Parkhill Nursing Home

Parkhill Nursing Home is a residential care home providing care and support for up to 38 people in one adapted building. The home is an extended Victorian property with bedrooms on three floors. At the time of our inspection there were 28 people using the service.

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

There was not always sufficient, trained staff deployed to meet people’s needs. People did not receive the support they needed in a timely manner. Improvements had been made to the building, furnishings, and decoration but some improvements to the décor and infection prevention practices needed improving. Various risks related to health and safety and accidents and incidents were not always well managed and people were at risk of harm. Recruitment processes were not always safe, and we found concerns in this area. There was a system in place for staff when they commenced their role. However, not all staff had the relevant training such as safeguarding and MCA and DoLS. Care records were person centred but did not always contain the relevant information to guide staff on how to safely care for people and some records were not accurate. We made a recommendation about this .

People were not always treated with dignity and respect. Not all staff knew people well which led to undue distress. Although we witnessed some choices being offered, this was limited, and we witnessed task focused interactions rather than person focused care. Feedback from people that use the service, and their relatives was mixed and whilst some people described the staff as caring, others did not.

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

End of life discussions were taking place when appropriate and documented. People’s communication needs were identified, and information was made available to people in accessible formats .

Activities were not always taking place and there was no schedule to guide staff. We made a recommendation about this. There was a system in place for responding to complaints but there was no log of previous concerns and limited evidence of lessons learnt.

Audits were in place. However, they did not always identify risk and there was little evidence of learning lessons when things go wrong. Where risk was identified, this was not actioned in a timely manner. There was evidence of people and their relative’s taking part in meetings to discuss on-going improvements at the service. Staff, people, and their relatives spoke highly of the manager.

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 26 January 2018)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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

Enforcement and Recommendations

We have identified breaches in relation to risk management, staffing, staff recruitment, dignity and respect and good governance. We have also made recommendations in relation to care plans and activities.

Please see the action we have told the provider to take at the end of this report.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

¿ Risk assessments to prevent the risk and spread of infection were in place. A separate entrance had been allocated for staff and residents accessing the unit allocated for the designated settings. Designated staff had been consulted to work within the setting and staggered start times and allocated break times for staff had been implemented.

¿ The environment was clean and hygienic. Separate equipment for monitoring people’s health, providing support and maintained contact with people’s friends, family and external services had been allocated for use within the designated setting. Cleaning schedules were clear and detailed, and processes for managing infectious waste were in place.

¿ National guidance was followed on the use of personal protective equipment (PPE) and the service had enough stock. Staff had received training in the use of PPE and infection prevention and control and handwashing. Clear signage regarding these were displayed throughout the service.

¿ Staff and residents were taking part in regular COVID-19 testing and the vaccination programme. Risk assessments had been completed on people using services and staff belonging to higher risk groups and actions taken to reduce the risks.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Further information is in the detailed findings below.

At the last inspection the service was rated Good. At this inspection we found the service remained Good.

Residents felt safe and the home had policies and procedures in place to guide staff on how to protect residents from harm. There were sufficient suitable staff on duty at the time of the inspection. People’s medicines were managed safely.

Residents’ care was given in a way that took account of and respected their choices. Care workers were well trained and felt well supported. Residents’ were involved in planning the food menus and told us the food was good. People were supported to access other health services for example opticians and dentists. The home was well decorated and clean. People’s rights under the Mental Capacity Act were protected.

The home had a friendly and welcoming atmosphere. Residents and their relatives spoke highly of the care workers and management. Care workers were observed interacting with residents in a caring and respectful way, treating them with dignity. Relatives told us they felt welcome when they visited the home.

Residents received care that was tailored for them and were encouraged to be as independent as possible. A range of activities were made available in the home which were popular with residents. Relatives and residents told us they knew how to make a complaint and felt confident their concerns would be addressed if they did complain. The home has Gold Standard Framework Platinum status for end of life care indicating they adhered to nationally recognised standards of good practice when supporting people at the end stage of their life.

The home had a registered manager in line with CQC registration requirements. 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.

Residents and relatives said they felt the home had an open and welcoming culture and we observed this during our inspection. Care workers were professional and friendly to both residents and each other. The home works well with other agencies and seeks to continually improve.

We found that people living in Parkhill were enabled to make choices about the support and treatment they received. People we spoke with during our visit told us that they could make their own decisions about their daily lifestyle and about things that are important to them. Comments included:

'They (staff) never do anything without asking you first'. 'I am always asked if I'm happy with things and the way I'm being looked after' and 'If I don't want to do something, then I won't.'

Visiting relatives told us: 'They pull out all the stops to make sure your relative receives love, care and gentleness'. 'The staff are absolutely brilliant and they all work extremely hard' and 'I recommend this place to everyone.'

We saw that care plans and associated risk assessments were in place, up to date and had been regularly reviewed.

We found the home to be clean, tidy and free from any unpleasant smells.

People were receiving their medication as prescribed by their doctor.