About the service:

Parkview Residential Home provides residential care for up to 32 people and is located in Bolton. This includes providing care for people both under and over 65 years old. The home is situated on Chorley New Road and has good access routes to the town centre.

Rating at last inspection:

Our last inspection of Parkview Residential Home was in May 2018. The overall rating was Requires Improvement and this report was published in July 2018. At this last inspection we found regulatory breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 regarding person centred care and good governance.

People’s experience of using this service at this inspection:

We carried out this comprehensive inspection on 8,9 and 10 January 2019. At the time of the inspection there were 30 people living at the home.

We looked at how new staff had been recruited since our last inspection. We found staff were not always recruited in line with the home’s recruitment policy and procedure. This was because two references from previous employers were not always obtained.

We looked at the systems regarding fire safety and the suitability of the premises. We found prompt actions had not been taken following the last fire risk assessment in 2018. A number of recommendations had been made and needed to be acted upon by the provider. We referred these concerns to Greater Manchester Fire Service after the inspection.

Where accidents and incidents had occurred such as falls, timely referrals were not always made to other health care professionals.

The principles of the MCA were not always being adhered to. This was because mental capacity assessments and best interest discussions had not always been held where people were unable to consent to their care and treatment.

Quality assurance systems needed to be improved to ensure the concerns from this inspection were identified and acted upon in a timely manner. The home has a poor inspection history and although improvements were noted during some of our previous inspections, these were not always being maintained.

The provider had not complied with the conditions of their CQC registration. This was because the home was only registered for 32 people, yet we were told the occupancy had gone beyond this in recent months. This was because an additional three beds had opened and were used to promote independent living. We are following up on this issue outside of the inspection process.

People living at the home said they felt safe. The visiting relatives we spoke with told us the home was a safe place for people to live.

There were enough staff to care for people safely and we saw people’s needs being responded to in a timely way.

Staff received the necessary induction, training, supervision and appraisal to support them in their roles.

People received enough to eat and drink and received appropriate support at meal times. Where people needed modified diets, due to having swallowing difficulties, these were being provided.

People living at the home and visiting relatives made positive comments about the care provided at the home. The feedback we received from people we spoke with was that staff were kind and caring towards people.

People said they felt treated with dignity and respect and that staff promoted their independence as required.

Appropriate systems were in place regarding end of life care

Complaints were handled appropriately. Compliments were also maintained about the quality of service provided.

There were a range of activities available for people to participate in and we observed people taking part in activities during the inspection.

We received positive feedback from everybody we spoke with about management and leadership within the home. Staff said they felt supported and could approach the home manager with any concerns they had about their work.

More information is in detailed findings below. We identified four breaches of the Hea

This inspection took place on 09 and 11 May 2018. The first day was unannounced. This meant the provider did not know we would be visiting the home on this day. The second day was announced.

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

At time of this inspection there was a manager employed who had submitted a request to CQC to become registered. 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 found was found to be meeting the requirements of the regulations at the last inspection which was carried out in December 2016.

At this most recent inspection we found the service in breach of two Regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. This was in relation to good governance and person centred care.

People were not always receiving care in line with their preferences and people’s care files in some cases had not been updated since January 2018.

Cleaning schedules had not been completed for the month of May, Medicines administration records contained gaps and risk assessments were not always completed in full to evidence what risk mitigating action the provider had taken in response. In addition the provider’s governance and auditing systems had failed to identify concerns we found throughout the inspection.

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

Safeguarding policies and procedures were in place to ensure people, staff and visitors were aware how to raise concerns and what abusive practice looks like. Staff received training in this area and a record of safeguarding referrals was kept securely.

Deprivation of Liberty safeguards were in place for people who required them and we saw evidence of a spread sheet kept by the manager in order to track any reviews and new orders.

Safe recruitment procedures were followed and new staff received a period of induction before being assessed as competent in their new role.

Medicines practice was found to require minor improvements, however a visiting medicines professional told us marked improvements had been made in this area and the service continued to work well with the external audit findings.

The service was embarking on a refurbishment plan in order to internally modernise the building and change the interior décor.

Business continuity plans were in place to offer information and guidance in the case of adverse weather or any other unforeseen circumstances which could affect the day to day running of the service. People had personal evacuation plans and fire audits were completed by both external agencies and internally.

Environmental risk assessments were completed for both internal and external areas. Appropriate checks were done by registered external tradespersons on areas such as gas appliances, fire equipment, electrical appliances, hoists and lifts.

Staff interacted and engaged well with people. Staff were caring, respectful and understanding in their approach and treated people as individuals. They promoted privacy and dignity and supported people to maintain control over their lives. People's opinions were routinely sought and acted upon by means of questionnaires and residents meetings and resident committee meetings which enabled people to provide influence to the service they received.

Positive feedback was received from people using the service, their visitors and visiting health professionals. People told us they felt the service had become a

This unannounced inspection took place on Tuesday 20 December 2016.

Parkview Residential Home is a large property built on three levels with a passenger lift to all floors. The home is registered with the Care Quality Commission to provide care for up to 32 people. The home which has garden areas to the front and rear is facing a local park. It is situated close to Bolton town centre and on the main bus routes.

At our previous inspection in April 2016, Park View Residential Home was rated as ‘Requires Improvement’ overall and for the ‘key questions’ Effective, Responsive and Well-led. The Safe ‘key question was rated as ‘Inadequate’, whilst Caring was rated as ‘Good’. At that inspection we identified regulatory breaches due to concerns relating to the safe management of medication, assessing/mitigating risk, infection control and monitoring the quality of service effectively to ensure good governance. At this inspection, we found the home had taken appropriate action to address these concerns.

People living at the home told us they felt safe. The staff we spoke with had a good understanding of safeguarding, whistleblowing and how to report any concerns.

We found medication was given to people safely and staff had received appropriate training. Management also undertook regular audits to ensure there were no shortfalls in practice.

Staff were recruited safely with references from previous employers sought and DBS (Disclosure Barring Service) checks undertaken. This would ensure that staff were suitable to work with vulnerable adults.

There were sufficient staff working at the home to meet people’s needs. Feedback from people living at the home, visitors and staff was that staffing levels were sufficient. Staffing levels at night had also increased from two members of care staff to three since our last inspection.

Staff received an induction when they started working at the home, as well as receiving appropriate training and supervision to support them in their role. This would ensure that staff were provided with thorough knowledge and understanding to work in a care environment.

The home worked within the requirements of the MCA (Mental Capacity Act) and DoLS (Deprivation of Liberty Safeguards). We saw appropriate assessments had been completed if there were concerns about a person’s capacity. DoLS referrals had been made as necessary to the local authority. Staff spoken with displayed a good knowledge about MCA/DoLS and what action they would take if they had concerns about a persons capacity.

We saw people received enough to eat and drink, with people also making positive comments about the food provided at the home. The staff we spoke with knew about people whose were at risk with regards to their nutrition such as if they had lost weight or were at risk of choking.

All of the people we spoke with during the inspection including people living at the home made positive comments about the care provided. The people living at the home said they liked the home manager and had noticed an improved level of care being provided since they had started working at the home.

People told us they felt staff treated them with dignity and respect and promoted their independence where possible. We also saw people being offered choices about how they wanted their care to be delivered.

People felt the home was responsive to their needs and we saw examples of staff doing this during the inspection when assisting people to walk around the home, administering medication and helping people to transfer from sitting to standing or in to their chairs..

Each person living at the home had their own care plan, which was person centred and detailed people’s choices, life history and personal preferences. This would help ensure staff had appropriate information available to them in order to provide person centered care.

There was a complaints procedure in place which allowed people to voice their concerns if they were unhappy with the

This unannounced inspection took place on Thursday 21 April 2016.

Parkview Residential Home is a large property built on three levels with a passenger lift to all floors. The home provides 32 places for the care of older people including six places for people with a physical disability. The home has garden areas to the front and rear and faces a local park. The home is situated close to Bolton town centre and main bus routes.

At our previous inspection on 16 and 18 September 2015, we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the skills relating to the registered manager, person centred care, assessing/mitigating risk, the safety of the premises, medication, infection control, nutrition/hydration, good governance, staffing levels, training/supervision and recruitment of staff. The home was rated as ‘Inadequate’ overall and in three of the five ‘key questions’ against which we inspected.

Although we found the home had made improvements in several areas, we did identify continuing breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to medication, infection control, assessing/mitigating risk and good governance. We also identified an additional breach in relation to seeking consent.

During this inspection we found the home did not always assess and mitigate risk effectively, to ensure the safety of people living at the home. We saw that hot water dispenser had recently been purchased by the home. This was very hot to touch and posed the risk of people scalding themselves if they came in contact with it. We saw no evidence of an appropriate risk assessment being considered by the service, to mitigate such risks. The deputy manager contacted us following the inspection to say they had replaced the dispenser with a kettle.

We saw people had risk assessments in their care plans relating to road safety, building security and safety in the community. These contained generic statements and control measures which appeared to have had been copy and pasted between different peoples risk assessments. In one risk assessment we looked at, a male resident had been referred to as a female, with the wrong name also used. We found a similar issue when looking at PEEPs (Personal Emergency Evacuation Plans), with one stating how a female resident must remain in ‘his’ room during an emergency. At the time of the inspection there were 20 people living at the home and only 9 PEEPS were in place. This meant that in the event of an emergency, staff wouldn’t have access to guidance to evacuate people safely from the building. This meant there had been a breach of regulation 12 (2) (b) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment. This was because the home had failed to mitigate risks presented to people living at the home.

We also saw no evidence of risk assessments being conducted in relation to falls and waterlow. A waterlow assessment would identify if a person was at risk of developing pressure sores. We saw there were blanks waterlow documents in people’s care plans, however these were incomplete. The deputy manager told us falls risk assessments had not been completed but would do so immediately following the inspection. According to the accidents and incidents records, one person had fallen from bed on four occasions, however we were unable to see what was being done to prevent this. This meant there had been a breach of regulation 12 (2) (a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment. This was because the home had failed to assess the risks to people living at the home.

We found several instances of uncleanliness around the building and poor practices in relation to infection control. We founds skirting boards on the ground floor of the home were dirty and dusty and lo

We carried out an unannounced inspection of Parkview Nursing and Residential Home on 14 April 2015. We last inspected this service on 19 September 2014 when we found the service was meeting the standards in all outcome areas inspected.

Parkview is a large property built on three levels. The home provides accommodation and personal care for up to 32 people. At the time of our visit there were 31 people living at Parkview. The home which has garden areas to the front and rear is situated close to Bolton town centre and is on main bus routes.

At the time of our inspection 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.

We found breaches of six regulations of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to safe care and treatment, staffing, safeguarding, need for consent, dignity and respect and good governance. You can see what action we told the provider to take at the back of the full version of this report.

We had concerns about how the service ensured people were safe. The environment was run-down and areas of the home were unclean. This posed a risk to people in relation infection prevention and control. Not everyone felt staffing levels were sufficient and we saw that shifts were not always covered when a staff member was absent. Not all staff were able to demonstrate a good understanding of safeguarding procedures

The service did not manage risk well. We were told one person was constantly supervised by staff in order to prevent them from falling but found this was not the case. The service had also failed to take action to manage a fire risk that had been highlighted during a recent fire safety inspection.

Medicines were not always administered using safe procedures. We also saw that cream medicines were not being kept safely as they were kept loose in people’s rooms.

The service told us all staff training was up to date. However, they were unable to provide any record of what training or supervision had been undertaken at the time of the inspection. Information on training received following the inspection showed some training had been undertaken. However, there was no evidence that safeguarding training was up to date for all staff, and there was no evidence of training in areas including the Mental Capacity Act, Dementia and behaviours that challenge services. We had concerns about staff competence to effectively support people who could present behaviours that challenged the service.

Staff did not always seek people’s consent in accordance with the Mental Capacity Act 2005. We observed staff on a number of occasions turning people’s chairs to face the other way without asking them, or informing them what they were doing. Staff understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards was limited.

Most people told us they liked the food on offer. We spoke with kitchen staff who told us they were starting to try new dishes to create a new menu.

Some people we spoke with did not think all staff were kind and caring. We observed interaction between staff and people to be limited and requests for support were not always acknowledged.

The service had installed CCTV, which covered areas including the communal lounge. People’s privacy and choice in this matter was not respected as the service had not regularly consulted people and the CCTV monitor faced out into the entrance lobby.

There were no arranged activities and there was little stimulation for people living at Parkview. Staff told us they did not always have time to arrange activities when they were short staffed.

There were resident and relatives’ meetings held around once or twice per year. Other than these meetings there was little evidence of the service seeking feedback from people. The registered manager told us people weren’t really interested in care plans, however, one relative and one visitor we spoke with told us they would have liked to have been involved in the process and were not.

Staff told us they would offer people choices such as around clothing and bed-times. However, some people felt their choices were limited in this area. We also found people’s choice had been restricted in relation to choosing when to watch the television in the main lounge.

Audits were carried out by the registered manager but did not cover all aspects of the service provided. This meant that areas where we identified concerns such as in relation to infection control and the environment had not been identified as areas where action was required.

Some staff felt well supported and thought the service was well-led. However, other staff raised concerns that they were not treated fairly or listened to. There was no evidence of recent staff meetings or other ways having been considered to involve staff in developing the service.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve
• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

We considered all the evidence we had gathered under the outcomes 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 found-

Is the service safe?

The Registered Manager set the staff rotas. We spent time in communal areas and saw adequate numbers of staff were available to meet the needs of people who used the service. One family member told us, "That`s why we chose Parkview. There are always enough staff on duty."

We saw the medication cabinet was locked and kept in a dedicated store room and secured to the wall. The manager told us medication training was revised on a regular basis which helped ensure the safety of people who used the service.

Deprivation of Liberty Safeguards (DoLS) become important when a person is judged to lack the capacity to make an informed decision related to their care and treatment. The provider told us no recent applications for DoLS had been made but knew the procedure to be followed if an application needed to be made. At the time of our inspection, no person who used the service was subject to a DoLS.

Is the service effective?

The manager told us an advocacy service was available at the care home. This meant that, when required, people who used the service could access additional support if required.

Before people were admitted to the care home, they underwent a pre-admission assessment of their care needs. We saw their choices and preferences had been recorded which showed they had been involved in creating their care plans.

Is the service caring?

We saw staff members supported people in a dignified manner and always asked the person before providing any care or support. This meant the person`s independence was respected.

We spoke with three people who used the service and two family visitors. One person told us, "Everything is champion. Could not be better." Another person told us, "I am very happy, really nice here. We are well looked after." A family member told us, "The staff work so hard. They are busy but if you need anything they are there for you."

Is the service responsive?

Accidents and incidents were recorded in a dedicated log book. The manager told us they were reviewed regularly and often discussed at staff meetings. This helped ensure any similarities were identified and, if necessary, further investigation took place.

The manager provided a daily record of the staff roles and responsibilities for each shift at the care home. One staff member told us, "I didn`t like it at first and thought it wouldn`t work. I must admit I think it`s a great idea now. We all know what we have to do each time we are on duty."

Is the service well led?

We found the provider had effective procedures in place that monitored the quality of service provided to people who used the service. Monthly care plan and medication audits were completed. Regular checks on the kitchen, laundry and environmental areas had also been conducted.

The provider worked well with other agencies. We saw records in care plans of GP and other professional visits and appointments. This helped ensure people received appropriate care when they needed it.

Care was provided in single rooms, which were of varying sizes. We found people who used the service were able to have their own belongings and furniture. We observed rooms were clean and free from any malodours.

We sampled seven care files and found care was appropriately planned and then reviewed on a monthly basis. We saw care plans were maintained in a chronological order and were personalised.

An Expert by Experience was part of the inspection team and was able to spend time speaking with people who used the service and visitors to the home. Comments included: “The people in charge seem to know what they are doing and are very approachable” and “The staff are very obliging”. We saw that people appeared clean, well dressed and cared for.

We found the nutritional needs of the people who lived at Parkview were appropriately assessed and were needed, people were supported to be able to eat and drink sufficient amounts to meet their needs.

We sampled four staff files and found they were maintained as required and demonstrated staff were safely and effectively recruited.

Monthly audits were undertaken and these included care plan reviews, medication administration, cleanliness and bedroom and environment checks.

People who used the service, their relatives and visitors to the home were encouraged to complete satisfaction forms on a regular basis.

Since the last inspection in May 2012 there had been improvements in how feedback was gained from people who used the service.

We spoke with 5 people who use the service and all comments were positive. We were told: "They are lovely to me, I have no complaints at all.", "The girls are very nice, they treat me well." and " Everyone is very kind here."

We sampled a total of 6 care files and we found that there were improvements in how these were maintained. Individual assessments of care needs were more person centred and demonstrated that the preferences and choices of the person, had been included when implementing care plans.

The provider had taken action to implement a refurbishment programme to individual rooms, as they became vacant. We observed that furniture and fittings had been replaced and much improved. Bathrooms had been retiled and redecorated and were fit for purpose.

We carried out a planned inspection of Parkview Nursing and Residential Home on 14th May 2012. We found that there were concerns in relation to how the provider was assessing and monitoring the quality of care and the service provision. We judged that to have a major impact on the people who used the service and enforcement action was taken. A follow up visit was carried out to review the actions taken to improve the service and to meet this regulation.

A further review will be undertaken to determine compliance with the remaining outcomes at a later date.

“If I have any concerns or questions the manager will make time to speak with me.”

“I have always found the staff to be very respectful. If I want to know anything, they are always happy to speak with me”.

“I find that my X is looked after well. The staff are very kind”.

“I haven’t been asked to attend any meetings but the manager is always here: she’s always been available to speak to”.

“Superb, we are very happy with the care”.

“I feel safe here”

“I have no concerns that ‘x’ is not safe here.”

“Staff look after me “.

Positive comments were received from residents, relatives and staff about their experiences at Parkview. Residents said they felt comfortable on expressing their needs and wishes. During our visit it was evident that good relationships had been made with the residents and staff, there was a friendly rapport between them.

Staff said they were supported by the manager and that they were kept informed about what goes on within the home.

We were told by the commissioning team that they previously had some concerns about Parkview, but they are now satisfied that these had been addressed.

This unannounced inspection took place on 16, 18 and 21 September 2015.We last inspected Parkview Nursing and Residential Home on 14 April 2015 when we rated the service as ‘inadequate’. We found seven breaches of the regulations, which were in relation to training, staffing levels, safeguarding, medicines management, infection control, managing risk, monitoring of the safety and quality of the service, need for consent, dignity and respect and seeking consent.

At this inspection we found the provider had made improvements and was meeting the requirements of three of these regulations in relation to the issues we previously found around safeguarding, dignity and respect and seeking consent. However, the required improvements had not been made to meet the requirements of four of the previously identified breaches of the regulations.

Overall we found 11 breaches of the regulations. These related to the safety of the premises, safe management of medicines, infection control, assessing and managing risk, employment of fit and proper persons, meeting nutritional and hydration needs, staffing, training, assessment of needs and preferences, records and systems in place to monitor the safety and quality of the service, and requirements relating to the registered manager. We are considering our enforcement options in relation to the regulatory breaches identified. We will report further when any enforcement action is concluded.

Parkview Residential and Nursing Home is a large property built on three levels with a passenger lift to all floors. The home provides accommodation and personal care for up to 32 people. The home did not provide, and was not registered to provide nursing care at the time of our visit. The provider has requested that their name be changed to reflect this. The home has a garden area to the front and rear is situated close to Bolton town centre. It is on a main bus route and faces a local park. At the time of our inspection there were 24 people living at Parkview.

At the time of our inspection 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.

We had concerns that the registered manager did not have the required skills to manage the service effectively. We looked at training records and found the registered manager had not received recent training in moving and handling or medicines administration. These were both areas where we found examples of poor or unsafe practice.

A safe environment was not maintained for people living at the home. We found a door in front of a steep staircase to the basement was unsecured on several occasions. We looked at records of servicing and maintenance and saw the electrical systems check had shown the system to be ‘unsatisfactory’. Several faults had been identified by an electrician as requiring urgent or immediate action. The provider had not taken action to ensure the electrics were safe despite this report having been carried out around two months previously. This put people at risk of potential harm.

Medicines were not managed safely. We found stocks of medicines that were not on people’s medication administration records and found missing signatures on the records. We found two people had not received their medicines as prescribed. The home was not following its documented procedures around medicines and stock control was poor. We observed a staff member following unsafe practice when administering medicines.

People commented that the cleanliness of the home had improved since our last visit. However we had continued concerns in relation to the effective prevention and control of infections. We observed a paddling pool containing urine that was sat in the bath of a bathroom accessible to people using the service that was not cleared up promptly. The rationale for using this item for this purpose was not clearly recorded. There were no audits of infection control procedures other than cleaning check-lists.

The night shift was staffed by two carers from 8pm to 8am to provide support to the 24 people living at the home. Staff and the registered manager were not able to explain how support would be provided should one of the people that required two staff to support them required assistance at the same time as other people who were described in their care plans as requiring ‘constant supervision and observations’ were out of bed. One person fell from bed during our inspection. The registered manager told us this was because they wanted to sit with friends in the lounge. They told us they were unaware why this person was still in bed, but thought it was because the night staff must have been busy.

The provider had not followed safe practice in the recruitment of staff. We found some staff who were working during out inspection did not have the required checks in place to help ensure they were of good character and suitable to work with vulnerable adults.

We found that not all staff who were providing support with moving and handling had received the appropriate training. We also observed unsafe practice in relation to moving and handling. The service supported people with a wide range of needs, however no specialist training had been provided, for example in supporting people with mental ill health or drug addiction. Staff had a poor understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). They were not able to explain how they would support people living with dementia effectively, despite having attended training in this area.

We saw improvements were underway to improve the physical environment at the home, such as the replacement of carpets and bathrooms. However the provider had not acted to make the environment more ‘dementia friendly’ despite this having been raised as an issue at our last inspection.

Whilst referrals had been made promptly to other health professionals, the records did not always demonstrate that advice in relation to food and nutrition was being followed. Staff told us they thought the records were not accurate. We looked at one person’s records, which appeared to have been amended between the first and second days of our inspection.

Most relatives we spoke with told us they were made to feel welcome and felt their family member was well cared for. The majority of interaction we observed between staff and people using the service were friendly and respectful. However, we observed a lack of effective communication by one staff member when supporting a person who was becoming distressed.

At our last inspection we had raised concerns that the provider was using CCTV in indoor communal areas and had not consulted with people or ensured they were aware of its presence. The CCTV in the lounge area had been turned off. However, CCTV recordings were still being made in the reception area and communal garden and people we spoke with were unaware of its presence. We have made a recommendation for the service to review guidance on the use of surveillance in care homes.

Some people living at the home had a high level of independence and told us they were allowed the freedom to come and go as they pleased. However, one person told us that staff discouraged them from going out and told us they had not been given a reason for this. This meant their independence was not being supported.

We saw various games and activities taking place, although there were also missed opportunities for interaction. We observed that staff sometimes sat next to people but did not attempt to interact with them. Some people told us they enjoyed entertainment that the home put on such as singers.

Most care plans contained some information about people’s preferences in relation to daily routines, hobbies, interests and social history. However, we saw two people did not have a full care plan in place and that there was no information on preferences recorded. The admission assessment for one person was incomplete and the service had not carried out a risk assessment for this person.

We saw the service kept a record of complaints. One relative told us their complaint had been addressed effectively. There had not been any meetings for relatives for over one year. The registered manager told us that relatives had requested to only have the meetings infrequently. The relatives we spoke with during the inspection did not express a desire for more frequent meetings, however we saw one person had written to the service and noted that they had wanted to raise concerns at a relatives meeting but that this was overdue. There was no evidence of the service having consulted with families on the frequency of meetings.

Relatives and staff commented that they had seen improvements within the service since our last inspection. We saw a schedule of works to improve the environment was displayed. Most visitors and people living at the home told us they felt comfortable discussing any concerns they might have with staff or the registered manager.

We found a lack of effective systems and processes to effectively monitor the quality and safety of the service. For example, there were no checks of recruitment procedures or infection control. Audits of medicines and care plans were limited in depth and were not effective at identifying issues. The service was not displaying the rating from its last inspection on their website despite having been reminded of this requirement.

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 timeframe 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.

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.