Park House

About the service

Park House is a residential care home which provides accommodation and personal care to up to 6 adults living with a learning disability or autism. At the time of the inspection 6 people were using the service.

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

Right Support

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 model of care and the setting maximised people’s choice and control. People had their own personalised ensuite bedroom and had access to shared facilities including a garden. One of the 6 rooms is a flat where a person could live more independently. People were protected from the risks associated with the spread of infection and were supported to take their medicines safely.

People’s risks were assessed in a person-centred way. Care plans and risk assessments were regularly reviewed and involved relatives as appropriate. People who may become anxious or distressed had proactive plans in place to reduce the need for restrictive practices.

Right Care

People’s needs were assessed before they began to use the service to ensure the provider could meet those needs. People had care and support plans that were personalised, holistic, strengths-based and reflected their needs and aspirations, included physical and mental health needs.

Relatives confirmed they were included in decision making about their relative’s care. People were supported to eat and drink enough to maintain a balanced diet. Staff involved people in choosing their food and planning their meals. Staff supported people to maintain their health and worked jointly with healthcare professionals to improve outcomes for people.

Right Culture

Management were visible in the service, approachable and took a genuine interest in what people, staff and other professionals had to say. Relatives said they would recommend the service. The management team worked directly with people and led by example. Relatives and staff confirmed they were able to make suggestions and raise concerns to enable improvements to be made to the service.

Staff were recruited safely and there were enough staff on duty to meet people’s needs. People were protected from abuse and poor care. The provider supported staff with training and supervision. Training included learning disability and autism so care could be provided effectively. Relatives were asked by the provider about their opinions of 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

The last rating for this service was good (published 02 April 2019).

At our last inspection we recommended that the provider seek advice and guidance in relation to including diversity and end of life care wishes as part of the care planning process. At this inspection we found the provider had acted on these recommendations and made improvements.

Why we inspected.

This inspection was prompted by a review of the information we held about this service. The inspection was prompted in part by an increase in notifications of incidents involving people using the service.

As a result, we undertook a focused inspection to review safe, effective 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 remains good based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, effective and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Park House 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 is residential care home providing personal care for up to four people with a learning disability.

• At the time of the inspection it was providing a service to four people.

• The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

People’s experience of using this service:

• People at the service were kept safe, staff had an understanding of their safeguarding responsibilities and knew how to identify abuse.

• People were encouraged to take positive risks in their lives and risk assessments were in place to protect people at the service and reduced the risk of harm people may face.

• Relatives were happy with the service and told us their family member was kept safe.

• People were looked after by staff who had gone through a thorough recruitment process.

• Accidents and incidents were recorded and analysed by the service. Staff told us they took part in debriefing sessions after the incident to learn from the incident to prevent it happening again in the future.

• People’s medicines were managed safely and safe practices were followed in the administration of medicines.

• The service was clean and free from malodour, hand washing guidelines were displayed to minimise the risk of infection.

• People were assessed by the service before being placed and staff observed people at the service to ensure care was being provided in accordance with their care plan. People’s nutrition and hydration needs were met by the service and healthy eating was encouraged.

• Staff were supported to give effective care as they received appropriate training relevant to their role, supervision and appraisal.

• People were comfortable with staff and staff spoke in a kind and caring manner to people. Relatives thought staff were caring and treated people with respect.

• People’s care plans were personalised and regularly reviewed and updated as the needed.

• People were supported to communicate in a way that helped them as the service provided information in easy read format.

• There was a complaints policy, there were no complaints made by people living at the service. Complaints received from outside the service had been responded to promptly.

• The service had strong quality assurance processes to check the quality of care people received and systems to drive improvement.

Rating at last inspection:

• Good (report published 7 March 2017)

Why we inspected:

• This was a planned inspection based on the previous rating.

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.

• We made two recommendations in our inspection report on diversity in care planning and documenting people’s end of life wishes. We will follow these up at our next inspection.

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

At our previous inspection on 5 and 6 August 2015 there were four breaches of legal requirements due to a lack of person centred care planning, people not being protected from risks, poor maintenance of the home and people not receiving one to one staffing that they needed. At this inspection we found improvements in these areas. Care plans had improved but were still not fully person centred. People were protected from risks to their safety and were receiving the one to one staffing they needed. The maintenance of the home had improved but there were maintenance issues outstanding at the time of this inspection.

Park House provides accommodation and care for six people who have a learning disability, some of whom also have mental health needs, an autistic spectrum condition and other complex needs. At the time of this inspection there were six men living at Park House. Each bedroom has ensuite bathroom and one of the six rooms is a flat where a person could live more independently.

We found that the person registered with us as manager was no longer managing the home. A new manager had been appointed and they were in the process of applying to become the 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.

People living in the home gave us positive feedback including a comment that, “the standard of care is good, it’s excellent.” Another person said, “mostly it’s good. There’s just tiny things…” and, “They’re doing a real good job.” Another person signed to us that staff were his friends which suggested he felt comfortable with staff. Staff had formed good relationships with people and were able to describe their needs and personalities well.

People’s families gave mixed feedback about the home. The comments ranged from, “I couldn’t think of anywhere nicer” to saying the communication between the home and the family was “poor” and being unhappy with the care provided. People who had lived at the home for longest and their families were the most satisfied. Some families felt their family member would benefit from a more specialised service.

People received support with their medicines and health care needs and were happy with the food.

Staff were happy with the training provided to them and felt well supported by the manager and the provider, Sequence Care Group. People received support from the provider’s multidisciplinary team which included a psychiatrist, psychologist, speech and language therapist and occupational therapist.

People were supported to have choice and control over their lives as much as possible. Four of the six people were living a good quality of life, going out every day, following their interests and maintaining regular contact with their families. Staff were trying to support the other two people to lead a more active life.

We made two recommendations at this inspection. One was to ensure people had suitable handwashing facilities and support to wash their hands. The other recommendation was to arrange a more responsive and timely repair and maintenance service.

We saw evidence that data was being gathered and analysed to help to improve the service. We saw that this information was informing patients' care plans and risk management plans. There was learning from experience. Members of the multi-disciplinary team were frequent visitors to the hospital, three were present for part of our visit.

Four care files were reviewed and were found to be up-to-date with good quality information. We spoke with and observed three of the four patients who were present on the day of our visit. We saw that they were comfortable with the staff on duty. When we asked staff members to explain patients' needs to us, their answers showed that they knew them well. Staff members felt they received good support from others within the team as well as management. One relative spoke to us by telephone.

We were able to ask one person what it was like to live at Ferme Park House and he said, "it's a bit noisy." We were not able to get any other comments from people. We arrived when people were waiting to go out so we had limited opportunity to talk to people, but we did observe some confusion as people did not have clear plans for what they were doing.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We found that staff treated people with kindness and patience. People were supported to go out regularly to a variety of places and staffing levels were good. Some staff did not have sufficient training on learning disability and autism to fully understand people's needs. We found that staff's conduct in previous employment had not always been checked and some staff had no previous experience of working with this client group which meant there was a risk of there not always being enough suitably qualified, skilled and experienced staff to meet people's needs.

We found that there was not enough evidence of a robust quality assurance system and lessons being learned from incidents.