Park View Care 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.

Park View Care Home can accommodate up to 65 people in one adapted building across three floors. At the time of the inspection 59 people were resident, some of whom were living with a dementia.

We last inspected Park View Care Home on 29 July 2015 and rated it good overall. During this inspection we found Park View Care Home continued to be ‘good.’

People and their visitors were very complimentary about the caring nature of the staff team. We were told people were well cared for, respected and treated with dignity. We observed warm and compassionate relationships between people, visitors and the staff.

There was a culture of mutual respect across the staff team and management. Senior management were positive about the team approach. The registered manager was supported to develop the team and improve the quality of the care and support provided.

Staff understood how to safeguard people from abuse, and were able to explain circumstances which would lead them to raise concerns. Complaints were recorded and investigated and people told us they would be comfortable raising any concerns. Accidents and incidents were logged and analysed, and action had been taken to minimise the risk of reoccurrences. Lessons were learnt in relation to concerns and new systems had been introduced to improve the quality of the service.

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

A new chef was in post and work was being completed with people to develop a new menu to ensure they received a well-balanced diet, which also met their preferences.

Medicines were managed safely.

Staff worked with other health care professions to ensure people received ongoing health care. Advice was included within care plans and people and visitors told us GP’s were accessed when needed.

People and visitors told us they were involved in care planning and making decisions about the care they would receive. Care records were personalised and included information on people’s life history, preferences, interests and hobbies. This information was used by the activities co-ordinators to develop activities that were of particular interest to people.

Ensuring people received appropriate and respectful end of life care was important to the staff team. The deputy manager explained how important it was that people’s wishes were respected and that the person and their family were well supported.

Risks were appropriately assessed and people were supported to take positive risks such as playing football. Environmental risks were assessed and appropriate measures were in place to prevent and control infection.

A refurbishment plan was in place to develop each floor and ensure the environment was suitable to meet people’s needs. This was especially important for those people living with a dementia. People told us they had been included in the decision making about the décor and were able to personalise their rooms as they chose to.

Staffing levels were maintained above the ‘safe’ level indicated by the dependency tool. Recruitment processes were robust and people living at Park View Care Home were included in interview panels and making decisions about employing new staff.

There was a shared vision for the future of Park View Care Home, which included the ongoing provision of high quality, person centred, specialist care and support. People, their relatives and staff were engaged and involved in service improvement. The governance framework was effective in driving improvements.

The unannounced inspection took place on 29 July 2015. We last inspected Park View Care Home on 19 November 2014 when we found the service was meeting the regulations that we inspected.

Park View Care Home provides residential care for up to 65 people, some of whom are living with dementia. At the time of our inspection there were 60 people living at the service, but one person was in hospital.

The service had a new manager in post who had not yet applied to become the 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.

People received their correct medicines from staff. The management team ensured that medicines were managed safely and effectively.

People told us they felt safe living at the service. Staff were aware of their personal responsibilities to report any incidents of potential or actual abuse to the manager.

Emergency procedures were monitored and staff knew what to do in response. Accidents and incidents were recorded and monitored to identify any trends.

The premises was clean, tidy and well maintained and suitably designed for people’s needs.

Staff working at the service were able to meet people’s needs, we confirmed this through viewing records and from our own observations. We found staff were suitably trained. They received induction, regular supervision and appraisal from the management team. There was appropriate recruitment procedures in place to check that people were suitable to work with vulnerable adults.

People were happy with the food and refreshments available to them and said they had a good selection of home cooked foods.

CQC Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure that people are looked after in a way that does not inappropriately restrict their freedom. In England, the local authority authorises applications to deprive people of their liberty. MCA assessments and ‘best interests’ decisions had been made where there were doubts about a person’s capacity to make decisions. Applications to the local authority had been made where a DoLS was required.

People told us that the staff team were very caring. Staff spoke with people in a caring, kind and compassionate manner. They treated people with respect and dignity. People’s care needs were identified, and comprehensively assessed, recorded and reviewed by staff with input from people, their families and healthcare professionals.

People made their own choices and there was a range of stimulating activities for them to participate in if they wished. Staff encouraged and supported everyone to maintain family, social and community links. People and their relatives told us they knew how to complain and would be able to if they thought it was necessary.

Audits and quality checks were in place which helped the provider and management team monitor the quality of the service.

Relatives told us they had confidence in the management and staff team and thought the service was well led. Staff told us they felt supported by their colleagues, the manager and deputy manager.

We considered all the evidence we gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• 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;

Is the service caring?

This was a responsive inspection to previous non-compliance against the regulations and we did not look specifically at this area.

Is the service responsive?

This was a responsive inspection to previous noncompliance against the regulations and we did not look specifically at this area.

Is the service safe?

People told us they felt safe and secure living at the home. People were protected against the risks associated with the use and management of medicines. They received their medicines at the times they needed them and in a safe way. Medicines were kept safely.

Is the service effective?

This was a responsive inspection to previous noncompliance against the regulations and we did not look specifically at this area.

Is the service well led?

The manager at the service was registered with the Commission as the manager of this location in line with the requirements of the registration of the service.

We spoke with three people who were happy with the support they received with their medicines and one relative. One person said that their skin condition had improved because care staff applied their creams regularly. The relative told us that care workers kept a close eye on their partner’s medication to ensure that it was taken safely.

Overall we saw the provider did not have effective systems in place to manage medicines. We found that medicines were not always safely handled and improvements are needed.

We had asked the provider to send us a report by 24 December 2013, setting out the action they will take to meet the standards. The provider supplied an action plan to meet the standards. This inspection was to check to make sure that this action was taken.

We found improvements had been made and the provider had taken appropriate measures to reduce the risk of the spread of infection.

The premises had been improved and people were provided with facilities that met their needs.

The provider had carried out the necessary repairs to provide people with safe and suitable equipment.

We saw that people's needs were assessed and their care and treatment was planned and delivered in line with their individual care plans. People told us they were well looked after and they were provided with a good service that met their needs. Comments included, "The staff are great, they deserve a medal" and "I'm very well looked after, they do everything to help me"

We found that people were provided with a choice of suitable and nutritious food to meet their individual needs.

The provider did not have adequate systems in place to reduce the risks of infection to protect people's health and safety.

Appropriate measures were not in place to ensure the premises were well maintained throughout to provide people with a suitable place to live.

Some equipment in the home was out of order so some people were not provided with appropriate equipment to meet their needs.

An effective recruitment procedure was in place to ensure people were cared for by staff who were appropriately qualified and trained to meet their needs.

We found the provider had an appropriate system to deal with comments and complaints.

We saw that people were cared for effectively and that care was planned for the individual. We saw that people were safe and that there were sufficient suitably qualified and experienced staff on duty. We saw that the home had effective systems in place to monitor its own performance.

The people staying in the service and the visitors we met during the visit were very positive about the way that the home was managed. Comments included: ”It’s really nice, you have your own privacy” and “The staff are all very pleasant and the amenities are good.”

People told us that they were happy with the care and attention they received at Park View. They confirmed that they were given choices in life and that staff supported them to take some risks and be independent. People we spoke with said 'I am really happy here' and 'I have made lots of new friends'.

People said they received enough to eat and drink and relatives said they were happy that people who needed assistance to eat received it. They said 'the food is really nice' 'I have put on weight' 'I really enjoy the food' 'they will get you whatever you fancy' 'you have lots of choice'.

People confirmed that they could receive medical and specialist attention when they

needed it and were helped to fulfil their social needs within the home and community.

People we spoke with said 'there is lots to do' 'I can join in or relax in my room' 'we are always thinking of things to do' 'we get out and about for a drink or coffee'.

People told us that their home was clean, comfortable and warm and commented 'I have a lovely room' 'look at the lovely christmas decorations' 'the place is spotless but feels cosy'.

They said staff were kind and caring and seemed to be well trained. People confirmed that they were given the opportunity to comment on the service, change routine or raise complaints. They said that their visitors were made to feel welcome and information exchange was good.

At the time of the inspection there were 53 people living at the home. Due to their health conditions and needs not all people were able to share their views about the service they received. During our visit we spoke with 12 people who used the service and observed their experiences. We spoke with the registered manager, eight members of staff and four visiting relatives.

We considered all the evidence we had gathered under the regulations we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we have found.

Is the service safe?

We found that the service was not safe because people were not protected against the risks associated with the use and management of medicines. Whilst we saw some improvements since our last visit, there were still some issues which meant that people did not receive their medicines at the times they needed them and in a safe way. Medicines were not obtained, administered and recorded properly.

The provider had systems in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.

We saw risk assessments had been completed for people who were assessed as being at risk of falls.

We saw people were safe and protected from abuse. Staff demonstrated to us an understanding of the types of abuse and how they should be reported. All staff had received training in the safeguarding of vulnerable adults and whistleblowing.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw policies and procedures were in place which related to the Mental Capacity Act 2005 (MCA) and DoLS.

We saw there were sufficient members of suitably qualified and experienced staff on duty to meet people’s needs.

We have taken enforcement action against the provider and told them that they must improve in this area. We will return to the service to ensure that changes in service provision are made.

Is the service effective?

We saw that people’s general care needs were addressed and that they had appointments with dentists, chiropodists and opticians. We noted that were people’s care needs changed then action was taken and care plans were updated to acknowledge this change.

People who used the service were asked about the support they received and if they understood their rights. People we spoke to were aware of their rights and what to do if there were any problems.

Is the service caring?

People's preferences, interests and needs were recorded in their care records. Staff were able to give examples of these when we spoke with them and displayed a good knowledge of the people living at the home and what their likes or dislikes were.

People's health and care needs were assessed with them and they were involved in this process.

Is the service responsive?

There was a system in place to record and monitor complaints. Complaints were taken seriously and responded to appropriately.

We saw evidence that care staff identified changes in people's needs and acted to make sure they received the care they needed. For example, there was evidence that where one person's health had declined an immediate referral was made to the correct medical professional for advice and support.

Is the service well led?

There was a registered manager in place at the service. The staff we spoke with were aware of the complaints, safeguarding and whistle blowing procedures. Staff told us they would immediately report any concerns they had about poor practice and were confident these would be addressed.

The service had a quality assurance system in place that included the use of surveys from people who used the service.