confident they would be fully supported by managers, should they be in the position where they were required to report such a concern.

Staff had a good understanding of people’s needs and the support they required. Staff were also fully aware of people’s individual wishes and preferred daily routines. All but one care plan we viewed contained a good level of information about the person’s daily care needs and the things that were important to them. The care plan missing this sort of information belonged to a person who had been admitted on an emergency basis. This was discussed with the manager who advised us that emergency admission procedures were under review to ensure all care plans were of a similar standard.

Staff spoken with were highly complimentary about the level of support they received from the management team. Staff told us they found the manager and provider to be extremely approachable and always available to provide advice or guidance.

Care workers told us they were satisfied with the training programme provided, which they felt equipped them to carry out their roles well. We noted that a review of the training had recently been undertaken by the manager and as a result the core training programme had been improved.

We received positive comments from all those we spoke with, including people who used the service, their relatives, staff and community professionals, about the management of the home. People told us the providers were ‘hands on’ and consistently ensured that adequate resources were made available for the effective running of the service.

There were systems in place to enable the provider and manager to monitor safety and quality across the service. Evidence was available to demonstrate that areas for improvement were identified and addressed in an effective manner.

People had care plans that promoted a person centred approach to their care. Staff were attentive to peoples request for assistance.

Staff knew how to care for people at risk of falling, developing pressure ulcers or may not eat enough.

People we spoke to told us they felt safe in the home. One person said, 'I feel safe with the staff more than I did when I was at home alone'.

People got their medicines safely and when they needed them. People were protected against the risks associated with medicine handling because staff had been trained and medicines were kept secure.

People who use the service benefit from staff who were well trained and had been subject to the necessary character checks to ensure they were fit, trustworthy, qualified and physically and mentally fit to do their job.

The provider had an effective system to regularly assess and monitor the quality of service that people received.

Records were kept secure and fit for purpose to protect people from unsafe or inappropriate care and support.

People told us staff treated them well. Staff spoke to them respectfully, communicated well and appropriately and generally considered all their needs. One person told us, 'I do enjoy living here. The staff are very good. If I need anything they will get it for me. I enjoy the exercise lady visiting. It gets the arms going, nothing too strenuous'. Another person told us, 'I am quite independent and can manage to do most things for myself. If I need help I get it. The staff are always at hand. We get out and about. We're going to the lights at Blackpool. That brings back memories. We used to take the children when they were little'. We were told there were no institutional practices and people were involved in making decisions regarding their day to day care.

Records showed staff followed care plans and responded to people's needs as required. Staff treated people with respect and maintained their dignity when providing support. People were supported to live as valued citizens within the home and the wider community. Staffing levels were very good.

One person we spoke with had chosen to self-administer some of their own medicines. They showed us that they had everything they needed, and had enough information about their medicines.