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Inspection carried out on 24 September 2019

During a routine inspection

About the service

Parkview is a residential care home providing personal care and support to 64 people living with dementia. At the time of this inspection, 63 people were living at the home. The home is purpose built and spread across three wings and over two floors.

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

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. We have made a recommendation about working within the principles of the Mental Capacity Act (MCA) 2005.

People’s care and support needs were met. Relatives and professionals were complimentary about the home. People told us they felt safe and were happy living at the home. People were protected from the risk of avoidable harm, abuse and neglect. People were supported by sufficient numbers staff to ensure their needs were safely met and the service followed appropriate recruitment practices. People’s medicines were managed safely, and staff followed appropriate infection control practices to prevent the spread of diseases.

People’s needs were regularly assessed and care and support was planned to meet their individual needs. Staff were supported through induction, training and supervision to ensure they had the required knowledge and skills to meet people’s needs. People were supported to eat and drink sufficient amounts for their health and wellbeing and to access healthcare services. People’s needs were met by the design, decoration and adaptation of the home.

People were supported by staff that were kind and caring and respected their end of life wishes. People were involved in making decisions about their care and support needs and their views were taken into consideration and acted upon. People’s privacy and dignity was maintained, their independence promoted, and their diverse and cultural needs respected. People were supported to develop and maintain relationships important to them and participate in activities that interest them.

People’s communication needs had been assessed and met and people told us they knew how to make a complaint if they were unhappy.

The service had systems in place to assess and monitor the quality and safety of the service and to continuously learn to drive improvements. The service worked in partnership with key organisations to plan and deliver an effective service.

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 24 April 2017).

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.

Inspection carried out on 21 February 2017

During a routine inspection

Parkview is a residential home providing accommodation, care and support for up to 69 people living with dementia. On the day of our inspection, 44 people living at the service. One unit that accommodated 16 people was closed for refurbishment.

A registered manager was appointed since our last 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.

We carried out an unannounced inspection of Parkview on 21 February 2017.

At our last inspection of the service on 6, 7 and 8 June 2016 we found the provider was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had not ensured people were protected from the environmental risks identified in the open plan kitchen areas. We undertook a comprehensive inspection on 21 February 2017 to check that the service now met the legal requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Parkview’ on our website at www.cqc.org.uk. We found the provider had taken sufficient action to address the concerns at the previous inspection and met the legal requirement in relation to safe care and treatment.

Risks to people were identified and managed appropriately. Support plans contained sufficient guidance for staff on how to support people to be safe. Incidents were recorded and monitored and action was taken to prevent a reoccurrence.

People were protected from potential abuse. Staff had received training in safeguarding adults and were able to describe abuse and the actions they needed to take to protect people from potential harm.

There were sufficient skilled staff deployed on each shift to meet people’s needs at the service and in the community. The registered manager reviewed staffing levels in line with people’s changing needs. The provider followed appropriate recruitment procedures to employ only staff suitable to support people safely.

People received their medicines as needed from staff trained and assessed as competent to do so. Medicines were safely and securely stored at the service.

Staff attended training and received regular supervisions and support to enable them to undertake their roles effectively.

People’s rights were maintained in line with the principles of the Mental Capacity Act 2005 and their freedom and liberty respected as required by the Deprivation of Liberty Safeguards. People who lacked mental capacity to consent to care received the support they required for a ‘best interest’ decision to be made on their behalf.

People enjoyed the food provided at the service and were satisfied with the choices offered. People had options of healthy meals that also took into account their needs and preferences. Staff involved healthcare professionals when needed to ensure people’s dietary and health needs were met.

People’s care was provided with kindness and compassion. Staff involved people in decisions about their care and how they spent their day. People had developed good working relationships with staff. Advocacy services were organised for people who required support to have their views known. Staff respected people’s privacy and dignity.

People were at the centre of care planning and service delivery. Staff had up to date information about people’s needs and preferences and the support they required. People received care as planned and in line with their wishes. People were supported to maintain their independence.

People had opportunities to share their views about the service. The registered manager used their feedback to improve quality of care. People had information about how to make a complaint and were confident their concerns would

Inspection carried out on 6 June 2016

During a routine inspection

This inspection took place on 06, 07 and 08 June 2016 and was unannounced.

Parkview provides accommodation and personal care for up to 69 older people living with dementia in the London Borough of Bexley. At the time of our inspection the home was providing support to 56 people. At the time of our inspection there was no registered manager in place although the current manager was going through the process of registration. The previous registered manager deregistered in February 2015. 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.

At our last comprehensive inspection on 20 and 21 October 2015 we found a breach of regulations because risks to people had not always been adequately assessed and action had not always been taken to ensure identified risks to people had been safely managed. The provider wrote to us following the inspection to tell us what action they would take to address this breach.

At this inspection we found that the provider had taken action to address these concerns. However, we found a further breach of regulations because environmental risks within the service were not always managed safely. You can see the action we have told the provider to take at the back of the full version of this report.

We found that there were sufficient staff deployed within the service to meet people's needs and that the provider had undertaken appropriate recruitment checks on new applicants before they started work. People's medicines were safely managed and were administered as prescribed, although improvement was required to some aspects of medicines recording.

People were protected from the risk of abuse because staff were aware of the action to take if they suspected abuse had occurred. Staff had received training in the areas considered mandatory by the provider. They undertook regular refresher training in these areas to ensure they remained up to date with best practice. Staff were also supported in their roles through supervision and an annual appraisal.

People received sufficient to eat and drink and their nutritional needs were regularly reviewed and monitored. They had access to healthcare professionals when required, in support of their health and well being. Staff sought consent from people when offering them support and the provider acted in accordance with the requirements of the Mental Capacity Act 2005 (MCA) to ensure specific decisions were lawfully made in people's best interests where they had been assessed as lacking capacity to make the decision themselves. People were also only lawfully deprived of their liberty when it was in their best interests under the Deprivation of Liberty Safeguards.

People were treated with dignity and their privacy was respected. They told us that staff treated them with kindness and consideration, and they were supported to maintain the relationships that were important to them. A range of activities were on offer to support people's need for stimulation. People were involved in day to day decisions about their care and treatment. They had care plans in place which had been developed based on an assessment of their needs and which took into account their views.

The provider had a complaints policy and procedure in place and on display within the service. People and relatives told us they had confidence that the manager would address any concerns they raised. They were able to share their views of the service at regular residents and relatives meetings and we saw that feedback from meetings was considered and used to drive service improvements.

Staff and people spoke positively about the manager and told us she was supportive and available to them when required. The service had quality a

Inspection carried out on 8 March 2016

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

We carried out an unannounced comprehensive inspection of this service on 20 and 21 October 2015 and took enforcement action, serving warning notices in respect of breaches found of Regulations 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to the provider not having adequate systems in place to monitor the quality and safety of the service provided, insufficient numbers of staff being deployed within the service, and staff not receiving refresher training in line with the provider’s training policy.

You can read the report from our last inspection, by selecting the 'all reports' link for ‘Parkview’ on our website at www.cqc.org.uk.

We carried out this unannounced focused inspection of the service on 08 March 2016 to check that requirements of the regulations had been met in response to the enforcement action we had taken. This report only covers our findings in relation to the follow up on the breaches of Regulations 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We have asked the provider to send us an action plan telling us how and when they will become compliant with the breach we found of Regulation 12. This breach will be followed up at our next comprehensive inspection of the service.

Parkview provides accommodation and personal care for up to 69 older people living with dementia in the London Borough of Bexley. At the time of our inspection the home was providing support to 56 people.

At this focused inspection on 08 March 2016 we found that the provider had addressed the breaches of Regulations 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We have revised and improved our rating for the key question ‘Is the service safe’ to ‘Requires Improvement’ as we also have yet to follow up on the breach of Regulation 12 identified at our inspection in October 2015. The rating for the key question ‘Is the service effective?’ remains as ‘Requires Improvement’ because we have yet to follow up on other key lines of enquiry which required improvement under this key question. The rating for the key question ‘Is the service well led?’ also remains as ‘Requires Improvement’ because the systems and processes that had been implemented have not been operational for a sufficient amount of time for us to be sure of consistent and sustained good practice

We found that the provider had put systems in place to assess and monitor the quality and safety of the service. There were sufficient staff deployed within the service to meet people’s needs although improvement was required to ensure that actual staffing levels reflected the levels that had been planned for. Staff were up to date with their training in line with the provider’s policy and told us they had the skills necessary to undertake their roles.

Inspection carried out on 20 and 21 October 2015

During a routine inspection

This unannounced inspection took place on 20 and 21 October 2015. At our previous inspection in August 2014 we found the provider was meeting the regulations in relation to the outcomes we inspected.

Parkview is a residential home providing accommodation, care and support for up to 69 people living with dementia. At the time of our inspection the home was providing support to 64 people. A registered manager was not 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.

At this inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The service did not have effective processes in place to monitor risks to people because risk assessments were not regularly reviewed, and audits of people’s care plans and risk assessments had not been undertaken in line with the manager’s stated requirements. There were not always sufficient staff available to support people at night, and staff had not always received appropriate refresher training in line with the provider’s requirements. CQC has taken enforcement action to resolve the problems we found in respect of these regulations. You can see the enforcement action we have taken at the back of the full version of this report.

We found a further breach of regulations because risks to people had not always been accurately assessed, and the risks to one person had not been properly managed because a relevant risk assessment relating to their fluid intake was not in place resulting in staff making incorrect assumptions as to why their intake was being monitored. You can see the action we have asked the provider to take at the back of the full version of this report.

There were procedures in place to protect people from the risk of abuse. Staff had received training in safeguarding adults and were aware of the action to be taken if they suspected abuse had occurred. The service undertook appropriate recruitment checks before staff started work and staff were supported in their roles through regular supervision and an annual appraisal.

Medicines were safely stored and recorded, although improvements were required in the overall management of medicines because there were high levels of medicines errors reported during the previous year. The provider had procedures in place to deal with foreseeable emergencies.

Arrangements were in place to ensure people consented to their care, or that decisions about the support they received were made in their best interest and in line with the requirements of the Mental Capacity Act 2005, However some improvement was required in the way people’s consent was documented within their care plans. There were arrangements in place to ensure the service complied with the requirements of the Deprivation of Liberty Safeguards.

People were supported to maintain a balance diet and told us they enjoyed the meals on offer within the home. They had access to a range of healthcare professionals where required and a visiting GP confirmed that staff were proactive in informing them of people’s conditions.

People were involved in decisions relating to their support and their care plans were reflective of their individual needs. However improvements were required in the frequency at which care plans were reviewed, and to demonstrate that people were involved in the reviewing process. A range of activities were available to people within the service which people told us they enjoyed.

The provider had a complaint procedure in place for people to refer to if needed and people we spoke with told us they knew who to raise concerns with if they had any issues.

People told us they were treated with kindness and consideration by staff. Staff were aware of people’s individual needs and preferences and could describe how they worked to ensure people’s privacy and dignity were maintained.

Most people and staff told us they felt the service was well led and the manager had put processes in place to make herself available to staff, people and their relatives when required. The service conducted satisfaction surveys and held regular meetings in order to get people’s views on the home, and feedback was used to drive improvements within the service.

Inspection carried out on 6 August 2014

During a routine inspection

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home. CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Recent applications had been submitted and we found proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one. We found staff had a good understanding about adult safeguarding and they told us they would always escalate any concerns. A safeguarding policy was in place and staff attended an annual training session.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff they understood people�s care and support needs and knew them well. One person told us. "The staff look after us well. I am happy here.� Staff had received training to meet the needs of the people living at the home.

Is the service caring?

People were supported by kind and attentive staff. We saw care staff were patient and gave encouragement when supporting people. We observed this at lunch time when we saw staff supporting people to eat their meal at their own pace and were not rushed. One person told us �They look after us properly. I have made new friends." A visitor told us "We can�t fault the care here; staff are very caring.� Another relative said� the staff are attentive.�

Is the service responsive?

People�s needs had been assessed before they moved into the home. People told us they were happy with the care they received. Records confirmed people�s preferences, history and diverse needs had been recorded and care and support had been provided which met their wishes. People had access to activities and people told us they enjoyed the recent coffee morning. We spoke to relatives who told us the staff were responsive and kept them informed of any changes. One relative said� they are good at communicate with me, they tell us what is happening.� The Reviewing Officer visiting on the day of our inspection described the staff as always caring and said, �I have seen staff reassuring people in a very caring way.�

Is the service well-led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. One relative said �The manager has an open door; they will listen to you and give you time to talk. They get things sorted out.� Staff told us the manager had an open door policy and they could raise any issues with them. They said they had regular team meetings, supervision and an annual appraisal.

During a check to make sure that the improvements required had been made

We reviewed the information sent to us by the provider. We found that the provider had made improvements to ensure appropriate arrangements were in place in relation to the recording of medicines. Staff administering medicines were provided with updated training and there were regular checks in place to ensure a safe management of medicines.

Inspection carried out on 1 May 2013

During a routine inspection

At our inspection on 01 May 2013 people and relatives we spoke with told us that they were happy with the care they received. One person told us that staff were "very helpful" and that they felt safe living in the home. One relative we spoke with told us that staff "were always available when needed" and that "their attitude is fantastic".

We found that people's care was planned and delivered in a way that was intended to ensure their safety and welfare. People spoke with told us that they had a choice in the food that they ate and we saw that they were appropriately supported to ensure they ate and drank sufficient amounts to meet their needs. Medicines were safely stored and administered in the home. However, we found that the administration of medicines was not always appropriately recorded.

Records maintained in the home were securely stored and were accurate and fit for purpose. We also found that there were enough staff available to meet people's needs and that staff were supported in their roles through training and supervision.

Inspection carried out on 3, 4 January 2013

During a routine inspection

People and relatives that we spoke with told us that staff were "very friendly and caring". One person told us that the staff had "a good attitude" and were "patient and considerate" when providing care to their relative. They told us that they felt safe and secure in the home and that staff supported their independence wherever possible. One person told us that their relative had "relaxed and become far less anxious" since they had moved in.

We found that people were able to express their views and were involved in making decisions about their care. However, we also found that care was not always being planned and delivered in a way that met people's individual needs and that there were not always plans in place for dealing with emergencies.

Staff were able to demonstrate an understanding of safeguarding of vulnerable adults but had not always been adequately supported through training and supervision in line with the provider's own requirements. There were not always sufficient staff on duty to meet people's needs and care records were not always accurate or stored securely.