This comprehensive inspection took place on 5 and 9 March 2018 and was unannounced.

Crownwise Parkview is a ‘care home’. People in care homes receive accommodation and nursing 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.

Parkview accommodates up to seventeen people in one large house over three floors, in the London Borough of Lambeth. At the time of the inspection there were 15 people using the service.

The service had a registered manager in place. 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.

The service was inspected previously on 15 and 18 November 2016 and was given an overall rating of ‘requires improvement’. This was because the service failed to provide staff with adequate guidance on how to manage identified risks. The service also failed to ensure staff received adequate support through regular supervisions, annual appraisals and necessary training to enable them to undertake their duties effectively. The service did not have robust systems and processes in place to identify pitfalls in the quality and safety of the service delivery.

At this comprehensive inspection we found the provider had made improvements to the service in relation to risk assessment guidance, staff training, support and auditing processes.

We made a recommendation in relation to the management structure at the service.

Systems and processes in place identified risks and gave staff clear guidance on how to mitigate those risks. Risks were reviewed regularly to identify trends, patterns and positive behavioural plans were then implemented.

People were protected against the risk of harm and abuse. Staff were aware of how to identify, report and escalate suspected abuse and were aware of the provider’s whistleblowing policy.

Staffing levels were adequate in meeting people’s needs and keeping them safe. Staff received support and guidance through regular one to one supervisions and annual appraisals where they reflected on their working practices. Staff received regularly training to increase their skills and knowledge.

People’s medicines were managed safely. Records indicated no errors or omissions. Medicines were stored in line with good practice and stocks and balances showed people received their medicines as prescribed.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. We checked whether the service were supporting people in line with the MCA and found the service was working within legislation.

People’s consent to care and treatment was sought prior to care being delivered. People were supported and encouraged to make decisions relating to their care, and have their decisions respected.

People’s health and wellbeing was monitored and assessed for any signs of deterioration. People had access to a wide range of healthcare professionals as and when required.

People received compassionate and caring support from staff that knew them well and treated them with dignity and respect. People’s right to privacy was adhered to and people had their independence monitored and encouraged.

People continued to receive personalised care, which was responsive to their needs. Care plan reviews were held regularly and where possible people were en

This unannounced inspection took place on 15 and 18 November 2016. The service provides support and accommodation to 15 people with mental health needs. There were 14 people using the service at the time of our inspection.

At our previous inspection of 24 July 2015 we found the service was in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014 relating to staffing levels and management of medicines. We undertook a comprehensive inspection to check that the service now met the legal requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Crownwise - Parkview Care Home’ on our website at www.cqc.org.uk.

At this inspection, the provider had sufficiently addressed the breach relating to medicines from our last inspection. The registered provider had made some improvement to staffing levels but not enough to meet people’s needs. We found three new breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 that relates to safe care and treatment, staffing and good governance. You can see what action we have told the provider to take at the back of the full version of this report.

We have made one recommendation in relation to management structure.

Staff identified risks to people. However care records did not always contain clear guidelines for staff to follow to manage identified risks.

Staff did not have regular supervision sessions and appraisal to carry out their roles effectively. Staff received training to do the job but they could not demonstrate understanding and knowledge to show they were competent and could apply it in practice.

Staffing levels were not always sufficient to safely meet the needs of people. People’s care needs were not met because there were not enough staff to support them.

The registered manager was responsible for the daily management, administration; and providing leadership to staff and hands-on assistance to people. There was gap in management when they were not around and they seem overstretched with their workload as tasks they needed to complete where either not done or not thoroughly done.

There were systems in place for assessing and monitoring quality but these did not always pick up on issues of quality. Incidents and accidents were recorded and reviewed but there were no evidence that staff were learning from them to prevent future reoccurrences.

People received their medicines in line with their prescription and medicines were stored securely and record medicines administered were fully completed.

People told us that staff supported them to keep safe. Staff were knowledgeable in recognising the signs of abuse and knew how to report it by following the provider’s safeguarding procedures.

Care records showed that people’s needs had been assessed, planned and delivered in a way that met their individual requirements. People told us they were involved in planning and reviewing their support to ensure it was effective.

People had access to a range of healthcare services and were supported to attend their health appointments. The service liaised effectively with the community mental health team (CMHT).

People were encouraged to follow and develop their interests. People took part in activities they enjoyed within the service and outside the service.

The manager understood their responsibility to protect people under the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Staff had been trained in the Mental Capacity Act 2005 (MCA). People’s mental capacity to make decisions had been assessed and “best interests” decisions were in place where required. People were not unlawfully deprived of their liberty.

We observed that people were treated with dignity and their privacy was respected by staff. People told us they enjoyed the food provided and their nutrition and hydration needs were met.

The registered manage

This unannounced inspection took place 24 July 2015. The service provides support and accommodation to 15 people with mental health needs. There were 14 people using the service at the time of our inspection.

The service has a registered manager who has been in post for several years. 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.

The last inspection of the service was on 14 May 2014 where we found the service was not meeting standards in relation to safeguarding people and informing us of notifiable incidents. We asked the provider to take action to make improvements. They sent us an improvement plan on how they would address the issues and at this inspection we found that the provider had made some improvements.

At this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report.

We have made a recommendation in relation to monitoring the quality of service provided.

Staffing level was not always sufficient to safely meet the needs of people. People did not always receive their medicines in line with their prescription and medicines administered were not clearly and fully completed. People told us they sometimes felt bullied and intimidated by some other people living at the service but staff supported them to keep safe. Staff were knowledgeable in recognising the signs of abuse and knew how to report it by following the provider’s safeguarding procedures.

Care records showed that people’s needs had been assessed, planned and delivered in a way that met their individual requirements. People told us they were involved in planning and reviewing their support to ensure it was effective.

The service liaised effectively with the community mental health team (CMHT). People had access to a range of healthcare services and were supported to attend their health appointments.

People were encouraged to follow and develop their interests. People took part in activities within the service and in the community to occupy them.

The manager understood their responsibility to protect people under the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Staff had been trained in the Mental Capacity Act 2005 (MCA). People’s mental capacity to make decisions had been assessed and “best interests” decisions were in place where required. People were not unlawfully deprived of their liberty.

We observed that people were treated with dignity and their privacy was respected by staff. People told us they enjoyed the food provided and their nutrition and hydration needs were met.

Staff had the training, support and supervision they needed to provide care to the people they looked after.

The manager responded appropriately to complaints about the service. People were consulted and asked for their feedback about the service provided. There were systems in place to check the effectiveness of the service provided. The provider undertook regular audit and action plan produced to address areas of concern.

Our inspection team was made up of one inspector. They helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, 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?

People told us they felt safe. Safeguarding procedures were in place but had not been followed on some occasions. This meant that people could not be confident that incidents of suspected abuse would be investigated properly. Systems were not in place to ensure that the manager and provider reviewed incident reports written by staff to ensure that all of the necessary actions had been taken and authorities notified as required.

Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk. People had been cared for in an environment that was safe, clean and hygienic.

A member of the management team was available on call in case of emergencies. Staff had received training to meet the needs of the people living at the home.

Is the service effective?

People’s health and care needs were assessed with them, and they were involved in writing their plans of care. Areas of support required for each person had been identified in care plans. Our observations confirmed that this support was provided.

Is the service caring?

People were supported by kind and attentive staff. Our discussions with staff on duty and our observations of the care and support provided confirmed this. We saw that staff showed patience and gave encouragement when supporting people.

Is the service responsive?

The staff responded quickly when people needed extra support from their health professionals. People completed a range of activities in and outside the service regularly. People knew how to make a complaint if they were unhappy and had been frequently asked for their views of the service. We saw that the provider used this feedback to make improvements. People can therefore be assured that their views were taken into consideration in regards to the running of the service.

Is the service well-led?

The service was well- led. The manager was registered and had been in post for many years. The provider visited the service often and followed up on any quality issues identified. The service worked well with other agencies and services to make sure people received their care in a joined up way. However, the provider had failed to notify us of some incidents that had taken place.

We spoke with seven people using the service and all were satisfied with the care and support they had received.

Their comments to us included -

"The cook is brilliant. I look forward to the roti and chick peas. It's delicious" and "The staff spoil me really".

"I am very happy with the service, the food and the staff".

"I know how to make a complaint if I need to. I just talk to the manager and he sorts it out".

"It's movie night tonight and we are watching one of my favourite films".

We found that people were being supported by staff in the way that they needed.

We saw that staff interacted well with people using the service and spoke to them with respect and an understanding of their mental health needs.

Staff were trained to meet the needs of the people using the service and they knew how to keep vulnerable people safe from harm.

The provider had a robust system in place to monitor the quality of the service provided to people. This included asking people for their views of the service.

We spoke with five of the 14 people living at Parkview when we visited. They told us that they were satisfied with their care, that they felt safe living at Parkview and that the staff were polite and treated them with respect. One person told us "It's very nice here".

A visiting community nurse spoke positively about the care provided by staff and the manager and of successful joint working.