Archived: Park View Residential Home

Park View Residential Home is a residential care home providing accommodation and personal care for up to 11 people aged 65 and over. At the time of this inspection there were 10 people living there. Located in a residential area of Morecambe within easy reach of the promenade and local amenities. On road parking to the side of the home is permitted. There are communal and dining areas on the ground floor. Bedrooms are located on the ground floor and the first floor, which is accessible by a stair lift for the less mobile. Bathrooms and toilets are available on both floors.

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

People told us they were very happy living at Park View. However, our observations and findings showed risks in the environment had not always been addressed in a timely way, specifically where external professionals had made recommendations to take action to reduce risk or make repairs to equipment. People’s individual risks had been appropriately identified and assessed. Where relevant actions to mitigate those risk had been implemented although for some recorded incidents, we could not see what actions had be taken. We have made a recommendation that the provider records all actions taken to protect people and prevent further incidents.

Audits and systems were in place to monitor the service on a regular basis. However, these systems had not been completely effective as we found some concerns relating to the safe management of the premises and equipment. We have made a recommendation that the provider ensures the systems are robust.

There were enough numbers of care staff available on each shift to meet peoples’ needs. However, at the time of our inspection the staff were also responsible for keeping the home clean. The provider was actively recruiting for new cleaning staff. We found some areas within the home that had not been included in the regular deep cleaning process. Infection prevention protocols were in place and we were assured by the measures in place. However, in the current pandemic consideration needs to be given to the crossing over of cleaning of the home and providing personal care to people.

People received their medicines safely and as prescribed. Medicines were stored and managed in a safe way. Safeguarding protocols were in place and staff had received regular training. Checks of suitability had been completed to ensure staff who had been recruited in the last year were fit and proper to work with vulnerable people. 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.

Staff spoke very positively about working at Park View. They told us they thought it was well-led by the management and that people received a very good standard of care. However, we found that the registered manager had limited supernumerary time allocated to perform all the requirements in managing the oversight and quality of the service. We have made a recommendation the provider continuously assess this arrangement.

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 31 October 2018).

Why we inspected

We received concerns in relation to the cleanliness and hygiene practises in the home. A decision was made for us to inspect and examine those risks. We inspected and found there was a concern with risks associated with the environment and equipment, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

We have found evidence that the registered provider needs to make improvements. Please see the safe and well led sections of this report. The registered provider took immediate action to address some of the concerns and improve the risks found with the kitchen environment and the management of fire safety and equipment.

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.

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

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

Enforcement

We have identified a breach in relation to the safety of the premises and equipment at this inspection and have issued a requirement notice.

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

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

Park View Residential Home provides accommodation for up to 11 older adults requiring help with personal care. It is in a residential area of Morecambe within easy reach of the promenade and local amenities, such as a public house, church, park and shops. Morecambe town centre is easily accessible and local bus and taxi services are nearby. On road parking to the side of the home is permitted. There are communal and dining areas on the ground floor. Bedrooms are located on the ground floor and the first floor, which is accessible by a stair lift for the less mobile. Bathrooms and toilets are available on both floors

At our last inspection in October 2017 the service was rated as ‘Requires improvement’. We identified a breach of Regulation 12 of the Health and Social Act Care Act 2008 (Regulated Activities) 2014. We found people could not be assured that medicines were managed safely and people were not always protected against the risk and spread of infection. In addition, we found the audit processes in place had not identified the concerns we noted on inspection and some policies required updating. This was a breach of Regulation 17 of the Health and Social Act Care Act 2008 (Regulated Activities) 2014. We took regulatory action and served requirement notices for these breach in regulation. We asked the registered provider to take action to make improvements to the areas we identified. The registered provider sent us an action plan which indicated improvements would be completed by January 2018.

At this inspection in October 2018, we found improvements had been made. Medicines were managed safely and people were protected from the risk and spread of infection. We found policies had been reviewed and audit systems at the home had identified if improvements were required.

At the time of the inspection visit there was a manager in place who was registered with the Care Quality Commission. 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.

The registered manager sought verbal feedback from people who lived at the home and their relatives and surveys were periodically provided.

Recruitment checks were carried out to ensure suitable people were employed to work at the home and staff told us they were able to attend training and supervision to maintain and increase their skills and knowledge.

Care records contained information regarding risks and guidance for staff on how risks were to be managed. We found information in two care records required updating as further information was required regarding the needs of the people they related to. Prior to the inspection concluding we were informed this had been completed.

We found information was recorded regarding people’s end of life wishes and people we spoke with told us they had been asked to share their wishes regarding this.

People told us they had access to healthcare professionals and their healthcare needs were met. Documentation we viewed showed people were supported to access further healthcare advice if this was appropriate. People and relatives told us they were happy with the care at support provided at Park View Residential Home.

People told us they could raise their views with staff and these were listened to. The registered manager told us they did not hold meetings with people who lived at the home as they sought feedback from people on a daily basis. This was confirmed by speaking with people who lived at the home. They told us they could raise their views with staff and these were listened to.

People told us they had a choice of meals to choose from and they enjoyed the meals provided. We observed the lunchtime meal. We saw people were given the meal of their choice and were offered more if they requested it. Staff were available to help people if they needed support.

Staff we spoke with knew the needs and wishes of people who lived at the home. Staff spoke fondly of the people they supported and said they cared about them and their wellbeing. We observed affectionate and caring interactions between people who lived at the home and staff. People told us they felt respected and valued.

Relatives told us they were consulted and involved in their family members care. People we spoke with confirmed they were involved in their care planning if they wished to be and staff treated them kindly and with respect.

Staff we spoke with were able to describe the help and support people required to maintain their safety and people who lived at the home told us they felt safe.

Staff told us they were committed to protecting people at the home from abuse and would raise any concerns with the registered provider or the Lancashire Safeguarding Authorities so people were protected.

There was a complaints procedure available at the home. People we spoke with told us they had no complaints, but they if they did these would be raised to the registered manager or staff.

People and relatives, we spoke with told us they were happy with the staffing arrangements at the home. We observed staff spending time with people and the atmosphere was relaxed and unhurried. Staff we spoke with told us they had the time to support people in a calm and unrushed way.

People told us there were a range of activities provided to take part in if they wished to do so. People told us they were asked if they wanted to take part in activities and if they declined, their wishes were respected.

The registered manager demonstrated their understanding of the Mental Capacity Act 2005. People told us they were enabled to make decisions and staff told us they would help people with decision making if this was required. People are supported to have maximum choice and control in their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

The registered manager told us they were committed to improving the service they provided and they wanted people to be happy and well cared for. They told us they believed team working was critical in providing an environment in which staff and people at the home could be comfortable and happy.

The registered manager spoke highly of the staff and praised them for the way they engaged with outside agencies and health professionals. Staff told us they felt supported by the registered manager and that the registered manager worked closely with them to achieve the best outcomes for people who lived at the home.

The registered manager told us they placed people at the centre of their care and supported professional relationships between staff and external health professionals. They explained that by working together, people would be assured the best quality of care. Relatives we spoke with told us they could speak with the registered manager if they wished to do so and they found the registered manager approachable.

Park View provides accommodation for up to 11 adults requiring help with personal care. It is located in a residential area of Morecambe within easy reach of the promenade and local amenities, such as a public house, church, park and shops. Morecambe town centre is easily accessible and local bus and taxi services are nearby.

There are communal and dining areas on the ground floor. Bedrooms are located on the ground floor and the first floor, which is accessible by a stair lift for the less mobile. One bedroom has en-suite facilities. However, bathrooms and toilets are available on both floors. There are a range of aids and adaptations to meet the needs of people living at the home. On road parking to the front and side of the home is permitted.

The home has a manager who is registered with the Care Quality Commission. 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.

We last inspected Park View Residential Home in April 2015. We identified no breaches in the regulations we looked at.

During this inspection visit carried out in August 2017 we asked people if they felt safe. People we spoke with told us they did. However, we identified improvements were required to ensure people were protected from the risk of infection. In addition, we found medicines were not always managed in a safe way. These were breaches of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We looked at the auditing systems used by the service to drive improvement. We found checks on medicines, care records and the environment were carried out. We saw evidence that accidents and incidents were monitored and the registered manager could explain actions taken to minimise reoccurrence. However, we found that required checks were not always carried out and had not identified the shortfalls we found during the inspection. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We reviewed staff files and found there were processes that ensured staff were suitably recruited. We found one staff did not have a DBS check in place. This is a check that helps ensure suitable staff are employed. We have made a recommendation regarding this.

We discussed staffing with people who lived at the home. People told us, “When I press my buzzer, they come as soon as they can if they are not seeing to anybody else.” And, “They come to me ok.” During the inspection we saw staff were patient and kind with people who lived at the home and people were supported at a pace appropriate to their individual needs. Staff appeared busy and told us they volunteered their own time to support people to go out. They told us they did not have time to take people who lived at the home out unless they did so. We have made a recommendation regarding the staffing at the home.

We looked at a range of health and safety documentation. We saw not all taps within the home were regularly checked to minimise the risk of scalding from hot water. We have made a recommendation regarding this.

We found documentation we viewed was not always complete. We found risks to people were identified, however the action required to maintain people’s safety was not always recorded. During the inspection visit we raised this with the registered manager. Prior to the inspection concluding we were informed documentation had been updated.

We checked to see if people without mental capacity were lawfully deprived of their liberty if this was necessary. We found appropriate applications to deprive people of their liberty were made to the local authorities as required.

Staff told us they met with the registered manager on an individual basis to discuss their performance and training was arranged to ensure their skills remained up to date. We saw documentation which evidenced this.

People who lived at Park View Residential Home told us they considered staff were caring. One person told us staff were, “Alright.” Another person described staff as, “Bob on. They’re all lovely.” We observed people being supported with kindness and compassion.

We asked people at the home how they spent their time. One person told us, “I watch my tv.” One relative commented they felt their family member would like to sit in the garden. We discussed this with the registered manager who told us they would explore this. During the inspection we saw an activity taking place. We saw people were supported to take part in a game of hoopla. We saw this was enjoyed by people who lived at the home. They laughed and clapped as the game took place.

There was a complaints policy available at the home. People told us they would talk to staff if they had any concerns.

People told us they enjoyed the food at the home. We observed the breakfast and lunchtime meal and saw this was a positive experience for people who lived at Park View Residential Home. People were able to choose where they ate their meal and alternative foods were offered if people did not like the meal provided.

People who lived at the home told us they could speak with the registered manager if they wished to do so. Surveys were offered to relatives and people who lived at the home as a way of receiving feedback. The registered manager told us they did not hold ‘residents and relatives meetings as they had regular contact with people who lived at the home and their relatives. They told us they would introduce these if this was requested.

People told us they were supported to see health professionals if the need arose and we found this was recorded in care documentation. We found people were referred to other health professionals if the need arose and care was delivered to meet people’s needs.

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

Comments received included:

"This is my home now and I am very comfortable here. I have nothing at all to complain about."

"I have just to ring my bell and the girls come straight away."

"The staff are all fantastic. Every single one of them. It is marvellous here. I am a carer myself and I am so impressed with the care here - it is second to none!"

"Oh, my love. I wouldn't want to be anywhere else. I am very happy living here."

Whilst at Park View we established how care was provided and how people were supported. Standards in relation to staff recruitment and the suitability of the premises were also assessed. We looked at cleanliness and infection control practices and how the service was being managed on a day to day basis. We did not find any concerns in any areas assessed on this occasion.

During our inspection we looked at care records and the homes duty rota. We did this to confirm people were being well supported and staffing levels were sufficient to meet people's needs.

The people we spoke with said they were receiving safe and appropriate care which was meeting their needs. They told us the staff were polite, caring and professional when undertaking their work. Comments received included:

'I get all I need here, I wouldn't choose anywhere else'.

'Mum gets all the care she needs here. All the staff are very supportive'.

'There are things going on most days, it's nice to be able to choose what I want to take part in'.

'We have just had the most wonderful Christmas, very busy and lots going on'.