Archived: Gorton Parks Care Home

Updated 13 September 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 10, 11 and 12 July 2017 and was unannounced. The inspection team consisted of three inspectors and an expert by experience on the first day. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert had experience of services for older people. One inspector returned for the second and third day of the inspection.

We did not ask the provider to complete a Provider Information Return (PIR) on this occasion. The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed other information that we held about the service including previous inspection reports and notifications. A notification is information about important events which the service is required to send us by law. We contacted the local authority commissioning and safeguarding teams as well as the local Healthwatch board and the Clinical Commissioning Group (CCG). The CCG commissions services for people requiring nursing care.

We had brought this inspection forward as we had been notified by the Manchester mental health team of a safeguarding allegation and had received information of concern from a ‘whistle blower.’ A whistle blower is a person who works or has worked at the service who raises concerns directly with the Care Quality Commission. These concerns and our findings are included in the main body of the report.

During the inspection we observed interactions between staff and people who used the service. As some people were not able to tell us about their experiences, we used the Short Observational Framework for Inspection (SOFI) during the lunch period in the lounge areas of the home. SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We spoke with ten people, five relatives, the registered manager, the clinical services manager, seven registered nurses and 14 care staff. We observed the way people were supported in communal areas and looked at records relating to the service. This included 13 care records, six staff recruitment files, daily record notes, medication administration records (MAR), maintenance records, quality assurance systems, incident and quality assurance records.

Updated 13 September 2017

We carried out an unannounced inspection of Gorton Parks Care Home on 10, 11 and 12 July 2017. This was the first inspection of Gorton Parks Care Home since it had been re-registered with the Care Quality Commission in January 2017. The re-registration had taken place as business entity to reflect changes to the providers named responsible people. This did not create any changes to the overall registration of the home. The home, under its previous legal entity, was inspected in April 2016. References throughout this report to ‘the last inspection’ concern this inspection.

Gorton Parks Nursing and Residential Home is owned by BUPA Care Homes. The service consists of four 30 bedded units; Melland House, Abbey Hey, Sunnybrow and Debdale. Part of the Debdale unit and a fifth unit on the same site are contracted to the NHS for re-ablement services for people discharged from hospital. They were not part of this inspection; being inspected by the CQC hospitals directorate. Each unit specialises in either nursing or residential care. Each unit has a lounge, dining area, a conservatory, a smoke room and a kitchenette. All bedrooms are single with no en-suite facilities. Accessible toilets and bathrooms are located near to bedrooms and living rooms.

The service had 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 registered manager was supported by a clinical services manager.

A new breach with regards to medicines was identified during this inspection. You can see what action we have told the provider to take at the end of the full version of this report.

Daily and weekly medicine monitoring sheets were in place to check that all medicines had been administered as prescribed. However we saw a weekly dose of one medicine had not been administered and this had not been noted by the monitoring process. The Bupa policies for missed doses had therefore not been followed. The registered manager instigated an investigation when we informed them of what we had found. Charts for the addition of thickeners to fluids and the application of creams were not fully completed so it was not possible to determine if they had been administered as prescribed.

A new breach with regards to activities was identified during this inspection. You can see what action we have told the provider to take at the end of the full version of this report.

There were few activities arranged to engage and stimulate people living at the home. One activity co-ordinators was on maternity leave and their hours had not been covered during this time. The activity co-ordinators in place worked across the four residential and nursing units. This meant they had very little time to arrange activities on each unit or engage in 1:1 activities with people who were nursed in bed.

People told us they felt safe living at Gorton Parks. Some relatives we spoke with said they thought their loved ones were safe at the service; however others said some people living at the service sometimes became aggressive towards them or their loved ones. Notifications had been made to the Local authority and the Care Quality Commission where required.

Care plans included details of people’s care and support needs. Risks had been assessed and guidance was provided for staff in how to reduce these, including how to support people whose behaviour may be seen as challenging. We saw that where appropriate people’s relatives had been involved in reviewing their loved ones care plans.

Daily notes were written for each person after each shift. These detailed the support a person had received.

A system was in place to recruit new members of staff. The reason for a gap in the employment history of one employee had not been recorded. New staff undertook a week’s induction and completed training, including safeguarding vulnerable adults, appropriate to their roles. Staff refresher training was being arranged and the number of courses had increased. Refresher training for challenging behaviour was required.

Staff said they felt well supported by the unit managers, clinical services manager and registered manager. Staff supervisions were held, although these were not as frequent as Bupa’s policy. Staff meetings were also held. Staff were able to contribute to discussions about the service and their training and development.

A new breach with regards to staffing levels and organisation around meals was identified at this inspection. There were sufficient staff to meet people’s support needs; however meal times on two units took a long time to complete, with people having to wait for support to eat their meal. The registered manager used a dependency tool to establish the number of staff required. We saw the staff on duty was above the number identified by the dependency tool.

We have made a recommendation to review the system used to handover information about people’s health and wellbeing to staff starting their shift. We found the handovers varied on each unit; however they were completed in communal areas or as walking handovers in the corridors which may mean that confidential information would be overheard by other people.

Staff knew people’s needs well. People and relatives said the staff were kind, respectful and supported them to make their own choices and complete tasks they were able to on their own. However we witnessed one staff member attempt to grab a person to prevent them from leaving the lounge area at lunchtime. This had been reported to the unit manger by a member of staff and they had promptly addressed the issue.

People were supported to maintain their health and nutritional intake. Records were kept were appropriate of what people had eaten and drunk. We saw referrals to relevant health professionals were made, for example to the Speech and Language Team, district nurses and GP’s.

We saw people were supported to make advanced decisions about the care they wanted at the end of their lives. Each unit had been accredited by the Six Steps programme for end of life care and support.

We found the service was working within the principles of the Mental Capacity Act (2005). Each person had a capacity assessment in place. Appropriate best interest decisions were in the process of being recorded.

All areas of the home were clean and there were no malodours on any of the units. Procedures were in place to prevent and control the spread of infection.

Regular checks of the firefighting equipment were made. Equipment was serviced and maintained in line with the manufacturer’s instructions. Checks on the water system had started to be carried out following a legionella risk assessment report.

A new breach with regards to governance was identified during this inspection. You can see what action we have told the provider to take at the end of the full version of this report.

Bupa has a number of quality assurance audits in place, including monthly care plan audits, medicines audits, monthly area manager audits, quarterly health and safety and infection control audits. However; issues identified during this inspection had not been identified by these audits. Only one of monthly area managers audit was available at the time of our inspection; therefore any issues identified could not be acted upon by the registered manager as they did not have sight of the audit.

Bupa also carry out surveys for relatives and staff. The registered manager told us they had not seen the results of the surveys. After the inspection we were informed the staff survey was in the process of being collated by the central Bupa department and the relative survey for 2017 had not been conducted as yet..

A number of night visits had been completed by the unit managers and clinical services manager. Unit managers were to start completing a night shift each month. These had been well received by the night staff who had commented that they made them feel more part of the team.

Systems were in place to record, investigate and respond to any complaints made to the service. All accidents and incidents were reviewed by the registered manager. A number of statistics were compiled for monitoring purposes, for example falls, pressure sores, nutrition, medicines errors, the use of bed rails and hospital admissions. This meant any trends or patterns of behaviour could be identified and action taken when necessary to keep people safe.