This unannounced inspection of Green Park Care Home took place on 21, 22 and 30 November 2017.When we completed our previous inspection on 22 and 23 May 2017 we found concerns relating to safe care and treatment, consent and governance. At this time these topic areas were included under the key question of safe, responsive and well-led. We reviewed and refined our assessment framework and published the new assessment framework in October 2017. Under the new framework these topic areas are included under the key question of safe, effective and well-led. Therefore, for this inspection, we have inspected this key question and also the previous key question of responsive to make sure all areas are inspected to validate the ratings.
The care home was previously inspected on 22 and 23 May 2017 and was rated inadequate and placed in “special measures.” At that time we found four breaches of regulation in relation to safe care and treatment, consent, dignity and respect and governance. We issued two warning notices for safe care and treatment and governance and requirement actions for the regulations related to dignity and respect and consent.
We asked the provider to complete an action plan to show the Commission what they would do and by when to improve and ensure they were meeting the legal requirements. This inspection took place to check if the provider had made enough improvements to meet their legal requirements.
Green Park is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The care home comprised of five units for 105 people. At the time of our inspection one unit was closed to admissions. The provider confirmed they intended to open the fifth unit in early 2018. 59 people were living at Green Park Care Home at the time of this inspection.
There was no registered manager. A home manager was present for the inspection and they confirmed their intention to apply to become the registered manager at the care home. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
On this inspection we found the provider had made improvements related to the concerns raised within the warning notices for safe care and treatment and governance.
These improvements meant the provider had demonstrated they had implemented a robust action plan to address the concerns we raised on the last inspection and within the warning notices.
However, we identified new concerns related to safe care and treatment and governance on this inspection. There remained breaches of the regulations related to safe care and treatment and governance.
During the inspection, we became aware of a serious incident around choking. This incident is subject to further investigation and we examined the risks of choking on this inspection.
We found people were not always being kept safe from harm. Risk assessments such as for those at risk of choking were not in place. Safe recruitment practices were not always in place. This meant that the provider had not done all that was considered reasonable to mitigate risks to people supported by the staff.
There were improvements seen in the provider’s quality assurance systems however they were not robust enough to highlight all of the concerns found on this inspection.
Medicines were being managed safely within the care home including prescribed medicines which were to be administered as and when (PRN). This was an improvement since the last inspection.
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.
We viewed a system in place of managing accidents and incidents with an analysis to identify trends and themes. Injuries sustained had wound care plans in place.
Staff were aware of their responsibilities to safeguard people and could explain the system in place of reporting any safeguarding concerns. Staff had heard of whistleblowing and knew what to do to whistleblow.
We observed people being treated with respect and dignity during the inspection. Staff followed practices which upheld people’s dignity such as knocking prior to entering the person’s room.
People we spoke with were positive about their care and visitors/relatives also provided positive feedback about the staff, management and the care home.
The care plans contained information regarding people’s likes and dislikes. Staff were knowledgeable about people and were aware of people’s preferences to provide person centred care.
People were provided with a four week menu with a choice of foods and drinks. We found that fresh fruit was not being offered on a regular basis.
Activities and events were being held at the care home such as recognition of Remembrance Sunday for people.
Staff had received an induction and received mandatory training which was being delivered and renewed when needed. Supervision and a system of appraisal was in place.
Healthcare professionals were being included in people’s care and we viewed referrals being made appropriately with positive outcomes for people.
We found there were enough staff to provide care when people needed it on this inspection.
The environment was stimulating for people with various pictures, murals and memorabilia however, some fixtures on the walls which were within people’s reach where made of metal. We asked the provider to undertake a review of all wall fixtures to ensure they were safe for people to touch.
There was a complaints system in place and lessons learnt from the complaints. We also viewed compliments made about the service.
This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.