Parklands Nursing Home

We found the following examples of good practice.

The registered manager had taken steps to ensure staffing was sufficient to fully meet people's needs. Staff had worked flexibly and had gone above and beyond during a difficult situation, working extra shifts and often taking on new responsibilities to ensure people received safe care and support.

Safe arrangements were in place for visitors to the service. This included the completion of hand sanitisation and wearing a mask. Staff and essential care givers engaged with a programme of regular testing according to government guidance.

Staff and visiting professionals were asked to provide evidence of their vaccination status against COVID-19 prior to entering the home.

We saw PPE was accessible within the home and staff used it in accordance with the most up to date guidance. Information about the correct use of PPE and handwashing guidance was displayed throughout the home.

A regular programme of testing for COVID-19 was in place for staff and people who lived in the service. This meant swift action could be taken if anyone received a positive test result.

Policies, procedures and risk assessments related to COVID-19 were up to date which supported staff to keep people safe. All staff had received training about the correct use of PPE including donning and doffing.

Isolation was used to manage the spread of infection. This meant people self-isolated in their rooms when necessary.

There was plenty of personal protective equipment (PPE) including masks, gloves, aprons and hand sanitiser available. PPE stations were located around the service and outside people’s rooms.

Parklands Nursing Home is a care home providing personal and nursing care for up to 30 people. This includes both permanent residents, and people who stay at the service for rehabilitation, before returning to their own homes. At the time of the inspection 22 people were receiving support.

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

People and relatives told us the service was safe, and staffing levels were sufficient.

Risk assessments were thorough and covered the risk present in people’s lives.

Medicines were stored and administered safely, and staff were trained to support people effectively. Staff were supervised well and felt confident in their roles.

The service was clean, and staff understood infection control procedures and followed them. Staff wore appropriate personal protective equipment.

Audits of the service were detailed and any issues found were addressed promptly. Staff felt well supported by the registered manager and were motivated to provide good care to people.

Staff referred to external professionals as required and followed advise to ensure people’s needs were met.

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.

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 the service was GOOD published on 24 November 2017.

We undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

During our last inspection on 27 February 2017 we rated the location as ‘Requires Improvement’. Although we found that the provider had instigated improvements since our previous inspection in October 2016, these had not been sufficiently embedded into practice for us to reflect a rating of ‘Good’. During this inspection we found that improvements had been further developed, embedded into practice and were working successfully and we rated the location as ‘Good’.

There was a registered manager in post who was also the provider of the service. 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.’

People could be assured that they would receive their prescribed medicines safely. Risks to people had been assessed and plans of care provided guidance for staff in reducing the known risks to people. People were supported by sufficient numbers of staff to provide their care and support in the way that they wanted. Systems were in place to ensure that staff were subject to robust recruitment procedures and were of a good character prior to working in the home.

Staff received the training, support and on-going professional development that they needed to work effectively within the home. People’s ability to consent to their care and support had been assessed and was sought by staff providing their care on a day to day basis. There were systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). People were supported to eat and drink enough and to access healthcare services when they needed to.

People had detailed plans of care in place that were reflective of their needs to provide guidance for staff in how to provide their care.

Staff treated people with dignity and respect. Staff knew people well and tailored their care according to their individual preferences, interests and life history.

People had the information they needed to make a complaint and the service had processes in place to respond to any complaints.

People were supported by a team of staff that had the managerial guidance and support they needed to carry out their roles. The quality of the service was monitored by the audits regularly carried out by the provider. The provider was accessible and knew people well.

At our previous inspection on 13 October 2016 we found that five legal regulations had been breached.

Risks to people were not always assessed fully and risk assessments did not always contain clear guidance regarding risks and how to manage them. This was a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The premises and equipment used by the service were not always clean or suitably maintained to ensure they were safe for people to use. This was a breach of regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People were not always treated with dignity and respect. This was a breach of regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations.

Care and treatment was not always provided in a way which reflected people's individual needs and preferences. This was a breach of regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There were not robust systems in place at the service to allow the provider to assess, monitor and improve the quality and safety of the care being provided at the service. This was a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We asked the provider to implement systems to ensure they were meeting the breach of regulation 17 by 31 January 2017. We also asked the provider to send us an action plan, detailing when they would have met the other breaches of regulation. They stated that they would have met all the breaches by 31 March 2017; however, during the inspection visit on 27 February 2017 they told us they had achieved the points in their action plan and were happy for us to look into each of these regulatory breaches during this inspection. We found that the provider had implemented steps to ensure that the breaches of regulation were now being met.

We found that there had been improvements to the way that risk was managed at the service. Risks were clearly assessed and old risk assessments were no longer in place, which helped to reduce the chances of confusion around risk. Control measures were in place and staff were aware of the action they should take in response to risk.

There had also been improvements to the cleanliness of the service. Floor coverings had been replaced throughout the service which helped staff to maintain a clean environment. In addition, cleaning systems and checks had been introduced to ensure all areas of the service were clean. Equipment was also appropriately maintained and steps had been put in place to ensure equipment, such as pressure relieving mattresses, were at the right setting.

People were treated with dignity and respect. Staff members made sure people were happy with the way they were treated and clearly communicated with them throughout the provision of care. Property and clothing was looked after well and staff ensured people got their personal clothing back from the laundry.

The provider had implemented a new system for care planning. This helped them to ensure that care plans were accurate and person-centred. It also meant that staff were able to spend more time with people, ensuring their needs were met and engaging in conversation with them. There were also improvements to the activities available at the service. People were more stimulated and there were plans to continue to develop in this area.

Quality assurance systems had been improved to help give the registered manager and the provider greater oversight of the service. Checks and audits were scheduled and completed in a range of different focus areas to help identify areas for improvement and to contribute to an action plan to drive these improvements.

Parklands Nursing Home is registered to provide accommodation for persons who require nursing or personal care, diagnostic and screening procedures and treatment of disease, disorder or injury. They can accommodate up to 30 older people at the service, who may also be living with dementia. When we carried out our inspection there were 20 people living at the service.

The service had 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.

There was a lack of robust quality assurance processes in place at the service. Some checks and audits had been introduced, however; they had failed to identify areas of concern. The provider had failed to use quality assurance processes to learn lessons and drive improvements at the service. People and their families were not always aware of who the registered manager was and did not have regular access to them. In addition, there was not a positive atmosphere at the service as people and their families did not always feel involved in changes or developments.

Risks to people's health and well-being were not always well managed at the service. Risk assessments were not always robust and checks did not always highlight areas of concern. Documentation was not always effective in providing staff members with the information they needed to effectively manage risks. This placed people at risk of potential harm. In addition, systems in place for medication management were not always robust to ensure that people's medicines were stored and administered correctly. Some areas of the service were not always clean and presented an increased infection control risk to people at the service.

Incidents at the service were reviewed by the registered manager and used to update care plans and practice. Where there were potential safeguarding concerns, the service had not been proactive in seeking the advice of external organisations, such as the local authority safeguarding team. The service was not able to demonstrate that staffing levels were sufficient to meet people's needs. Basic care needs were being met, however; staff were often rushed and lacked time for additional care, such as activities. Staff members had been recruited robustly and appropriate checks had been completed prior to their employment.

People were not always treated with dignity and respect. At times, staff members did not handle people's property appropriately and did not always communicate with people whilst providing them with care and support. Care plans had been written for people, however; they did not always show that people or their family members, where appropriate, had been involved in the planning process.

The care provided to people was not always in accordance with their individual needs and preferences. Improvements had been made to some care plans in this area, but not all. In addition, there was a lack of activities and stimulation available to people, therefore they were not able to engage in their hobbies and interests. There were systems in place for complaints to be made, however; people and their relatives were not aware of the complaints policy and did not feel that action was taken in response to their concerns.

Staff members received training and supervision to help them perform their roles. People did not always feel that they were provided with choice, or that their consent to their care and support arrangements had been sought. Not all people were happy with the food available at the service and we found that were not always supported to have their meals in a timely manner. Food provided was nutritious and regular drinks and snacks were offered. People were supported to attend medical appointments both within the service and in the local community, such as outpatient appointments, if required.

The principles of the Mental Capacity Act 2005 had been followed for those people unable to make decisions for themselves. Decisions were taken following a best interests' process and authorisations under the Deprivation of Liberty Safeguards had been submitted where appropriate.

You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We found that the provider had failed to ensure that the environment and premises were safe for people to use. Hazards had not been identified by members of staff or the provider; therefore action had not been taken to mitigate those dangers.

We also found that people's care plans were not person-centred. They lacked specific information about people's history and individual likes, dislikes and interests, therefore staff were unable to ensure that their personal needs and preferences were met. Care plans had not been produced with people's consent and the principles of the Mental Capacity Act 2005 (MCA) had not been followed for those people that lacked mental capacity.

The quality assurance systems in place at the service were not effective. The provider had failed to identify areas in need of improvement at the service, therefore problems were not rectified and the quality of people's care could not improve.

We asked the provider to submit an action plan to tell us how they would meet these regulations in the future; they stated that they would be meeting them by 20 April 2016. During this inspection we returned to see if the service had made the improvements they stated in their action plan. We found that the provider was now meeting these regulations.

Parklands Nursing Home is situated in a residential area of Milton Keynes and is registered to provide nursing and personal care for up to 30 older people, who may be living with dementia. At the time of this inspection there were 25 people living at the service.

This inspection took place on 27 April 2016.

The service had 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.

Improvements had been made to the way in which the environment was managed to ensure it was safe for people to use. The provider had taken remedial action following our previous inspection and had introduced risk assessments and regular checks to ensure the safety of the environment was maintained.

The service had also improved how it gained and recorded people's consent. Care plans had been updated and demonstrated that, where possible, people had agreed to their content. Where people lacked mental capacity to consent to their care, treatment and support, the service had followed the principles of the MCA and acted in people's best interests.

Care plans had been developed and were now person-centred. They contained information regarding people's background, as well as their specific likes, dislikes, interests and preferences. Staff were able to provide people with a wider range of activities which were based upon their history and interests.

Improvements had been made to the quality assurance systems in place at the service. The registered manager carried out a number of checks and audits to measure quality and make improvements to the care being delivered.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive to people's needs?

' Is the service well led?

This is a summary of what we found-

Is the service safe?

People told us they felt safe living at Parkland Nursing Home. One person said, 'Everyone is kind.' A visitor told us, they were happy with the care provided to their relation and felt at ease when they visited. People's needs had been assessed, and risk assessments described how any identified risks to people were minimised. The staff were knowledgeable about people's care and support needs and there were sufficient staff on duty to provide the necessary care. Staff were aware of their responsibility to protect the people using the service from any potential abuse. We saw regular checks of the environment were made to ensure any faults were identified and rectified.

Is the service effective?

We observed staff responded promptly to people's needs and call bells were not left unanswered. We saw that care plans had been updated when people's needs had changed, and referrals had been made to other health and social care professionals when needed. The service treated people with dignity and respect and the people we spoke with were happy with the care they received. The care documentation we reviewed evidenced how people's health had stabilised while at the home. At the time of our visit none of the people at the home had pressure ulcers as staff identified the risk and the correct equipment was provided.

Is the service caring?

During our visit we observed positive interactions between the staff and the people using the service. People were provided with choices and supported to make appropriate decisions. The staff we spoke with had good knowledge about people's medical conditions and needs. One person said, 'Everyone is kind.' Throughout the service we saw cards displayed thanking the staff for the care provided.

Is the service responsive to people's needs?

We observed that staff responded promptly to people's needs and that call bells were close at hand for those people that spent time in bed or their bedrooms. We saw care plans had been updated when people's needs had changed, and referrals had been made to other health and social care professionals when needed. The service took account of individual preferences. People were supported as necessary in a considerate manner, for example during mealtimes.

Is the service well-led?

The service had a registered manager. Staff told us the manager was approachable and supportive. Documentation confirmed that the manager supported the staff to learn from incidents. We saw that the provider had effective systems to assess and monitor the quality of the service they provided. They regularly sought the views of people using the service and their representatives, and took account of these to improve the service.

We saw that people seated in the communal lounge were appropriately dressed in clean clothes and that they were relaxed in the presense of staff and visitors.

We found the home to be clean, comfortable, free from odour throughout. We found that one bedroom required attention to flaking plasterwork and we were given assurances that this work will be carried out promptly.

We found that 'Parklands Nursing Home' was appropriately staffed and met the needs of the people in residence.

We spoke with three relatives of people who used the service. They were all very happy with the service that their relative received. One person told us "I can't fault it", and another person told us "I am quite content".

We spoke with four members of staff who worked at the service. They all told us that people who used the service received a good standard of care.

We found that people's privacy, dignity and independence was respected and that people were involved in decisions about their care. We found that people's needs had been assessed and care plans to meet their needs were put in place. We saw that there were risk assessments in place to ensure people's welfare and safety.

We saw that there were systems in place to ensure that people's medication was managed safely. We found that there were sufficient numbers of staff on duty and that the provider had an effective complaints system in place.

We were concerned about the care records that were being kept and that they were not consistent with people's care plans. We also saw that where people's fluid intake was being monitored that these were not always being totalled each day.