This inspection took place on 10 and 13 April 2018 and was unannounced.

At our last inspection on 27 February 2017 we rated the service as ‘Requires Improvement’ and identified two breaches which related to safe care and treatment and good governance. Following the last inspection, we asked the provider to take action to make improvements to the management of risks and overall governance of the home. At this inspection we found this action had been completed.

Park View Nursing Home 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. The home provides nursing and personal care for up to 43 older people. Accommodation is provided on two floors with lift access between floors. There are communal areas on the ground floor, including three lounges and a dining room. There were 32 people in the home when we inspected.

The home has 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 2008 and associated Regulations about how the service is run.

Risk management had improved. Regular checks of the environment meant issues were being identified and dealt with promptly. Individual risks to people were assessed and mitigated. People told us they felt safe in the home and we found there were enough staff to meet people’s needs. Staff recruitment procedures ensured staff were suitable to work in the care service.

Staff had received safeguarding training and knew how to identify and report abuse. We saw where incidents and accidents had occurred appropriate action was taken to keep people safe. The registered manager had dealt with a number of medicine errors which related to incorrect stock balances and gaps on administration charts. These issues had been referred to safeguarding and addressed individually and collectively with staff and new systems had been put in place to make improvements.

Staff received the induction, training and support they needed to carry out their roles.

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 supported this practice.

We saw personalised care was delivered however this was not reflected in people’s care records. There was not enough detail in care plans to guide staff about the care and support each person required. We have made a recommendation about making sure care plans reflect individual needs. People’s nutritional needs were met. People had access to healthcare services and systems were in place to manage complaints.

People gave mixed feedback about the activities which were mainly provided by the care staff with some external entertainers visiting regularly. However, a new activity organiser was due to start in post the week after the inspection.

People and relatives spoke positively about the care they received and praised the staff who they described as kind and caring. People were treated with respect and their privacy and dignity was maintained.

At the last inspection the registered manager had been the only permanent nurse employed in the home and the service was heavily reliant on agency nurses. This situation had improved as permanent nursing staff had been recruited. This provided the registered manager with more time to devote to governance and enabled them to develop and embed effective quality assurance processes. This was evidenced by us as we found the registered manager had already identified, and was taking steps to address, the issues relating to medicines and care records.

This is the third time the service has been

This inspection took place on 27 February 2017 and was unannounced.

At the last inspection on 6 June 2016 we rated the service Requires Improvement and there were no regulatory breaches.

Park View Nursing Home provides accommodation and nursing care for up to 43 older people. There were 26 people living at the home when we visited. Accommodation is provided over two floors with lift access between the floors. There are communal lounges and a dining room as well as toilets and bathroom facilities. A kitchen and laundry are located on the ground floor.

A manager is in post whose application for registration is being processed by the Care Quality Commission. 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.

Generally we found the improvements made at the last inspection had been maintained. However, we identified inconsistencies in record keeping, the management of risk and monitoring of nutritional needs.

People told us they felt safe in the home and we found there were enough staff to meet people’s needs and keep them safe. The home has experienced ongoing difficulties in recruiting permanent nurses and has used regular agency nurses to ensure continuity of care. Three permanent nurses were due to start work at the home in coming weeks once all employment checks had been completed. Recruitment processes ensured new staff were suitable to work in the care service.

Staff knew about the different types of abuse and the signs to look for that may indicate abuse was occurring. They were aware of reporting systems and knew about the whistleblowing procedures. We saw safeguarding incidents had been dealt with and reported appropriately to the relevant agencies.

We had concerns about how risks were assessed, monitored and managed in relation to individuals and the environment. For example, we found a lack of information and consistency around the management of blood sugar monitoring where people had diabetes. Our tour of the building also found risks related to unguarded radiators and wardrobes which were not secured posing a risk of them being pulled over. These issues had not been identified or resolved through the home’s own daily checks.

Systems were in place to ensure staff received the training and support they required to carry out their roles. However, we found some staff were overdue refresher training in some areas and some staff supervisions were behind. The manager was aware of this and had a plan in place to address these issues.

People told us they liked the food and we saw they were provided with a varied choice of different meals and drinks throughout the day and at night if required. However, people’s nutritional needs were not always monitored effectively and consistently. For example, we found food and fluid charts were not always completed correctly or reviewed and monitored.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People told us they received their medicines when they needed them and overall there were good systems in place. However, we found the recording of creams applied by care staff needed to improve.

People and relatives praised the staff who they described as kind and caring. We saw staff treated people with respect and ensured their privacy and dignity was maintained. People knew how to make a complaint and records showed complaints were taken seriously and dealt with according to the complaints procedure.

People told us they enjoyed the activities and we saw people had a good time playing bingo. However, we recommended further support was sought to

This inspection took place on 6 June 2016 and was unannounced.

At the last inspection on 30 November and 7 December 2015 we rated the service Inadequate and in ‘Special Measures’. Although we found some improvements had been made following our inspection in April 2015 we still found seven breaches in regulations which related to medicines, staff recruitment, staff training, the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS), person-centred care, complaints and good governance.

Placements at the home were suspended following our inspection in April 2015 when we identified multiple breaches and first rated the service as Inadequate and in ‘Special Measures’. The commissioners at the Local Authority and Clinical Commissioning Group (CCG) have continued to work with the provider to support them in making improvements to the service.

We carried out this inspection to check if the improvements stated by the provider in their action plan had been made. The suspension on placements was still in place when we visited.

Park View Nursing Home provides accommodation and nursing care for up to 43 older people. There were 17 people living at the home when we visited.

Accommodation is provided over three floors with lift access between the floors. There are communal lounges and a dining room as well as toilets and bathroom facilities. A kitchen is located on the ground floor and laundry in the basement.

The home had a registered manager who left in May 2015. A new manager was appointed and was still in post at this 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.

Overall we found significant improvements had been made in the home since our last inspection

People told us they felt safe and we found there were enough staff on duty to meet people’s needs. However, we remain concerned at the impact the lack of employed permanent nurses will have on the long term sustainability of safe care and treatment, particularly when admissions to the home re-commence.

Staff understood safeguarding procedures and how to report any concerns. Safeguarding incidents had been identified and referred to the local safeguarding team and reported to the Commission. Risks to people were assessed and managed to ensure people’s safety and well-being.

The home was clean and well maintained and effective systems were in place to ensure these standards were maintained.

Robust recruitment procedures were in place which helped ensure staff were suitable to work in the care service. Staff received the training and support they required to carry out their roles and meet people’s needs.

Medicines management systems had improved and were being monitored through regular audits. This helped to ensure people received their medicines when they needed them.

The home was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and acting within the legal framework of the Mental Capacity Act (MCA).

People told us they enjoyed the food. Lunchtime was a pleasant experience with people offered choices and given the support they required from staff. People's weights were monitored to ensure they received enough to eat and drink.

People and relatives praised the staff who they described as 'good’ and 'kind'. We saw staff treated people with respect and ensured their privacy and dignity was maintained.

Leadership and management of the home had improved and staff praised the manager who they credited with making the improvements in the home. Staff said teamwork had improved which they felt had benefitted the people who used the service.

Effective quality assurance systems were in place although these were in their infancy and ne

Park View Nursing Home provides accommodation and nursing care for up to 43 older people at any one time. On the date of the inspection, 26 November 2014, 33 people were living in the service. This included 12 people receiving residential care, nine people receiving nursing care and 12 people receiving intermediate care. Intermediate care aims to help re-able people to allow them to return home following a hospital admission or to prevent the need for long term residential care.

This was an unannounced inspection. At the last inspection in October 2013 the home met all the regulations we looked at.

A registered manager was 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 and associated Regulations about how the service is run.

Medicines were not safely managed. Appropriate arrangements were not in place to give people their medicines at a time that met their individual needs. Arrangements for the ordering, storage, and disposal of medication were not sufficient to keep people safe.

This was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Risk assessments were in place which considered the risks associated with caring for each person. However we found some risks to people’s health and safety such as risks associated with the building had not been identified and managed to keep people safe. This was a breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

People’s capacity was assessed under the Mental Capacity Act 2005 (MCA). We found care records considered people’s capacity to make decisions for themselves and best interest decisions were made where people lacked capacity. Further work was required to meet the requirements of the Mental Capacity Act Deprivation of Liberty Safeguards (DoLS). Restrictions on people’s liberties had not been considered through the care planning process.

The manager agreed to take immediate action to speak with the local authority DoLS team to determine whether any applications were required.

People told us they felt safe in the home and told us they were happy with the level of care and support they received. People said the food was good. People praised the staff team and said they were kind and compassionate. However there was a lack of involvement of people and/or their relatives in care planning.

People’s individual health and support needs were met as staff completed assessments and planned and delivered appropriate care. However, record keeping evidencing the care people received was inconsistent. This was a breach of Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We saw some activities were available to people. However, because the activities co-ordinator was on extended absence, there was a lack of structure to daily activities and some people told us that staff did not always have the time to engage in activities.

Staff and people who used the service praised the manager and said they were effective in dealing with any issues. However there was a lack of quality assurance systems in place to assess and monitor the quality of care provided. We found several areas of risk, such as to the medication management system, care records and environmental hazards which could have been identified and rectified through a robust system of audits/checks. This was a breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

You can see what action we told the provider to take at the back of the full version of the report

During our visit to the service we spoke with six people who lived at the home, one visitor and several members of staff including the manager, the owner, the nurse in charge, student nurses and care assistants, These are some of the things they told us:

"It's comfortable, staff are nice and very helpful".

"I love Mondays as I can watch all the soaps"

"There's always a choice of food, (the cook) is wonderful and a lovely cook".

"We always have fish and chips on a Friday, Sunday always a Sunday lunch with Yorkshire puddings and it's lovely"

"The staff are very good, particularly when my relative was very poorly"

"It's brilliant, I love working here. I learn lots of things about the people who live here"

We found that detailed care plans were in place for each person and that care and treatment was delivered in line with the care plans.

Staff had received safeguarding training and knew how to keep people safe.

Staff received regular training and said the support from the manager was good. Staffing levels during the day were sufficient to meet the needs of the people who lived at the home. Evenings/nights were not always being staffed to the levels the manager had identified as necessary.

We saw that record keeping was of an appropriate standard and all the records we asked to see were located easily.

We spoke with five people who reside at Park View Nursing Home and they all told us they were happy with the quality of care they received. One person told us, “It’s a good home,” another person told us, “I’m happy here.” We spoke with a relative of a person on respite care at Park View Nursing Home and they told us the quality of care “was great.” We spoke with a visiting community matron and they told us that there was always enough staff on duty and that they had no concerns about the quality of care people received. They told us that they had confidence in the staff ability to follow care plans and provide the necessary care and treatment people required.

This inspection took place on 30 November and 7 December 2015 and was unannounced.

At the last inspection on 13 and 22 April 2015 we found seven breaches in regulations which related to staffing, safe care and treatment, safeguarding, safety of the premises, dignity and respect, person-centred care and good governance. Following the inspection we took enforcement action. The commissioners at the Local Authority and Clinical Commissioning Group (CCG) were made aware of our concerns and placements at the home were suspended.

We carried out this inspection in response to concerns received about the care people received at night and to check if improvements had been made following our inspection in April 2015. The suspension on placements was still in place when we visited.

Park View Nursing Home provides accommodation and nursing care for up to 43 older people. There were 22 people living at the home when we visited. This included 18 people receiving nursing care and four people receiving personal care.

Accommodation is provided over two floors with lift access between the floors. There are communal lounges and a dining room as well as toilets and bathroom facilities. A kitchen and laundry are located on the ground floor.

The home had a registered manager who left in May 2015. A new manager was appointed but had not registered with the Commission. 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.

People were kept safe from abuse as staff were aware of safeguarding procedures and we saw these were followed when abuse was alleged or suspected. Staffing levels were sufficient to meet people’s needs, however we found recruitment processes were not always being followed to ensure staff’s suitability. The training matrix was incomplete which meant we could not be assured staff had received the training they needed. Although some supervisions and appraisals had been completed the manager acknowledged these were not up to date.

The management of medicines had not improved and unsafe systems meant people were not always receiving their medicines as prescribed.

People enjoyed the food however we found people’s weight and nutritional needs were not being monitored effectively placing people at risk of not receiving sufficient amounts to eat and drink. People had access to healthcare services however, a lack of communication meant advice was sometimes not followed through by staff.

Staff lacked knowledge and understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), which meant assessments and best interest decisions were not considered when people lacked capacity to make a decision.

Improvements had been made to the environment and we found the home was generally clean and well maintained.

Staff engagement with people had improved and we saw staff were kind and caring in their interactions with people. Staff showed respect for people’s privacy and dignity and supported them to maintain their independence. An activity co-ordinator had recently started employment and had developed a good rapport with people.

An electronic care record system had been implemented since the last inspection, however we found information recorded was sometimes contradictory and did not reflect people’s current needs. This was concerning as the home relied upon agency nurses to lead the care team and ensure care was delivered to meet people’s needs and a lack of accurate care records placed people at risk of receiving inappropriate or unsafe care.

The home had a complaints procedure but this was not made available to people who used the service. We saw complaints were not always dealt with in accordance with the home’s procedures.

Although the manager has been committed to making improvements, progress has been limited due in part to a lack of permanent nursing staff to support them in their role. Quality assurance systems have failed to identify or address issues for example with regards to medication, consent, complaints, nutrition, care records and records relating to the management of the service such as training and recruitment.

The overall rating for this service is ‘Inadequate’ and the service remains 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 time frame 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.