Park View

Park View provides accommodation with personal care for up to 64 people. The home has three floors which each have communal lounges and dining areas and there are pleasant enclosed gardens which are accessible from the ground floor. At the time of this inspection, 57 people lived at the home, some of whom had dementia.

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

Governance systems and checks provided monitoring and oversight of the quality and safety of care people received. However, some improvements were needed to ensure a consistently open culture within the home. Issues around adherence to policies and procedures and confidentiality had impacted on the confidence of some staff in the effective management of concerns. The provider acknowledged these issues and had plans to assure staff they were being listened to and action taken.

Despite this, people, relatives and staff spoke positively about the standards of care within the home. The registered manager was described as visible and supportive and clear in their expectations of the staff team. The registered manager had a service improvement plan which was monitored by the provider to ensure people experienced the best outcomes.

There were enough suitable staff on duty who had been recruited safely. Staff were trained in safeguarding and understood their responsibilities to identify and report any concerns. Risks to people’s health and wellbeing had been identified, assessed and were managed well. People received their medicines as prescribed, and staff followed good infection control practices.

Staff had the skills, knowledge and experience to deliver effective care and support. Throughout our inspection they explained and demonstrated how they implemented their training to support people who experienced episodes of distress or anxiety. 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.

Risks around people’s diet and nutrition had been identified and staff understood the value of providing a good mealtime experience to encourage people to eat and drink well and enjoy the companionship of others. Staff supported people to maintain their health through regular appointments or timely referrals with other healthcare professionals.

The registered manager was aware of their responsibility to be open and honest when things went wrong, and any learning identified was shared with the staff team.

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 this service was good (published 30 November 2018).

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding and understanding of the Mental Capacity Act 2005. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and effective section of this full report.

The overall rating for the service remains good based on the findings of this inspection.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Park View on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Park View provides accommodation with personal care for up to 64 people. The home has three floors which each have communal lounges and dining areas and there are pleasant enclosed gardens which are accessible from the ground floor. At the time of this inspection, 55 people lived at the home, some of whom were living with dementia.

People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

A requirement of the services’ registration with us is that they 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. At the time of this inspection the home had a registered manager in post.

We last inspected this service in December 2017 and found improvements were required in the safety of the service and how well led the service was. The overall rating of the service was Requires Improvement.

As part of this inspection, we looked to see whether the provider had made the required improvements. We found they had, and improvements made by the registered manager and provider ensured people received a safe, effective, caring, responsive and well led service. At this inspection we gave a rating of Good.

The registered manager had been in post for 12 months at the time of our inspection visit. Staff told us the home had improved in that time because they now had a consistent management team. People and staff told us the registered manager was visible in the home, understood the needs of the people who lived there and responded to any concerns raised.

There were enough staff to provide safe care. Staff told us they worked well as a team, because they were allocated specific responsibilities by the care team manager while they were on duty. The suitability of staff was checked during recruitment procedures to make sure they were safe to work at the home. New staff were appropriately introduced to the home and later had regular refresher training and were supported to develop their skills and to obtain nationally recognised qualifications.

People’s individual risks were assessed and care plans were written to minimise the identified risks. When accidents did happen, there was a process to analyse what had happened to ensure appropriate action had been taken and minimise future risks.

The environment was supportive of people's needs. The home was clean and tidy, and staff had received training to understand how to reduce the risk of infection being transmitted from one person to another.

The registered manager and care staff understood the principles of the Mental Capacity Act 2005 (MCA) and how to put these into practice. Staff promoted the rights and choices of people who lived in the home by offering them the opportunity to make decisions about their daily lives.

People’s nutritional and healthcare needs were assessed and kept under review. People had sufficient to eat and drink during the day. Healthcare professionals visited people regularly to review their care and treatment. Managers and senior staff completed audits and stock checks of medicines to ensure people had received their medicines as prescribed.

Staff received training in dementia awareness and dignity and respect, which enabled them to understand people’s complex needs and to support them with empathy and compassion. Staff took care to ensure they had positive interactions with people as they carried out their roles. People were encouraged to maintain their interests and to socialise.

The provider and management team checked the quality of the service people received and implemented improvements.

At the last inspection on 14 November 2016, the service was rated as requires improvement. This was because we found a lack of managerial oversight by the provider and the management did not operate effective audit systems to drive improvements within the service. We found monitoring of people’s food and fluid intake was not always consistent with what they had consumed. Actions were not always recorded to show how people were supported and audit systems had not identified this as a concern.

Following the last inspection visit, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Effective and Well led to at least good.

This inspection visit was a comprehensive inspection and during this inspection we checked to make sure improvements had been made. Whilst some improvements had been made, we found some improvements were still needed in their audit systems because they had not identified some of the improvements we found.

Park View is a care home registered to provide care to 64 people. People in care homes receive accommodation and nursing and/or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our inspection visit, 54 people lived at the home.

A requirement of the service’s registration is that they 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 and the associated Regulations about how the service is run. At the time of our inspection visit there was no registered manager in post. The registered manager had left the service in July 2017. Since then a manager has been in post, and in December 2017, had applied to become the registered manager at the home.

People told us they felt safe at the home, because they felt safe with the staff who supported them. Staff had received training so they understood what might constitute abuse and the action they should take to safeguard people if they had any concerns.

The provider used recognised risk assessment tools to identify any risks to people’s health and wellbeing. Staff knew how to support people to reduce identified risks to people. However, some risks to people had not always been mitigated to prevent further risk,

People told us their needs were met because they were supported and cared for when needed. People were complimentary of the staff and said staff were kind, caring and considerate in their approach. People spoke positively about the friendliness and willingness of staff to help them.

People told us they had a choice of meals and could eat in the dining room or their own bedroom, according to their individual preference.

People’s privacy and dignity was respected and staff knew how to maintain this to prevent people feeling uncomfortable. Staff promoted people’s choices and independence which gave people a sense of worth and ownership in how their care was delivered.

The home was clean, free of odour and staff wore personal protective equipment (PPE) at the necessary times. Regular spot checks and effective monitoring ensured standards of cleanliness were maintained.

People told us they would feel happy to raise any concerns or complaints and they knew how to do this and expected timescales regarding a response.

There were enough staff who were available to provide people’s care and support at times people preferred. Staff respected people’s privacy and dignity and people felt comfortable when staff supported them to maintain their health and wellbeing.

Medicines were administered safely and people received their medicines as prescribed. Time critical medicines were given at the required times and PRN protocols ensured staff provided those medicines as and when required, safely.

The audit systems required improvement to ensure actions led to improvements. We found examples where food and fluid charts were incomplete, but we satisfied action was taken to support them if a concern was known. Where checks were delegated to others, there needed to be greater scrutiny to ensure improvements to the delivery of service were made.

Recent management changes meant not everyone knew who was the permanent manager, however people were complimentary of the manager and their approach. The manager was committed to improve the service and wanted people’s experiences to be positive. The manager gave us a commitment that actions would be taken. When we discussed improvements with the manager, when we returned on the second day, an action plan was in place to improve the standards within the home.

The registered manager had submitted a Provider Information return (PIR) to us, they and the provider understood their legal responsibility to notify of us of important and serious incidents. The provider displayed a copy of their previous inspection rating.

Further information is in the detailed findings below.

Park View is a residential home which provides care to older people including some people who are living with dementia. Park View is registered to provide care for up to 63 people. At the time of our inspection there were 55 people living at the home.

This home was last inspected in October 2015 and was rated as ‘requires improvement’. We found two breaches of the regulations relating to unsafe staffing levels and unsafe care and treatment. At this inspection we found improvements had been made, although we found some improvements where required in the management and governance within the home.

The registered manager had quality monitoring processes which included audits and checks on medicines management, care records and accidents and incidents. However, when some checks were delegated to others, improvements did not show what action, if any, had been taken to improve the delivery of service. We could not be confident statutory notifications involving serious incidents and safeguarding concerns had been sent to us.

The home is required to 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 and associated Regulations about how the service is run. At the time of this inspection the home had a registered manager, however they were leaving the service at the end of November 2016. A new manager had been appointed and was receiving a handover from the registered manager. The new manager told us they would be applying to us to become registered manager.

People and relatives were complimentary about the care and support they received. People received care that enabled them to live their lives as they wanted and people were supported to remain as independent as possible. People were supported to make their own decisions where possible and care was given in line with their expressed wishes.

Care plans contained accurate and relevant information for staff to help them provide the individual care people needed, although some care plans required updating when people’s needs changed. People’s care and support was provided by a staff team who were knowledgeable, trained and knew people well.

People were encouraged and supported by a caring staff team. People told us they felt safe living at Park View and staff knew how to keep people safe from the risk of abuse. Staff understood what actions to take if they had any concerns for people's wellbeing or safety and if so, they had reported them to senior management. However, we found two examples of potential safeguarding incidents that the provider had not reported to us.

Potential risks were considered positively so that people did things they enjoyed. People were encouraged to maintain relationships and kept in touch with those people who were important to them.

Staff received essential training to meet people’s individual needs, and effectively used their skills, knowledge and experience to support people and develop trusting relationships.

There were enough staff to support people and the permanent staff team were being supported by agency staff whilst the provider continued to recruit to fill care vacancies. Improvements in shift management and staff tasks would help ensure people continued to receive a prompt and effective service.

The registered manager and staff understood their responsibilities in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity, staff’s knowledge and people’s records ensured people received consistent support when they were involved in making more complex decisions, such as decisions around finances or where they wanted to live. Staff gained people’s consent before they provided care and supported people to retain as much independence as possible.

People were supported to pursue various hobbies and leisure activities and further improvements were being made with the support of the dementia service manager.

People had meals and drinks that met their individual requirements and people said they enjoyed the food choices provided.

People told us they could raise concerns or complaints if they needed to because the provider, registered manager and staff were available and approachable.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People who lived at the home told us, 'Very nice here, they are nice to me.'

We saw staff were kind and attentive when they delivered care to people. We saw people were supported and encouraged to maintain their independence.

We looked at three people's care records and saw their care plans reflected some of their personal needs.

We saw that people were provided with a good choice of food and they told us they were happy with the choices available to them.

We spoke with three staff members about what they thought abuse was and they showed they had a good awareness of the importance of keeping people safe. They understood their responsibilities for reporting any concerns regarding potential abuse.

Care staff had received training to enable them to look after people safely. We saw some of the staff had a formal meeting with the manager.

We found the service had good systems in place to monitor the quality of service provided at Park View.