About the service:

Park House is a residential care home registered to provide accommodation and personal care for up to 20 older people. People at the home were living with dementia. The home does not provide nursing care. At the time of the inspection there were 20 people living in the home.

Rating at last inspection:

At our last inspection we rated the home Good (published 25 October 2016). We rated the key question: Is the service responsive? Requires Improvement at that time as we had some concerns about how people’s communication needs were being met.

At this inspection we found the shortfalls in the responsive key question had been addressed and the rating for that area of the service had improved.

Why we inspected:

This inspection was a scheduled inspection based on the previous rating.

People’s experience of using this service:

People were happy living at Park House. People felt safe and well cared for. Staff demonstrated a good understanding of the risks people faced in their day to day lives and the practical ways they could support them to minimise those risks to keep them safe. People received their medicines on time, at the correct dose and had regular medicines reviews.

People’s desired outcomes were known, and staff worked with people, relatives and relevant professionals to help achieve and review these. Staff had received the necessary induction, competency checks and ongoing training to help them meet people’s specific needs. People were encouraged and supported to retain their independence, develop new interests and live their lives as they wanted to live them. 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’s individual communication needs were known, respected and met.

People were supported to maintain contact with those important to them including family and other people living at the home. Relatives felt welcomed and involved. Staff understood the importance of these contacts for people’s health and well-being. Staff and people were observed enjoying meaningful, compassionate and mutually beneficial interactions. Staff knew people well and what made them individuals.

The registered manager was respected by the staff and promoted and open and transparent culture. Management and staff understood their roles and responsibilities. Staff felt supported and valued. Annual feedback surveys were undertaken and analysed to ensure that people, relatives and staff could express their views and contribute to development at the home.

Quality and safety checks by the registered manager and other senior management helped ensure people were safe and protected from harm. This also ensured that practice standards were maintained and improved. Audits helped identify areas for improvement with learning from these shared with staff.

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

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.

The inspection took place on 13 September 2016 and was unannounced. The inspection continued on 14 September 2016 and was announced. Day one was carried out by a single inspector. A specialist advisor in elderly nursing and dementia care was present on day two.

Park House provides accommodation and personal care to up to 20 older adults with dementia and learning disabilities. The accommodation was split over two floors with a management office being situated on the second floor. There were six bedrooms on the ground floor and 14 on the first floor. A passenger lift supported people up and down the stairs. 19 bedrooms were ensuite and one was not. There were two bathrooms which both had assisted baths and one level access shower room. The home had a kitchen and a multipurpose room. There was a communal living area and a separate dining room for people to come together.

The service did not have a registered manager 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 new manager had been recently recruited and was in the process of applying for their registration. The new manager had an interview arranged for the following week with a registration inspector.

Staff had a good knowledge of people’s support needs and received regular e-learning training as well as some training specific to their roles for example, end of life, nutrition and dementia. Staff told us however that they had not received any training around learning disability and felt that this would support them to deliver an even better service to some people who lived at Park House. Staff were aware of the Mental Capacity Act however training records showed that they had not received training in this.

We have made a recommendation about staff training on the subject of learning disabilities.

Park House was not always responsive to people’s communication needs. We observed on several occasions staff relying on verbal communication to interact with everyone who lived at the home however we found that some people’s care files reflected that their communication needs included; visual prompts, pictures and facial expressions.

There was a system in place for recording complaints which captured the detail and evidenced steps taken to address them. We noted that there were no recorded complaints for the past 12 months. We checked with the management and asked if this was correct. We were told about feedback received from a family and actions which the service had taken to address this but it had not been recorded as a complaint.

People and staff told us that the service was safe. Staff were able to tell us how they would report and recognise signs of abuse and told us they had received safeguarding training. We reviewed the training records which confirmed this.

Care plans were in place which detailed the care and support people needed to remain safe whilst having control and making choices about how they lived their lives. Risk assessments were completed, regularly reviewed and up to date.

Medicines were managed safely, securely stored, correctly recorded and only administered by staff that were trained to give medicines. Medicine Administration Records reviewed showed no gaps. This told us that people were receiving their medicines as prescribed.

Staff told us they received regular supervisions which were carried out by management. We reviewed records which confirmed this. A staff member told us, “I receive regular supervisions and find them useful”.

The service completed capacity assessments and recorded best interest decisions. This ensured that people were not at risk of decisions being made which may not be in their best interest.

People were supported t

We used a number of different methods to help us understand the experiences of people using the service. We observed care being delivered to people, spoke with staff and looked at records related to care delivery.

We looked at four care records and spoke with five people who use the service. We also spoke with two people about their relative’s care. We spoke with the owner, one visiting health professional and six members of staff. Three of the staff were carers, one was the registered manager, one a chef and another was an activities worker. We saw that people’s care plans were clearly set out and people’s needs met. The care plans included people’s preferences and choices.

We saw that people were treated with respect, and that their privacy and dignity was valued and maintained. All the people we spoke to felt they were treated well; one person told us “they help me in all ways; perfectly happy can’t find any fault with them”. One of the relatives of people who use the service told us “they can’t do enough to help and they know the individual, which I like”.

Staff felt supported and received appropriate training to support them in their role. Staff were able to describe the agency’s safeguarding procedures and their role in keeping people safe.

The views of people who use the service and their relatives and friends were surveyed and systems were in place to monitor the ongoing performance of the service.

People that we spoke with told us they felt staff were respectful to them when seeking their consent. People said they were looked after well and staff answer call bells quickly. One person told us “I think they are marvellous. I like it here.”

People told us that the home was always clean. One person told us “The cleaner cleans once a day but not at weekends. It is a good standard.” There were effective systems in place to reduce the risk and spread of infection.

There were effective recruitment and selection processes in place to recruit staff. People’s personal records including medical records were accurate and fit for purpose.

We identified shortfalls in the quality of service at Park House when we previously visited in November 2011. We required the provider to produce an action plan to show how they were going to become compliant with the Regulations. We visited Park House on Friday 3 February 2012 to check that the provider of the service had carried out improvements in line with their action plan.

We spoke with two care workers, the registered manager and the provider of the service. We looked at care plans, and records about management of medicines, staff recruitment and meetings with staff and people living in the home. We spoke to three visitors and met with people in the main lounge. We visited one person in their private room.

Visiting relatives were pleased with the standard of care their respective relatives received. They told us they saw staff providing attentive care at different times of the day. They said staff maintained a balance between respecting privacy and checking that people’s needs were met. A person in the home was receiving all care in their bedroom. Their room was clean and tidy and a visitor told us they always found it so.

We saw staff interactions with people had a conversational style. Staff took time to offer choices and to understand people’s wishes.

The visitors we spoke with told us they considered there were enough staff to meet people’s needs. They had observed call bells being answered promptly and saw staff had time to spend with people. We saw a care worker go to a sitting room to sit with a group of people and join in conversation. People sitting there told us this was usual. We saw a care worker go to a sitting room to sit with a group of people and join in the conversation. People sitting there told us this was usual.

People told us their choices of when to get up and go to bed were respected and supported. They chose how to use various parts of the home and where they took their meals.

Some people recalled agreeing the nature of care and support they needed, through initial assessment or being asked about care planning. A visitor to a person receiving end of life care said they and other family members had been consulted about changes and involved in decision-making about how to meet care needs.

Some people living in the home had relatively low dependency needs and some enjoyed high levels of contact with family or friends. One person told us about their continuing attendance at the Women’s Institute in the village where the home is situated.

People that could express an opinion told us they felt safe living in the home. They saw staff as appropriate in their manner, and they trusted staff and management to respond to any concerns they might have.

We met a person that spent considerable time in their bedroom. Their care plan said they needed assistance of two care workers for most aspects of every day life. We observed that they experienced long gaps in attention from staff. In contrast to other people we met, their clothing, hair and immediate surroundings did not suggest their personal care received much attention. Care workers told us they looked in on people who remained in their rooms but one said they “worried about people that sit behind closed doors with little contact”.

A group of four people in a sitting room told us they found there were enough staff to meet their needs. However, they all said they found mornings “boring” because of not seeing many staff. They contrasted this with afternoons when they were engaged by a specialist worker in activities, as we saw. The home was staffed by two care workers after 2pm. This limited opportunities for staff to give people individual attention. Some people in the home needed two staff to work with them.

We found there had been some shortfalls in giving people medicines when they were due, and in records to account for medicines held in the home.