Park View Care Centre

Park View Care Centre is a residential care home providing personal and nursing care to up to 88 people. The service provides support to people aged 18 and over, some of whom live with dementia or require complex nursing care. At the time of our inspection there were 58 people using the service.

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

People and relatives told us the service had improved since the last inspection and they felt safe living at Park View Care Centre, however, further improvements were still required.

The provider had increased their oversight of the service and a new manager had been employed since the last inspection. The provider had identified shortfalls within the service and had worked to rectify these. However, this action had not always been successful. Potential risks to people’s health and welfare had not been consistently assessed and there was not always person centred guidance in place for staff to mitigate risks. Accidents and incidents had been recorded, analysed and changes had been made to reduce the risk of them happening again.

Medicines were not managed in a consistently safe way, medicine records were not accurate and there was not always guidance for staff about when to give when required medicines.

The provider had put systems in place to improve the quality and continued oversight of the service, some of these systems had not yet been embedded or had time to be fully effective.

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.

People and relatives told us the culture within the service had improved and they were now confident their concerns would be taken seriously and investigated. There was now a system in place to make sure the provider’s policy was followed.

People and relatives told us the food had improved. Staff had received training in the provision of textured diets, to help to keep people at risk of choking safe. Staff training had increased, staff told us they had the skills they required to complete their roles. Improvements had been made to staffing levels and there were enough staff to meet people’s needs. Some relatives and staff raised concerns about the staffing levels in the future when new people came to live at the service. The provider told us they would take this into consideration when new people were assessed before moving into the service.

Staff knew people well, people told us they received care in the way they preferred and had the opportunity to take part in activities.

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 inadequate (published 24 November 2023) 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 but the provider remained in breach of regulations.

This service has been in Special Measures since 23 November 2023. On 21 June 2023, we imposed urgent conditions on the provider's registration to ensure that risks relating to choking, malnutrition and dehydration were safely managed. We also requested the provider reviewed their quality assurance systems to ensure effective oversight of these risks, and that the relevant investigations were completed. We requested the service provided regular updates to CQC. We also restricted any new admissions to the service. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures and the conditions imposed have been removed.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to risk management, medicines and governance 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 Centre is a residential care home providing personal and nursing care to up to 88 people. The home provides support to people aged 18 and over, some of whom live with dementia or require complex nursing care. At the time of our inspection there were 85 people living in the home.

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

People told us they were not receiving person-centred care that promoted their choice, needs or independence. People were placed at serious risk of harm because care was not delivered safely. Risks people faced were not fully identified, assessed, or reviewed. Staff were not always following people's care plans or risk assessments which put people at risk of avoidable harm. Medicines were not always managed safely and provided to people as prescribed.

People were not supported to maintain a balanced diet and meal options did not reflect people’s individual needs and choices. Staff did not always follow each person's dietary requirement or support needs, which placed them at serious risk of choking, malnutrition, and dehydration. People had their weights monitored but these were not always regular enough to mitigate the risk of malnutrition.

People and their relatives were not involved in decisions about their care or care reviews. People were not always treated with dignity and respect and their independence was not promoted. A relative told us, “There’s lot of confused people there and staff don’t know how to deal with it. They just ignore it.” People had to wait for extended periods of time to receive support. There was not enough staff to meet people’s physical and emotional needs. A relative told us about their observations, “On the ground floor at weekends I have to search and find a nurse. Staff ignore people who are shouting “help me, help me”. Bells go off and they ignore it.”

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. People and their relatives told us their complaints were not always listened to and addressed appropriately. Relatives told us, “I’ve complained, and they haven’t acted on it. It was a few months ago and I’ve heard nothing back.”

The provider failed to ensure the quality and safety of the service was monitored effectively. The provider’s quality assurance systems were not effective. Records at the service, including people's care records, were not always present, accurate or reviewed when required. This put people at risk of not receiving the care they needed safely and consistently and staff not knowing how to support them when their needs had changed.

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 19 May 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 the provider remained in breach of regulations.

At our last inspection we recommended that the provider considered a formal audit of call bell response times. At this inspection we found the provider had not made improvements in reviewing the staffing levels to ensure people received support as per their individual needs and in a timely way.

Why we inspected

The inspection was prompted in part due to concerns received about the safety of care provided. A decision was made for us to inspect and examine those risks.

The inspection was also prompted in part by notification of an incident following which a person using the service died. 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 of choking. This inspection examined those risks.

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

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

The provider put an action plan in place to address the breaches identified during this inspection.

Enforcement

At this inspection we have identified breaches in relation to management of risk, safeguarding, staffing and staff training, person-centred care, respect and dignity, provider oversight and failure to learn from accidents, incidents and complaints.

Please see the action we have told the provider to take at the end of this report.

On 21 June 2023, we imposed urgent conditions on the provider's registration to ensure that risks relating to choking, malnutrition and dehydration were safely managed. We also requested the provider reviewed their quality assurance systems to ensure effective oversight of these risks, and that the relevant investigations were completed. We requested the service provided regular updates to CQC. We also restricted any new admissions to the service.

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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Park View Care Centre is a residential nursing home providing personal and nursing care for to up to 88 people. The service provides support to a range of people including frail and elderly, people with various nursing needs and people living with dementia. At the time of our inspection there were 79 people using the service.

Park View Care Centre accommodates 88 people across four units. Two units on the ground floor are predominantly for people living with dementia and two units on the first floor are for people with nursing needs.

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

We found a risk relating to the correct use of PPE that was not being managed safely. We raised this with the provider who took action.

Some risks were not being managed as safely as possible, such as around fluid charts or one person’s weight loss. This was raised with the provider and actions were taken.

People were receiving their medicine when they needed them, but we found paperwork for end of life medicines was missing. The provider took action to put this right.

One relative and some staff said that there could be times when people have to wait for their call bells to be answered. We have made a recommendation about how call bells are audited.

Governance systems had been improved and were in the process of being embedded in to practice. Some issues we found with care plans had not been identified by the provider but they were working towards reviewing all people’s care.

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.

People told us they felt safe at the service. One person said, “I am very happy here. They look after me well.”

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 inadequate (06 October 2021)

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 some improvements had been made and the provider was no longer in breach of regulations relating to safeguarding people from abuse and staffing. We found the provider remained in breach of regulations relating to safe care and good governance.

This service has been in Special Measures since 06 October 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

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 continued breaches in relation to safe care and treatment and good governance 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 Centre is a residential care and nursing home for people living with dementia and older people. The care home accommodates up to 88 people. At the time of inspection there were 82 people living at the home. There are two units which accommodate people with nursing needs upstairs and there are two units which accommodate people living with dementia downstairs. The upper floors are accessible via a lift. Each unit has their own communal dining and lounge facilities.

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

There was a lack of guidance for staff to follow to care for people effectively and staff did not know how to meet the needs of some people. People were not supported positively with behaviour that challenged. Risk management was poor which meant people were at risk of avoidable harm, for example from falls or constipation.

The provider had failed to ensure people were always supported in the least restrictive way in line with current law. Some staff were not aware of when they needed to safeguard people from abuse. We found two people at risk of harm which the registered manager alerted the local safeguarding team about following our inspection.

There was not always enough staff available to meet people’s needs. People told us they had to wait a long time when they rang the call bell. Staff had received training for their role, but the provider had failed to ensure staff were knowledgeable on safeguarding people from abuse. People told us there were some language barriers with staff who did not speak good enough English.

Medicines were managed safely except for ‘as required’ medicines. There was a lack of guidance for staff when people needed these medicines and how to monitor their effectiveness. There was a lack of learning from accidents and incidents. It was not always clear what action had been taken and lessons had not always been learnt to prevent a reoccurrence.

Infection prevention and control was not always managed as we observed staff moved between units on the ground floor without changing their Personal Protective Equipment (PPE). This increased the risk of the spread of infection. Quality systems were not always effective and had either not identified the issues we found or where they had identified issues, they had not always been actioned.

The provider had not always acted within the law and best practice guidance. Some people’s care plans did not recognise when they were being restricted. People’s mental capacity assessments were not completed for specific decisions around their care. The registered manager did not promote positive behaviour support. People did not always receive person centred care as their needs were not always fully planned for and staff did not always have the guidance they needed to provide care to people.

People were not always engaged in their care and the service as there was a lack of guidance for staff how they could communicate with some people. People’s relatives told us they were happy with the communication they had with the staff and were kept updated on their loved one’s care.

The registered manager had not understood their responsibilities on the duty of candour. They had informed relatives of incidents or accidents but they had failed to recognise neglect of their duty of care and breaches of people’s human rights and therefore had failed to report and act on these.

Some staff knew people well and we observed some positive, caring interactions with people. Staff were positive about the support they received from the registered manager. The provider had notified CQC about events as required. The provider had displayed a copy of their ratings in easy view for people and visitors at the service.

People told us when they raised complaints these were resolved quickly. The provider had sought and acted on feedback to identify areas for improvement.

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 7 October 2020).

Why we inspected

This inspection was prompted by our data insight that assesses potential risks at services, concerns in relation to aspects of care provision and previous ratings. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. This enabled us to look at the concerns raised and review the previous ratings.

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.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Park View Care Centre 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 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.

At this inspection we have identified breaches in relation to managing risks to people, ensuring people are not unlawfully restricted; ensuring staff are knowledgeable about safeguarding people and ensuring there are enough staff available to keep people safe and meet their needs. We have also identified breaches in relation to the providers failure to assess, monitor and improve the quality and safety of the service; and maintaining accurate and up to date care records.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Park View Care Centre is a residential care and nursing home for people living with dementia and older people. The care home accommodates up to 88 people. At the time of inspection there were 61 people living at the home. There are two units which accommodate people with nursing needs upstairs and there are two units which accommodate people living with dementia downstairs. The upper floors are accessible via a lift. Each unit has their own communal dining and lounge facilities.

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

People told us they felt safe and were happy with the care provided. Risks to people were managed safely. There were enough safely recruited and competent staff to ensure people’s needs were met. The registered manager ensured lessons were learnt from any accidents and incidents.

The home had assured good practice in the management of infection prevention and control and had managed very well through a difficult time during the Covid-19 pandemic.

The quality and safety of the service was ensured by the registered manager. Care workers told us it was a good place to work and they were well supported. There was a positive and caring culture. Feedback from staff and people was listened to and used to make improvements.

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 20 March 2020).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about safe care and treatment of people using the service. The overall rating for the service has not changed following this targeted inspection and remains Good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They 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.

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.

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 Centre is a residential care home providing personal and nursing care to 82 people aged 65 and over at the time of the inspection. The service can support up to 88 people. There are two units which accommodate people with nursing needs, these are Beech and Oak. There are two other units, Ash and Cedar, which provide accommodation for people living with Dementia.

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

People and their relative spoke positively about the service and the staff. People felt safe and were supported by a consistent number of staff who had been recruited safely. Staff completed regular training to keep their skills and knowledge up to date with best practice. The registered manager coached, mentored and motivated the staff team. Staff understood how to support people to stay as safe as possible and knew how to report concerns about people’s safety. Risks to people’s health, safety and welfare were assessed, identified and regularly reviewed. Measures were in place to help reduce any risks. When people had an accident, such as a fall, these were recorded and monitored. This enabled staff to identify any pattern and refer people to the relevant health care professionals for advice and guidance. People were supported to have their medicines safely and as prescribed.

People’s physical, mental health, social and emotional needs were assessed to make sure staff were able to provide their care in the way that suited them best. Care plans were regularly reviewed and kept up to date when people’s needs changed. People had access to health care professionals, such as GPs, dentists and chiropodists, to help them stay as healthy as possible.

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.

People and their relatives said the food was good. Meals were social occasions and many people dined together. People were offered a healthy and balanced diet and encouraged to drink plenty.

People and relatives told us the staff were kind and caring. Throughout the inspection, staff showed genuine compassion, patience and concern for people’s well-being. People had developed trusting relationships with the staff and the staff knew them well.

People did not have any complaints about the quality of service at Park View Care Centre. The registered manager welcomed feedback and responded to any concerns in a timely way and made sure they were satisfactorily resolved.

People were supported at the end of their life by staff who were passionate about making sure their last days were as comfortable as possible. Nurses worked with health care professionals, such as hospice nurses, to make sure specialist equipment and medicines were available when needed.

The registered manager led by example and had good oversight of the service. They promoted an open culture where people and staff felt valued. Robust audits and checks on the quality of service were completed and used to drive improvements.

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 April 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, we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.

People’s experience of using this service:

At our last inspection in November 2017 we identified that staff recruitment checks did not meet the requirements of regulation to ensure people were cared for by suitable staff. The provider told us what action they would take to improve this. At this inspection we found that the required improvements had been made and the full range of staff suitability checks were now in place for all staff.

At this inspection we found that medicines were not being managed safely and we have issued a new requirement for this breach of regulation.

Some information had not been completed to assess whether a new person was at risk from using equipment or from choking within the first few days of admission, this could mean staff were not made aware of potential risks and take the necessary measures to reduce these. This was rectified at inspection but is an area for improvement to ensure all risks are assessed on admission.

There was a new service manager. They had applied to the Care Quality Commission to become the registered manager; their application was currently being processed by the commission.

Overall the service was being managed well but there had not been enough time to embed the improvements the new management team were making to address the shortfalls identified at inspection. Quality and safety monitoring checks of the operation of the service and the delivery of care happened at regular intervals and actions from these informed service improvements.

People told us that they felt safe and well cared for and overall outcomes for most people were good. People lived in a safe clean and well-maintained environment. There were low levels of incidents, pressure ulcers and falls and staff sought advice and guidance from other professionals about people’s health needs when needed. People could make their own choices and decisions in their day to day lives and staff sought their consent. People felt staff understood their needs, treated them with dignity and respect. Staff understood how to keep people safe from harm.

There were enough staff to support people’s needs, they received an appropriate range of training and supervision, they felt supported and found the management team approachable when they wanted to raise issues.

A programme of activities to suit different tastes and abilities was provided. Adjustments were made to ensure activities and information was accessible to people with sensory impairments. There were some opportunities for people to go out to a local coffee shop and superstore with staff support.

People and relatives were surveyed for their views and had opportunities through resident and relative meetings to express their views. Their feedback informed the continuous improvement and development of the service.

Rating at last inspection:

• At our last inspection, the service was rated "requires improvement" (18 January 2018). This service has been rated requires improvements at the last two inspections.

Why we inspected:

• This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

• We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned in line with our inspection schedule.

Park View Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Park View Care Centre provides accommodation, personal and nursing care for up to 88 older people. There are two units in the home, Beech and Oak, which accommodate people with nursing needs; and two, Ash and Cedar, which accommodate people living with dementia, however only one dementia unit, Ash, was open at the time of the inspection. There were 49 people at the service at the time of our inspection. People were living with a range of care and health needs, including diabetes and Parkinson's. Many people needed support with all of their personal care, and some with eating, drinking and mobility needs. Other people were more physically independent and needed less support from staff.

At the last comprehensive inspection in September 2016 the overall rating for the service was Requires Improvement. Five breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified. The provider failed to: ensure there were sufficient numbers of staff deployed to meet people’s needs; to ensure risks to people were minimised;, to ensure quality assurance systems were robust; to apply the principles of the Mental Capacity Act consistently and to manage complaints effectively.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective, responsive and well led to at least good.

At this inspection we found that some improvements had been made and the breaches had been met. There are still improvements to be made and embedded to ensure improvements were sustained. We found one new breach of Regulation.

The service did not have a registered manager in post 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. There was a manager in place who was in the process of applying to become registered.

Staff had not been consistently recruited safely. Gaps in employment had not been discussed and recorded. References were inconsistently obtained.

People told us they felt safe living at the service. They were protected from the risks of abuse, discrimination and avoidable harm. Risks to people were assessed, identified, monitored and regularly reviewed.

People were supported by sufficient, regular staff who knew them well. Staff levels were monitored to make sure they had enough quality time to spend with people. Staff completed regular training and were supported through one to one supervision and appraisals by the manager.

People’s medicines were stored, managed and disposed of safely. People were protected from the risks of infection. The service was clean and staff wore the correct personal protective equipment when needed.

Accidents and incidents were reported, investigated and reviewed and lessons learned were shared with staff to improve safety.

People’s physical and mental health were regularly assessed to make sure they received effective care and support. They were supported to eat a healthy diet and to drink well.

Staff liaised with health and social care professionals to make sure people received co-ordinated care and support. People were supported to stay as healthy as possible.

People had access to communal areas, such as lounges and the garden. Signage was designed to help meet people’s needs and promote their independence.

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 were treated with kindness and compassion. Their privacy and dignity were maintained and promoted. Staff showed a genuine concern for people’s well-being. Staff spoke with people, relatives and each other in a kind and caring manner. People were given the information they needed, when they needed it and in a format they could understand. They were supported to maintain their religious beliefs.

People and their relatives were involved in the planning of their care. They were supported to keep busy and enjoyed numerous activities both in and outside the service. People were supported to maintain relationships with the people who were important to them.

People knew how to raise a concern or complaint, felt they would be listened to and that action would be taken if needed.

People’s choices for the end of their life were discussed with them and recorded so that staff could manage, respect and follow their wishes.

People, relatives and staff felt the service was well-led. The leadership was visible and the manager promoted a culture of openness. They led by example and coached and mentored staff.

People’s views and those of their relatives, staff and health professionals were encouraged and feedback was used to drive improvements in the quality of the service.

The manager and staff worked with the local authority and multi-disciplinary teams to ensure people received consistent and co-ordinated care.

Regular checks and audit were completed by the manager and the quality improvement manager to continuously drive improvements. Action plans were discussed with staff to ensure shared accountability.

Notifications had been submitted to CQC in line when they were required. The rating from the previous CQC report was displayed at the service and on the provider’s website in line with guidance.

You can see what action we told the provider to take at the back of the full version of the report.

The service did not have a registered manager in post at the time of our visit. 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 was, however a manager in place; who was applying to become registered.

Park View Care Centre was last inspected on 2 and 4 February 2016 and was rated as inadequate overall. The service was placed into special measures and the provider sent us action plans to tell us what they would do to improve.

At this inspection, we found that there had been much improvement overall; however, some of the issues we raised last time had not been fully addressed.

Risks to people’s safety and welfare had been appropriately assessed but actions to reduce those risks were not always taken. There were not enough staff deployed to meet people’s needs, but more staff were brought in immediately we highlighted this.

Medicines were well-managed and recruitment processes helped ensure that the right applicants were employed to work in the service. Incidents and accidents were properly documented and raised with the local safeguarding authority when necessary. The CQC were made aware of any events which required statutory notification.

Equipment was regularly serviced and the risks of fire had been assessed and minimised by routine fire alarm testing, personal evacuation plans and proper maintenance of fire equipment. The premises were well-maintained and improvements to décor were seen. There was appropriate picture signage and equipment such as coloured toilet seats to help people orientate themselves.

The principles of the Mental Capacity Act (MCA) 2005 were not consistently followed in practice; to ensure people’s rights were considered; but the use of stair gates on people’s doors had ceased and assessments of people’s capacity had been made appropriately.

Records about people’s food and fluid intake were not always being completed accurately or with enough information to monitor if people were receiving enough to keep them well. However, dietician input had been sought promptly when needed and people’s weights were monitored. There were choices of meals available and dining tables were laid with cloths, flowers and condiments.

Staff training had improved and supervision and appraisal were being carried out regularly. People’s healthcare needs had been met and were monitored for changes. Staff were consistently kind and caring and protected people’s dignity. They encouraged people to remain as independent as possible. There was a range of activities on offer and people were observed enjoying group crafts and one to one interaction.

Complaints had been actioned by the manager but records and communication about what had been done were sometimes lacking. Care plans had been reviewed and updated but this area required further work to ensure consistent records were kept.

Feedback had been sought from people, relatives and staff and there was evidence that it had been acted upon. Staff said they felt supported by the manager and her deputy and that they were led by example.

Quality monitoring had not been sufficient to highlight the problems we found during this inspection. More work was needed to fully address the areas which we raised in our last report.

As this service is no longer rated as inadequate, it will be taken out of special measures. Although we acknowledge that this is an improving service, there are still areas which need to be addressed to ensure people's health, safety and well-being is protected. We identified a number of continued breaches of Regulations. We will continue to monitor Park View Care Centre to check that improvements continue and are sustained.

The service had a registered manager in post at the time of our visit. 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 to people’s safety and welfare had not always been appropriately addressed. There was not a robust system for keeping people safe from harm because staff had not been consistently completing incident reports and the registered manager had not raised safeguarding concerns with the local authority.

Actions to minimise identified risks to people had not been carried out in practice, leaving people exposed to risk of harm. This included people who had experienced repeated falls and those who were at risk of skin breakdowns. Creams had not been stored or recorded appropriately, which created a risk that people might not receive them as intended by the prescriber. Other medicines had been properly managed.

There were not enough staff on duty because data about people’s needs and dependencies had been inaccurately submitted to the provider by the registered manager. Staff training was lacking in some areas and ineffective in others. Supervisions by the registered manager had not identified shortfalls in staff knowledge which affected their ability to carry out their roles competently.

Fire drills and testing had been conducted regularly and the premises were well-maintained throughout. Auditing however, was largely ineffective in highlighting where the quality and safety of the service could be improved.

The principles of the Mental Capacity Act 2005 (MCA) had not been properly followed in relation to assessments about people’s capacity and decisions made on their behalves. Restrictive practices were observed but staff did not understand that these deprived people of their liberty.

Most staff were caring and considerate but people’s dignity was not always considered or protected. Some staff did not always act to meet people's needs and this impacted on people’s experience of living in the service. People had not always been protected from the risk of social isolation. There were three activities coordinators working at the service for a total of 118 hours per week. We spoke with one of the coordinators who worked three days per week. Some people spent long periods without any stimulation or interaction.

Complaints had not always been managed effectively. Care planning was not sufficiently person-centred in some cases, but people’s need for independence where possible was considered. People and relatives said they had not been involved in care planning.

The service was not well-led and there was no proper or robust quality assurance processes in place.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The inspection was carried out by one inspector over seven hours. During this time we talked with 14 people who were living in the home, and observed staff carrying out care duties with other people. We talked with 12 staff and met other staff briefly; and talked with five relatives and visitors, and a visiting GP. The manager was present throughout the inspection and assisted us by providing documentation for us to view. The area manager was present in the home for some of the day, and was included when we gave feedback about the inspection.

We looked at the answers to five questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Is the service safe?

We viewed all parts of the premises and saw that they were well maintained and visibly clean. We saw that staff followed directions from individual risk assessments to protect people from harm. For example, they kept communal rooms and corridors free of obstacles for people who might be at risk of tripping and falling.

The home had clear procedures in place to check that people had consented to the care and treatment provided for them. People who lacked the mental capacity to make decisions about where they lived or the care that they needed had been appropriately supported by their family members or advocates, and by health and social care professionals, to make decisions on their behalf and in their best interests. The manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

Staff told us that they had been trained in understanding how to safeguard vulnerable adults; and were able to give clear explanations of the different types of abuse to be aware of, and the action to take in the event of any suspicion of abuse. Some people who lived with dementia sometimes displayed behaviours that might be challenging to others. The staff demonstrated their knowledge of different people, and how to distract their attention and deflect potentially difficult situations.

We spent time in one of the lounges carrying out an observational inspection. The Short Observational Framework Inspection (SOFI) is a method for observing people's care when they are unable to give clear verbal feedback. We saw that staff treated people with respect and dignity, and were kind and attentive to their needs.

We inspected medicines management in two of the units, and found that reliable procedures were in place to ensure correct storage and administration of medicines.

Is it effective?

Staff told us that they felt supported in their different job roles, and were able to talk with their line managers for any advice. Staff had individual supervision sessions approximately every two months. This gave them the opportunity to discuss any concerns about their responsibilities, and any training needs. Staff meetings were held for different groups of staff (for example, nurses, kitchen staff,) so that they could discuss relevant issues together.

People were provided with a suitable choice of foods to promote a healthy and balanced diet. We saw that staff supported people who needed assistance to eat and drink, and were sensitive and did not rush them.

People had access to other health and social professionals. A visiting GP told us that he carried out a routine visit to the home once per week, and visited at other times as needed. Nursing staff had assessments and care plans in place for monitoring people's health care needs, and we saw that these were carried out reliably.

Is it caring?

We noticed that staff treated people with gentle affection, listened to them, gave them time to reply, and were attentive to their individual needs. People's comments included, 'They are all very good'; and 'They look after me very well'. A relative said, 'The staff are very good, I can't fault them. They do everything for X. And they are always friendly and welcoming.'

We saw that staff gave people choices about where they wanted to sit, what they wanted to do, and what they wanted to eat or drink. People with dementia were supported to carry out different activities throughout the day. Staff were mindful of people who were wandering, by checking for their safety, and stopping to chat with them. People said they were 'Always' treated with dignity; and we saw that staff were careful to observe people's privacy when carrying out personal care.

Is the service responsive?

People's care plans had been discussed with them or their relatives as appropriate. We saw that nursing assessments and care plans were reviewed on a regular basis, and staff were informed of changes at daily handovers.

The service employed three activities co-ordinators, who worked in different units so that they could get to know people's social preferences and hobbies. We found there was a wide variety of activities available. The activities staff spent individual time with people, as well as arranging group activities.

People told us that they could ask staff about anything at any time. The manager had an open door policy and was easily available to people and their relatives. A relative told us that 'The staff always contact me if there is any change in X, and I can ask any of them questions and know I will get a good response.'

Is the service well-led?

The manager had a visible presence in the home, and was well-known by people living there and their relatives. She had been in post for three months, and it was clear that she had taken time to get to know people. Staff said that she sometimes worked alongside them, and this gave them confidence in her knowledge and abilities.

The company had systems in place for on-going monitoring of different aspects of the home. This included weekly and monthly checks and audits to see how the home was performing. Systems included checks for any accidents or incidents to see if action could be taken to prevent these in future.

People's views and ideas were listened to through one to one conversations; through the use of questionnaires; through residents and relatives' meetings; and through use of a comments book in the entrance hall. We saw that the manager had put an action plan into place as a result of reading questionnaire responses, and appropriate action had been carried out to bring about the desired changes.

At this inspection we found that systems were in place to make sure that care records were kept up to date and these had been followed by staff.

We did not speak to people using the service on this occasion.

People told us they liked living at the service and relatives we spoke with were complimentary about it. A relative told us 'we are very happy with it here' and 'we feel we did the right thing'.

People told us they liked the staff and that staff treated them kindly and with patience and respect. One person told us 'the staff are very good' and another person said 'they are so good, they come when I call them'. A relative told us 'they really do know people'. We observed that staff took time to explain things to people and supported people to be as independent as they could and to follow their preferred daily routines.

There were enough staff to provide people with the support they needed and staff told us they felt well supported.

The service had a complaints procedure and any concerns or complaints from people or relatives were taken seriously and addressed.

We found that some people's care records, which were held electronically, did not always reflect their current needs and had not always been kept up to date. This meant that staff did not always have access to the correct information about people.

People felt that their care needs were met and that they were able to get involved in activities throughout the day if they wished. One person said, "We have lovely music and entertainment, tonight the bar is open and we will be playing bingo". Another person said, "the staff are very caring, they look after us well".

We found that people were looked after in a way which respected their independence but also provided them with the care and support they required. People were given a good choice of nutritious food and drink and they enjoyed what they ate. One person told us, "There are always alternatives if you fancy something different, I like a salad sometimes".

We saw that staff were recruited appropriately and checks were undertaken to ensure that they were suitable to care for people with nursing needs and dementia. We found that there were enough staff on duty to tend to the needs of the people although at times staff were stretched on one unit.

We found that the service had effective systems in place to ensure the quality of the service delivered. These included audits, meetings and surveys to take account of peoples views and suggestions.