Parkgate Manor

Updated 8 December 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we could understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

There was two inspectors on the first day of inspection and one inspector on the second and third days.

Service and service type

Parkgate Manor is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement dependent on their registration with us. Parkgate Manor is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed the information we held about the service and the service provider. We looked at notifications and any safeguarding alerts we had received for this service. We sought feedback from the local authority and professionals who work with the service. Notifications are information about important events the service is required to send us by law.

The provider was asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all this information to plan our inspection.

During the inspection

We spoke with six people and observed staff interacting with others to help us understand the experience of people living at the service. We spoke with eight staff, an agency staff member, all members of the management team, the cook and a maintenance staff member. We spent time reviewing records, which included five care plans. We looked at two staff files and documentation related to the management of the service such as accidents and incidents and medicines management. We also looked at staff rotas, and records relating to health and safety and the management of the home. Following our inspection, we also spoke or received correspondence from four people’s relatives and from four professionals. We also continued to seek clarification from the provider to validate the evidence found. We looked at training data, care plans for two people, quality assurance records and meeting minutes.

Updated 8 December 2022

About the service

Parkgate Manor is a residential care home providing personal care to 24 people at the time of the

inspection. The service can support up to 40 people. The service is a large manor house, set in private grounds within a small rural village. Some people have specialist needs associated with downs syndrome, autism or dementia. A number of people have age related health conditions such as diabetes or mobility issues.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

The model of care and setting did not always maximise people's choice, control and independence.

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

There were systems to ensure people's needs were assessed but people and their relatives, where appropriate, had not been involved in the process. Significant progress had been made to increase opportunities for people to participate in activities, but further work was required to make activities more person centred. The design and layout of the premises was centred on communal living and did not support the promotion of people’s independence.

Risks to people were assessed, monitored and managed safely. People’s medicines were managed safely. The systems in place ensured that people were protected from abuse and improper treatment. Parkgate Manor was kept clean. There were enough staff to safely meet people's needs. Emphasis had been placed on ensuring that staff had the skills, knowledge and experience to meet people’s needs.

Right Care

Care was not always person-centred or promoted people's dignity, privacy and human rights.

Some staff practices although well intentioned were institutional and did not enable people to make informed choices. For example, people were served tea with milk already included. There were not enough opportunities to enable people to share their views about how they were supported.

Recording did not always demonstrate that people’s assessed needs were being met. It was recognised however, that the electronic care planning system was still in its infancy and with further training for all staff this could eliminate some of the shortfalls found.

Staff were caring in their approach and people responded warmly to them. People had increased access to activities, external entertainers were visiting the service and there were opportunities for people to go out more.

Right culture

The ethos, values, attitudes and behaviours of leaders and care staff did not always ensure all people using the service could lead confident, inclusive and empowered lives.

Systems to obtain people’s views were not effective either through keyworker meetings or surveys and further work was needed to adopt a more person-centred approach to enable people’s individual views to be sought. There were no recent surveys to seek the views of people’s relatives. Staff morale had improved and whilst staff had opportunities to share their views at meetings, further development was needed to ensure there were increased opportunities for staff to attend supervision meetings.

The systems for auditing of care plans and health checks were not effective, and this left the risk of issues not being identified quickly and support sought. Auditing in relation to infection control, health and safety and medicines were clear and thorough and any shortfalls found had been addressed promptly.

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 Inadequate (published 14 March 2022).

This service has been in Special Measures since 14 March 2022. At this inspection we found the provider remained in breach of regulations. However, during our inspection the provider demonstrated that some improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 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.

The overall rating for the service has changed from Inadequate to Requires Improvement.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified continued breaches in relation to person centred care and good governance 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.