Park House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We identified 1 breach of the legal regulations in this key question. This related to the need for consent. People gave mixed feedback regarding whether staff understood and provided support that met their needs. People's care plans did not always contain enough information to enable staff to support them effectively. People gave mixed feedback on nutrition offered. Peoples care records lacked details regarding effective person centred care. There was a lack of effective communication systems between staff, meaning people's developing needs were not communicated when things changed. There was a lack of activities or incentives to enable people to live healthier lives. People had outcomes recorded in their care plans but these were not reviewed. The provider was not always following the principles of the Mental Capacity Act and people's rights were not always respected.

This service scored 42 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People gave mixed feedback regarding staff understanding their needs. People said, “They [staff] definitely do, it's the little things like bringing relative a cup of tea in their favourite mug” and “I think they [staff] do, but don't have time to help.” However, the majority of people felt staff did not understand or respect their needs. They said, “No, some staff don't understand my needs”, “Its 50/50 depends who [staff] is on, some people know me and some don't” and “Some staff do. My relative needs help with eating and some staff will help. Others will just leave the food."

Staff told us that they were able to provide feedback and input into care planning and reviews. However, staff told us that due to time constraints, they could not always review or read care plans.

Care plans did not always contain the correct information to guide staff on how to support people safely. There was no evidence people or their relatives were actively involved in their care and support. When people’s needs changed these were often not updated within the care plan. The provider was in the process of moving to an electronic system however, this had yet to be implemented.

People gave mixed feedback about the nutrition offered at the home. People said, “It’s nice, and I do get offered choices which is nice” and “Its okay, can't complain about it really.” However, other people told us, “The food and presentation isn’t good, I do get offered choices but it's all as bad” and “Sometimes it's very good, but sometimes it's awful.”

Staff told us there were snacks and drinks available, for people, throughout the day. As described in other sections of this report staff described people as being picky when wanting something different to drink or eat.

Processes did not support good practice guidance in ensuring people received good person-centred care. Care plans did not capture what was important to people to ensure care was personalised and incorporated what support people wished to receive. Processes did not ensure people's nutrition and hydration needs were met in line with current guidance. Fluid and dietary charts were not effective. They did not contain information to guide staff on how much people’s fluids intake should be. Care plans did not include diet management for people to ensure they received a healthy and balanced meals. Menus were not provided or visible within the home.

People and relatives gave mixed feedback on whether staff worked well together. A person told us, "I have made complaints regarding staff laziness in the past and things are getting better” whilst another commented, "My relative is safe I think, but there have been instances in the past with previous staff members."

Staff told us they worked well in trying to meet people’s needs, however with low morale, staff leaving and high reliance on agency staff, it was sometimes difficult to meet people’s deteriorating health needs such as dementia.

Partners told us they had at times, struggled to obtain a point of contact at the service to liaise with regarding on site visits. Recommendations and advice from partners had not always been disseminated to all staff members by the management. Where partners had offered resources and training to upskill staff members, this had not always been accepted by the provider. Several partners commented on the ineffective communication between the management at the service and the support staff. Partners confirmed staff were often left with little information on people's needs as a result of management not keeping them informed.

There was no effective communication system in place. Handover records were poor with limited information. Where a problem had been identified during a shift, actions required were not clearly documented. Agency staff relied on permanent staff to inform them of people’s needs. Care plans did not ensure peoples needs and wishes could be shared across different services if people moved or went into hospital for treatment.

People we spoke with told us they had access to a regular GP, and were confident their requests for medical assistance would be supported. A relative told us. "[Person] gets to see the GP when needed and we are always told they have been seen or are going to be seen." However, we noted from people's care records that they did not have regular have access to other health professionals. A person told us,"I haven't been outside in such a long time. If someone is available they will take me out, but there is never anyone available."

Staff told us they reported any concerns with people’s health and wellbeing to the nurse or to the management team. However, we saw care records and daily notes did not reflect what staff were telling us such as people's past medical history, current medication or other health needs.

People's care records did not evidence they were involved in regular reviews of their health and wellbeing needs. There was a lack of activities to support people to promote their health and wellbeing. Some rooms, including bedrooms were not inviting and needed decorating. There was no signage within the home to orient people and to promote their independence. Not providing people with personalised care and a clean environment can have a negative impact on people’s health and wellbeing.

People we spoke with did not give any direct feedback regarding monitoring and improving outcomes. However, they did confirm they had not had any input into the reviewing of their care plans. Therefore, we were not assured people were supported to achieve positive outcomes which were meaningful to them.

Staff told us they were not always informed of peoples changing needs in a way that was effective. Staff told us they did not have regular handovers of people’s changing needs and we could not be assured that staff were being given up to date information or was documented in care records.

Care plans lacked person-centered details, focusing primarily on individuals' needs rather than personalised considerations. Identified outcomes, where present, contained minimal person-centered information and were not subject to regular review.

People gave mixed feedback on whether staff asked for and respected consent before providing care. People told us, “I do get asked about a shower and they do listen if I don't want one today, but they always try again later” and, “Oh yes, every time I get asked.” However, a person said, “I don’t get a choice about getting a shower, they just come in and make me go.”

Staff told us they did not have an effective handover at the start of their shift, which meant they were not always aware of people’s changing needs or how best to support them. One staff member told us, “Handover doesn’t happen. We get told what side we are working and then get on with it. We get told some important stuff. We need handovers and they [the management team] are telling us they are going to long."

Systems and processes in place did not demonstrate that people understood care and support being offered. We were not assured people had been involved in making informed decisions in relation to their care. The provider was not always following the principles of the Mental Capacity Act. For people who lacked the capacity to make the decisions about their care, there was little evidence to demonstrate advocates or relatives had been involved in decision making. CCTV had been implemented throughout the public areas within the home however, there was no evidence of Mental Capacity Assessments and Best Interest decision meetings to ensure the decision was made in the best interest of the people living within the home.