About the service:

Parkfield House Nursing Home is a care home providing accommodation with nursing care for up to 44 older people. There were 40 people living at the service at the time of our inspection. Parkfield House Nursing Home is a purpose-built building over three floors. People with nursing needs lived on the ground floor, whilst people living with dementia were situated on the first floor.

People’s experience of using this service:

¿There was strong evidence that people were fully engaged in a wide range of meaningful activities led by a ‘wellbeing team’. People were consulted about what they wanted to do, and were listened to. Activity plans were displayed and people reported they were very happy with the activities on offer.

¿ Staff were extremely responsive to people’s individual needs and knew them well. They supported each person to achieve their wishes by spending time with them and listening to them. They ensured that each person felt included and valued as an individual.

¿ The registered manager led a hard working and dedicated team. Together, they met people’s individual needs and improved their quality of life.

¿ The provider had systems in place to help ensure people who used the service were safe from avoidable harm and these were effective.

¿ Where there were risks to people who used the service, these had been assessed and included clear guidelines for staff to follow to help ensure people were safe from harm.

¿ People’s healthcare needs were met and we saw that staff took appropriate action when concerns were identified.

¿ The provider had robust systems in place to monitor the quality of the service and put action plans in place where concerns were identified. People’s care records were reviewed and updated monthly or more often if their needs changed.

¿ People received their medicines safely and as prescribed. Staff received training in the administration of medicines and had their competencies checked.

¿ Care plans were developed from pre-admission assessments and contained relevant and up to date information about people’s needs and preferences so staff knew how to care for and support them.

¿ People were supported by staff who were suitably trained, supervised and appraised.

¿ Staff had received training in end of life care. People had an end of life care plan in place which stated their individual wishes when they reached the end of their lives.

¿ Recruitment checks were carried out before staff started working for the service and included checks to ensure staff had the relevant previous experience and qualifications.

¿ People were protected by the provider’s arrangements in relation to the prevention and control of infection. The home was clean, tidy and well maintained throughout.

¿ The environment was tailored to the individual needs of people who used the service, including those living with the experience of dementia.

¿ The provider acted in accordance with the Mental Capacity Act 2005 . People had their capacity assessed before they moved into the home. Where necessary, people were being deprived of their liberty lawfully.

¿ The provider had processes for the recording and investigation of incidents and accidents. We saw that these included actions taken and lessons learned.

Rating at last inspection: At the last inspection on3 August 2016 the service was rated good.

Why we inspected: This was a planned inspection based on the previous rating. During our last inspection we rated the service good overall although we rated the key question of ‘well led’ as requires improvement. During this inspection we found the service had made the required improvements.

Follow up: We will continue to monitor information we receive about the service until we return to visit as per our re-inspection program. If any concerning information is received, we may inspect sooner.

Parkfield House nursing home provides long term accommodation with nursing care for up to 44 older people, some of whom were living with dementia. There were 33 people living in the service at the time of the inspection and one person was in hospital.

This inspection was unannounced and took place on 8, 11 and 12 July 2016.

During our last inspection on 4, 5 and 11 August 2015 the provider was not meeting the legal requirements in relation to ensuring that the care or treatment that was planned, recorded and delivered was linked to people’s needs and preferences. At this inspection we found that although there were still areas that needed further review and improvement, overall we saw that the information recorded in people’s care records was more person- centred and detailed. This included, recording people’s individual preferences and likes and dislikes.

There was a registered manager in post. 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.

We recommend the provider reviews recognised guidance on designing and using the environment that takes account of people’s needs. In particular for people living with the experience of dementia and other needs they might have such as visual impairments.

We recommend the provider seeks recognised guidance on providing suitable activities that meet people’s needs.

There were systems to monitor and audit the service and plans for improvement. However, these had not picked up on the areas we found at the inspection that needed addressing.

People gave us complimentary comments about the service they received. People felt happy and well looked after. However, there was mixed feedback from some staff and a relative about the service and how it was run, including staffing levels. We saw that staffing levels had been reviewed and had decreased but we found no evidence that people were at risk of neglect or were not being cared for effectively.

People’s needs were assessed prior to their admission to the service and were reviewed on a regular basis. Risk assessments were in place that reflected current risks for people at the service and ways to try and reduce these.

People’s capacity to consent to their care and treatment had been considered and assessed. The registered manager had acted in accordance with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

Staff knew people well and understood how to meet their individual needs. We observed positive relationships between staff and people at the service and their relatives or visitors.

People were supported to maintain relationships with those who mattered to them.

There were procedures designed to safeguard people and the staff knew what to do if they thought someone was at risk of abuse.

Staff received training to help them undertake their role and were supported through supervision and appraisal.

Staff had been suitably recruited.

Medicines were stored, administered, recorded and disposed of safely. Staff were trained in the safe administration of medicines and kept records that were accurate.

People’s nutritional needs were assessed and they had a variety of freshly prepared food.

The staff worked with other healthcare professional to assess and meet healthcare needs.

There was an appropriate complaints procedure and people and their relatives knew how to make a complaint.

This inspection took place on 13 November 2015 and was unannounced.

The last inspection of the service took place on 4, 5 and 11 August 2015, where we identified two breaches of Regulation. One breach related to people's care records which although contained information about people’s needs they were sometimes contradictory and some lacked sufficient detail. The second breach was a continued breach in the management of medicines. We issued a warning notice telling the provider that they needed to make improvements to medicines management by 30 September 2015. This inspection was to check the provider had made the necessary improvements to medicines management. The other breach of Regulation was not inspected on this occasion.

There was a registered manager in post. 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.

This inspection looked at how medicines in the service were being managed. We found that the medicines were stored, recorded and administered safely. Staff had received training and support to make sure they administered medicines appropriately. Medicine administration records were accurate and up to date. The staff undertook daily audits of medicines and the registered manager undertook additional monthly audits to ensure people were accurately and safely receiving their medicines. We found the provider had made the necessary improvements and was now meeting the legal requirements in relation to medicines.

We spoke with 13 people using the service, the relative of another person, seven nurses and care staff working in the home and the registered manager. We also looked at the care plan records for eight people using the service.

People told us they were happy living in the home and satisfied with the care and support they received. One person said “it’s alright here, I can do most things myself but the staff are here to help if I need it.” Another person said “the staff are busy but they do their best.” A relative told us “the manager visited before he moved in to see what he needed.”

People were involved in planning and agreeing the care and treatment they received, wherever possible. We saw people enjoyed a range of activities in the home and the local community.

We saw that during lunchtime people were well supported by staff who respected their rights and maintained their dignity.

We saw that people’s care needs were assessed and reviewed and care was delivered in line with people’s care plans.

The provider was not referring suspected safeguarding issues and other significant incidents to the local authority or the Care Quality Commission (CQC). This meant people may have been at risk of receiving unsafe care or treatment.

Staff told us they felt well supported and there were enough staff on duty at all times to meet people’s needs. We saw that staff worked well together and support was provided that respected people’s dignity.

Complaints were recorded but the record did not always show the outcome for the person making the complaint.

We spoke with ten people using the service. They told us they felt safe in the home and staff were kind and helpful. Their comments included "they look after me very well, the staff are very good."

We saw staff supported people in a professional and friendly way. People were offered choices with regard to the food at lunchtime and activities in the afternoon. One person told us "I always enjoy the food and there’s always a choice.” Another person said "I can eat where I like, sometimes I stay in my room and other times I come to the dining room. If I don't like what's on the menu, they will get me something else."

We spoke with nine people working at Parkview House, including the home's manager. Staff were able to tell us about how they maintained people's dignity, respected their privacy and gave them choices throughout the day. Staff also told us they felt supported and well trained. Staff comments included "we’re a team, we work well together to make sure people are looked after” and "it’s a good home, I’ve done all the training I need to do my job.” The staff we spoke with were aware of the risk of abuse were able to tell us how they would respond if they had concerns about a person using the service.

We saw that the provider had arrangements in place to make sure people using the service were cared for safely, appropriate checks were carried out before staff were appointed and any complaints were investigated and where possible resolved.

Parkfield House nursing home provides long term accommodation with nursing care for up to 44 older people, some of whom were living with dementia. Staff received training in dementia so that they understood how to support people appropriately. There were 27 people living in the service at the time of the inspection.

This inspection was unannounced and took place on 4 and 5 August 2015.

During our last inspection on 7 and 9 January 2015 the provider was not meeting the legal requirements in relation to the safe management of medicines, ensuring that people were assessed if they had restrictions in place, such as bed rails, supporting staff and having effective systems in place to assess and monitor the quality of service provision. At this inspection we found the provider had made improvements and was now meeting some of the legal requirements. However, we identified there were still continued shortfalls with how medicines were managed in the service and therefore people were at risk because their medicines were not always managed in a safe way.

The service had a new manager who started the end of June 2015. They were in the process of applying to be the new 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.

We also found at this inspection that care plans contained information about people’s needs but these were sometimes contradictory and some lacked sufficient detail to enable nurses and care workers to provide personalised care. There were activities taking place but it was not evident that these were always linked to people’s interests and preferences.

The provider had procedures to help identify and deal with abuse and the different members of the staff team had been trained in these. The provider had taken appropriate action and liaised with other agencies to investigate safeguarding concerns.

We found the service to be meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and Mental Capacity Act 2005 (MCA). DoLS are in place to ensure that people’s freedom is not unduly restricted. Where people were at risk and unable to make decisions in their own best interests, they had been referred for assessment under DoLS. People’s capacity had also been considered and assessed to ensure they were supported and where possible encouraged to make daily choices and decisions.

There were enough staff to meet people’s needs and to keep them safe. Appropriate checks were carried out for the different staff who worked in the service before they were employed.

The different staff members told us they received regular training and support to gain new skills and make them more competent in their roles.

People and relatives told us that they were happy with the food and drink provided. They were supported appropriately to eat and drink sufficient amounts to meet their needs.

The nurses and care workers worked with other healthcare professionals if there were concerns about a person’s safety or welfare so that people’s individual needs could be met.

People and relatives were happy to talk with the manager and to raise any concerns that arose. People, relatives and the different staff members told us that the manager was approachable, visible and supportive. One relative told us the service provided a “high standard of care and nursing for people.” A second relative said the care workers and nurses were, “very attentive.”

There were systems in place to monitor the quality of the service being provided to look at where improvements could be made to ensure people received a safe and caring service. Some of the new audits had only recently been introduced and so would require more time to ensure these were effective in picking up any issues within the service.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to person-centred care.

We also found a breach of the legal requirement in relation to the management of medicines. We have taken action against the provider and will report on this when our action has completed.

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