Park View Care Home

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

People felt safe and systems were in place to support staff to maintain safety across the home. People and their relatives commented on the kind, caring and compassionate nature of staff. The atmosphere and culture at the home had improved.

Medicines were generally managed well. We have made a recommendation regarding medicines record keeping.

Domestic staff maintained a clean and tidy service. Staff followed infection control procedures.

Enough staff were in place and less agency staff were used. Robust recruitment procedures were followed and there was a continuous recruitment drive in place.

Activities had improved and this was being kept under review by the provider and registered manager.

Care plans were in the process of being updated and fully reviewed. Monitoring charts in relations to people’s care were not always completed fully. We have made a recommendation about this.

Quality monitoring checks had improved. These were to be further reviewed after feedback given.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 23 November 2022) and there were breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended the provider review activities to ensure they met the needs of every person. At this inspection we found the recommendations had been acted upon and improvements had been made.

Why we inspected

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions, Safe and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

For the key question of Caring, Effective and Responsive which was not inspected, we used the rating awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed to good. This is based on the findings at this inspection.

At our previous inspection published 23 November 2022, we were aware of a notification of an incident, following which, a person using the service sustained a serious injury. This incident is still subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. We did, however, check the overall management of risk as part of 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 COVID-19 and other infection outbreaks effectively.

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

Recommendations

We have made two recommendations. The provider should further review medicines record keeping and review record keeping in relation to monitoring of people’s care to ensure they are fully completed in line with best practice.

Follow up

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

Park View Care Home is a residential care home providing personal care to up to 65 people in a purpose-built building. The service provides support to older people including those who may be living with a dementia and/or a physical disability. At the time of our inspection there were 56 people using the service.

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

Medicines were not always managed safely. Monitoring of people’s care records was not always maintained well.

Monitoring processes associated with risks people may face were not robust, this included monitoring checks on people’s food and fluid and safety in the garden area.

Quality assurance checks and audits had not always found the issues we raised during the inspection, or when they had, issues continued.

Infection control procedures were safe, and the home was kept clean and tidy.

People felt safe and enjoyed living at the home. People and relatives were very complimentary about the kindness and caring attitude of the permanent staff team.

There was enough staff, although agency staff had to be used at times due to shortages. Recruitment procedures were good.

Activities were limited; however, the provider was reviewing this. We have made a recommendation about this.

Accidents and incidents were reported but we have asked the provider to review this after staff indicated some incidents were not always reported.

We received mixed views about the culture of the service relating to the management of the home. This was shared with the provider and a communication plan was put in place.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was good (published 6 October 2021).

At our last inspection we recommended the provider kept infection control and corresponding records under review, to ensure best practice was followed and recorded. At this inspection we found the recommendations had been acted upon and improvements had been made.

Why we inspected

The inspection was prompted due to concerns received about the care people received, staffing concerns and the culture at the service. A decision was made for us to inspect and examine those risks.

We were also aware of a notification of an incident, following which, a person using the service sustained a serious injury. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk at Park View Care Home. This inspection examined those risks.

As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 COVID-19 and other infection outbreaks effectively.

For the key question of Caring, Effective and Responsive which was not inspected, we used the rating awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed to requires improvement. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to medicines management, risk management and quality assurance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Park View Care Home provides accommodation and personal care for up to 65 people; some of who were living with a dementia related condition. There were 62 people living at the home at the time of our inspection.

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

There was a system in place to manage risk. However, there were several outstanding actions highlighted in the fire safety officer’s report from 2017. The provider wrote to us after our inspection and confirmed that all necessary fire safety actions had been completed.

Action had been taken to improve in relation to infection prevent and control (IPC); however, further action was required to ensure best practice was followed. We have made a recommendation about this.

A system was in place to monitor the quality and safety of the service. We have made a recommendation that the provider reviews their monitoring system to ensure it effectively assesses and identifies risk in order that timely action is taken when any shortfalls are identified.

Systems were in place to manage medicines safely. A specific medicines incident occurred following our visit to the home. Lessons learned were identified and the provider told us action had been taken to help ensure there was no reoccurrence.

People’s needs were met by the number of staff on duty. Safe recruitment procedures were followed.

Staff spoke positively about working at Park View Care Home and the people they supported. People also said they enjoyed living at the home. One person told us, “It’s nay bother here. It's good - the food, staff, everything is good, we are looked after well. They are very pleasant.”

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 12 February 2021). We carried out a focused inspection of this service on 15 December 2020. We identified two breaches of the regulations relating to safe care and treatment and good governance. We took enforcement action and imposed conditions relating to IPC upon the provider's registration.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, sufficient action had been taken to improve. The provider was no longer in breach of the regulations and we have removed the conditions relating to IPC from the provider’s registration.

Why we inspected

We undertook this inspection to confirm they now met legal requirements. This report only covers our findings in relation to the key questions of safe and well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has improved to good. This is based on the findings at this inspection.

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

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.

Park View Care Home provides accommodation and personal care for up to 65 people; some of whom have a dementia related condition. There were 57 people living at the home at the time of our inspection.

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

Government guidance relating to safe working practices including the management of waste and the use of personal protective equipment (PPE) was not always followed by staff. An effective system to assess and monitor infection control and other aspects of health and safety was not fully in place.

People’s needs were met by the number of staff on duty. Staff told us they had worked hard as a team to help ensure people received appropriate care and support. Safe recruitment procedures were followed.

Medicines were managed safely. Staff were knowledgeable about safeguarding procedures and raised no concerns about people's care and support.

The service had been through a difficult period due to the Covid-19 pandemic. Staff spoke positively about working at the home and the people they supported. We observed positive interactions between staff and people.

The registered manager and provider took action to address the concerns we raised. The nominated individual and registered manager were open and honest and told us that improvements had been made and lessons had been learnt following our inspection.

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 25 January 2018).

Why we inspected

We undertook a targeted inspection to look at infection control. However, we found shortfalls with infection control, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified two breaches of the regulations relating to safe care and treatment and good governance. Please see the action we have told the provider to take at the end of this report.

Follow up

We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Park View Care Home can accommodate up to 65 people in one adapted building across three floors. At the time of the inspection 59 people were resident, some of whom were living with a dementia.

We last inspected Park View Care Home on 29 July 2015 and rated it good overall. During this inspection we found Park View Care Home continued to be ‘good.’

People and their visitors were very complimentary about the caring nature of the staff team. We were told people were well cared for, respected and treated with dignity. We observed warm and compassionate relationships between people, visitors and the staff.

There was a culture of mutual respect across the staff team and management. Senior management were positive about the team approach. The registered manager was supported to develop the team and improve the quality of the care and support provided.

Staff understood how to safeguard people from abuse, and were able to explain circumstances which would lead them to raise concerns. Complaints were recorded and investigated and people told us they would be comfortable raising any concerns. Accidents and incidents were logged and analysed, and action had been taken to minimise the risk of reoccurrences. Lessons were learnt in relation to concerns and new systems had been introduced to improve the quality of the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; policies and systems in the service support this practice.

A new chef was in post and work was being completed with people to develop a new menu to ensure they received a well-balanced diet, which also met their preferences.

Medicines were managed safely.

Staff worked with other health care professions to ensure people received ongoing health care. Advice was included within care plans and people and visitors told us GP’s were accessed when needed.

People and visitors told us they were involved in care planning and making decisions about the care they would receive. Care records were personalised and included information on people’s life history, preferences, interests and hobbies. This information was used by the activities co-ordinators to develop activities that were of particular interest to people.

Ensuring people received appropriate and respectful end of life care was important to the staff team. The deputy manager explained how important it was that people’s wishes were respected and that the person and their family were well supported.

Risks were appropriately assessed and people were supported to take positive risks such as playing football. Environmental risks were assessed and appropriate measures were in place to prevent and control infection.

A refurbishment plan was in place to develop each floor and ensure the environment was suitable to meet people’s needs. This was especially important for those people living with a dementia. People told us they had been included in the decision making about the décor and were able to personalise their rooms as they chose to.

Staffing levels were maintained above the ‘safe’ level indicated by the dependency tool. Recruitment processes were robust and people living at Park View Care Home were included in interview panels and making decisions about employing new staff.

There was a shared vision for the future of Park View Care Home, which included the ongoing provision of high quality, person centred, specialist care and support. People, their relatives and staff were engaged and involved in service improvement. The governance framework was effective in driving improvements.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

Below is a summary of what we found;

Is the service caring?

This was a responsive inspection to previous non-compliance against the regulations and we did not look specifically at this area.

Is the service responsive?

This was a responsive inspection to previous noncompliance against the regulations and we did not look specifically at this area.

Is the service safe?

People told us they felt safe and secure living at the home. People were protected against the risks associated with the use and management of medicines. They received their medicines at the times they needed them and in a safe way. Medicines were kept safely.

Is the service effective?

This was a responsive inspection to previous noncompliance against the regulations and we did not look specifically at this area.

Is the service well led?

The manager at the service was registered with the Commission as the manager of this location in line with the requirements of the registration of the service.

We considered all the evidence we had gathered under the regulations we inspected. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we have found.

Is the service safe?

We found that the service was not safe because people were not protected against the risks associated with the use and management of medicines. Whilst we saw some improvements since our last visit, there were still some issues which meant that people did not receive their medicines at the times they needed them and in a safe way. Medicines were not obtained, administered and recorded properly.

The provider had systems in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.

We saw risk assessments had been completed for people who were assessed as being at risk of falls.

We saw people were safe and protected from abuse. Staff demonstrated to us an understanding of the types of abuse and how they should be reported. All staff had received training in the safeguarding of vulnerable adults and whistleblowing.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw policies and procedures were in place which related to the Mental Capacity Act 2005 (MCA) and DoLS.

We saw there were sufficient members of suitably qualified and experienced staff on duty to meet people's needs.

We have taken enforcement action against the provider and told them that they must improve in this area. We will return to the service to ensure that changes in service provision are made.

Is the service effective?

We saw that people's general care needs were addressed and that they had appointments with dentists, chiropodists and opticians. We noted that were people's care needs changed then action was taken and care plans were updated to acknowledge this change.

People who used the service were asked about the support they received and if they understood their rights. People we spoke to were aware of their rights and what to do if there were any problems.

Is the service caring?

People's preferences, interests and needs were recorded in their care records. Staff were able to give examples of these when we spoke with them and displayed a good knowledge of the people living at the home and what their likes or dislikes were.

People's health and care needs were assessed with them and they were involved in this process.

Is the service responsive?

There was a system in place to record and monitor complaints. Complaints were taken seriously and responded to appropriately.

We saw evidence that care staff identified changes in people's needs and acted to make sure they received the care they needed. For example, there was evidence that where one person's health had declined an immediate referral was made to the correct medical professional for advice and support.

Is the service well led?

There was a registered manager in place at the service. The staff we spoke with were aware of the complaints, safeguarding and whistle blowing procedures. Staff told us they would immediately report any concerns they had about poor practice and were confident these would be addressed.

The service had a quality assurance system in place that included the use of surveys from people who used the service.

Overall we saw the provider did not have effective systems in place to manage medicines. We found that medicines were not always safely handled and improvements are needed.

We found improvements had been made and the provider had taken appropriate measures to reduce the risk of the spread of infection.

The premises had been improved and people were provided with facilities that met their needs.

The provider had carried out the necessary repairs to provide people with safe and suitable equipment.

We found that people were provided with a choice of suitable and nutritious food to meet their individual needs.

The provider did not have adequate systems in place to reduce the risks of infection to protect people's health and safety.

Appropriate measures were not in place to ensure the premises were well maintained throughout to provide people with a suitable place to live.

Some equipment in the home was out of order so some people were not provided with appropriate equipment to meet their needs.

An effective recruitment procedure was in place to ensure people were cared for by staff who were appropriately qualified and trained to meet their needs.

We found the provider had an appropriate system to deal with comments and complaints.

The people staying in the service and the visitors we met during the visit were very positive about the way that the home was managed. Comments included: 'It's really nice, you have your own privacy' and 'The staff are all very pleasant and the amenities are good.'