This inspection took place on 30 November and 7 December 2015 and was unannounced.
At the last inspection on 13 and 22 April 2015 we found seven breaches in regulations which related to staffing, safe care and treatment, safeguarding, safety of the premises, dignity and respect, person-centred care and good governance. Following the inspection we took enforcement action. The commissioners at the Local Authority and Clinical Commissioning Group (CCG) were made aware of our concerns and placements at the home were suspended.
We carried out this inspection in response to concerns received about the care people received at night and to check if improvements had been made following our inspection in April 2015. The suspension on placements was still in place when we visited.
Park View Nursing Home provides accommodation and nursing care for up to 43 older people. There were 22 people living at the home when we visited. This included 18 people receiving nursing care and four people receiving personal care.
Accommodation is provided over two floors with lift access between the floors. There are communal lounges and a dining room as well as toilets and bathroom facilities. A kitchen and laundry are located on the ground floor.
The home had a registered manager who left in May 2015. A new manager was appointed but had not registered with the 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.
People were kept safe from abuse as staff were aware of safeguarding procedures and we saw these were followed when abuse was alleged or suspected. Staffing levels were sufficient to meet people’s needs, however we found recruitment processes were not always being followed to ensure staff’s suitability. The training matrix was incomplete which meant we could not be assured staff had received the training they needed. Although some supervisions and appraisals had been completed the manager acknowledged these were not up to date.
The management of medicines had not improved and unsafe systems meant people were not always receiving their medicines as prescribed.
People enjoyed the food however we found people’s weight and nutritional needs were not being monitored effectively placing people at risk of not receiving sufficient amounts to eat and drink. People had access to healthcare services however, a lack of communication meant advice was sometimes not followed through by staff.
Staff lacked knowledge and understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), which meant assessments and best interest decisions were not considered when people lacked capacity to make a decision.
Improvements had been made to the environment and we found the home was generally clean and well maintained.
Staff engagement with people had improved and we saw staff were kind and caring in their interactions with people. Staff showed respect for people’s privacy and dignity and supported them to maintain their independence. An activity co-ordinator had recently started employment and had developed a good rapport with people.
An electronic care record system had been implemented since the last inspection, however we found information recorded was sometimes contradictory and did not reflect people’s current needs. This was concerning as the home relied upon agency nurses to lead the care team and ensure care was delivered to meet people’s needs and a lack of accurate care records placed people at risk of receiving inappropriate or unsafe care.
The home had a complaints procedure but this was not made available to people who used the service. We saw complaints were not always dealt with in accordance with the home’s procedures.
Although the manager has been committed to making improvements, progress has been limited due in part to a lack of permanent nursing staff to support them in their role. Quality assurance systems have failed to identify or address issues for example with regards to medication, consent, complaints, nutrition, care records and records relating to the management of the service such as training and recruitment.
The overall rating for this service is ‘Inadequate’ and the service remains 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 time frame 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.
You can see what action we told the provider to take at the back of the full version of the report.