The inspection took place of 11 and 12 September 2018 and was unannounced.

Parkview Care Home is a residential care home that provides care and support for up to ten people living with mental health conditions. On the day of the inspection seven people were living at Parkview Care Home. Accommodation is provided over four floors and includes a shared lounge, dining room and kitchen and a garden area to the rear.

Parkview 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.

A registered manager was in post at the time of the 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. However, the registered manager had recently returned from a period working away from the service and we had not been notified of their absence. This is an event notifiable to CQC.

Medicines were not always managed safely. We found inconsistencies in the recording around medicines and could not be sure that people always received their medicines safely. Competency assessments had been completed for some staff who were administering medicines, but others were administering medicines without an assessment of their competency to do so. On one occasion when a person had received an overdose of their medicine had not been appropriately recognised and reported as a safeguarding concern.

Accidents and incidents were recorded but there was no oversight of these, to ensure that lessons were learnt and to allow improvements to be made to prevent reoccurrence.

A quality assurance framework was in place but it did not support the service to identify and address all the areas we noted within the inspection.

The premises were not always suitable for the people living there. We were told this was due to the recruitment of new maintenance staff.

Safe recruitment processes were followed. Staff were inducted to the service. However, the training programme did not ensure that staff had all the skills they needed to support people. For example, only four of the staff team had received mental health awareness training.

Risks to people were assessed and ways to reduce the risk considered and implemented. Care plans included various aspects of people’s lives and the support they needed from staff.

People were involved in the preparation and tasks around mealtimes. People told us their choices were considered in the menu and that alternatives were available.

People were treated with kindness and compassion. Staff provided emotional support to people. People’s identities and preferences were respected and they were treated with dignity.

Activities were tailored to people’s interests and goals. People were involved in daily tasks including laundry and cleaning up after meals.

When people had raised concerns or complaints these were responded to in a timely and considered manner.

People, their relatives and professionals told us the registered manager was approachable and supportive.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

We inspected Parkview Care Home on the 7 December 2015. Parkview Care Home is a residential care home that provides care and support for up to eight people living with past and present mental health needs. On the day of the inspection, eight people were living at the home. The age range of people living at the home varied between 40 –80 years old. Predominately people required support with their mental health, support was also needed in relation to self-harm, diabetes, anxiety and physical healthcare needs.

Accommodation was provided over four floors. Stairs connected all floors. Everyone living at the home could safely use the stairs. Located in Hove, the home provided access to the city centre and seafront. There was good access to public transport which was regularly used by people living at Parkview Care Home. During the course of the inspection, people were seen coming and going independently, going out with staff and family.

People spoke highly about living at the home. One person told us,” It’s nice and quiet and everyone gets on well here.” Another person told us, “It’s a safe environment.” A third person told us, “I enjoy it here.” Staff also spoke highly of the home. One staff member told us, “There is a sense of a family atmosphere here and the variety of staff is really good. They are flexible and do everything from cooking to caring and interacting with residents.”

There was a registered manager in post. 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.

Quality assurance systems were in place to review and monitor the effectiveness of the home. However, these systems were not yet fully embedded or completed. Incidents and accidents were not monitored or audited for any emerging trends, themes or patterns. Staffing levels were sufficient and no significant concerns were raised regarding staffing levels. However, robust systems were not in place for determining, assessing and reviewing that two staff members were sufficient to meet the needs of eight people living with past and present mental health needs. In relation to the above concerns, we have therefore asked the provider to make improvements.

The recovery model was fully utilised and people were encouraged to regain their independence. Support was provided to enable people to cook independently, do their laundry and self-administer their medicines independently. One staff member told us,” We try to give people the tools to empower themselves, enable them to recover and improve their daily lives.”

Staff received training to help them undertake their role and were supported through regular supervisions and appraisals. Staff had training in working with the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Training specific to mental health was also provided and staff spoke highly of the training provided. One staff member told us, “The training is good. We are encouraged to do specialist training and any other subject related to our work which we have a special interest in. I came out feeling inspired after the physical intervention training day.”

Safe recruitment procedures were followed and appropriate pre-employment checks had been made including evidence of identity and satisfactory written references. Appropriate checks were also undertaken to ensure new staff were safe to work within the care sector.

Training schedules confirmed staff members had received training in safeguarding adults at risk. Staff knew how to identify if people were at risk of abuse or harm and knew what to do to ensure they were protected.

People were supported to make sure they had enough to eat and drink and their nutritional needs were met to ensure they stayed healthy. Lunch time was a sociable event where staff and the registered manager joined people, eating together discussing various topics. Any special dietary requirements were met and action was taken if people were losing weight. Menus were devised in partnership with people and were changed every four weeks.

Medicines were stored, administered, recorded and disposed of safely. Staff were trained in the safe administration of medicines and kept records that were accurate. People were also supported to self-administer their medicines independently.

Staff recognised the signs of when someone’s mental health may be deteriorating. One staff member told us, “We recognise that someone is deteriorating mentally if they become agitated, tearful, stay in their rooms or neglect themselves and will arrange a review of their care.” Communication was valued and staff and the registered manager recognised the importance of effective communication in supporting people to remain well.

There were six people who used the service and five were present at the time of our inspection. We used a number of different methods to help us understand their views and experiences. We talked to three people who used the service. We observed the care provided and looked at supporting documentation. We spoke with two members of care staff and the manager. We found that people were treated with respect and were supported to maintain and or increase their independence. The level of support offered to people was flexible. At times when people felt less able to do things such as accessing the doctors then staff support was increased. This meant that people could continue with their everyday lives and maintain their health when they otherwise would be unable to. People told us there were not any restrictions placed on them. One person who used the service said, "I get up and go to bed when I want to. I can come and go as I want”. We found that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People who use the service were protected from the risk of abuse and told us that they felt safe at the service. People were protected by the service’s recruitment procedures. There were systems in place to identify, assess and manage risks to people who used the service.

During our visit to Parkview Care Home there were eight people using the service. We used a number of different methods to help us understand the views and experiences of people who use the service. We spoke with two people who use the service and six staff members including the registered manager.

We observed staff interacting with people who use the service in an open, friendly and respectful way. We viewed the care records of four people and saw that care was planned and delivered in line with their individual care plan. We saw that care was delivered as part of a process of assessment, planning and review.

People who use the service told us they were happy with the care they received. One person told us "I wouldn't want to be anywhere else. I love it here. We have nice, friendly staff." Another person told us "Staff are very caring, I feel happy here."

We saw that people were supported to maintain or increase their independence and that people were encouraged to continue with their everyday lives. We were told by people that they were able to make their own decisions and that there were no restrictions placed on them. One person told us "I go out when I want to. Sometimes I go alone and meet my sister, other times I will go out with my key worker."