Archived: Parkview Residential Home

We completed an unannounced comprehensive inspection of this service on 2 and 5 February 2015 and found the provider was failing to meet legal requirements. Specifically the provider had breached Regulations 12, 13, 15 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

During our February 2015 inspection we concluded people were not being protected against the risks of receiving care that was inappropriate or unsafe. People were not fully protected against the risks associated with medicines because the provider did not manage medicines appropriately. The provider did not have effective systems in place to protect people from the risks of exposure to a health care associated infection. People’s rights against inappropriate restriction of liberty were not in place to make the required assessments and applications, in line with Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) legislation. People were not fully protected against the risks associated with unsafe or unsuitable premises.

We undertook an unannounced focused inspection on 28 April 2015 as part of our on-going enforcement activity and to check whether the provider now met legal requirements. However we found continuing breaches of legal requirements. Specifically these related to Regulations 12, 13, 15 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. In summary people were not fully protected against the risks associated with medicines because the provider did not manage medicines appropriately. The provider did not have effective systems in place to protect people from the risks of exposure to a health care associated infection. People’s rights against inappropriate restriction of liberty were not protected because appropriate measures were not in place to make the required assessments and applications, in line with MCA and DoLS legislation. People were not fully protected against the risks associated with unsafe or unsuitable premises.

Parkview Residential Home provides care and accommodation for up to 26 people. On 25 November 2015 there were 17 people using the service.

The home had a registered manager 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.

Safeguarding concerns had not been raised in relation to incidents where one person was sleeping in a room where the roof was leaking above their head. Nor was an incident of inappropriate touch between people raised as a concern. The registered manager, despite attending training, did not acknowledge these events as safeguarding incidents and therefore no alerts had been made, meaning people remained in potentially harmful situations.

Risk assessments for the building, equipment and people were ineffective and did not identify risk or control measures to keep people safe.

The building was in a poor state of repair. There were no risk assessments or effective monitoring of the leaking roofs. People were using a bathroom with a draughty window that did not close properly. The registered manager told us people preferred to use this bathroom however the other bathroom was not useable due to the bath hoist being broken.

There was no ongoing maintenance schedule to evidence a rolling programme of repairs for the building or equipment. External exit routes were found to be padlocked which would prevent people leaving in the case of an emergency evacuation; fire doors were compromised and compartments breached.

Care plans contained inaccurate information about people’s care, and the registered manager confirmed the contradictions but did not act to rectify them.

Do Not Attempt Cardio Pulmonary Resuscitation orders were in place for some people but the registered manager had not questioned the content of these which was in breach of the Mental Capacity Act (2005) code of practice.

Staff did not understand the MCA (2005) code of practice. Capacity summary sheets were in place but were not decision specific. Relatives were giving consent when they had no Lasting Power of Attorney in place to give them the authority to do so.

We saw two people asleep during mealtimes; one person’s head was on a cup of tea, the other in a bowl of cornflakes. There were no staff available in the dining area to respond to people’s needs.

Staff were task focused and there were not enough of them to meet people’s needs as detailed in care plans. For example, one person required two-to-one support for transfers; another person needed to be observed whenever mobile and another person was to be observed if presenting with challenging behaviour. This would need four staff but there was only three care staff working at any given time which meant the remaining people were left without supervision or support.

We saw accidents had occurred where people had fallen or hit their head on the dining table. They were attended to by staff who were not trained in first aid nor was medical support sought for people.

There were not enough seats in the dining area for everyone to sit and have a meal together if they chose to do so.

The registered manager failed to recognise, investigate and respond to complaints and in the process failed to follow the provider’s own policy in relation to complaint management.

There was no effective quality assurance process in place. The registered manager did not complete any audits nor did they respond to actions identified on audits completed by the quality manager. There was no system or process to assess quality and drive continuous improvement.

Medicines were managed appropriately.

Staff received supervision and appraisal however some training had not been delivered, such as nutrition and hydration, dignity and respect and first aid.

The overall rating for this service is ‘Inadequate’ and the service is therefore 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 timeframe 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.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives and the staff supporting them, and from looking at records.

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

Is the service safe?

Before anyone received care from the service, pre-admission information was obtained and assessments of people's individual needs took place. This meant the staff knew how to care for the people who used the service.

The provider had a safeguarding of residents policy and all staff were trained in safeguarding and knew what to do if they witnessed anything that caused them concern.

Staff had been suitably checked and the provider had an effective recruitment procedure in place.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager understood the home's responsibilities under the Mental Capacity Act 2005 however following a recent court ruling regarding DoLS in care settings, the provider may wish to review people's living arrangements to check whether their circumstances may amount to a deprivation of liberty, according to the revised definition.

People we spoke with told us they felt safe and comfortable with their care workers. One person told us, 'Yes, very safe'

Is the service effective?

Each person had individual care plans which set out their specific needs and people had been involved in the assessment and planning of their care. People we spoke with told us they were involved in the planning of their care.

We saw that support plans and risk assessments were up to date and reflected people's individual needs.

Is the service caring?

People were supported by suitably trained staff and we saw that care records were accurate and up to date. The assessment, planning and delivery of care and support was centred on the individual and considered all aspects of their individual circumstances.

People and their relatives told us they were happy with the care provided by Parkview. One person told us, 'It's lovely' and 'I love the girls, every one of them.'

Is the service responsive?

People and their relatives were asked their views via regular questionnaires and action was taken when any issues were identified.

Records showed that people's needs had been taken into account and care and support had been provided in accordance with people's wishes.

Is the service well-led?

The provider gathered information about the quality of their service from a variety of sources. Care records, including care plans and risk assessments, were regularly reviewed.

Staff meetings were regularly held to keep staff up to date with any new issues or changes within the organisation.

We spoke with staff and found that they were very knowledgeable about people's likes and dislikes and how they wished to be supported. We were able to see how people's skills and independence were promoted. We saw that staff were very caring and supportive of people.

We spoke with staff who were very knowledgeable about people's dietary preferences. We saw people were offered a choice of food and hydration. Staff said an alternative would be offered if people had changed their mind. One person we spoke with told us, 'If I want something different to eat, I can have it.'

During our inspection we saw many health professionals visiting people in line with their health care needs. The records showed that people had contact with services when needed.

We saw there were enough qualified, skilled and experienced staff to meet people's needs.

We saw that there was a complaints policy and complaints had been handled appropriately.

Parkview Residential Home was undergoing refurbishment at the time of our inspection. Some aspects of the building were in need of updating and decorating as reflected by the refurbishment programme. Safety checks around the building, lifts, electrics, heating and fire alarms were carried out regularly in line with legal requirements. People who lived there, lived in a safe environment.