We carried out an unannounced inspection of this service on 18 and 19 July 2018. Park View is a care home providing accommodation and nursing care for 108 adults including younger adults who may have a diagnosis of dementia. At the time of our inspection 108 people were living in the service.

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. This service provides personal care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service did not have a registered manager in post. At the time of the inspection there had not been a registered manager in post for 100 days. 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.

At our last inspection on 18, 19, 21 and 28 July 2017, the service was rated 'Requires Improvement'. We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider did not always have plans in place for managing risks people faced. The provider did not always manage and administer medicines safely, and guidance for how to administer medicines covertly was not always clear and some decision forms were incomplete. There was not enough suitably qualified, competent, skilled and experienced staff in place to meet the requirements of people using the service. The provider did not ensure staff received appropriate support, training, professional development and supervision necessary to enable them to carry out their duties. Quality assurance systems and audits had not operated to assess and improve the quality and safety of the service provided.

At this inspection we found that these breaches had been addressed.

People using the service and their relatives said the service provided safe care and treatment. The service managed medicines safely. However, not all ‘decision to administer’ forms were updated to match people’s changing prescriptions and not all medicines were disposed of appropriately. The acting manager addressed these concerns following the inspection. There were sufficient numbers of suitable staff employed by the service. Staff had been recruited safely with appropriate checks on their backgrounds completed. People were protected by the prevention and control of infection. There were robust procedures in place to protect people from harm and staff were clear on how to recognise and report abuse. The provider assessed and managed risks to people in a way that considered their individual needs.

Staff understood the Mental Capacity Act 2005 (MCA). MCA is law protecting people who are unable to make decisions for themselves and where people were not able to do this, the appropriate authorisation procedures had been completed. These are referred to as the Deprivation of Liberty Safeguards (DoLS).

Staff undertook training and received regular supervision to help support them to provide effective care. People were encouraged to live a healthy lifestyle and received holistic support from various health and social care professionals.

People and their relatives told us staff supported them or their relative with dignity and respect. They ensured people’s privacy was maintained particularly when being supported with their personal care needs. People were supported to be as independent as possible and staff supported them in the least restrictive way possible. People and their relatives felt involved in the running of the service and could have an input into the care provided.

Each person had an individual care plan. However, these care plans were not always up to date and did not always reflect people’s support needs. The acting mana

Park View provides accommodation and 24 hour care, including personal care for up to 108 adults. This includes nursing care for older people and younger adults who may be living with dementia. The service is a large purpose built property. The accommodation is arranged across five units over two levels. There are four units for people living with dementia and complex needs all providing nursing care and one unit for people living with dementia. There were 106 people living at the service at the time of our inspection.

The service had 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.

At the last inspection on 9, 10 and 16 June 2016 we found one breach of the Health and Social Care Act 2008 (regulated activities) Regulations 2014. This was because staff did not always receive supervisions in line with the provider’s policies and procedures and did not always receive up to date training to carry out their role. Some staff did not have a clear understanding of application of the Mental Capacity Act 2005.

At this inspection we found improvements in staff supervision and training. However we found gaps in staff knowledge of the Mental Capacity Act 2005. We found three breaches of the Health and Social Care Act 2008 (regulated activities) Regulations 2014. This was because the approach to recording management plans in risk assessments was not always consistent. People using the service, their relatives and staff felt there were not enough staff at the service. Medicines were not always managed and administered safely. Guidance for how to administer medicines covertly was not always clear and some decision forms were incomplete. Staff were not always supported to receive on-going training to enable them to fulfil the requirements of their professional role. Quality assurance systems in place to identify areas of improvement were not always used effectively. Staff had mixed views about the support they received from the management team. You can see what action we told the provider to take at the back of the full version of the report.

We have made recommendations about providing opportunities for people to participate in meaningful activities and about involving people in their care.

People and their relatives told us they felt safe using the service. Staff knew how to report safeguarding concerns. There were effective and up to date systems in place to maintain the safety of the premises and equipment. Recruitment checks were in place to ensure new staff were suitable to work at the service.

Appropriate applications for Deprivation of Liberty Safeguards had been made and authorised. People using the service had access to healthcare professionals as required to meet their needs.

People were offered a choice of nutritious food and drink. Staff knew people they were supporting including their preferences to ensure personalised care was delivered. People using the service and their relatives told us the service was caring and we observed staff supporting people in a caring and respectful manner. Staff respected people’s privacy and dignity and encouraged independence. People and their relatives knew how to make a complaint.

Regular meetings took place for staff, people using the service and their relatives. The provider carried out satisfaction surveys to find out the views of people and their relatives.

People and their relatives told us the registered manager and management team were supportive and approachable.

Park View provides 24 hour care, including personal care for up to 108 adults. This includes nursing care for older people and younger adults who may be living with dementia. The service is a large purpose built property. The accommodation is arranged across five units over two levels. There are four units for people living with dementia and complex needs all providing nursing care and one unit for people living with dementia. There were 104 people living at the service at the time of our inspection. At the last inspection on 22 August 2014 we found the service met the required standards.

The service had 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.

We inspected Park View on 9, 10 and 16 June 2016. This was an unannounced inspection. At this inspection we found one breach of the Health and Social Care Act 2008 (regulated activities) Regulations 2014 regarding supporting staff.

People and their relatives told us they felt safe using the service. Staff knew how to report safeguarding concerns. Risk assessments were completed and management plans put in place to enable people to receive safe care and support. There were effective and up to date systems in place to maintain the safety of the premises and equipment. We found there were enough staff working at the service and recruitment checks were in place to ensure new staff were suitable to work at the service. Medicines were administered and managed safely.

Staff did not always receive supervisions in line with the provider’s policies and procedures. Staff did not always receive up to date training to carry out their role. Some staff did not have a clear understanding of application of the Mental Capacity Act (2005).

Appropriate applications for Deprivation of Liberty Safeguards had been made and authorised. People using the service had access to healthcare professionals as required to meet their needs.

People were offered a choice of nutritious food and drink. Staff knew people they were supporting including their preferences to ensure personalised care was delivered. People using the service and their relatives told us the service was caring and we observed staff supporting people in a caring and respectful manner. Staff respected people’s privacy and dignity and encouraged independence. People and their relatives knew how to make a complaint.

Regular meetings took place for staff, people using the service and their relatives. The provider carried out satisfaction surveys to find out the views of people and their relatives. The provider had quality assurance systems in place to identify areas of improvement. Staff, people and their relatives told us the registered manager and management team were supportive and approachable.

A single inspector and an expert by experience carried out this inspection. This is a person who has personal experience of using or caring for someone who uses this type of care service. We spoke with the registered manager, six relatives and five people who used the service. We also looked at records and policies and procedures to give us more information on the service provided. Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We saw care plans that reflected person centred care. These were sufficiently detailed to allow care staff to deliver safe and responsive care. A senior care worker said, "The care plans are written in detail to help us work confidently with that person and to meet their needs." We saw that risk assessments had been carried out to help make sure people who lived there received safe and appropriate care and treatments. These included areas such as personal care, skin care and mobility.

CQC monitors the operation of the Deprivation of Liberty Safeguards, which apply to care homes. The home had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). We looked at the DoLS applications that were in process and saw the correct procedure was being followed. Relevant staff had been trained to understand when an application should be made, and how to submit one. We spoke with one person who used the service. They told us they had recently had a meeting to discuss whether a DoLS application was needed and it was agreed that it was not required.

Equipment used in the home was maintained under service contracts and by the full time maintenance staff. The equipment was clean and in good supply.

Is the service effective?

People's health and welfare was protected and promoted and we recognised the service had sought expertise and support from other health and social care services that people required in order to meet their needs effectively. We saw that people or their representatives had been involved in their care assessments and reviews.

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and they knew them well. One relative told us, "We feel involved in their care. The staff are excellent." Staff had received appropriate training to meet the needs of the people receiving care.

Records confirmed that staff recruitment had been done effectively. Staff said they had been given the training and supervision needed to ensure they understood their roles and responsibilities and were able to carry out their job effectively.

Is the service caring?

People were supported by kind, committed and attentive staff. We saw that care staff were patient and empathetic when supporting people. One comment from a relative was, "We really cannot fault this place." There was a calm and friendly atmosphere in the home at the time of the inspection.

Is the service responsive?

People's needs were continually assessed. Records confirmed people's preferences, interests and diverse needs had been recorded and care had been provided in accordance with people's wishes. We observed people who used the service undertaking various activities and many of the residents and relatives attended a special event held in the main lounge in the afternoon.

We saw that care records had been reviewed and contained up to date and relevant information about the care and support needs of people who used the service.

Is the service well-led?

Staff had a good understanding of providing personalised individual care and the need to promote independence where possible. Quality assurance processes were in place to support this. People told us they were asked for their feedback on the service they received and they confirmed they had felt listened to. Staff told us that it was a good place to work and the manager was very approachable. Systems were in place to help the service develop and learn.

All the people we spoke to were very positive about Park View, a relative said 'the manager has very high expectations and everyone else just follows. Everyone greets you; there’s an aura of friendliness. What you see is what you get. Never a sense of anyone putting on a show.' We found that the service made sure that people's choices were respected and they had access to the care and treatment they required. A person's relative said, 'they have improved since they came here. They ring if anything happens. No complaints at all. It’s a really good home.' We saw that the service safely stored and administered people's medicines. We spoke to staff and looked at records and confirmed that staff were trained and supported to carry out their role. We saw that people could use the home's complaints procedure and records confirmed that people had received an appropriate response.

People were pleased with the services provided by Park View. They told us that everything was lovely in the home and they were happy there. They said, “staff treat us good,” “the care in this home is out of this world” and “the manager and staff listen to you and give you the care you need”.

There were 105 people using the service during our inspection and we found that the home was sufficiently staff in all four units to meet peoples’ needs. We spoke with twenty people and noted that they were happily interacting with the staff throughout the inspection. They looked comfortable, particularly those on Memory Lane (residential dementia) who were dancing with the staff to several Vera Lyn classics.

The building was clean, safe and warm and people were seen accessing all areas designed for their care, treatment and support.