Park View Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good.

This meant people were safe and protected from avoidable harm.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

People and their relatives told us they were encouraged to raise concerns with staff and management through meetings, feedback surveys and an open-door policy. People felt concerns were acted upon and they always received a response.

Lessons learned and actions taken were recorded and accountability was demonstrated in documentation. We saw evidence of an active learning culture through team meetings and clinical risk meetings. Staff told us they were encouraged to report safety events and lessons learned were discussed with them to prevent reoccurrence.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People and their relatives told us the transition into the service went well. They felt the provider had liaised with them and partners involved to ensure they had all the relevant information available. One person said, “My [Relative] went in about 6 months ago as an emergency admission from the hospital and they have been very helpful, the staff go out of their way. [Person] have needed Doctors and things, and they have done as much as they can to help.”

One partner described how staff supported people with a diagnosis of dementia when moving into the home and how the service worked collaboratively with them during the transition.

Staff told us they received information about people before they came into the home so they could plan for the person’s needs.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People and their relatives told us the service was safe. Comments included, “I am confident [Person] is safe here, they ring me and tell me everything, even if it is only a little bruise,” and “100% safe there, the staff are really good, there is plenty of them.”

Staff and leaders understood their responsibilities in raising any safeguarding concerns. We identified the safeguarding documentation was well maintained, accurate and matched files we reviewed. There was evidence that people and their relatives were kept up to date with any concerns or outcomes. Information was available throughout the service for people, relatives and staff to understand how to raise safeguarding concerns.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found that the provider was able to identify when people were potentially being deprived of their liberty, complied with the basic principles of the Act, and made applications or/and urgent authorisations in a timely manner.

Staff had received training in safeguarding, the Equality Act and MCA and this was completed annually.

The provider did not always work well with people to understand and manage risks

We saw most care plans and risk assessments had relevant information about people to manage risks in relation to falls and pressure wound management. Where people had been assessed at risk of pressure wounds, relevant equipment was available to minimise the risk of deterioration. Pressure relieving mattresses were set at correct settings and daily notes were comprehensively updated by staff.

However, we saw a lack information in people’s care plans and risk assessments to help staff identify the early warning signs associated with epilepsy and diabetes. This meant staff did not always have the relevant information to be able to identify any changes in people’s diabetes or epilepsy which could increase the risk of harm. Although we saw no harm had come to people and staff had received training in these areas.

We also saw 2 people who had been assessed by the speech and language team (SALT) as needing a different level of pureed diets. However, we identified the information was lacking in the care plan and risk assessment about any risks of choking. This meant there could be an increase in harm to people if information is not available in care plans and risk assessments to guide staff. However, staff had received training in emergency first aid which covered the topic of choking risks and how to manage the situation.

We also saw 1 kitchen staff member had not completed training in International Dysphagia Diet Standardisation Initiative (IDDIS). The IDDIS framework is used to ensure people with swallowing difficulties have been assessed appropriately for specific food preparation and modified diets to prevent choking risks. However, staff we spoke with in the kitchen were able to describe how to prepare different types of food for people and the reasons why. Information was also available in the kitchen to guide staff on modifications needed for people’s diets.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

People told us they had access to equipment they needed to be safe. We observed various equipment being used by staff throughout our assessment and staff explained to people what was happening and what was going to happen. We saw this made people feel safe during transfers.

Staff were able to tell us what they would do if there was a fire and had received appropriate training in manual handling and fire safety.

Safety checks had been completed by external contractors. There was evidence of regular maintenance checks being completed on-site. A dedicated facilities staff member had oversight of work that needed completing.

We saw window restrictors to prevent the risk of falls from height and wardrobes were attached to walls to prevent the risk of falling on people.

The business continuity plan identified what to do in an emergency and highlighted areas of risk.

However, we observed some areas where maintenance could be improved. For example, we saw some scuffed skiting boards and door frames. Leaders told us a refurbishment plan was in place and provided us with evidence of this.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Regular supervisions and appraisals were taking place and staff told us they were supported well by leaders. People provided positive comments about the staff and their skills. Comments included, “All the staff know what to do, it's all the regulars that I see, not much of a turnover of staff and that says a lot.” People told us there were enough staff available to meet their needs and responded when they called for assistance.

Disclosure Barring Certificates (DBS) and references had been sought prior to staff commencing in their role. Where staff had joined the service prior to their DBS being confirmed, risk assessments were in place and staff were only allowed to complete induction training and shadowing. We saw evidence of reasonable adjustments taking place for staff and health questionnaires had been completed.

However, we saw some training for staff was out of date, in line with the provider’s schedule of training. The provider took immediate action, and training was sourced and completed by staff within days of our site visit. We saw no harm had come to people due to the lack of training in these areas.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

People, relatives and professionals visiting the service all commented about the cleanliness of the service. One person commented, “The place is very clean and tidy, it the first thing I check, their room is lovely and clean always.” People told us staff also wore personal and protective equipment (PPE).

We saw daily cleaning schedules which included high area cleaning and monthly deep cleaning of communal areas and people’s rooms.

Staff used PPE and understood their duties to protect people from infections. Prior to our assessment there had been a flu outbreak in the service which had been managed well with people recovering in a timely way due to the infection, prevention and control (IPC) process put in place. There was enough PPE available throughout the service and in communal areas. There was an IPC policy available.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

There were established systems to support the management of medicines, and overall, medicines were administered as prescribed. Records showed no missed doses, and medicines were labelled appropriately with running balances maintained. Competencies for staff had been completed. Controlled drug (CD) processes were effective, the CD cupboard was orderly, daily stock checks were undertaken, and the CD register was completed appropriately.

There were risk assessments, including self-administration risk assessments for people administering their own medicines. Fire risk assessments for topical medications containing paraffin were seen and completed appropriately. There were PRN (when required medicines) protocols and there was evidence of PRN medication reviews. Allergy recording and preferences were documented consistently. We saw evidence of the ordering and maintaining medication supply schedules.

People receiving their medicines via a percutaneous endoscopic gastrostomy (PEG) tube had clear instructions documented for feeding and medication administration flush volumes.

We observed a Nurse administering medicines to people who followed a clear and structured process for administering medication.

One person had a transdermal patch which is a patch applied to the skin to deliver medication through the blood stream overtime. There was a Transdermal Medicines Administration Record (TMAR) which included the time it was applied, removed, the location and evidence of weekly site rotation. However, there was no evidence of daily checks to show the patch was still in place. Daily checks should be completed to ensure the patch is still in place, intact and functioning as intended. However, we identified no harm had come to the person and the provider rectified this immediately and put daily checks in place.

We also saw some fridge temperatures had not always been consistently recorded by staff and there were some small gaps. This meant the provider could not always be assured medicines were fit for purpose at the point of administration to people because temperatures had not been monitored consistently. However, we identified no harm had come to people as a result of the fridge temperature not being monitored regularly.