This inspection took place on 13 December 2017 and was an unannounced visit. We returned on 18 December 2017 so we could speak with more staff and look at their quality assurance systems. At the last inspection on 14 November 2016, the service was rated as requires improvement. This was because we found a lack of managerial oversight by the provider and the management did not operate effective audit systems to drive improvements within the service. We found monitoring of people’s food and fluid intake was not always consistent with what they had consumed. Actions were not always recorded to show how people were supported and audit systems had not identified this as a concern.
Following the last inspection visit, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Effective and Well led to at least good.
This inspection visit was a comprehensive inspection and during this inspection we checked to make sure improvements had been made. Whilst some improvements had been made, we found some improvements were still needed in their audit systems because they had not identified some of the improvements we found.
Park View is a care home registered to provide care to 64 people. People in care homes receive accommodation and nursing and/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. At the time of our inspection visit, 54 people lived at the home.
A requirement of the service’s registration is that they have a registered manager. 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 and the associated Regulations about how the service is run. At the time of our inspection visit there was no registered manager in post. The registered manager had left the service in July 2017. Since then a manager has been in post, and in December 2017, had applied to become the registered manager at the home.
People told us they felt safe at the home, because they felt safe with the staff who supported them. Staff had received training so they understood what might constitute abuse and the action they should take to safeguard people if they had any concerns.
The provider used recognised risk assessment tools to identify any risks to people’s health and wellbeing. Staff knew how to support people to reduce identified risks to people. However, some risks to people had not always been mitigated to prevent further risk,
People told us their needs were met because they were supported and cared for when needed. People were complimentary of the staff and said staff were kind, caring and considerate in their approach. People spoke positively about the friendliness and willingness of staff to help them.
People told us they had a choice of meals and could eat in the dining room or their own bedroom, according to their individual preference.
People’s privacy and dignity was respected and staff knew how to maintain this to prevent people feeling uncomfortable. Staff promoted people’s choices and independence which gave people a sense of worth and ownership in how their care was delivered.
The home was clean, free of odour and staff wore personal protective equipment (PPE) at the necessary times. Regular spot checks and effective monitoring ensured standards of cleanliness were maintained.
People told us they would feel happy to raise any concerns or complaints and they knew how to do this and expected timescales regarding a response.
There were enough staff who were available to provide people’s care and support at times people preferred. Staff respected people’s privacy and dignity and people felt comfortable when staff supported them to maintain their health and wellbeing.
Medicines were administered safely and people received their medicines as prescribed. Time critical medicines were given at the required times and PRN protocols ensured staff provided those medicines as and when required, safely.
The audit systems required improvement to ensure actions led to improvements. We found examples where food and fluid charts were incomplete, but we satisfied action was taken to support them if a concern was known. Where checks were delegated to others, there needed to be greater scrutiny to ensure improvements to the delivery of service were made.
Recent management changes meant not everyone knew who was the permanent manager, however people were complimentary of the manager and their approach. The manager was committed to improve the service and wanted people’s experiences to be positive. The manager gave us a commitment that actions would be taken. When we discussed improvements with the manager, when we returned on the second day, an action plan was in place to improve the standards within the home.
The registered manager had submitted a Provider Information return (PIR) to us, they and the provider understood their legal responsibility to notify of us of important and serious incidents. The provider displayed a copy of their previous inspection rating.
Further information is in the detailed findings below.