Parkview Care Home

Parkview Care Home is a residential care home providing personal to up to 10 people. Most people living at the service live with complex or enduring mental health difficulties. At the time of our inspection there were 5 people using the service however only 1 person was receiving personal care support.

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

Over the past two inspections, we had rated this service inadequate and took enforcement action against the provider. At this inspection, we found progress and improvements had been made. Some areas still required further work, such as documenting risks to people and how these were managed, and decoration of the building. However, the service had enhanced its quality assurance and governance processes to drive improvements. The embedding of these new ways of working is now required to ensure consistency moving forward.

People spoke positively about Parkview Care Home and told us they felt safe living there. We observed warm interactions between people and staff, who clearly knew each other well. Improvements had been made to people’s care plans making them more person centred and focused on people’s needs and wishes.

Staff demonstrated a good knowledge of safeguarding and spoke of being confident to report matters when needed and that these would be dealt with robustly by the registered manager. Medicines were administered safely, the systems around this had been reviewed and improvements implemented. Accident and incidents were being more robustly monitored to ensure learning and development of staff.

Training for staff had improved with mandatory courses taking priority. Staffing levels were sufficient to meet people’s current needs and this was under regular review by the registered and assistant managers.

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. They were supported to partake in activities and interests important to them.

The registered manager was passionate about their role and making continued improvements of the service. They were open and proactive to any queries we raised during the inspection.

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 12 October 2022) and there were breaches of 6 regulations. This service has been in Special Measures since 4 February 2022. 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

We carried out an unannounced inspection of this service on 23 and 26 May 2022 and continued breaches of legal requirements were found. CQC took enforcement action and imposed a condition onto the provider’s registration. The provider completed an action plan after the last inspection to show what they would do and by when to improve person centred care; safe care and treatment; premises and equipment; good governance and fit and proper persons employed.

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

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.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Parkview Care Home is a residential care home providing personal care and support to people experiencing complex or enduring mental health difficulties. The service can support up to 10 people. At the time of inspection there were eight people living at the home, one person was receiving personal care. This is help with tasks related to personal hygiene and eating.

Parkview Care Home accommodates people in one adapted building across four floors. The building is in a residential area of the city close to public transport and public recreational areas.

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

Areas previously found to require actions and improvements to meet fire safety regulations had been carried out. However, people’s personal safety in the event of a fire was not clearly risk assessed or recorded.

There was a lack of management action to ensure improvements identified from provider audits were addressed. This included home hygiene, maintenance and care plan reviews.

Infection prevention and control was not always well managed. Some areas and facilities had been improved and decluttered. However, other communal or shared areas remained unclean, in need of deep clean or repair.

Staff had not received all the training they needed to support people safely, for example to manage fire risks, use of equipment and safeguarding people from harm.

Care and support plans and risk assessments had not been kept up to date and were not person centred. People’s individual needs and plans were not accurate or sufficiently detailed.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support best practice.

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 5 February 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.

Why we inspected

We carried out an unannounced inspection of this service on 26 October 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements.

At this inspection we also checked whether the Warning Notice we previously served in relation to Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met regarding specific concerns we had about fire safety.

The overall rating for the service has remained inadequate. 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 Parkview Care Home 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 found the provider had taken the required fire safety actions in regard to the Warning Notice we previously served. We found continuing breaches in relation to safe care and treatment, person centred care, premises and equipment, good governance and record keeping.

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 remains in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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.

Parkview Care Home is a residential care home providing personal care and support to people experiencing complex or enduring mental health difficulties. The service can support up to 10 people, at the time of inspection there were seven people living at the home.

Parkview Care Home accommodates people in one adapted building across four floors. The building is in a residential area of the city close to public transport and public recreational areas.

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

There was a lack of management and provider action to ensure safety concerns around the building were addressed. The provider had not responded to recommendations from their own audits to maintain the environment. Maintenance and repairs were needed but not scheduled. Some areas of the home needed actions to meet fire safety regulations and reduce avoidable risk of harm. The provider had not prioritised the reduction of these risks. Following our inspection the provider started to take actions to address the risks identified.

Infection prevention and control was not well managed and there was a lack of leadership to ensure people were protected from the risk of infections. The local authority were providing advice and guidance about safe deployment of staff and good infection prevention and control measures.

Medicine was not always managed safely. Medicine administration competency assessments were overdue and not all support staff had completed medicine awareness training.

There was poor governance of safe staffing numbers, recruitment, support or training to staff. There were sometimes not enough staff working to double sign controlled medicines so managers had advised staff to call on colleagues from another service nearby to support them when required. Staff had not always received the mandatory training they needed and there was no specialist training to reflect the needs and risks of people at the service.

Person centred risk assessments, risk management and support was not evident in people’s care plans. Care and support was not regularly reviewed to ensure people’s goals and changing needs were understood and supported. Incidents and accidents were not analysed in order to find ways to reduce risks.

Systems were not managed well to improve the service. Quality assurance audits were carried out by the provider, but there was no leadership or drive to reduce risks or improve the quality of care offered to people.

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 8 November 2019).

Why we inspected

We received concerns in relation to infection control, governance and staff support. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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. 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Parkview Care Home 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 have identified breaches in relation to fire safety, infection control, medicine management, staffing, recruitment, person centred care and governance at this inspection.

Please see the actions we have told the provider to take, and enforcement action we have taken, 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.

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.

About the service

Parkview Care Home is a residential care home providing personal care to eight people living with a mental health condition at the time of the inspection. The service can support up to 10 people in one adapted building.

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

People told us Parkview Care Home was a good place to live. One person said, “I like it here, it is a free and easy home.” Another told us, “I like it here, the food is good, and the people are alright. The staff are nice and kind.” People were treated with dignity and their independence was respected and promoted.

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 knew people well and understood how to support them. People were encouraged to take an active role in their recovery. People’s needs and wishes were assessed and planned for in line with evidence-based guidance and standards. Risks were considered and mitigated. People were involved in their care planning, and regularly met with key workers to discuss their support and review their care and recovery plans.

Staff were available to support people as needed. When people’s needs increased, the number of staff was reviewed. Staff were supported with induction, training and supervision to make sure they had the right skills to support people.

Staff worked well in partnership with other health and social care professionals to ensure people received the right support at the right time. Staff kept other professionals up to date with people’s progress.

People were supported to take their medicines as needed. People were encouraged to take part in activities of daily living, such as laundry and cooking. People were involved in choosing the menu and had enough to eat and drink.

When things went wrong, lessons were learnt, and changes made to prevent reoccurrence. The views of people, their relatives, staff and other professionals were used to develop and improve the service. People knew how to make complaints, if needed.

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 24 October 2018) and there were three breaches of regulation. 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.

Parkview Care Home is a residential care home that provides care and support for up to ten people living with mental health conditions. On the day of the inspection seven people were living at Parkview Care Home. Accommodation is provided over four floors and includes a shared lounge, dining room and kitchen and a garden area to the rear.

Parkview Care 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.

A registered manager was in post at the time of the 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. However, the registered manager had recently returned from a period working away from the service and we had not been notified of their absence. This is an event notifiable to CQC.

Medicines were not always managed safely. We found inconsistencies in the recording around medicines and could not be sure that people always received their medicines safely. Competency assessments had been completed for some staff who were administering medicines, but others were administering medicines without an assessment of their competency to do so. On one occasion when a person had received an overdose of their medicine had not been appropriately recognised and reported as a safeguarding concern.

Accidents and incidents were recorded but there was no oversight of these, to ensure that lessons were learnt and to allow improvements to be made to prevent reoccurrence.

A quality assurance framework was in place but it did not support the service to identify and address all the areas we noted within the inspection.

The premises were not always suitable for the people living there. We were told this was due to the recruitment of new maintenance staff.

Safe recruitment processes were followed. Staff were inducted to the service. However, the training programme did not ensure that staff had all the skills they needed to support people. For example, only four of the staff team had received mental health awareness training.

Risks to people were assessed and ways to reduce the risk considered and implemented. Care plans included various aspects of people’s lives and the support they needed from staff.

People were involved in the preparation and tasks around mealtimes. People told us their choices were considered in the menu and that alternatives were available.

People were treated with kindness and compassion. Staff provided emotional support to people. People’s identities and preferences were respected and they were treated with dignity.

Activities were tailored to people’s interests and goals. People were involved in daily tasks including laundry and cleaning up after meals.

When people had raised concerns or complaints these were responded to in a timely and considered manner.

People, their relatives and professionals told us the registered manager was approachable and supportive.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

We observed staff interacting with people who use the service in an open, friendly and respectful way. We viewed the care records of four people and saw that care was planned and delivered in line with their individual care plan. We saw that care was delivered as part of a process of assessment, planning and review.

People who use the service told us they were happy with the care they received. One person told us "I wouldn't want to be anywhere else. I love it here. We have nice, friendly staff." Another person told us "Staff are very caring, I feel happy here."

We saw that people were supported to maintain or increase their independence and that people were encouraged to continue with their everyday lives. We were told by people that they were able to make their own decisions and that there were no restrictions placed on them. One person told us "I go out when I want to. Sometimes I go alone and meet my sister, other times I will go out with my key worker."