About the service: Park View Care Centre provides accommodation, and personal and nursing care for up to 88 older people. There are two units in the home which accommodate people with nursing needs these are Beech and Oak and two which accommodate people with dementia these are Ash and Cedar. At the time of inspection there were 43 people using the service in total.

People’s experience of using this service:

At our last inspection in November 2017 we identified that staff recruitment checks did not meet the requirements of regulation to ensure people were cared for by suitable staff. The provider told us what action they would take to improve this. At this inspection we found that the required improvements had been made and the full range of staff suitability checks were now in place for all staff.

At this inspection we found that medicines were not being managed safely and we have issued a new requirement for this breach of regulation.

Some information had not been completed to assess whether a new person was at risk from using equipment or from choking within the first few days of admission, this could mean staff were not made aware of potential risks and take the necessary measures to reduce these. This was rectified at inspection but is an area for improvement to ensure all risks are assessed on admission.

There was a new service manager. They had applied to the Care Quality Commission to become the registered manager; their application was currently being processed by the commission.

Overall the service was being managed well but there had not been enough time to embed the improvements the new management team were making to address the shortfalls identified at inspection. Quality and safety monitoring checks of the operation of the service and the delivery of care happened at regular intervals and actions from these informed service improvements.

People told us that they felt safe and well cared for and overall outcomes for most people were good. People lived in a safe clean and well-maintained environment. There were low levels of incidents, pressure ulcers and falls and staff sought advice and guidance from other professionals about people’s health needs when needed. People could make their own choices and decisions in their day to day lives and staff sought their consent. People felt staff understood their needs, treated them with dignity and respect. Staff understood how to keep people safe from harm.

There were enough staff to support people’s needs, they received an appropriate range of training and supervision, they felt supported and found the management team approachable when they wanted to raise issues.

A programme of activities to suit different tastes and abilities was provided. Adjustments were made to ensure activities and information was accessible to people with sensory impairments. There were some opportunities for people to go out to a local coffee shop and superstore with staff support.

People and relatives were surveyed for their views and had opportunities through resident and relative meetings to express their views. Their feedback informed the continuous improvement and development of the service.

Rating at last inspection:

• At our last inspection, the service was rated "requires improvement" (18 January 2018). This service has been rated requires improvements at the last two inspections.

Why we inspected:

• This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

• We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned in line with our inspection schedule.

We inspected Park View Care Centre on 16 and 17 November 2017 and the inspection was unannounced.

Park View Care Centre 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.

Park View Care Centre provides accommodation, personal and nursing care for up to 88 older people. There are two units in the home, Beech and Oak, which accommodate people with nursing needs; and two, Ash and Cedar, which accommodate people living with dementia, however only one dementia unit, Ash, was open at the time of the inspection. There were 49 people at the service at the time of our inspection. People were living with a range of care and health needs, including diabetes and Parkinson's. Many people needed support with all of their personal care, and some with eating, drinking and mobility needs. Other people were more physically independent and needed less support from staff.

At the last comprehensive inspection in September 2016 the overall rating for the service was Requires Improvement. Five breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified. The provider failed to: ensure there were sufficient numbers of staff deployed to meet people’s needs; to ensure risks to people were minimised;, to ensure quality assurance systems were robust; to apply the principles of the Mental Capacity Act consistently and to manage complaints effectively.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective, responsive and well led to at least good.

At this inspection we found that some improvements had been made and the breaches had been met. There are still improvements to be made and embedded to ensure improvements were sustained. We found one new breach of Regulation.

The service did not have a registered manager in post at the time of our 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. There was a manager in place who was in the process of applying to become registered.

Staff had not been consistently recruited safely. Gaps in employment had not been discussed and recorded. References were inconsistently obtained.

People told us they felt safe living at the service. They were protected from the risks of abuse, discrimination and avoidable harm. Risks to people were assessed, identified, monitored and regularly reviewed.

People were supported by sufficient, regular staff who knew them well. Staff levels were monitored to make sure they had enough quality time to spend with people. Staff completed regular training and were supported through one to one supervision and appraisals by the manager.

People’s medicines were stored, managed and disposed of safely. People were protected from the risks of infection. The service was clean and staff wore the correct personal protective equipment when needed.

Accidents and incidents were reported, investigated and reviewed and lessons learned were shared with staff to improve safety.

People’s physical and mental health were regularly assessed to make sure they received effective care and support. They were supported to eat a healthy diet and to drink well.

Staff liaised with health and social care professionals to make sure people received co-ordinated care and support. People were supported to stay as healthy as possible.

People had access to communal areas, such as lounges and the garden. Signa

This inspection took place on 12 and 13 September 2016 and was unannounced. Park View Care Centre provides accommodation, personal and nursing care for up to 88 older people. There are two units in the home which accommodate people with nursing needs; and two which accommodate people living with dementia. There were 65 people at the service at the time of our inspection. People were living with a range of care and health needs, including diabetes and Parkinson’s. Many people needed support with all of their personal care, and some with eating, drinking and mobility needs. Other people were more physically independent and needed less support from staff.

The service did not have a registered manager in post at the time of our visit. 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. There was, however a manager in place; who was applying to become registered.

Park View Care Centre was last inspected on 2 and 4 February 2016 and was rated as inadequate overall. The service was placed into special measures and the provider sent us action plans to tell us what they would do to improve.

At this inspection, we found that there had been much improvement overall; however, some of the issues we raised last time had not been fully addressed.

Risks to people’s safety and welfare had been appropriately assessed but actions to reduce those risks were not always taken. There were not enough staff deployed to meet people’s needs, but more staff were brought in immediately we highlighted this.

Medicines were well-managed and recruitment processes helped ensure that the right applicants were employed to work in the service. Incidents and accidents were properly documented and raised with the local safeguarding authority when necessary. The CQC were made aware of any events which required statutory notification.

Equipment was regularly serviced and the risks of fire had been assessed and minimised by routine fire alarm testing, personal evacuation plans and proper maintenance of fire equipment. The premises were well-maintained and improvements to décor were seen. There was appropriate picture signage and equipment such as coloured toilet seats to help people orientate themselves.

The principles of the Mental Capacity Act (MCA) 2005 were not consistently followed in practice; to ensure people’s rights were considered; but the use of stair gates on people’s doors had ceased and assessments of people’s capacity had been made appropriately.

Records about people’s food and fluid intake were not always being completed accurately or with enough information to monitor if people were receiving enough to keep them well. However, dietician input had been sought promptly when needed and people’s weights were monitored. There were choices of meals available and dining tables were laid with cloths, flowers and condiments.

Staff training had improved and supervision and appraisal were being carried out regularly. People’s healthcare needs had been met and were monitored for changes. Staff were consistently kind and caring and protected people’s dignity. They encouraged people to remain as independent as possible. There was a range of activities on offer and people were observed enjoying group crafts and one to one interaction.

Complaints had been actioned by the manager but records and communication about what had been done were sometimes lacking. Care plans had been reviewed and updated but this area required further work to ensure consistent records were kept.

Feedback had been sought from people, relatives and staff and there was evidence that it had been acted upon. Staff said they felt supported by the manager and her deputy and that they were led by example.

This inspection took place on 2 and 4 February 2016 and was unannounced. Park View Care Centre provides accommodation and personal and nursing care for up to 88 older people. There are two residential units in the home which accommodate people with nursing needs, and two which accommodate people living with dementia. There were 82 people at the service at the time of our inspection. People were living with a range of care and health needs, including diabetes and Parkinson’s. Many people needed support with all of their personal care, and some with eating, drinking and mobility needs. Other people were more physically independent and needed less support from staff.

The service had a registered manager in post at the time of our visit. 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.

Risks to people’s safety and welfare had not always been appropriately addressed. There was not a robust system for keeping people safe from harm because staff had not been consistently completing incident reports and the registered manager had not raised safeguarding concerns with the local authority.

Actions to minimise identified risks to people had not been carried out in practice, leaving people exposed to risk of harm. This included people who had experienced repeated falls and those who were at risk of skin breakdowns. Creams had not been stored or recorded appropriately, which created a risk that people might not receive them as intended by the prescriber. Other medicines had been properly managed.

There were not enough staff on duty because data about people’s needs and dependencies had been inaccurately submitted to the provider by the registered manager. Staff training was lacking in some areas and ineffective in others. Supervisions by the registered manager had not identified shortfalls in staff knowledge which affected their ability to carry out their roles competently.

Fire drills and testing had been conducted regularly and the premises were well-maintained throughout. Auditing however, was largely ineffective in highlighting where the quality and safety of the service could be improved.

The principles of the Mental Capacity Act 2005 (MCA) had not been properly followed in relation to assessments about people’s capacity and decisions made on their behalves. Restrictive practices were observed but staff did not understand that these deprived people of their liberty.

Most staff were caring and considerate but people’s dignity was not always considered or protected. Some staff did not always act to meet people's needs and this impacted on people’s experience of living in the service. People had not always been protected from the risk of social isolation. There were three activities coordinators working at the service for a total of 118 hours per week. We spoke with one of the coordinators who worked three days per week. Some people spent long periods without any stimulation or interaction.

Complaints had not always been managed effectively. Care planning was not sufficiently person-centred in some cases, but people’s need for independence where possible was considered. People and relatives said they had not been involved in care planning.

The service was not well-led and there was no proper or robust quality assurance processes in place.

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 sig

The company appointed a new manager for the home in June 2014, but whose name is not at the front of this report. This is because she was still going through formal registration processes with CQC at the time of the inspection.

The inspection was carried out by one inspector over seven hours. During this time we talked with 14 people who were living in the home, and observed staff carrying out care duties with other people. We talked with 12 staff and met other staff briefly; and talked with five relatives and visitors, and a visiting GP. The manager was present throughout the inspection and assisted us by providing documentation for us to view. The area manager was present in the home for some of the day, and was included when we gave feedback about the inspection.

We looked at the answers to five questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Is the service safe?

We viewed all parts of the premises and saw that they were well maintained and visibly clean. We saw that staff followed directions from individual risk assessments to protect people from harm. For example, they kept communal rooms and corridors free of obstacles for people who might be at risk of tripping and falling.

The home had clear procedures in place to check that people had consented to the care and treatment provided for them. People who lacked the mental capacity to make decisions about where they lived or the care that they needed had been appropriately supported by their family members or advocates, and by health and social care professionals, to make decisions on their behalf and in their best interests. The manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

Staff told us that they had been trained in understanding how to safeguard vulnerable adults; and were able to give clear explanations of the different types of abuse to be aware of, and the action to take in the event of any suspicion of abuse. Some people who lived with dementia sometimes displayed behaviours that might be challenging to others. The staff demonstrated their knowledge of different people, and how to distract their attention and deflect potentially difficult situations.

We spent time in one of the lounges carrying out an observational inspection. The Short Observational Framework Inspection (SOFI) is a method for observing people’s care when they are unable to give clear verbal feedback. We saw that staff treated people with respect and dignity, and were kind and attentive to their needs.

We inspected medicines management in two of the units, and found that reliable procedures were in place to ensure correct storage and administration of medicines.

Is it effective?

Staff told us that they felt supported in their different job roles, and were able to talk with their line managers for any advice. Staff had individual supervision sessions approximately every two months. This gave them the opportunity to discuss any concerns about their responsibilities, and any training needs. Staff meetings were held for different groups of staff (for example, nurses, kitchen staff,) so that they could discuss relevant issues together.

People were provided with a suitable choice of foods to promote a healthy and balanced diet. We saw that staff supported people who needed assistance to eat and drink, and were sensitive and did not rush them.

People had access to other health and social professionals. A visiting GP told us that he carried out a routine visit to the home once per week, and visited at other times as needed. Nursing staff had assessments and care plans in place for monitoring people’s health care needs, and we saw that these were carried out reliably.

Is it caring?

We noticed that staff treated people with gentle affection, listened to them, gave them time to reply, and were attentive to their individual needs. People’s comments included, “They are all very good”; and “They look after me very well”. A relative said, “The staff are very good, I can’t fault them. They do everything for X. And they are always friendly and welcoming.”

We saw that staff gave people choices about where they wanted to sit, what they wanted to do, and what they wanted to eat or drink. People with dementia were supported to carry out different activities throughout the day. Staff were mindful of people who were wandering, by checking for their safety, and stopping to chat with them. People said they were “Always” treated with dignity; and we saw that staff were careful to observe people’s privacy when carrying out personal care.

Is the service responsive?

People’s care plans had been discussed with them or their relatives as appropriate. We saw that nursing assessments and care plans were reviewed on a regular basis, and staff were informed of changes at daily handovers.

The service employed three activities co-ordinators, who worked in different units so that they could get to know people’s social preferences and hobbies. We found there was a wide variety of activities available. The activities staff spent individual time with people, as well as arranging group activities.

People told us that they could ask staff about anything at any time. The manager had an open door policy and was easily available to people and their relatives. A relative told us that “The staff always contact me if there is any change in X, and I can ask any of them questions and know I will get a good response.”

Is the service well-led?

The manager had a visible presence in the home, and was well-known by people living there and their relatives. She had been in post for three months, and it was clear that she had taken time to get to know people. Staff said that she sometimes worked alongside them, and this gave them confidence in her knowledge and abilities.

The company had systems in place for on-going monitoring of different aspects of the home. This included weekly and monthly checks and audits to see how the home was performing. Systems included checks for any accidents or incidents to see if action could be taken to prevent these in future.

People’s views and ideas were listened to through one to one conversations; through the use of questionnaires; through residents and relatives’ meetings; and through use of a comments book in the entrance hall. We saw that the manager had put an action plan into place as a result of reading questionnaire responses, and appropriate action had been carried out to bring about the desired changes.

At our inspection on 14 January 2014 we found that some people’s care records held on computer did not always reflect all of their current needs, and the information had not always been kept up to date by staff. This meant that staff did not always have access to correct information about people. The provider wrote to us on 28 February 2013 and told us that systems had been put into place to make sure that people’s care records contained up to date information about people, and that staff had received care planning and record keeping training.

At this inspection we found that systems were in place to make sure that care records were kept up to date and these had been followed by staff.

We did not speak to people using the service on this occasion.

We used a number of different methods to help us understand the experiences of people using the service, because some of the people who lived there had complex needs which meant they were not able to tell us about their experiences. We spoke individually with 12 people who were living at the service and with 6 relatives.

People told us they liked living at the service and relatives we spoke with were complimentary about it. A relative told us “we are very happy with it here” and “we feel we did the right thing”.

People told us they liked the staff and that staff treated them kindly and with patience and respect. One person told us “the staff are very good” and another person said “they are so good, they come when I call them”. A relative told us “they really do know people”. We observed that staff took time to explain things to people and supported people to be as independent as they could and to follow their preferred daily routines.

There were enough staff to provide people with the support they needed and staff told us they felt well supported.

The service had a complaints procedure and any concerns or complaints from people or relatives were taken seriously and addressed.

We found that some people’s care records, which were held electronically, did not always reflect their current needs and had not always been kept up to date. This meant that staff did not always have access to the correct information about people.

People told us that they were very happy living in the home and that their independence has been respected. They said they felt involved in their care and encouraged by staff to do things for themselves if possible. One person said, " I don’t feel rushed, the staff have encouraged me to keep going".

People felt that their care needs were met and that they were able to get involved in activities throughout the day if they wished. One person said, "We have lovely music and entertainment, tonight the bar is open and we will be playing bingo". Another person said, "the staff are very caring, they look after us well".

We found that people were looked after in a way which respected their independence but also provided them with the care and support they required. People were given a good choice of nutritious food and drink and they enjoyed what they ate. One person told us, "There are always alternatives if you fancy something different, I like a salad sometimes".

We saw that staff were recruited appropriately and checks were undertaken to ensure that they were suitable to care for people with nursing needs and dementia. We found that there were enough staff on duty to tend to the needs of the people although at times staff were stretched on one unit.

We found that the service had effective systems in place to ensure the quality of the service delivered. These included audits, meetings and surveys to take account of peoples views and suggestions.

Some of the people that use the service at Park View Care Centre have dementia and therefore not everyone was able to tell us about their experiences. To help us to understand the experiences people have we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences. Some people using the service were able to tell us about their experiences and we also spoke with some visitors to the service.

People told us that they were getting the care they needed. Comments included “It’s very good here” and “I am quite happy with the help I am getting”. We spoke with some relatives who were visiting who told us that they were happy with the care provided.

People told us that they were able to choose when to get up and go to bed. One person said “they never rush me”. People we spoke with said that they liked to stay as independent as they could and that the staff let them do things for themselves where they were able to. People also said that they had a choice of meals and could decide whether they wanted to join in the social activity for the day. One person said “there are always a lot of things going on that you can do if you want to, but if you want to stay in your room that is fine too”. People told us that they were happy with their bedrooms and that they were comfortable in the home.

People told us that they liked the staff. One person said “yes, they are very kind”. They said that the staff treated them with respect and that their privacy was always maintained. Comments included “they always knock on the door before they come in” and

“the staff treat me very well”.

People told us that they felt safe in the home and knew that they could talk to the staff or the manager if they were worried about any part of their care. They told us that they were often asked their views of their care by the manager and that if they were not happy with something it would always be sorted out quickly.