We carried out an unannounced comprehensive inspection on 28 May 2018. We made a further two announced visits to the home on 30 May and 31 May 2018 to complete the inspection.The service was last inspected in September 2017. At that time we identified two breaches of the regulations relating to safe care and treatment and good governance. We rated the service as requires improvement. We asked the provider to complete an action plan to show what actions they were going to take to improve. At this inspection, we found that although action had been taken to address the previous shortfalls; we identified new concerns and shortfalls.
Park House 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. Park House is registered to provide accommodation for persons who require nursing or personal care and for treatment of disease, disorder or injury. Park House can accommodate up to 50 people. At the time of the inspection there were 46 people living at the service, some of whom were living with dementia.
A new manager had been appointed in October 2017. They had applied to register with CQC as a registered manager. However, they were not present during or following our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
During this inspection, concerns were highlighted about how people were treated. Several people raised safeguarding allegations of a physical and psychological nature. Two staff informed us of their concerns about how certain staff spoke with people. We passed this information to the regional manager who notified the local authority safeguarding adults team and the police. We found that the correct actions had not been taken with regards to several safeguarding allegations. They had not all been reported to the necessary authorities including CQC.
There were shortfalls and omissions with the management of risk. Staff did not always follow risk assessments in relation to moving and handling. Documented risk assessments were not always in place for identified risks such as choking.
People received their medicines as prescribed. Records relating to administered medicines were well kept and medicines were stored appropriately.
Timely action had not been taken to resolve the bathing and plumbing issues at the home. At the time of the inspection, there was only one bath in use to bathe all people on both floors because none of the showers or other baths were working. This was resolved by the third day of our inspection. Maintenance records showed that suitable water temperatures were not always maintained in people’s bedrooms. Some water temperatures were recorded at less than 30°C.
We received mixed feedback from people and staff about staff deployment. We considered that more direction from senior staff could help staff deployment. We have made a recommendation that staff deployment is kept under review to ensure sufficient staff are deployed at all times
The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The manager had submitted Deprivation of Liberty Safeguards [DoLS] applications in line with legal requirements. We found however, that consent to care and treatment was not always sought in line with the Mental Capacity Act 2005 (MCA).
Training records were not well maintained. The training matrixes contained gaps against certain training courses. It was unclear which training staff had completed or needed to undertake.
An effective system to assess, manage and monitor people’s nutritional needs was not fully in place. People were supported with their health care needs. Care records contained details of referrals and input from health care professionals.
Observations of staff interactions with people were varied. We saw some staff were very friendly and chatted with people whilst they supported people. We observed that others spent time talking amongst themselves, rather than engaging with people. In addition, some of the language used by staff did not promote people’s dignity.
There were two activities coordinators employed. We found however that there was a lack of meaningful activities.
Complaints had not always been fully investigated and there had been a failure to link themes between complaints and safeguarding.
The provider had not carried out robust, thorough and questioning audits of the service capable of identifying areas for improvement. Audits did not demonstrate who was accountable for which task and action plans had not been completed.
The overall rating for this service has deteriorated from ‘requires improvement’ to ‘inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any of key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or varying the terms of their registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
Following the inspection, we wrote to the provider to request an action plan which listed what action they had taken or planned to take to address the concerns and shortfalls identified during the inspection. We also met with the chief operating officer and regional staff to discuss our concerns and the improvements required for this service to become compliant with the regulations.
We referred all of our concerns about the service to Newcastle local authority, Newcastle Clinical Commissioning Group and the police. At the time of our inspection, the local authority had placed the home into 'organisational safeguarding.' This meant that the local authority was monitoring the whole home. The provider had also agreed not to accept any new admissions to the home.
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During this inspection, we identified eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also identified a breach of the Care Quality Commission Registration Regulations 2009, Notification of other incidents. You can see what action we have told the provider to take at the back of the full version of the report.
Full information about CQC’s regulatory response to the more serious concerns found during this inspection is added to reports after any representations and appeals have been concluded.