Park House Rest Home

Park House Rest Home is a residential care home providing personal care for up to 18 people. The service provides support to older people and those living with dementia. At the time of our inspection there were 10 people using the service. The home is compiled of three floors and bedrooms are located on all floors. There is a combined communal lounge and dining room and a large accessible garden.

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

People and their relatives told us they felt safe care was provided at Park House Rest Home and that staff knew how to look after them. Staff understood their safeguarding responsibilities and knew how to keep people safe from harm.

Medicines were managed safely by trained and competent staff. Medication administration records (MARs) were fully completed and regularly audited to identify any areas for development and improvement. Staff had access to medicines policies and procedures as well as best practice guidelines.

Recruitment practices were safe and there were sufficient numbers of staff available to meet people’s needs. Quality assurance processes were robust, risks to people and the environment were managed safely and people had access to appropriate equipment where needed.

Staff were motivated and enjoyed working in the home. Continuous learning was embedded in the home's culture and staff had received appropriate training to enable them to carry out their role safely.

Staff had received training in infection control, including additional training since the start of the coronavirus pandemic. They followed good infection control processes, which met government guidelines for care homes.

People told us they felt staff were caring. Staff were observed to treat people with kindness and compassion.

The provider, registered manager and staff were open and transparent. They understood their regulatory responsibilities.

People, relatives and staff said the registered manager and provider were approachable and supportive. There were effective governance systems in place to identify concerns in the service and drive improvement.

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 16 October 2019).

Why we inspected

We inspected this service as a review of the information we hold indicated improvements had been made. We were supporting the potential of increasing capacity in the local system.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Park House Rest 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.

Park House Rest Home is a care home registered to provide accommodation for up to 18 people. The service provides care to older people and those living with dementia. At the time of our inspection there were 13 people living in the home.

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

At our last inspection of Park House Rest Home in July 2018, we found that risks to people were not always safely managed. At this inspection, we found improvements had been made, but action had not always been taken when required.

Risks associated with people's care were not always fully assessed and care plans lacked detail to support staff in keeping people safe. This included management of nutritional risks that could impact on people's health.

The provider had systems and processes in place to assess and monitor the service provided. However, these quality monitoring systems had not been effective in identifying or acting on the concerns we found.

There were enough staff to safely meet people’s needs and provide person-centred care. Staff had received appropriate training and support to enable them to meet people’s needs. They received regular supervision to help develop their skills and support them in their role.

Recruitment processes were safe to ensure only suitable people were employed.

People were protected from the risk of abuse. People's rights and freedoms were upheld.

People received their medicines safely and as prescribed. Appropriate arrangements were in place for obtaining, recording, administering and disposing of prescribed medicines.

Environmental risks were managed safely. People had access to appropriate equipment where needed.

People and their relatives told us they were happy with the care provided and staff were kind and caring. We observed staff respected people’s privacy and treated them with dignity and respect.

People were supported to engage in a variety of activities within the home. These were tailored to people’s individual needs.

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.

The manager understood their regulatory responsibilities and shared information when required.

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 5 September 2018) and there were multiple breaches 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 improvements had been made and the provider was no longer in breach of regulations. However, the service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Park House Rest Home on our website at www.cqc.org.uk.

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.

This service was last inspected in October 2017. This was a focussed inspection and was carried out as a result of concerns raised about poor and unsafe care and treatment regarding poor hygiene practices and general lack of cleanliness of the home. The focussed inspection found that risks associated with the environment were not being effectively managed. At this inspection we found that risks associated with the environment had been assessed and were managed effectively.

There had been a history of non–compliance with the regulations at this service since February 2016. Following the inspection in February 2016 we started our enforcement action. The subsequent four inspections and this inspection have helped to inform what action we should take regarding our enforcement pathway. At the previous full comprehensive inspection in March 2017, we found the provider had made some progress with compliance against the regulations. However, at this inspection, we found five new breaches of regulations. These had all been previously

breached in the history of non-compliance for this service.

Park House Rest Home 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 House Rest Home is registered to provide accommodation for up to 18 older people. There were 16 people, some living with dementia, at the home at the time of the inspection. It is situated in a residential area of Hayling Island. The home has bedrooms provided over two floors in single and shared double occupancy rooms. Stair lifts provide access between the floors. There is one communal lounge joined with a dining area and appropriate toilet, bathing and shower facilities. Externally there is an enclosed garden with gravel pathways and an area of lawn.

A registered manager was in place. 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.

A quality assurance process was in place. However, this had not identified the areas of concern we found during this inspection and ensured that improvements were sustained over time.

Audits to monitor the environmental risks had been carried out and were managed safely. Risks to fire were managed well and each person living at the home had an emergency evacuation plan. Most areas of the home were clean and there were systems in place to protect people from the risk of infection. Staff had access to personal protective equipment to reduce the risks.

Risks to people's safety had been assessed but a lack of detailed guidance for staff about how people should be supported to keep safe, meant that people were placed at risk of unsafe care and treatment.

There were not enough staff to provide person centred care at key times of the day. Staff did not always engage with people respectfully and support them to be involved in meaningful activities.

Recruitment processes were not safe and checks to assess the suitability of staff to work with vulnerable people, had not been completed.

Medicines had not always been managed safely. Temperatures of the room where medicines were stored had not been effectively monitored and medicines that required additional security measures, had not been booked into the medicines record book.

Staff were not always sufficiently trained to safely meet the needs of people living in the home.

We observed some staff support people in a caring manner, but we found this was not always the case. Staff did not always consider people’s communication needs and how living with dementia could affect the support they needed to be engaged in their surroundings and with other people.

Activities were not consistently provided, and staff had not always considered the communication and sensory needs of people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.’

People had access to a range of health professionals, such as GPs, chiropodists and community nurses. Where people and their families needed to consider end of life care, care plans contained individualised information about people’s current end of life wishes and preferences.

Care plans and confidential documents were kept securely in a lockable cabinet which staff could access. Care plans contained background information about each person including details of their care preferences. Care plans were reviewed monthly to keep them up to date. However, descriptions of how staff needed to support people’s specific needs, were not clear and we observed poor and unsafe practice as a result.

Staff received supervisions and appraisals to support them in their roles.

People's nutrition and hydration needs were met. Meals were provided by an external company and people told us that they thought the food was good.

Staff told us they were happy working at the home and felt supported in their roles by the registered manager.

We identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Full information about the commission's regulatory response to the breaches will be added to the report after any representations and appeals have been concluded.

Park House Rest Home provides accommodation and care for up to 18 older people some of whom may be living with dementia. At the time of our inspection there were 14 people living at the home.

The Registered manager left shortly before the inspection and there was a new manager in post who was applying to register with CQC. 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.

People and their relatives told us they felt safe living at the home.

Risks associated with the environment were not being effectively managed.

People felt the home was clean and staff followed infection control guidelines. The manager had started to take action to replace some of the fixtures and fittings where these were no long fit for purpose.

There were appropriate management arrangements in place. Staff and people were encouraged to talk to the manager about any concerns. Audits were undertaken but these were not being fully effective in driving improvements.

Park House Rest Home is a care home, which accommodates up to 18 older people, some living with dementia. On the day of our inspection 15 people were living at the home and one person was in hospital. We were advised five people were staying at the service on a respite basis.

The home had a registered manager. 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.

There had been a history of non–compliance with the regulations at this service since we inspected in December 2015. Following the inspection we started our enforcement action. The subsequent two inspections and this inspection have helped to inform what action we should take in regards to our enforcement pathway. At this inspection we found the provider had made further progress with compliance against the regulations. There was one new breach found at this inspection.

Potential risks to people's safety had been identified and specific risk assessments showed how people should be supported to keep safe. Medicine records supported the safe administration of medicines. People received their medicines from trained care workers. Infection control audits were taking place on a regular basis but we identified some areas which had not been picked up these by these audits, which were of a concern. We also found some equipment in the home had been properly maintained.

There was sufficient staff deployed within the home with agency staff being used. The provider completed a range of recruitment checks to help ensure new care workers were suitable to work with the people living at the home. Staff felt supported in their roles and the training they received equipped them with the knowledge they needed to do their jobs.

The provider followed the requirements of the Mental Capacity Act 2005 (MCA), including the Deprivation of Liberty Safeguards (DoLS). People had access to a range of health professionals, such as GPs, opticians, chiropodists and community nurses.

Care records included background information about each person including details of their care

preferences. People's needs had been assessed and personalised care plans written. Care plans were reviewed monthly to keep them up to date.

A complaints policy was in place and there had been two complaint’s since the last inspection, which had been investigated.

We were informed the management were visible and there was a range of quality assurance audits were in place.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Park House Rest Home is a care home, which accommodates up to 18 older people, some living with dementia. On the day of our inspection 12 people were living at the home.

The home had a registered manager. 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.

There had been a history of non–compliance with the regulations at this service from the last two inspections. At this inspection we found progress had been made. We made two recommendations and there was a continued breach of Regulation 17 regarding record keeping.

Staff understood the principle of keeping people safe. Risk assessments had been completed and staff were aware of the risks facing people and how to minimise these risks. Staffing levels met the needs of people.

Recruitment checks had been completed before all permanent staff started work but records for agency staff were not available.

Medicines were administered and stored safely. We have made a recommendation regarding night staff completing medicines training.

There was a training programme and staff enjoyed the training and felt it equipped them to do their job. Staff had a good knowledge of the Mental Capacity Act (2005) which had been incorporated into people’s records. People enjoyed their meals and there was support for those who needed it. People were supported to access a range of health professionals.

People received personalised care which took into account their choices and preferences. We have made a recommendation regarding personalising activities for people. People felt confident they could make a complaint and it would be responded to. Complaints were logged and there were recordings of investigations into complaints.

People felt the staff were caring, kind and compassionate. The home had an open culture where staff felt if they raised concerns they would be listened to. Staff felt supported by the provider. Records were not always accurately maintained. There was an effective quality audit system.

We found a repeated breach in one of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we found progress had been made in all areas and where the provider remained in breach of one regulation the impact and possible impact on people was low. The service had demonstrated that they were no longer inadequate overall or in one domain and therefore were no longer in special measures. CQC is now considering the appropriate regulatory response to the shortfalls we identified during this and previous inspections. Where providers are not meeting the fundamental standards, we have a range of enforcement powers we can use to protect the health, safety and welfare of people who use this service. When we propose to take enforcement action, our decision is open to challenge by the provider through a variety of internal and external appeal processes. We will publish a further report on any action we take.

Park House Rest Home is a care home, which accommodates up to eighteen older people, some

living with dementia. On the day of our inspection 15 people were at the home; two of these people were on a short respite stay. On the second day of our inspection another person came in for a short stay.

The home does not have a registered manager. 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. The provider had recruited a manager who has submitted an application to us to become the registered manager.

We found the provider had made progress in most areas of non-compliance, but in most breaches there was still room for improvement, and in some breaches the impact on people was lower than before. The management of medicines, mental capacity understanding and the training and supervision of staff had been improved to reach compliance. However, this inspection found that there was not enough improvement to take the provider out of special measures.

Risk assessments had not been completed for all people to ensure staff were aware of the risks facing people.

Staffing levels had improved but they were still not adequate to ensure all people’s needs were met at all times.

The provider had completed an audit of staffing recruitment records but had not taken any action to ensure the gaps found had been actioned to ensure the safety of people.

Peoples’ nutritional and hydration needs were not adequately provided for.

People had their mental capacity assessed and best interest decisions had been made appropriately.

All people were not receiving personalised care.

The recording of complaints had improved but these were still not being investigated.

Quality assurance processes and record keeping had improved but there were still shortfalls in these areas, which had not been identified or addressed.

The overall rating for this provider is still ‘Inadequate’. This means that it remains in ‘Special measures’. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate

care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

We found six repeated breaches and one new breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

CQC is considering the appropriate regulatory response to the shortfalls we found during this and previous inspections. Where providers have not been meeting the fundamental standards, we have a range of enforcement powers we can use to protect the health, safety and welfare of people who use this service (and others, where appropriate). When we propose to take enforcement action, our decision is open to challenge by the provider through a variety of internal and external appeal processes. We will publish a further report on any action we take.