Parkview Residential Home

Parkview Residential Home is a residential care home for 22 people. There are bedrooms on the ground and first floor. There is a communal lounge and dining area located on the ground floor. At the time of our inspection there were 21 people living at the service.

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

Following our last inspection, we imposed conditions on the provider's registration which required them to complete a selection of monthly audits and report their findings to CQC. This was because we identified breaches in relation to safe care and treatment, good governance, fit and proper persons employed, need for consent and failure to send statutory notifications to the CQC as required by law.

At this inspection, we identified improvements had been made and risks to people had been significantly reduced, however the systems and process to ensure staff were employed safely had not been consistently followed. We identified that improvements had been made in relation to the safe management of medicines but further improvements were still needed. We have made a recommendation about the use of some medicines and also around the disposal of medicines. Governance in the service had significantly improved but required further development to ensure recruitment was fully compliant with the regulations.

The provider had worked closely with the local authority and the registered manager had received support in relation to implementing a good governance framework. This had resulted in improvements around the management of people’s care and support records and the service environment. The new arrangements were currently being embedded into the service to ensure they were fully effective.

People felt safe at the service and spoke positively about the staff that supported them. Staff were trained in safeguarding and knew how to identify and report concerns. There were sufficient staff on duty to support people. The service was clean with appropriate infection control policies in place.

The provider had ensured a training package was in place for staff and the registered manager was implementing a structure around supervision and appraisal. People were supported to eat and drink enough and where required, the service worked with other healthcare professionals.

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. Improvements had been made around Deprivation of Liberty Safeguards (DoLS) applications and compliance with the requirements of the Mental Capacity Act 2005.

People’s care records were personalised and we received positive feedback from people in relation to the level of care they received. One person said, “I am very happy here, the staff are kind and caring.” Improvements had been made in relation to end of life care and this was still being further developed.

There were new governance systems in operation to ensure the health, safety and welfare of people using the service and others. Auditing of care records, environmental risks and Mental Capacity Act 2005 documentation had been implemented and was being embedded into the service. The provider had notified CQC about any significant events at the service in line with regulatory requirements.

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 Inadequate (published 13 January 2023). The provider sent us monthly reports in line with conditions imposed on their registration.

At our last inspection we recommended the service sought advice and guidance from an accredited source around the current systems in place for training and complying with the Accessible Information Standard. At this inspection we found improvements had been made in this area.

This service has been in Special Measures since 13 January 2023. During this inspection the provider demonstrated that improvements had 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

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 of this inspection.

Enforcement and Recommendations

We have identified a continued breach in relation to fit and proper persons employed at this inspection. We have also made a recommendation about the management of medicines.

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.

Parkview Residential Home is a residential care home for 22 people with conditions associated with old age including dementia. There are bedrooms on the ground and first floor. There is a communal lounge and dining area located on the ground floor. At the time of our inspection there were 15 people living in the service.

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

People were at risk of receiving unsafe or inappropriate care. The current systems in operation for the management of medicines was unsafe. Care records were not always reflective of people’s needs and risks. One person’s risk identified by the service had not been escalated to healthcare professionals so the Care Quality Commission (CQC) raised a safeguarding alert.

We identified some concerns around the overall management of the service environment. The fire risk assessment in use by the service at the time of the inspection was historical and emergency evacuation plans were not available which was not in line with the provider’s policies. This placed people at risk of harm.

There were no formal systems to review incidents and accidents, placing people who may have evolving care and mobility needs at risk. If the provider had an effective system in place this may have prevented further falls by the same people so patterns and trends could be identified. Records relating to falls and accidents during a specific period of time could not be located by the service management. We identified some staff had not been recruited in line with legal requirements.

There was a significant lack of understanding around the Mental Capacity Act 2005 and how it was applied in the service. There were no effective systems in place that ensured that where required, people who may need applications to be submitted to lawfully deprived of their liberty were completed. This meant there was a risk the service were unlawfully depriving people of their liberty. However, people were supported in day to day decisions by staff who worked in their best interests.

The provider had failed to ensure training appropriate to the needs of people living at the service had been adequately provided. This placed people at risk of receiving unsafe or inappropriate care that was not in line with best practice. We have made a recommendation about the current training provision.

People told us they received personalised care and observations we made supported this. However, the records being used did not always reflect people’s current care needs or evidence a fully person centred approach to achieving the best outcomes for people. Improvements were needed around end of life care planning to ensure it was consistent throughout the service for all of the people being supported. There was no understanding of the Accessible Information Standard to which providers of publicly funded adult social care services must meet. We have made a recommendation about the Accessible Information Standard.

Current governance systems in operation to ensure the health, safety and welfare of people using the service and others were inadequate. There was insufficient auditing of care records, environmental risks, medicines, training and Mental Capacity Act 2005 compliance. The service was clean and domestic staff completed cleaning schedules but the provider had no oversight through an infection control audit. Where audits had been completed, for example for medicines, they were not effective in improving the service or making changes to current practice which placed people at risk. The provider had also failed to notify CQC in full about any significant events at the service in line with regulatory requirements.

People told us they felt safe at the service and the feedback we received about the staff and provider was positive. People were kept safe from harm as staff knew how to identify and report safeguarding concerns. Visitors were able to enter the service in line with current guidance. The staff at the service worked well with other health professionals.

People and their relatives spoke positively of the caring staff that supported them. One person told us, "The staff are very caring here, I really enjoy being here." A relative told us, "I really can't praise them enough here, they provide some amazing care." We reviewed the compliments the service had received and we saw peoples’ records were stored confidentially to promote their privacy.

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 16 March 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service. There had been a low number of statutory notifications received from the provider. A statutory notification contains information about certain incidents and events the provider is required to notify us about by law. A decision was made for us to inspect and examine those risks.

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.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, good governance, fit and proper persons employed, need for consent and the failure to send statutory notifications to the CQC as required by law. We have also made a recommendation around training provision and the current systems in place for complying with the Accessible Information Standard.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow Up

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.

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 choosing meals to put in the menus. People’s health needs were managed well and the service had good working relationships with the local GP’s and community nurses.

People were able to undertake activities of their choice, both inside and outside of the service. The activities programme was being developed by a designated activities organiser who recognised people’s individual interests, hobbies and abilities.

There were governance systems in place to monitor and improve the service. Policies and procedures were in place to support staff. There was an up to date service improvement plan in place. The registered manager had been supported by the local authority quality assurance and improvement team and a care home educator. The systems were continuing to grow and add all aspects of care delivery.

All equipment was serviced as per individual contracts and kept in good condition. All systems relating to health and safety were appropriately and safely managed and maintained.

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 unpleasant odours during our visits. The decoration was tired in some areas of the home however the provider had recently decorated the lounge and was working with people to choose the decorations they wanted in their rooms. The registered manager had completed a health and safety risk assessment and had several assessment tools to assess the safety of the service. However we identified a few areas which had not been covered. These included the exterior of the service where moss posed a slip risk on an external fire escape and hot water coming from taps which was too hot. Action was taken to address these and measures put into place to reduce the risks.

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 of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). Staff understood their responsibilities in relation to the MCA and DoLS. They gained people’s consent and maintained their rights.

People said they felt safe and cared for in the home. The registered manager had held meetings with people and sought their feedback about the food at the service.

Staff had a good understanding of what constituted abuse and how to report if concerns were raised. There were sufficient, suitably qualified staff to meet people’s needs. The registered manager said they had several staff vacancies which they were actively trying to recruit to. They and staff had been undertaking additional duties where there were gaps on the rota. The provider said since the last inspection they had needed to use the services of a care agency where staff were unable to fill gaps. There were suitable recruitment checks in place.

There was a safe system to ensure the safe management of medicines at the service. Medicines were administered by staff who had been trained regarding medicine management. Staff had received regular supervisions and support with their performance and future development. New staff undertook an induction when they started working at the service.

People were supported to have a balanced and variable diet. Where people had specific dietary requirements these were catered for. The registered manager had asked people their views about the food at the service and were taking action to address concerns. People’s health needs were managed well and they saw health and social care professionals when they needed to and staff followed their advice.

Staff were very caring and kind. They treated people with respect and dignity at all times. There was a friendly atmosphere at the home and a culture led by the registered manager and deputy manager about it being the people’s home. One person said, “They always say to us, this is your home.”

The registered manager was putting in place a new care plan format. They were in the process of rewriting everybody’s care plans and had completed seven at the time of our visit. The new care plans were personalised and guided staff how to meet people’s needs. The registered manager had put in place a system to ensure the care plans were regularly reviewed. We have made a recommendation about people being given access to information in a format that was accessible to them.

Some areas of the environment were not suitable for people living with dementia. We recommended the provider consult current guidance on the design of environments for people living with dementia.

A care worker had dedicated time to support people to engage in activities that they were interested in. The registered manager confirmed they would be increasing the provision of activities by implementing additional hours for the staff member once they had a full complement of staff. This would enable them to undertake more individual sessions.

People knew how to make a complaint if necessary. They said if they had a concern or complaint they would feel happy to raise it with the registered manager. The registered manager was aware of their responsibilities in relation to the provider’s complaints policy and the action they needed to take. People, relatives and staff were asked their views and these were taken into account in how the service was run.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 related to safe care and treatment. This is the second time the service has been rated Requires Improvement. We will be meeting with the provider to discuss our concerns, improvements needed and support that may be available.

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.

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.

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.