Archived: South Park Care Centre

Updated 16 February 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection was planned to check whether the provider was working towards its action plan that it submitted to us following our inspection on 27 and 28 May and 2 and 3 June 2015.

We undertook an unannounced comprehensive inspection of South Park Care Centre on 30 November and 1 December 2015 including an early morning visit on 1December 2015. This inspection was done to check that improvements to meet legal requirements planned by the provider after our 27 May 2015 inspection had been made and to provide a rating.

The inspection was undertaken by one adult social care inspector, a specialist advisor who was a registered nurse and an adult social care manager. During our inspection we spoke with the provider, the operations director, the manager, the clinical lead, two nurses, the administrator, the head chef and eight members of care staff. We looked at records in relation to the service and we looked at the care records of six people.

Before we visited the home we checked the information that we held about this location and the service provider. We checked all safeguarding notifications raised and enquiries received. We noted that these were now being submitted in a timely fashion. This had not been the case prior to our last visit in June 2015.

We spoke with the local authority, the Clinical Commissioning Group and a Community Psychiatric Nurse both immediately prior to and after our visit to the service.

Updated 16 February 2016

We carried out an unannounced inspection of this service on 30 November and 1 December 2015.

At the last unannounced, comprehensive inspection on 27 and 28 May and 2 and 3 June 2015, we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take action to make improvements. The provider wrote to us to say what they would do to meet legal requirements in relation to these breaches a summary of which is below;

• Staff were not mitigating the risks posed for people on the nursing unit.
• People on the nursing unit were not being administered their medication in line with their prescription.
• Training records showed that the majority of the staff had not received any form of safeguarding training until March 2015. Despite this staff on the nursing unit remained unclear about safeguarding protocols and left people with histories of disinhibition unobserved.

• From observations of practice, documentation and from discussions with staff, we had concerns regarding ability to adequately meet people’s challenging behaviour needs.
• People on the nursing unit were not receiving appropriate amounts and types of nutrition and hydration.
• We saw that the nurses took no part in organising and overseeing food and fluid intake.

• Staff on the nursing unit were not ensuring the privacy and dignity of people were maintained.

• Staff on the nursing unit did not meet people’s needs.

• We found that the governance arrangements were not ensuring people who required nursing care received appropriate treatment

We undertook this comprehensive inspection to check that the registered provider had followed their action plan and had made the improvements required at the service. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for South Park Care Centre on our website at www.cqc.org.uk.

We carried out a focussed inspection in September 2015 to monitor improvements. This visit focussed on the nursing unit only, situated on the ground floor of the home. You can read the report from this focussed inspection, by selecting the 'all reports' link for South Park Care Centre on our website at www.cqc.org.uk. During this inspection visit we saw that some improvements had been made.

The service did not have 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. The manager at South Park had applied to be registered with the Care Quality Commission.

At this latest inspection visit we saw that people had appropriate risk assessments in place. However the design of the building (with bedroom doors recessed so people could not be seen coming out from the corridor) and the compatibility of people who required general nursing care and people who required nursing care in the management of their dementia and mental health meant that risks to people’s health and safety were not always mitigated.

Staff we spoke with understood the principles and processes of safeguarding, as well as how to raise a safeguarding alert with the local authority, but we saw from incident reports that not all staff were aware of this process or even to raise an alert with the manager. Staff we spoke with said they would be confident to whistle blow (raise concerns about the home, staff practices or provider) if the need ever arose.

There were appropriate numbers of staff employed to meet people’s needs but care was not provided consistently due to the number of agency staff at the service. There was a new clinical lead nurse who had been in post for two weeks at the time of this visit and who we observed leading by example. There was also a new administrator and a new head chef. Other changes had taken place with the activity co-ordinator leaving and a senior care assistant going on maternity leave. Although these changes had led to further change for people using the service, the manager told us they felt they were improving the calibre of staff brought into the home. The service was still in the process of recruiting to the nursing and care staff team and the number of agency staff in the service was still high. The service however endeavoured to keep consistency through employing the same agency staff who knew the people living at the service.

Medicines were stored safely. Administration had improved but the use of agency staff at times appears to frustrate the process as a number of recording errors were identified. Additional safeguards had been introduced by way of a detailed weekly management audit. Where any errors or omissions had occurred, these had been identified promptly and the necessary actions taken. We saw on one occasion stock levels for a person on end of life care were not maintained meaning medicines to manage their condition and keep them pain-free may not have been available.

Lighting had improved the ground floor corridors and the environment was generally clean and free from clutter. We saw safety checks and certificates that were all within the last twelve months for items that had been serviced such as fire equipment and water temperature checks.

The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff.

Staff had received training and were knowledgeable about their roles and responsibilities. Established staff had the skills, knowledge and experience required to support people with their care and support needs however other agency or newly recruited staff did not always have the skills to manage behaviour that may challenge or follow the correct procedures in relation to recording incidents.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. We saw that Mental Capacity assessments had been carried out and appropriate authorisations had been sought.

The meals we saw served were of good size and people found them enjoyable. The service had been working with the Focus on Under Nutrition team and the new head chef told us they had a clear focus on improving nutritional standards in the home. We saw that records relating to people’s nutritional intake were much improved.

We saw that the three nurses on duty during the two days of our visit appeared confident and competent in relation to providing good nursing care. One nurse was from an agency but had worked at the service for several months. Feedback from healthcare professionals was that the service sought support appropriately.

Established staff knew the people they were supporting and provided a caring service. Care plans were in place detailing how people wished to be supported. Care plans were reflective of people’s needs and had been shared with people or their relatives where able.

Staff received regular supervision and appraisal which meant that staff were properly supported to provide care to people who used the service.

We observed staff treated people with dignity and respect.

We saw there was a clear process for complaints and the manager responded to and kept appropriate records of investigations and outcomes.

People told us the manager was accessible and approachable. Staff and people who used the service felt able to speak with the manager and provided feedback on the service. We saw the manager made appropriate referrals to healthcare professionals and safeguarding authorities where needed.

Established staff spoke of an improving service and some relatives we spoke with also said the service had improved and they were able to discuss issues with the manager and felt they would be addressed.

The provider had a quality assurance system in place. There was a clear action plan that was regularly reviewed and the manager was in the process of gathering information about the quality of the service from a variety of sources.

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