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Parkview Residential Home Good

Reports


Inspection carried out on 15 January 2019

During a routine inspection

This announced comprehensive inspection took place on 15 January, 12 and 13 February 2019. When we arrived on the first day, the service had experienced a recent outbreak of influenza. Therefore, we could not continue with the inspection which was cancelled and rescheduled.

Parkview Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a 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.

Parkview accommodates 22 people in a residential area of Ilfracombe, North Devon. People's bedrooms were on both floors and had en-suite facilities. There was a stair lift giving access to the upper floor.

At the time of the inspection, there were 21 people using the service with one vacancy. One person was on a short stay placement (respite) at the service.

We carried out a comprehensive inspection of this service on 21 and 27 November 2017 and rated the service as ‘requires improvement’ for the second consecutive inspection. At that inspection we found the provider had not met all the regulations. This was because:

• the premises were not always safe,

• risks to people had not always been identified, and

• the systems to monitor and improve the service were not fully established.

At that inspection, we asked the provider to take action to make improvements. They sent us an action plan, telling us what they were doing to meet the relevant requirements and the timescales for the actions to be completed.

At this inspection, we found all the legal requirements had been met and the service had improved to an overall ‘good’ rating.

People felt safe living at Parkview. They described staff as kind, caring and respectful.

The registered manager was passionate and motivated in their work. They worked alongside care staff and promoted an open and visible culture. Staff felt appreciated, valued and listened to. The registered manager led from the front and knew people and their families well. The provider and registered manager had worked together for many years and respected each other’s opinions.

People were cared and supported by enough staff who were suitable for their roles. Staff were safely recruited, trained and supervised in their jobs. They all enjoyed working at Parkview and felt part of a team. Staff showed an understanding of what constituted abuse and what they needed to do if they wanted to raise concerns.

People had assessments undertaken before they came to live at Parkview to ensure their needs could be met. This was except for emergency admissions. Each person had a care plan in place which was comprehensive and detailed. The plans showed each person’s individualised care plan and included any assessments of risk identified. People were cared for and supported well at the end of their lives.

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 support this practice. The registered manager had put in processes required by the Mental Capacity (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). Staff understood their responsibilities in relation to the MCA and DoLS. They were aware of how these impacted on their approach and ensured people gave consent before any care was given.

People’s experiences were sought through questionnaires and meetings. When ideas or concerns were raised, the registered manager acted on them. People were able to complain if necessary with all complaints fully investigated.

People received their medicines safely and on time. There were infection control policies and procedures in place, but staff had not always adhered to them. This was addressed by the registered manager and resolved.

People received a balanced and nutritious diet. People’s views were taken into consideration when

Inspection carried out on 21 November 2017

During a routine inspection

Parkview Residential Home provides accommodation and support for up to 22 people who require support and personal care. The home is a two storey building in Ilfracombe in North Devon. Bedrooms are on both floors and all have ensuite facilities. There is a stair lift to enable people to access all parts of the home. Parkview Residential Home 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.

This unannounced comprehensive inspection was carried out on 21 and 27 November 2017. At the time of the inspection there were 21 people using the service, two of these people were staying at the service for a respite stay.

We carried out a comprehensive inspection of this service on 22 June and 6 July 2016 and rated the service as requires improvement. At that inspection we found the provider had not met all of the regulations. This was because they had not followed the requirements of the Mental Capacity Act (2005); had not undertaken environmental risk assessments to ensure the premises and equipment were clean, suitable and well maintained for their intended purpose; there were poor infection control measures in place and poor governance of systems and processes for the assessment, monitoring and improvement of the quality and safety of the service. At that inspection we asked the provider to take action to make improvements. They sent us an action plan, telling us the actions they were taking to meet the relevant legal requirements and the timescales. For example: they said they would introduce consent forms by 31 April 2017. Risk assessments would be put into place and the laundry room would be rearranged to prevent cross contamination by the end of March 2017. They also confirmed questionnaires would be sent out to people, visitors and health professionals to ask their views about the service. At this inspection we found they had completed their actions and improvements had been made.

A registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 said they had worked at the service for 20 years in different roles. They had agreed to take on the role of manager and had only recently undertaken their fit person interview with CQC and were registered as the manager on the 20 November 2017.

The registered manager was very active within the service and undertook shifts working alongside the staff. They led by example and had a high level of expectation of the staff to deliver good quality care. They were supported by the provider who worked at the home each day in the kitchen as the cook and a deputy manager. They had recognised there were areas of concern and were addressing these.

The registered manager had been working with a local NHS nurse educator who had been visiting the service regularly and offering support as well as delivering training. The provider was also working with the local authority Quality Assurance and Improvement Team (QAIT) to access support and guidance to help improve the service further. The registered manager attended a local registered manager’s forum where they could share information.

In response to the concerns raised at our last inspection the provider had made changes to the laundry room layout. This included putting in a sluicing sink and moving the laundry equipment around so soiled laundry did not come into contact with clean laundry. They had also had a second communal toilet put in on the ground floor. The home was clean and free from any u

Inspection carried out on 22 June 2016

During a routine inspection

Parkview is registered to provide accommodation for 22 older people who require support and personal care.

This unannounced inspection was carried out on 22 June and 6 July 2016. At the last inspection on 12 June 2014 we found the provider met the regulations we looked at.

At the time of the inspection there were 22 people using the service.

A registered manager was in place and they were present on the days 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.’

Environmental risk assessments had not been carried out. There was an infection control risk due to the layout of the laundry room and its facilities. Areas of the home were in need of cleaning, maintenance or redecoration. There were offensive odours in some areas of the home. There was a lack of available communal toilets on the ground floor.

People were very happy with the care and support they received. They lived in a homely environment and were comfortable and relaxed. People described the good relationships they had developed with staff. Two people said, “The staff are good here … I can’t grumble … we have a joke and a laugh but they are always on the ball” and “I am happy here because the staff make me happy.”

Staff were enthusiastic and motivated in their jobs. The felt supported by the registered manager and had been recruited safely. They received training to do their jobs properly and were all very experienced in care. Several staff had worked at the home for several years. There were sufficient numbers of staff on duty at all times.

People said staff were kind and caring. Staff were compassionate towards people and ensured people’s privacy and dignity was respected at all times. Staff treated people with respect and knew people well. People had opportunities to participate in a range of different social activities both inside and outside of the home. One person said, “If I was the Queen of England they couldn’t look after me any better …”

Staff were aware of issues relating to safeguarding, and could describe the action to take should they have any concerns or should concerns be reported to them. Plans were in place to minimise identified risks. People's medicines were managed and stored appropriately.

People had a plan of care in place and any assessments of individual risk identified. People were supported to maintain good health. They had access to healthcare services. People liked the food served, although they would like more choice over the variety of meals offered.

The provider had not always followed the processes required within the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Best interest decisions had not involved the people required.

People and their relatives knew how to make a complaint and would be listened to.

There was an open culture within the service. People were relaxed with the registered manager who knew people well. Staff spoke highly of the registered manager and two said, “No door is closed here …. (registered manager) works the floor so she knows what it’s like” and “(registered manager) is brilliant … absolutely fantastic …”

The provider did not seek regular formal feedback about the quality of the care and support provided. Some systems were not in place to regularly monitor the delivery of the care. Records required for the running of the service were not always held.

We found three breaches of regulation and made one recommendation. You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 12, 18 June 2014

During a routine inspection

We considered our inspection findings to answer questions we always ask:

Is the service safe?

Is the service caring?

Is the service effective?

Is the service responsive?

Is the service well led?

This is a summary of what we found.

On the days of our inspection there were 20 people living at Parkview. The summary is based on conversations with eight people living at the service, one relative, five staff, one visiting health care professional and the provider. We looked at records of people's care and quality monitoring systems used with the home. We also spent time observing how care and support was being delivered to people.

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

Is the service safe?

We found the service was safe because there were enough staff in place to meet people's identified needs. During a previous inspection completed on 13 September 2013 we found there were not always enough staff available to meet the needs of people at the home. We had set a compliance action and asked the provider to send us an action plan about how they intended to achieve compliance. We received an action plan and followed up with a phone call in December 2013 to seek assurances from the manager that the service had employed, and were having more staff on duty at key times to ensure peoples needs were being met. During this inspection we found there was enough staff across the shifts to meet people's needs in a safe and timely way.

We saw care was being well planned and where people's needs had increased a GP or other healthcare professionals were consulted. One person commented to us about how the ''Staff have gone out of their way to make sure I am looked after and I am so glad to be back from hospital, this is my home and this is where I want to be.''

We found people were being cared for in an environment which was clean and safe. We identified one issue of risk in the environment, where wardrobes had not been secured to the walls. This had been addressed by the provider within 24hours.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Whilst no applications have needed to be submitted, we judged that staff had a limited understanding of this. The provider immediately booked some training to help staff better understand assessing mental capacity and when they may need to consider making an application for a DoLS for an individual.

Is the service effective?

The service was effective. People who were able to give their views about their experience said they were happy at the home. Comments included ''It's very good here, I would tell you if we weren't being looked after'' and ''It's very homely, we love it here.''

When we spoke with staff, they showed a good understanding of people's needs and preferred routines. Our observations of how care and support was being delivered supported this. This showed the staff had the right knowledge and skills to provide effective care and support to people.

Is the service caring?

The service was caring. We saw people were supported by staff in a kind and respectful way. For example, we saw how staff worked with an individual who became restless and disorientated during the afternoons and early evenings. We also saw how one person was given time and support to eat their meal at a gentle and encouraging pace. People we spoke with during the inspection described staff as caring. One person said she felt they ''went above and beyond to make sure everything was right.''

Is the service responsive?

We saw the service was responsive. People's needs had been assessed before moving into the home and their care plan was reviewed regularly to ensure all needs were being monitored and met. Plans included people's life history as well as their known likes and dislikes. This helped staff to deliver care in a more person centred way.

We saw some activities were organised such as a BBQ, ball games, singing and music. We heard other activities were usually carried out in the afternoons, including bingo, quizzes and games. This showed the service was responding to people's emotional well-being.

Is the service well-led?

We found the service was well-led. We heard from staff how they were having handover meetings as well as one to one supervisions about their work. Staff we spoke with felt their opinion was listened to. People who lived at the home told us they could talk over any concerns with the manager and/or staff. We also saw people and their families had been asked to complete questionnaires about all aspects of their care. The provider had not yet collated all the results, but planned to do this, and action any suggestions. This showed the provider used people's views to improve the quality of the service provided.

Inspection carried out on 13 September 2013

During a routine inspection

At the time of this inspection there were 21 people living at the home. We were able to talk with nine people about their experiences of living at the home. We also spoke with four staff and the registered provider. We spoke with one visiting health care professional and one visiting relative.

We spent time observing how care and support was delivered and looked at records relating to people's care needs. We also looked at staff recruitment records to check there were robust systems in place to fully protect people.

People we spoke with told us they were happy with the care and support. They were very complimentary about the staff who supported them. Comments included ''You couldn't wish for a better place, the staff here are excellent.'' Another person told us ''Staff are all wonderful.''

We found care and support was well planned and delivered by a staff team who knew the needs and wishes of the people they cared for. The community nurse team were confident the staff would alert them to any health care issues in a timely manner. There were times when staffing levels were not sufficient to meet the number and needs of people and we have asked for this to improve.

We found staff recruitment was robust and staff understood the safeguarding process because they received updated training on an annual basis. This helped to protect people as staff were made aware of what signs to watch for and who they needed to contact if they were concerned.

Inspection carried out on 3 October 2012

During a routine inspection

We brought forward this planned inspection to check on compliance of outcome 13- staffing. When we inspected in March 2012, we found that there was no provision made for someone to cook whilst the provider, who does most of cooking, had gone on holiday. This meant that the home had been short staffed and people had been placed in potential risk. We did not receive an action plan form the provider, although we checked that holidays had been covered by a phone call to the home.

We completed this unannounced inspection on 3 October 2012 and spoke with five people living at the home, one relative and one visiting healthcare professional. We also spoke with three care staff, the registered manager and the registered provider. We looked at some key records including, care plans, risk assessments, staff rotas and medication records.

Some people who live at the home have dementia and were less able to give their views of life within the home. To help us understand the experiences of people we used our SOFI (Short Observational Framework for Inspection) This tool helps us record how people spend their time, the type of support they get and whether they have positive experiences.

We spoke to five people in detail about their experience of living at the home. One person told us ��The staff here are very good, they know my routines and what I like and don�t like and they go out of their way to make sure that I get good care.�� Another person confirmed that care staff always talked to them and explained what care and support they were helping them with.

Care and support was planned, with risk assessments in place to minimise any identified risks for people. We saw that daily records gave a good account of how people�s personal, health and emotional needs were being met. Care plans had been updated to reflect any changes.

We observed that care and support was delivered in a kind and sensitive way. Care staff had a good rapport with people and the atmosphere was relaxed and calm.

We saw that there were sufficient staff available, although there had been some recent reductions in staffing levels. The provider agreed to re instate a third carer for the afternoon shift, once it was pointed out that two care staff was not enough to provide care and support safely to the number and needs of people currently living at the home. Although we have judged the service compliant in this outcome we have not been able to test that this compliance has been sustained.

Inspection carried out on 7 March 2012

During a routine inspection

We carried out an unannounced inspection to Parkview on 7 March 2012 as part of our planned inspection programme. We spent time talking to eight people living at the home and to four staff as well as the registered manager. We also spent time looking at some of the key documents including care plans, staff training records and the audit of individuals personal monies. This helped us to better understand how well the home was run.

People we spoke with were very complimentary about the care and support they received at Parkview. Comments included ��Staff are wonderful, whatever you ask for you get�� ��I have been here a long time and regard this as my home now�� ��couldn�t ask for better. When I first moved here I got nightmares, staff came as soon as I rang the bell, they are very caring�� ��we have lots of entertainment, singers, dances and the local vicar comes in to give communion ��.

We looked at three care plans in some detail and saw that they gave good accounts of people�s personal and healthcare needs and included their morning and bedtime routines. This helped to ensure that care and support was done in a person centred way. We saw for newer people to the service that a pre-admission assessment was completed. Not all plans had recorded any identified risks or how these risks should be minimised.

We saw that on the day of our inspection there were three care staff on duty for 22 people. The registered provider was away on holiday and had not made provision for cover for cooking, which they normally covered. This meant that care staff were not available in the midmorning period as they were cooking lunch. We saw that usually there were sufficient staff on duty to cover all tasks and ensure that care and support for people was met in a timely fashion.

Staff told us they felt well supported and trained to do their job and were able to demonstrate they were knowledgeable about the needs of people they care for. They were also able to show how they would protect people from potential abuse.

Reports under our old system of regulation (including those from before CQC was created)