Parkville Care Centre

We found the following examples of good practice.

The service was accessing the government testing scheme which had assisted them to identify an outbreak quickly. The service worked with the local authority infection, prevention and control (IPC) team and other health professionals to manage the outbreak.

The home was clean and had regular cleaning regimes in place. Clear infection prevention signs reminded everyone at the point of entry and throughout the home about procedures for infection control.

Measures were in place to support visitors to safely access the service and prevent them from spreading infection during their visits. Alternative arrangements were in place to support people to maintain contact with their loved ones when face to face visits were not possible.

Staff and people were supported to maintain social distancing. Furniture had been moved to support people to be able to stay two meters apart where possible.

Hand sanitising points were readily accessible throughout the home and staff used these frequently.

Appropriate risk assessments were carried out to assess the impact of COVID- 19 on people and staff.

People isolating in their rooms had regular contact with staff who wore personal protective equipment (PPE) appropriately. Staff told us they had a plentiful supply of PPE.

Further information is in the detailed findings below.

Parkville care centre is a nursing and residential care home providing personal and nursing care for up to 94 older people, including people living with dementia. The home provides care and support to people within two buildings. At the time of the inspection 52 people were living at the home.

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

People and relatives said they were safe living at the home. Lessons had been learned. Good improvements were in place to ensure people were safe. Risks to people were well managed. There were enough staff on duty to safely support people. Medicines were safely managed. Infection control measures were in place.

Staff had the right skills and knowledge to support people. Improvements had been made to manage the risks associated with nutrition. Some gaps in these records remained; we have made a recommendation about this. People had good access to health professionals and recommendations were acted upon. The environment was well maintained.

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 home supported this practice.

The leadership team had been effective in supporting the development of the home. Quality monitoring measures were effective. The staff team were united and skilled in providing people with the care they needed. Feedback from professionals had been acted upon. Staff were open and transparent.

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 13 December 2019). 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

We carried out an unannounced comprehensive inspection of this service on 4 November 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the quality assurance of the home and the care which people received, such as risk management, medicines and nutritional needs.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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 coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Parkville care centre on our website at www.cqc.org.uk.

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.

Parkville Care Centre is a care home registered to provide nursing and residential care for up to 94 older people, including some people living with dementia. At the time of inspection 72 people were using the service. The service at Parkville Care Centre is provided within two buildings. One of which, Auguste Community provides nursing care.

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

At our last inspection medicines were not always managed safely. Quality assurance systems were not robust. At this inspection we found we found ongoing issues with medicines management and the governance of the service. People’s nutritional needs were not always well managed and the lunchtime experience for people required improving.

Risks to people had not always been identified and mitigated. We found some people’s care records were not always comprehensive.

People and relatives told us permanent staff were kind and caring. We were told there had been a lack of continuity of staff at times due to a high level of agency staffing being used. The provider told us they were in the process of recruiting additional staff to address this issue.

Staff knew how to safeguard people from abuse. Staff were recruited using systems which reduced the risk of unsuitable candidates being employed.

Peoples care records were not always person centred however, staff knew people’s care needs well.

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. Staff sought consent from people when assisting them. However, some staff did not show an understanding of the legislation related to people’s capacity to make their own decisions.

We have made a recommendation about Mental Capacity Act guidance for staff.

Staff were supported through induction, training and supervision. We identified some gaps in staff training. The registered manager told us they were addressing this issue with training scheduled.

People’s dignity was not always fully maintained. We observed people’s bedroom doors were not always closed when staff were supporting people.

A range of activities were available to people. The service worked with other professionals to meet people’s needs.

A complaints system was in place. Lessons had been learnt from adverse incidents.

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 22 November 2018). There was a breach of regulation related to people’s safe care and treatment. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not 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 risks to people, medicines management, people's nutrition and the governance of the service at this inspection.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. 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.

Parkville Care Centre is a purpose-built care home located in central Middlesbrough. It comprises of two buildings, both have two floors. This service provides support and accommodation for up to 93 people assessed as requiring residential or nursing care. This includes support for people living with a dementia type illness. At time of our inspection there were 69 people living at Parkville Care Centre.

Parkville Care Centre is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

There was a registered manager in post however they were absent from the service during this inspection. 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 identified a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities 2014) relating to Safe care and treatment.

You can see what action we told the provider to take at the back of the full version of this report.

This is the first time the service has been rated Requires Improvement.

We observed one occasion where staff transferred a person using an unsafe technique. We brought this to the attention of the management team who took appropriate action to address the issue. All other observations of transferring people were carried out by staff in a safe and competent way.

Medicines were not always managed safely. We could not be confident that people had received their medicines as prescribed. This could put people at risk of ill health. Medicine records were not comprehensive. Medicine audits had not identified most of the issues we found in this area.

Policies and procedures were in place to support staff in protecting people from harm, such as safeguarding and whistleblowing polices. Staff knew how to identify and report suspected abuse. People and their relatives felt the service was safe.

People’s files contained the information staff needed to support them. Risks to individuals were documented with information available for staff in how to manage these to reduce risks to people. Risk assessments were reviewed on a regular basis.

Most people and their relatives told us that there were sufficient numbers of care staff on duty to ensure people’s needs were met. Some staff felt that the service would benefit from staffing levels being increased. The management team used a dependency tool to ascertain staff levels were sufficient. During this inspection we saw call bells were answered in a timely manner.

Safe recruitment practices were in place. Pre-employment checks were made to reduce the likelihood of employing staff who were unsuitable to work with vulnerable people.

Staff said that they received regular supervision. We received mixed feedback from staff regarding how supported they felt by the management team.

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. However, some additional work was required with record keeping in this area.

People had access to, and the service worked with, a range of healthcare services such as GPs, hospital departments and dentists. People’s nutritional needs were met.

The premises were spacious and tidy. One of the two buildings had been updated and adapted to meet the needs of people with a dementia type illness. We were informed by the provider that they planned to update the other building to improve people’s surroundings.

Staff knew how to help control the spread of infection. Equipment and building checks were undertaken to help ensure the environment was safe. Emergency contingency plans were in place.

People were supported by a regular team of staff who were knowledgeable about their likes, dislikes and preferences. Visitors told us that they were made very welcome. Staff members were kind and caring towards people. People’s privacy, dignity and independence were respected. Staff encouraged people to access a range of activities and to maintain personal relationships.

The policies and practices of the service helped to ensure that everyone was treated equally. Care plans included information about people as individuals including their preferences. End of life care procedures were in place which recognised the needs of people and their relatives at this important time.

Feedback was sought to monitor and improve the service. Meetings for people and staff took place regularly.

Learning took place following reviews of accidents and incidents where themes and trends were addressed. A clear complaints policy and procedure was in place.

The last inspection was conducted on 9 August, 3 and 10 September 2015, which rated the service as requires improvement and identified breaches in two of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to adhering to the requirements of the Mental Capacity Act 2005, assessing the performance of the home, maintenance of the building and the records. The registered provider wrote to us to outline how these breaches would be rectified. At this inspection, we found that the action taken had ensured the breaches were resolved.

Parkville Care Centre is a care home that can accommodate up to 94 people, which is registered for both residential and nursing care. The service has two buildings but in December 2015 the registered provider choose to close the smaller and to stop providing nursing care. The remaining building can support up to 54 older people with general care needs and people who may be living with dementia. The home is currently full.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 the refurbishment programme commenced before our last inspection was nearing completion. The registered provider had made marked improvements to the home. We saw that the bathrooms and showers had been renewed and a redecoration programme was being completed.

At the last inspection, we found that staff were still completing work to ensure each care record clearly recorded people’s individualised care. At this inspection, we found that people’s care plans were tailored for them as individuals and created with them and their family involvement.

We found that the operational manager and registered manager had introduced a range of quality assurance processes and audits that ensured the care and treatment was delivered in a safe and effective manner.

People were cared for by staff that knew them really well and understood how to support them. We observed that staff had developed very positive relationships with the people who used the service. The interactions between people and staff were jovial and supportive.

People who used the service and the staff we spoke with told us there were enough staff on duty to meet people’s needs. The registered provider and registered manager had closely considered people’s needs. For the 54 people using the service, there were two senior carers and seven care staff on duty during the day and two senior carers and five care staff member on duty overnight.

We found that a range of stimulating and engaging activities were provided at the home. People told us staff worked with them and supported them to continue to lead fulfilling lifestyles. Staff outlined how they supported people to continue to lead independent lives. We found that people were encouraged and supported to take responsible risks and positive risk-taking practices were followed. Those people who were able to were encouraged and supported to go out independently, and others routinely went out with staff.

Where people had difficulty making decisions, we saw staff gently worked with them to work out what they felt was best. Staff understood the requirements of the Mental Capacity Act 2005 and had appropriately requested Deprivation of Liberty Safeguard (DoLS) authorisations. Staff had been working hard to ensure capacity assessments were completed in line with the Mental Capacity Act 2005 code of practice.

People told us they were offered plenty to eat and we observed staff assisting individuals to have sufficient healthy food and drinks to ensure their nutritional needs were met. We saw that each individual’s preference was catered for and people were supported to manage their weight and nutritional needs.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff or relatives to hospital appointments.

Staff were kind and respectful. We saw they were aware of how to respect people’s privacy and dignity. Staff also sensitively supported people to deal with their personal care needs.

People told us they were happy and we heard how people felt the home was well-run and that the registered manager was extremely effective.

Staff were supported and had the benefit of a programme of training that enabled them to provide the best possible care and support. Staff were all clear that they worked as a team and for the benefit of the people living at Parkville Care Centre.

We saw the registered provider had a system in place for dealing with people’s concerns and complaints. The registered manager understood the complaints process and detailed how they would investigate any concerns.

The registered manager and staff also had a clear understanding of safeguarding.

We reviewed the systems for the management of medicines and found that people received their medicines safely.

Effective recruitment and selection procedures were in place and we saw appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

The service had a strong leadership presence with a registered manager who had a clear vision about the direction of the service. They were committed and passionate about the people they supported and were constantly looking for ways to improve the service.

Our inspection team was made up of three inspectors and two experts by experience. We gathered evidence against the outcomes we inspected to help answer the 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 looked at a range of records; spoke with the manager, deputy manager and 19 staff of varying grades and roles including catering and activities staff. We also observed the interactions between staff and people living at Parkville, spoke with 22 people who used the service and nine relatives.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us that they felt safe and well looked after by staff. We found that staff responded to people's needs and took action when needed when these needs changed. We found staff were confident about the steps they needed to take if they suspected people were at risk of abuse. Procedures for dealing with emergencies were in place and staff were able to describe these to us.

Parkville Care Centre was clean, hygienic and generally well maintained. We did identify that some refurbishment was needed to areas such as bedroom carpets and bathrooms. People had the equipment which they needed. There were effective systems in place for the ongoing maintenance and servicing of equipment.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The home had proper policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. We found that there was some awareness of the process to follow when Deprivations of Liberty Safeguards needed to be considered; however further training was needed and further development to ensure robustness.

People were aware of the complaints procedure and there were systems in place for monitoring complaints.

In the main, there were sufficient staff and skill mix of staff to meet people's needs, however we identified that this needed to be reviewed in respect of the dementia residential unit.

Is it effective?

People all had their needs assessed and had care records, which set out their care needs and associated risks. The care records did not capture all of the information needed in respect of people's needs and were not found to be person centred.

It was clear from our observations and from speaking with staff that they had a good understanding of the people's individual care and support needs and that they knew them well. Some of our observation identified that staff needed more specific training in relation to people's conditions, for example, dementia, which would enable them to deliver more person centred care.

Staff knew how and when to involve other health and social care professionals. We saw lots of evidence of this during our inspection.

Is it caring?

We saw that a number of staff engaged with people in a positive way and showed respect and kindness.

From other observation though we found that some staff were not as engaging as others and we saw them getting on with care tasks as opposed to providing holistic person centred care.

People's needs had been assessed and care plans put in place which detailed people's needs and to some degree preferences. These records provided guidance to staff on what care and support people needed. We found that the care records did not contain sufficient detail of people's life history information. We also found that care records were not as accessible as they should be.

Is it responsive?

There was clear evidence contained within people's care plans to show how they worked with other health and social care professionals.

We saw that care plans were reviewed regularly; however some care plans were not always reflective of people's needs. We could not always see if people and their relatives were involved in their care plans and reviews.

The home employed an activities co-ordinator and were in the process of appointing another co-ordinator. We found that limited activities were available and we could not be sure how meaningful these activities were to people.

People told us that they knew how to make a complaint if they needed to. People we spoke with told us that they felt able to raise a concern if they needed to.

It is well led?

There was a lack of consistency in management between the two buildings and inconsistency in providing person centred and effective care.

The home had a registered manager, who was supported by a deputy manager and also had support from a regional manager and a contracts manager. The manager had been in post for approximately three months and outlined that there was still a lot to be achieved. They acknowledged the lack of leadership within the dementia care unit and were taking steps to address this. They also acknowledged that there was work to do across a number of areas of the home, which they were prioritising.

There were systems in place to assure the quality of the service they provided. The way the service was run was regularly reviewed. Actions were put in place when needed and in the main we were able to see that these actions had been addressed.

People who used the service, their relatives and friends had opportunities to attend regular meetings and also give feedback about the service via annual questionnaires.

Staff were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and were knowledgeable about people's needs. This helped to ensure that people received a good quality service at all times.

We found that appraisals, supervision, staff meetings and some training were not up to date for all staff working at the home. This meant that not all staff were supported to deliver care safely.

What people told us.

People we spoke with in the residential units told us, 'The carers are really nice, pleasant and helpful.' Everyone felt safe in the home and we was told, 'Staff respond quickly if I ring my bell and never complain.'

People were very positive about choice stating, 'I can get up when I want' and 'I love breakfast and had full English this morning with black pudding." Also, 'I can get a drink when I want and only have to ask for whatever I want'. Another resident said she had asked for a newspaper every day and this was delivered for her on a morning.

Quite a few residents said, 'I am encouraged to do little things for myself', and one said, 'I make my bed every day even though I am told I do not have to do it but I try to keep active.'

One relative we spoke with said, 'The girls are lovely ' they do the job'. One lady's husband told us, '"The staff are lovely; 'I'm quite content with her being here.'

Staff we spoke with told us that they enjoyed working at the home. We heard comments such as, 'It's a nice happy environment to work in with nice residents' and 'We all work well together and encourage people to be independent.'

We spoke with seven people who used the service and one relative. People told us that they found the staff were good at their jobs. They told us that they were able to make their own daily life decisions, had choices and that staff did not impose restrictions on them. People said, 'I make my own decision, sometimes I decide to have a lie in and I usually like to go to bed at about 10.30 pm', 'You don't have to be up at a specific time. I don't feel like life is restricted by being here' and 'It's really lovely here, it's a nice home.' The relative we spoke with thought that staff supported the people well..

Many of the people who lived at the home found it difficult to think about recent events or at times, to have a conversation. During the visit we used a specific way of observing care to help to understand peoples' experience of the service. We found that the nursing and care staff were empathetic, sensitive and supported people to meet their care needs.