Park View Residential Home

Park View Residential Home provides accommodation and personal care for up to five people with mental health and learning disability support needs. At the time of our inspection there were four people who were receiving support.

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

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. This was because people’s choice, control and independence was not always promoted. Mental capacity assessments did not accurately reflect one person’s fluctuating capacity. Whilst best interest decisions on behalf of people were documented, records did not reflect if the action deemed appropriate was the “least restrictive”, in line with the principles of the Mental Capacity Act 2005.

The quality assurance systems where not robust enough to recognise improvements were needed to meet best practice guidance and legislation.

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 14 May 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 07 March 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the restrictions in place on people at the service and the promotion of people’s independence.

We undertook this targeted inspection to check they had followed their action plan and to confirm they now met legal requirements. Targeted inspections do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

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 coronavirus and other infection outbreaks effectively.

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 will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a further breach in relation to the lack of adherence to the principles of the MCA and the use of inappropriate restrictions.

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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The provider needed to improve how the service met the values of Registering the Right Support and other best practice guidance. Including promoting people’s choice, independence and inclusion and encouraging people to have control of their lives and lead interesting and enjoyable lives.

People’s experience of using this service:

People were safe at the service and they developed trusted relationships with staff.

People lived in a clean environment, there was a separate building which could be used for social occasions and activities.

Staff told us they received training and support to carry out their role. Staff felt supported by the registered manager.

Where people did not have capacity to understand and make decisions affecting their lives in line with the mental capacity act 2004, in some cases this had been taken into consideration. The manager had submitted a deprivation of liberty application, however there were other restrictions found at the time of the inspection which had not been considered.

Support plans and risk assessments were in place, these detailed the persons immediate support needs, as well as people’s goals and aspirations.

The service had quality assurance systems in place to monitor the care provided, However the system did not identify the area’s needing review that were found at this inspection.

Rating at last inspection: At our last inspection, the service was rated “good”. Our last report was published on 30th August 2016.

Why we inspected: This was a planned comprehensive inspection that was scheduled to take place in line with Care Quality Commission (CQC) scheduling guidelines for adult social care services.

Enforcement: At this inspection we identified a breach of the Health and Social Care Act

(Regulated Activities) Regulations 2014 around need for consent. As a result, the overall rating for this service is rated ‘requires improvement’.

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care.

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

The service provides care and support to people with learning disabilities and mental health conditions. Five people were being supported by the service at the time of our inspection.

During our inspection in June 2014, we had found the provider needed to improve the quality of the food provided to people who used the service and that records were not always up to date. This had been followed up in 2015 and at this inspection, and we found they had made the required improvements.

There was a 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.

There were risk assessments in place that gave guidance to staff on how risks to people could be minimised. There were systems in place to safeguard people from risk of possible harm. The provider had effective recruitment processes in place and there was sufficient staff to support people safely.

Staff received regular supervision and they had been trained to meet people’s individual needs. They understood their roles and responsibilities to seek people’s consent prior to care being provided. Where people did not have capacity to consent to their care or make decisions about some aspects of their care, this was managed in line with the requirements of the Mental Capacity Act 2005 (MCA).

People were supported by caring, friendly and respectful staff. They were supported to make choices about how they lived their lives. People had adequate food and drinks to maintain their health and wellbeing. They were also supported to access other health services when required.

People’s needs had been assessed, and care plans took account of their individual needs, preferences, and choices. They were involved in reviewing their care plans and were supported to pursue their hobbies and interests.

The provider had a formal process for handling complaints and concerns. They encouraged feedback from people who used the service, their relatives, and other professionals, and they acted on the comments received to improve the quality of the service.

The provider’s quality monitoring processes had been used effectively to drive continuous improvements. The manager provided stable leadership and effective support to staff. They also promoted a caring culture within the service.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

A person we spoke with all said that they felt safe living at the home and that their privacy and dignity was respected by staff. We saw evidence that risk assessments had been undertaken to help minimise the risk to people living at the home. The home had a complaints policy and procedure in place, which was user friendly.

We found one food item which was out of date and some food was not being stored in a way which would ensure that people consumed food which was safe.

We have asked the provider to tell us how they will become compliant with the regulation which relates to meeting nutritional needs.

Is the service effective?

We looked at the care records of three people who lived at the home. We found these provided details of what support people needed. We noted that people who had the capacity to make decisions were involved in the care planning process. However, we found that the home had not demonstrated that they involved other professionals such as social workers or advocates in cases where people could not fully participate in their care planning process.

We also noted that care plans did not always record important information such as why food had been locked away. Medication audit and surveys were not available on the day of our inspection. We have asked the provider to tell us how they will become compliant with the regulation relating to records.

The provider had a clear protocol in place for dealing with Deprivation of Liberty Safeguarding (DoLS). We saw evidence that staff had received training in the Mental Capacity Act (MCA) and in the DoLS.

Is the service caring?

A person we spoke with stated that staff were caring and helpful. We observed staff interaction we people and we were able to see that staff acted in a caring and supportive manner.

Is the service responsive?

We saw evidence that people were supported to attend medical appointments. Relatives where appropriate had been informed of any changes to people's care and support.

Is the service well-led?

People expressed their satisfaction with the service they received. We found that staff worked well with each other and were aware of people's care needs.

There was a registered manager in place and we found that the service was well-led. The leadership, management and governance of the organisation assured the delivery of high-quality person-centred care, in an open and transparent way.

We observed the home to be visibly clean on the day of our visit.; All the people who lived at Park View appeared to have had their personal care needs met.

We saw that staff had completed relevant training and had regular supervisions and appraisals.

However, we found that care plans did not contain all relevant information and were not in a format people were able to understand. Suitable on-call arrangements were not in place in the event of an emergency.

We also found that adequate food choices were not available and that some food was out of date. Activities provided were not sufficient to ensure people received appropriate and a suitable amount of stimulation.

People's personal finance expenditure was accounted for although income and overall financial management arrangements were not sufficiently clear.

We discussed our concerns with the manager who was receptive to our findings and assured us that the points raised would be addressed.

We were told that people's privacy and dignity was respected and that staff encouraged them with meeting their personal care needs and provided them with plenty of opportunities to undertake activities. One member of staff told us, 'I like working here, it is a small and we can keep a watch over the service users. It is a nice place, I like helping to cook' another said, 'It is a good place to work, the staff ratios are very good, lots of time to spend with my service user.

We observed the home to be visibly clean on the day of our visit; All the people who lived at Park View appeared to have had their personal care needs met. We found that their support plans were detailed and records had been maintained and regularly reviewed. We identified some minor issues which have been discussed in the main body of the report we discussed these with the manager. We were assured these would be actioned immediately.