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Inspection carried out on 19 February 2019

During a routine inspection

About the service:

Park View Nursing Home is a 'care home'. People in care homes receive accommodation and nursing 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. The home is registered to provide accommodation for up to 14 people with learning or physical disabilities. At the time of our inspection there were 13 people living at the service.

At the time of our inspection there was an experienced registered manager in post. 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.

Rating at last inspection:

At our last inspection of the service on 1 July 2017 we rated the service overall as 'Good' and 'Requires Improvement' in Effective. The service at that time was not consistently effective. Further improvements were required with regard to how the principles of the Mental Capacity Act (20015) and Deprivation of Liberty’s Safeguards were applied.

During this inspection, we found that there were systems in place which ensured the service complied with the Mental Capacity Act 2005 (MCA 2005). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People’s experience of using the service:

Risks to people were assessed and managed safely. Medicines were managed, administered and stored safely. People were protected from the risk of abuse and staff knew what action to take to ensure people's safety.

Accidents and incidents were recorded and reported in a timely manner. There was evidence that they were monitored and lessons were learned and shared with staff appropriately.

There were safe staff recruitment practices in place and appropriate numbers of staff to meet people's needs in a timely manner. There were systems in place to ensure staff were inducted into the service appropriately. Staff received training, supervision and appraisals.

People's nutritional needs and preferences were met.

People had access to health and social care professionals when required and staff worked well with external agencies.

People were treated respectfully and staff ensured their privacy and dignity was maintained.

People's diverse needs were met and staff were committed to supporting people to meet their needs with regard to their disability, race, religion, sexual orientation and gender.

People were involved in making decisions about their care.

There was a wide range of activities available to meet people's interests and needs.

The service provided care and support to people at the end of their lives. People's needs were reviewed and monitored on a regular basis.

There were systems in place to monitor the quality of the service provided. People's views about the service were sought and considered.

Concerns were discussed relating to the cleanliness of some parts of the service. We saw evidence that the home had an action plan in place to address the issues identified in a recent audit. The provider gave assurance that the refurbishment programme would address the key concerns identified in this, relating primarily to new bathroom provision.

The provider worked in partnership with the local community and other professionals to ensure people received appropriate levels of care and support to meet their needs.

Why we inspected:

This planned inspection took place on 19 February 2019 and was unannounced.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information

Inspection carried out on 24 May 2017

During a routine inspection

We carried out an unannounced inspection of the service on 24 May 2017. Park View Nursing

Home is registered to provide accommodation and nursing care for up to 14 people with learning or physical disabilities. On the day of our inspection 13 people were using the service.

The service had a registered manager in place at the time of our inspection. 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.

Staff were aware of their responsibilities to protect people from avoidable harm. Staff had received adult safeguarding training and had information available of the action required to respond to any safeguarding concerns. The management team had taken appropriate action when safeguarding incidents had occurred to reduce further risks.

The process to assess and plan and monitor risks associated to people’s needs had been improved. One area was identified that required additional monitoring was the system in place to monitor pressure relieving mattresses. The registered manager took action to address this. People were not unduly restricted and accidents and incidents were recorded and monitored and action was taken to reduce further reoccurrence.

There were sufficient and experienced staff available to meet people’s needs and safety and staffing levels were flexible to meet people’s individual needs. Safe staff recruitment practices were in place and followed.

Improvements had been made to how prescribed medicines were managed and stored and this was found in line with best practice guidance. Body maps were not used to inform staff of the application of topical creams. The registered manager took immediate action to address this.

Staff received an appropriate induction and ongoing training and support. However, not all staff had received specific training in learning disability, mental health awareness and communication. The registered manager had already identified this and was taking action to provide staff with this training.

At the last inspection some concerns with regard to how the principles of the Mental Capacity Act 2005 (MCA) and Deprivations of Liberty Safeguards (DoLs) were applied. At this inspection some improvements had been made but further action was required to sustain these improvements.

People were supported to maintain their nutrition and their food preferences were known and understood. Staff were monitoring and responding to people's health conditions and worked well with external health and social care professionals.

Improvements had been made about the information available to staff about people’s communication needs. Staff were kind, caring and respectful towards the people they supported. They had a person centred approach and a clear understanding of people's individual needs, routines and what was important to them.

Whilst people did not have direct access to independent advocacy services people had been supported to access this services were required. The registered manager agreed to provide people with this information.

People were involved as fully as possible in their care and support. People received an opportunity of annual holiday of their choice. People were supported to participate in activities, interests and hobbies of their choice.

The provider enabled people who used the service and their relatives to voice their views and

opinions. The registered manager listened to what people had to say and took action to resolve any issues.

The provider had checks in place that monitored the quality and safety of the service. These included daily, weekly and monthly audits. The registered manager was approachable and recognised where improvements were needed in the service.

Inspection carried out on 26 July 2016

During a routine inspection

We inspected the service on 26 and 27 July 2016. The inspection was unannounced. Park View Nursing Home is registered to provide accommodation for up to 14 people with learning or physical disabilities. On the day of our inspection 11 people were using the service.

The service had a registered manager in place at the time of our inspection. 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.

Risks were not always assessed and planned for appropriately and medicines were not always managed safely. Seating in the service was not always clean.

People were supported by staff who knew how to recognise abuse and how to respond to concerns. People were supported by enough staff to ensure they received care and support when they needed it.

People were supported to make decisions but the Mental Capacity Act 2005 (MCA) was not always applied consistently in the service to protect people who did not have the capacity to make certain decisions. People were supported by staff who had the knowledge and skills to provide safe and appropriate care and support.

People were supported to maintain their nutrition and staff were monitoring and responding to people’s health conditions.

People's diverse needs and methods of communication were not always assessed or planned for. People and their relatives were involved in making choices about the care and support they received. People were supported by staff who cared about the individual they were supporting. People were supported to enjoy a social life.

People were involved in giving their views on how the service was run and there were systems in place to monitor and improve the quality of the service provided. The registered manager knew what improvements were needed in the service and were working towards these.

Inspection carried out on 21 and 22 January 2015

During a routine inspection

We inspected the service on 21 and 22 January 2015. Park View Nursing Home is registered to provide accommodation for up to 14 adults with learning or physical disabilities. On the day of our inspection 10 people were using the service.

The service had a registered manager in place at the time of our inspection. 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.

People felt safe in the service and staff and the manager shared information with the local authority when needed. However allegations were not always investigated appropriately and there were not always enough staff to support people in an emergency.

People were supported by staff that had not always had all of the checks needed to ensure they were safe to work with vulnerable adults. This was in breach of regulation 21 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 19 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 were supported by staff who had the knowledge and skills to provide safe and appropriate care and support.

The Deprivation of Liberty Safeguards (DoLS) is part of the Mental Capacity Act 2005 (MCA) which is in place to protect people who lack capacity to make certain decisions because of illness or disability. DoLS protects the rights of such people by ensuring that if there are restrictions on their freedom these are assessed by professionals who are trained to decide if the restriction is needed. The manager had made the required applications and people were supported by these safeguards.

People were supported to maintain their nutrition. Referrals were made to health care professionals for additional support or guidance if people’s health changed.

People were treated with dignity and respect and had their choices acted on. We saw staff were kind and caring when supporting people. However they could not be assured that staff would support them appropriately with their behaviour or that information about their care would be stored confidentially.

People enjoyed the activities and social stimulation they were offered. People also knew who to speak with if they had any concerns they wished to raise and they felt these would be taken seriously.

People were involved in giving their views on how the service was run through the systems used to monitor the quality of the service. Audits had been completed that resulted in the manager implementing action plans to improve the service.

Inspection carried out on 29 October 2013

During a routine inspection

People told us they were able to make choices about their care and treatment. People's privacy and dignity was respected by staff. We saw that the way people preferred to be cared for was documented in care plans.

People told us they were happy with the care and support staff delivered. One person told us, “I am happy here.” Another told us, “It’s alright here. They [staff] look after me well.”

People's needs in relation to nutrition were documented and we saw staff supporting people in accordance with this. People were provided with a choice of suitable and nutritious food and drink. One person told us about their favourite foods and said they were able to eat them in the home.

We observed positive interactions between staff and people using the service. There was a relaxed atmosphere and we saw that people using the service were comfortable talking to staff and managers. We spoke with three people who all told us they liked the staff. One person said, “The staff are lovely”.

Appropriate checks had been undertaken before staff began working in the home.

None of the people we spoke with had any concerns about the service. One person said, “I am happy and if I wasn’t I would tell them [the staff].”

Inspection carried out on 2 April 2013

During an inspection to make sure that the improvements required had been made

We observed staff interacting with people and we saw they were respectful and patient. Our observations showed people were being supported to make choices about their care and support. One person chose to spend the day in their room and staff supported this.

We spoke with two people using the service and they both told us they were happy with the care they were receiving. One person said, “I like it here. The staff are good and look after me.”

We looked at the records being kept in relation to people’s care such as food and fluid intake charts, re-positioning charts and daily notes. We found that generally staff were recording appropriately and describing the care people were receiving in detail.

Inspection carried out on 20 February 2013

During an inspection to make sure that the improvements required had been made

We issued a warning notice after our previous inspection on 9 January 2013. We found that proper steps had not been taken to ensure that each service user was protected against the risks of receiving care or treatment that was inappropriate or unsafe, by means of the carrying out of an assessment of the needs of the service user. We also found that the planning and delivery of care and, where appropriate, treatment did not always meet the service user's individual needs or ensure the welfare and safety of the service user.

We carried out this inspection to check the required improvements had been made. We found there had been improvements to the way care was being assessed and planned for. However we found there were further improvements needed. For example the care plans of one person did not give staff clear instructions on how to manage a health need of this person. This meant if the person needed emergency medical help it may not be sought in a safe timescale.

We spoke with two people using the service and asked them if they were happy living in the home and they both told us they were. We asked if they felt the staff cared for them well and they both told us they were happy with the care. We also saw two people joined in a baking activity where staff supported them to make cakes. One person told us they liked baking and they had also baked biscuits in the past.

Inspection carried out on 9 January 2013

During an inspection to make sure that the improvements required had been made

Since we last inspected the service two people, who could not communicate verbally had a picture card communications book in place. The pictures were being used to help these two people to make decisions and also to communicate to them the care and support staff were going to provide. However we still had concerns about this outcome due to the undignified way some staff referred to peoples behaviour.

Some improvements had been made in relation to the care people were receiving since we last visited. However we still had concerns about the care and treatment some people using the service were receiving. For example, one person had a health care need which was not being monitored or managed safely and this put the person at risk.

We were not intending to inspect this outcome but we saw evidence which gave us concern about the quality of records in the service. For example staff were not recording the actual times a persons health need was monitored. This meant the records were not fit for purpose.

Inspection carried out on 27 November 2012

During an inspection to make sure that the improvements required had been made

We saw from the care plans of two people that they had difficulty in communicating their needs and choices. During our visit we did not see staff attempting to use picture cards or objects of reference to support people to be involved in decisions about their care.

We saw examples of where staff did not respect peoples choices, dignity or independence. We saw one member of staff wipe a person’s face after they had finished eating. They did not speak to the person or explain what they were doing. This could have caused some alarm to the person, who did not have any verbal communication.

We saw from accident records that one person had fallen twice since our last visit and on both occasions the importance of the person wearing well fitting slippers or shoes had been recorded. Despite this we observed the person was wearing slippers which were far too big for them and this created the risk of a further fall.

We saw evidence that the registered manager and staff were responding to incidents and unexplained injuries appropriately and were informing the safeguarding vulnerable adult’s team.

We saw that all staff had received at least one supervision and some had received two. The records showed the manager had followed up and concerns about staff practice and recorded the actions needed to improve.

Inspection carried out on 28 September 2012

During a routine inspection

People we met told us that they were happy living in the home. Detailed information about people’s care needs were kept and appropriate arrangements were in place for recording medicines. Medicines were stored safely.

Inspection carried out on 13 August 2012

During an inspection to make sure that the improvements required had been made

As some of the people using the service were unable to communicate verbally we

were accompanied by two experts by experience. One of these experts is a person who uses services and specialises in observations of people in residential settings.

We sat in a communal dining area on the ground floor throughout the duration of the inspection and observed the care being delivered to people living at the service. This was because most of the people who live on the ground floor would find it difficult to help us understand their views about the quality of the care being provided to them. We looked at how staff interacted with people and how care was being provided to support people with their needs.

Our observations were more positive than the last time we visited. We saw people’s privacy and dignity was respected with bedroom doors being closed when people were in bed or in their room. When staff supported people with personal care they made sure the door was closed first and we saw staff knock on doors prior to entering.

We asked two people using the service if they felt safe. They both said they did and when asked what made them feel safe one said, “the staff.” When asked what they would do if they were worried about anything both people indicated they would talk to the manager or the owner.

Throughout our observations we saw most of the staff provided regular drinks for people to make sure their health was maintained and we saw that they had an understanding of people’s particular needs (for example we saw staff use thickeners in drinks for people who needed this.) We also saw a variety of adapted crockery and cutlery was in use to ensure people could retain their skills and independence when eating and drinking wherever possible.

However, people's capacity to make decisions about their care or treatment was not always assessed in line with legislation. There had been instances where concerns in relation to staff practice had not always been followed up by the manager in the appropriate way.

We received positive comments about most members of staff from people using the service during our visit. One person said, “I think they are alright.” Another said, “I like them, they are really nice.”

The registered provider was at the home during our visit. We observed him interacting with the people using the service and it was apparent they felt comfortable and relaxed with him. One person said, “He (the registered provider) is nice, he always talks to me and asks how I am.”

Inspection carried out on 20 June 2012

During a routine inspection

As some of the people using the service were unable to communicate verbally we were accompanied by two experts by experience. One of these experts is a person who uses services and specialises in observations of people in residential settings.

We sat in a communal dining area on the ground floor throughout the duration of the inspection and observed the care being delivered to people living in the upstairs unit.

We saw that staff would routinely sit apart from people living at the service and have frequent conversations with each other rather than sitting and interacting with people. We saw staff routinely spoke about people living at the service without discretion in communal areas. This practice was prevalent amongst all staff observed. This compromised people’s rights to confidentiality and did not demonstrate respect for people’s privacy and dignity.

We observed many occassions where peoples privacy and dignity were not respected. Some people were in bed in their nightwear and their bedroom door was propped open with other people using the service able to see them in bed. One person was assisted to dress and the staff member assisting had not closed the door and other people could see the person in a state of undress.

We saw that people did not always have the opportunity to make choices about their care and staff did not use any alternative methods to communicate with people who could not communicate verbally.

We saw that some staff did not react properly when people displayed challenging behaviour. Some incidents and injuries had not been referred to the appropriate external agencies. This did not protect people from the risk of abuse in the home.

During our visit, we received positive comments about most members of staff from people using the service who lived upstairs. One person said, “they are great, I get on with most of them, they make me laugh.” Another said, “staff are alright here, I get on with them OK.” However our observations did not always support these views. We did not always see staff treat people with dignity or respect. Staff did not always deliver care safely in line with people's assessed needs.

We observed there was generally a good rapport between staff and people using the service on the upstairs unit. People appeared comfortable with some staff and confident to approach them.

We saw that staff were not always following the guidance set out in peoples care plans and this put them at risk on unsafe care and treatment. One person sat in the same position for eight hours without being assisted to the toilet. This did not reflect instruction in their care plan, which said they were at high risk of developing a pressure sore. This means staff were placing the person at risk of developing a pressure sore.

Although there were some trips out for people and an annual holiday, there were not many activities for them to do when they were in the home. People didn't do much apart from watch television and listen to music.

We found evidence the registered provider did not have an effective system in place to monitor the quality of service people recived in the home. This means the concerns we identified were not identified by them or acted on to improve the service.

Reports under our old system of regulation (including those from before CQC was created)