Archived: South Park Care Centre

We carried out an unannounced inspection of this service on 30 November and 1 December 2015.

At the last unannounced, comprehensive inspection on 27 and 28 May and 2 and 3 June 2015, we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take action to make improvements. The provider wrote to us to say what they would do to meet legal requirements in relation to these breaches a summary of which is below;

• Staff were not mitigating the risks posed for people on the nursing unit.
• People on the nursing unit were not being administered their medication in line with their prescription.
• Training records showed that the majority of the staff had not received any form of safeguarding training until March 2015. Despite this staff on the nursing unit remained unclear about safeguarding protocols and left people with histories of disinhibition unobserved.

• From observations of practice, documentation and from discussions with staff, we had concerns regarding ability to adequately meet people’s challenging behaviour needs.
• People on the nursing unit were not receiving appropriate amounts and types of nutrition and hydration.
• We saw that the nurses took no part in organising and overseeing food and fluid intake.

• Staff on the nursing unit were not ensuring the privacy and dignity of people were maintained.

• Staff on the nursing unit did not meet people’s needs.

• We found that the governance arrangements were not ensuring people who required nursing care received appropriate treatment

We undertook this comprehensive inspection to check that the registered provider had followed their action plan and had made the improvements required at the service. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for South Park Care Centre on our website at www.cqc.org.uk.

We carried out a focussed inspection in September 2015 to monitor improvements. This visit focussed on the nursing unit only, situated on the ground floor of the home. You can read the report from this focussed inspection, by selecting the 'all reports' link for South Park Care Centre on our website at www.cqc.org.uk. During this inspection visit we saw that some improvements had been made.

The service did not have 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. The manager at South Park had applied to be registered with the Care Quality Commission.

At this latest inspection visit we saw that people had appropriate risk assessments in place. However the design of the building (with bedroom doors recessed so people could not be seen coming out from the corridor) and the compatibility of people who required general nursing care and people who required nursing care in the management of their dementia and mental health meant that risks to people’s health and safety were not always mitigated.

Staff we spoke with understood the principles and processes of safeguarding, as well as how to raise a safeguarding alert with the local authority, but we saw from incident reports that not all staff were aware of this process or even to raise an alert with the manager. Staff we spoke with said they would be confident to whistle blow (raise concerns about the home, staff practices or provider) if the need ever arose.

There were appropriate numbers of staff employed to meet people’s needs but care was not provided consistently due to the number of agency staff at the service. There was a new clinical lead nurse who had been in post for two weeks at the time of this visit and who we observed leading by example. There was also a new administrator and a new head chef. Other changes had taken place with the activity co-ordinator leaving and a senior care assistant going on maternity leave. Although these changes had led to further change for people using the service, the manager told us they felt they were improving the calibre of staff brought into the home. The service was still in the process of recruiting to the nursing and care staff team and the number of agency staff in the service was still high. The service however endeavoured to keep consistency through employing the same agency staff who knew the people living at the service.

Medicines were stored safely. Administration had improved but the use of agency staff at times appears to frustrate the process as a number of recording errors were identified. Additional safeguards had been introduced by way of a detailed weekly management audit. Where any errors or omissions had occurred, these had been identified promptly and the necessary actions taken. We saw on one occasion stock levels for a person on end of life care were not maintained meaning medicines to manage their condition and keep them pain-free may not have been available.

Lighting had improved the ground floor corridors and the environment was generally clean and free from clutter. We saw safety checks and certificates that were all within the last twelve months for items that had been serviced such as fire equipment and water temperature checks.

The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff.

Staff had received training and were knowledgeable about their roles and responsibilities. Established staff had the skills, knowledge and experience required to support people with their care and support needs however other agency or newly recruited staff did not always have the skills to manage behaviour that may challenge or follow the correct procedures in relation to recording incidents.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. We saw that Mental Capacity assessments had been carried out and appropriate authorisations had been sought.

The meals we saw served were of good size and people found them enjoyable. The service had been working with the Focus on Under Nutrition team and the new head chef told us they had a clear focus on improving nutritional standards in the home. We saw that records relating to people’s nutritional intake were much improved.

We saw that the three nurses on duty during the two days of our visit appeared confident and competent in relation to providing good nursing care. One nurse was from an agency but had worked at the service for several months. Feedback from healthcare professionals was that the service sought support appropriately.

Established staff knew the people they were supporting and provided a caring service. Care plans were in place detailing how people wished to be supported. Care plans were reflective of people’s needs and had been shared with people or their relatives where able.

Staff received regular supervision and appraisal which meant that staff were properly supported to provide care to people who used the service.

We observed staff treated people with dignity and respect.

We saw there was a clear process for complaints and the manager responded to and kept appropriate records of investigations and outcomes.

People told us the manager was accessible and approachable. Staff and people who used the service felt able to speak with the manager and provided feedback on the service. We saw the manager made appropriate referrals to healthcare professionals and safeguarding authorities where needed.

Established staff spoke of an improving service and some relatives we spoke with also said the service had improved and they were able to discuss issues with the manager and felt they would be addressed.

The provider had a quality assurance system in place. There was a clear action plan that was regularly reviewed and the manager was in the process of gathering information about the quality of the service from a variety of sources.

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

We carried out an unannounced focused inspection of this service on 2 September 2015.

At the last unannounced, comprehensive inspection on 27 and 28 May and 2 and 3 June 2015, we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take action to make improvements. The provider wrote to us to say what they would do to meet legal requirements in relation to these breaches.

We undertook this focussed inspection to check that the registered provider had followed their action plan and were making improvements at the service. This visit focussed on the nursing unit only, situated on the ground floor of the home. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for South Park Care Centre on our website at www.cqc.org.uk

South Park Care Centre provides nursing and personal care for up to 67 people, close to Darlington town centre. On the day of our inspection there were 23 people receiving nursing care.

The service did not have a registered manager in place. 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. The acting manager who was on leave during the course of our visit had submitted an application to be registered with the Care Quality Commission.

There has been an improvement overall at South Park, the environment on the ground floor was now more dementia friendly. The on site management team has been strengthened, and the role of the clinical lead was having a practical impact on staff and people living in the service. There were now much clearer signs of effective leadership and this was also the feedback we received from staff and visitors to the home.

Since our last inspection three permanent nursing staff had been appointed, and the management structure of the home had been improved. The acting manager was now supported by a deputy manager (Registered Mental Nurse) and a clinical lead (Registered Nurse Learning Disability). The service was still in the process of recruiting to the nursing and care staff team but we saw that the number of agency staff the service was using had decreased and staff told us it was much better now with a consistent nursing team.

The lighting had improved significantly on the ground floor since the previous inspection visit. We were pleased to see the ground floor had been fitted with halogen light bulbs, which produced much clearer light and removed shadows. Artwork, bygone era pictures and rummage boxes had also been implemented to make the ground floor more ‘dementia friendly.’ There was now clear differentiation between doors e.g. toilets and bathroom doors painted blue, offices, sluice etc. painted white, and signage for key areas such as the dining room and lounge was also much improved.

Since our last review of medication, a significant amount of work has been undertaken in relation to medication storage, administration and recording. We saw medicines being given safely and in a timely manner.

The appointment of a clinical lead and appointment of permanent nursing staff should ensure continuity of care. We were told by staff and relatives that agency nurse usage had decreased and this had improved the quality of the care given. Communication between the two nurses on duty was observed to be effective and professional and they were confident in their approach.

Staff interaction with people who used the service, and interactions between staff and visitors was noted to be good. People were offered choices at mealtimes, and were offered a choice of drinks during the day.

Staff told us they found the management at the home supportive and we saw that a variety of training events had taken place since our last visit. We saw staff had undertaken training in dementia care and challenging behaviour, oral healthcare and safe handling of medicines amongst others. Staff told us this training had been helpful and had improved how they cared and supported people.

The regional support manager told us that ten care plans had been fully transferred into a new format and that others were in the process of being changed. The care plans of four people were reviewed, and were seen to be significantly improved in layout and content. We discussed with management that the service must prioritise this work to complete all care plans as soon as possible.

At lunchtime, it was noted that there were now two ‘sittings’ which enabled staff to support more dependant people more effectively. The meals served appeared to be of good size and quality. The service had been working with the Focus on under nutrition team and the chef told us they felt more confident and knowledgeable about food preparation for vulnerable people since this training.

We saw records in relation to communication had improved since our last visit. Handover sheets were fully completed and contained a pen picture of each person and their needs for any new or agency staff. Daily notes and food, fluid and pressure care chart recording were much improved and there was now a responsibility on nurses and a chart champion on each shift to ensure these were completed.

During this inspection visit, we saw improvements had been made in relation to audits since the new acting manager started working at the home in May 2015.