Carlisle Dementia Centre - Parkfield

Carlisle Dementia Centre – Parkfield is a residential care home providing personal care and nursing for up to 44 people, some of whom were living with dementia or a mental health related condition. At the time of the inspection, there were 28 people living at the service.

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

Staff were thoughtful and caring. Positive interactions took place between people and the staff team.

Medicines were managed in a safe manner.

Care plans now fully reflected people’s care needs and health conditions.

People and their relatives said they were involved in planning their care and were encouraged to provide feedback regarding the service.

There were enough safely recruited staff available to meet people's needs. Staff felt supported and morale had improved.

The service was light and welcoming. Good infection control procedures were now in place and the service was clean and tidy. The provider worked in line with current guidelines to support safe visiting.

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.

People were supported with their dietary needs and had enough to eat and drink. People were referred to healthcare professionals when necessary.

People, relatives, staff and healthcare professionals were positive about the new manager and commented on the positive changes the manager had introduced.

The manager and provider monitored the quality and safety of the service. There was an improved programme of checks in place. Many improvements had been made, including enhancing garden areas for people to enjoy with further work planned.

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 14 January 2022) and there were breaches of regulations.

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 focussed inspection of this service on 22 November 2021. Breaches of legal requirements were found. We issued a warning notice. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions, Safe, Effective and Well-led which contain those requirements.

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 has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Carlisle Dementia Centre - Parkfield on our website at www.cqc.org.uk.

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.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Carlisle Dementia Centre – Parkfield provides nursing and residential care for up to 44 people, some of whom were living with dementia or a mental health related condition. There were 29 people living at the service at the time of our inspection.

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

Following our last inspection some improvements had been made in relation to infection control practices at the service. However, some improvements were still required. Vaccination checks on professionals entering the building needed to be fully monitored. Some areas within the home needed to have improved cleaning programmes in place.

Improvements needed to be made with medicines management, including in connection with record keeping.

Records were not well maintained, including care plans and risk assessments. Oversight of the governance and safety procedures within the service was not always well managed, including failing to identify omissions in connection with infection control and medicines management.

There were enough staff at the service, although in previous weeks some gaps had occurred due to staff sickness.

People and relatives told us staff worked hard to ensure their care needs were met and were complimentary about the caring nature of staff. People said they felt safe and their relatives said their family members were safe too.

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 did not always support this practice as records were not always in place. We have made a recommendation about further dementia friendly signage within the building being 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 15 April 2021) and there where three breaches of regulations. We took enforcement action around infection control by imposing urgent conditions on the provider’s registration.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection whilst we found some improvements had been made there were additional concerns and further new breaches of regulations were found.

This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a focussed inspection to review whether the provider had met the urgent conditions we had previously imposed on their registration and the previous breaches identified. The inspection was also prompted in part due to concerns received about the care people received.

We looked at the safe, effective and well-led domains. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating 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 COVID-19 and other infection outbreaks effectively.

Although the conditions set against the providers registration had been met, we have found evidence that the provider needs to make further improvements. Please see the safe, effective and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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 will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the safe management of medicines, monitoring of vaccinations for visiting professionals and infection control, record keeping and management oversight of the service.

We issued a warning notice in connection with regulation 17, good governance. We have told the provider to address the concerns in the warning notice by a specified date.

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.

Carlisle Dementia Centre - Parkfield is a care home providing personal and nursing care for up to 44 people. At the time of the inspection, there were 28 people who were living with dementia or mental health needs accommodated at the home.

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

Staff did not always follow the correct infection control practices including the use of PPE and hand hygiene. This placed people at risk of infection which is a concern during this time of a national pandemic. We have imposed conditions on the providers registration in relation to IPC.

Staff did not consistently follow safeguarding processes, and incidents were not always reported to the safeguarding authority.

Records of prescribed topical medicines were not completed. Some care records were poorly completed and did not demonstrate how risks were being effectively managed.

The provider’s quality systems within the home were not effective. There were gaps and inconsistencies in a number of care records.

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

People we spoke with told us they liked the staff and we saw people were comfortable and engaged with staff. Staff were patient and friendly towards people. Relatives said their family members were settled and happy in the home.

Staff had essential training and relatives said they were confident in their skills at supporting people who were living with dementia.

People and relatives said they got enough to eat and drink. People were offered meals in a way they could manage and given choices of different dishes.

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 23 October 2018).

Why we inspected

We received concerns in relation to a safeguarding matter. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led. After the initial inspection visits, we received concerns about financial matters, so we carried out another visit. We found no evidence of financial misappropriation.

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.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Carlisle Dementia Centre - Parkfield on our website at www.cqc.org.uk.

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 will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to infection control, safeguarding and quality assurance.

Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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

We found the following examples of good practice.

¿ The provider had identified a self-contained unit within the home to be the designated area. The unit had 12 single beds all with en-suite facilities.

¿ There was a separate entrance into this unit so access to this area was safe and did not affect the rest of the home.

¿ The provider had fitted air purifying units in all bedrooms and the lounge to sterilise the air.

¿ The designated unit was clean. The provider had arranged for additional cleaning to take place, including surfaces that were frequently touched.

¿ A dedicated staff team were employed to work in the unit. They would be led by a unit manager and nurses. The staff team would not work anywhere else in the home during the use of this unit. This helped to minimise the risk of cross infection.

¿ The provider had enough supplies of appropriate personal protective equipment (PPE) such as gloves, aprons and masks. All staff had been trained and checked as competent in how and when to wear the PPE correctly. There were PPE stations around the unit so they would be easily accessible by staff.

¿ The provider had up to date infection prevention and control policies and was following national guidance.

We were assured that this service met good infection prevention and control guidelines.

Accommodation is provided over two floors. The bedrooms are single occupancy and have en-suite toilet and wash basin facilities. There are shared bath and shower rooms, as well as lounge and dining areas throughout the home. There is a sheltered, accessible garden and car parking at the home.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. At this inspection we found the service remained Good. However, there are areas that would benefit from some improvements. We have made some recommendations to the registered provider.

There was a registered manager in post. A registered manager is a person who has registered with the (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.

Medicines were not consistently stored safely or recorded accurately and appropriately. We have made a recommendation about this.

The hot water supply in some areas of the home was not always reliable. The water temperature monitoring procedures were not clear or fully understood by staff. We have made a recommendation about this.

The schedules in place for cleaning had not always been followed. We found some areas of the home required better cleaning. There was a refurbishment plan in place at the home to help make improvements to the environment and the facilities.

The provider had systems in place to help monitor and assess the quality and safety of the service. We found that actions were taken to make improvements to the service. However, the monitoring systems could have been more robustly applied across the service.

Safeguarding concerns or incidents had been reported by the registered manager to the appropriate authorities to help keep people safe.

During the inspection we found that there were sufficient numbers of suitable staff to meet people's needs that plans were in place should extra staff be needed.

Staff were provided with training and support. We saw that staff were confident and competent when supporting the people who used this service.

People were provided with a good variety of food and drink. We saw that mealtimes were a pleasant and sociable event. Staff provided support with eating and drinking in a sensitive and discreet manner. Records about eating and drinking did not always contain enough information about people at risk of poor nutrition.

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 support this practice.

Staff were caring, capable and engaged with people throughout the day. They worked very well as a team including the domestic and administrative staff.

People who lived at the home were smartly groomed and appeared relaxed and content. Some people became distressed and anxious in the late afternoon but staff supported them expertly and with kindness.

People were provided with opportunities to have their say on how the service was operated. However, there had been few responses to surveys and meetings.

Further information is in the detailed findings below.

Carlisle Dementia Centre- Parkfield (CDC) provides nursing and residential care for up to 44 people, some of whom may have dementia or a physical disability. The home is a three storey property and accommodation is provided on the ground and first floors. The bedrooms are single occupancy and have en-suite toilet and washbasin facilities. There are communal bath and shower rooms as well as lounge areas and dining rooms on all floors. There is a sheltered garden area and car parking at the home.

The service 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.

Care plans were subject to regular review to ensure they met people’s changing needs. They were easy to read, based on assessment and reflected the needs of people. Risk assessments were carried out, and plans were put in place to reduce risks to people’ safety and welfare. The way the service gathered information on people's life history was being improved with the support of the local authority quality officer.

Where people were not able to make important decisions about their lives the principles of the Mental Capacity Act 2005 were followed to protect their rights. Staff were aware of how to identify and report abuse. There were also policies in place that outlined what to do if staff had concerns about the practice of a colleague.

There were sufficient staff to meet people’s needs. They were trained to an appropriate standard and received regular supervision and appraisal. As part of their recruitment process the service carried out background checks on new staff.

The service managed medicines appropriately. They were correctly stored, monitored and administered in accordance with the prescription. People were supported to maintain their health and to access health services if needed. People who required support with eating and drinking received it and had their nutrition and hydration support needs regularly assessed.

Staff had developed good relationships with people and communicated in a warm and friendly manner. They demonstrated good communication skills in relation to supporting people who lived with dementia. They were aware of how to treat people with dignity and respect. Policies were in place that outlined acceptable standards in this area.

There was a complaints procedure in place that outlined how to make a complaint and how long it would take to deal with. People were aware of how to raise a complaint and who to speak to about any concerns they had. The registered manager understood the importance of acknowledging and improving areas of poor practice identified in complaints.

The home was well led by a registered manager who had a vision for the future of the service. A quality assurance system was in place that was utilised to improve the service.

We found some areas of the home to have an unpleasant odour, we made a recommendation about this.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found:

Is the service safe?

People were cared for in a clean and hygienic environment. We saw that further investment was required to refurbish parts of the home. The provider was able to show us a schedule of works that confirmed this would be done. On occasion there were not enough staff to meet people's needs in a timely manner. We found the home to be non compliant in this area and a compliance action was made

Is the service effective?

People were cared for effectively because the staff worked in conjunction with other providers to ensure people's needs were met. The service had detailed care plans that ensured people's physical health needs were met.

Is the service caring?

People were cared for by warm and friendly staff who were knowledgeable about the people they cared for. Care plans were based on assessments of people's needs but we judged that they required more person centred information.

Is the service responsive?

The home had a robust complaints policy and staff were able to give good examples of how they had dealt with people's concerns.

Is the service well-led?

Staff had a good understanding of the standards expected by the manager and quality assurance processes were in place. People who used the service and staff had been consulted with about changes and they had been listened to. The provider had ensured there was a corporate quality assurance system in place. The manager provided leadership and was aware of areas that required improvement.

We found that people were well looked after by sufficient amounts of staff. The staff worked well with other providers to ensure that people received quality care. Staff had received safeguarding training and were aware of how to identify and report abuse. The home had a quality assurance system in place and acted on people's feedback. However we noted that the home was in need of significant refurbishment though this was underway at the time of our inspection.

People told us that they were 'happy at the home' and that the staff were 'kind, helpful and friendly.'

Nutritional assessments and records had been completed and were up to date. Where necessary the doctor or speech and language therapist had been contacted for advice and support. Some of the people we spoke with told us that the food was 'very nice and there are always various things to choose' and 'we can choose what we want to eat, the meals are good and I always have enough to eat.'

We checked all areas of the home including the bathroom and shower areas as there had been concerns about the cleanliness and safety at our last inspection. We found that generally the home was warm, clean and tidy, although we did note that there were some slight unpleasant odours in some areas of the home.

We found that staff were recruited appropriately and relevant pre-employment checks had been completed. This helped to ensure that people were supported by staff that were suitable to work with vulnerable adults.

We found that people living at the home were able to comment on the quality of the service they received. Regular resident meetings were held, surveys were always available for residents and visitors to the home and the manager always took comments seriously.