Western Park View House provides nursing and personal care and accommodation for up to 60 people. The registered manager informed us that 51people were living at the home.

This inspection took place on 11 and 13 January 2017. The inspection was unannounced on the first day and was carried out by one inspector and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. Our expert for this inspection had experience of the care of older people. They attended for the first day of the inspection.

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.

People using the service and their relatives we spoke with said they thought the home was safe. Staff had been trained in safeguarding (protecting people from abuse) and generally understood their responsibilities in this area.

People's risk assessments provided staff with information of how to support people safely. Staffing levels were sufficient to ensure people were safe. People using the service told us, in the main, they thought medicines were given safely and on time. There were systems in place to ensure that the premises were safe for people to live in.

Staff had been subject to checks to ensure they were appropriate to work with the people who used the service.

Most staff had been trained to ensure they had the skills and knowledge to meet people's needs though more training was needed in specific areas to ensure staff had the skills and knowledge they needed to meet all of people’s assessed needs.

Staff generally understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to allow, as much as possible, people to have an effective choice about how they lived their lives, and the service had obtained legal approval for limiting people's choices when necessary for their best interests.

People had plenty to eat and drink, everyone we spoke with told us they liked the food served and people were assisted to eat when they needed help. People's health care needs were met.

People and their representatives told us that staff were friendly and caring and we saw many examples of staff working with people in a kind and compassionate way.

There was some evidence that people and their representatives were involved in making decisions about their care, treatment and support.

Care plans were individual to the people using the service and covered their health and social care needs. There were sufficient numbers of staff to ensure that people's needs were responded to in good time.

Activities were organised to provide stimulation for people.

People and relatives told us they would tell management or staff if they had any concerns and they were confident they would be followed up.

People, their relatives and staff were satisfied with how the home was run by the registered manager. They all said that this was a well led and well run service.

Not all safeguarding incidents had been reported to CQC as required, which meant we were unaware of all the issues relating to people's safety which prevented a comprehensive risk assessment to see when the service should be inspected.

Management carried out audits and checks to ensure the home was running properly to meet people's needs, though analysis of issues had not always taken place to ensure incidents could be prevented in the future.

Western Park View Nursing Home provides accommodation and nursing care for up to 60 people accommodated over three floors. This includes the care of people with mental health and physical health needs. On the day of the inspection 54 people were living at the home.

At the last inspection on 13 October 2014 we asked the provider to take action to make improvements. We issued compliance actions to improve the care and welfare of people living at the home, staffing levels, supporting staff with adequate training and supervision, improving complaints handling, and ensuring the provider had systems to check that services met the needs of the people living in the home. We were sent an action plan by the provider to deal with these issues. At this inspection we found the provider had made improvements.

This inspection took place on 24 and 26 August 2015 and was unannounced.

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.

Since our previous inspection in September 2015 we had received information from the local authority safeguarding team which had partially substantiated issues of a person's monies not being held securely. At this inspection we found monies had been securely held for people.

Staffing levels had been improved to ensure people were generally safe, though staff cover did not fully cover people’s needs. The provider quickly took steps after the inspection to ensure staff were able to more closely supervise people's safety.

People received their medicines in a timely manner. Medicines were stored safely and people were supported, where possible, to take their medicines.

Staff had a good understanding of people’s needs and had had the training they needed to ensure they had the skills to deliver all aspects of care.

Staff were seen to support people in a confident manner and understand their needs. We saw people were relaxed in the company of staff. Staff supported people to attend regular health care appointments. Staff understood people’s health care needs and referred them to health care professionals when necessary.

People’s dietary needs were met.

People were supported by staff who had developed positive and professional working relationships with them.

People were supported to make their views known about the service. Complaints were investigated and followed up.

The registered manager and staff were committed to meeting the needs of people.

Staff were positive about the support they received from the registered manager. Meetings and supervision provided them with an opportunity to develop and influence the service provided.

The provider had a quality assurance system in place, which assessed the quality of the service though action plans had not always been put in place to ensure any identified issues were dealt with.

Western Park View House provides nursing and personal care and accommodation for up to 60 people. The registered manager informed us that 51people were living at the home.

This inspection took place on 11 and 13 January 2017. The inspection was unannounced on the first day and was carried out by one inspector and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. Our expert for this inspection had experience of the care of older people. They attended for the first day of the inspection.

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.

People using the service and their relatives we spoke with said they thought the home was safe. Staff had been trained in safeguarding (protecting people from abuse) and generally understood their responsibilities in this area.

People's risk assessments provided staff with information of how to support people safely. Staffing levels were sufficient to ensure people were safe. People using the service told us, in the main, they thought medicines were given safely and on time. There were systems in place to ensure that the premises were safe for people to live in.

Staff had been subject to checks to ensure they were appropriate to work with the people who used the service.

Most staff had been trained to ensure they had the skills and knowledge to meet people's needs though more training was needed in specific areas to ensure staff had the skills and knowledge they needed to meet all of people’s assessed needs.

Staff generally understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to allow, as much as possible, people to have an effective choice about how they lived their lives, and the service had obtained legal approval for limiting people's choices when necessary for their best interests.

People had plenty to eat and drink, everyone we spoke with told us they liked the food served and people were assisted to eat when they needed help. People's health care needs were met.

People and their representatives told us that staff were friendly and caring and we saw many examples of staff working with people in a kind and compassionate way.

There was some evidence that people and their representatives were involved in making decisions about their care, treatment and support.

Care plans were individual to the people using the service and covered their health and social care needs. There were sufficient numbers of staff to ensure that people's needs were responded to in good time.

Activities were organised to provide stimulation for people.

People and relatives told us they would tell management or staff if they had any concerns and they were confident they would be followed up.

People, their relatives and staff were satisfied with how the home was run by the registered manager. They all said that this was a well led and well run service.

Not all safeguarding incidents had been reported to CQC as required, which meant we were unaware of all the issues relating to people's safety which prevented a comprehensive risk assessment to see when the service should be inspected.

Management carried out audits and checks to ensure the home was running properly to meet people's needs, though analysis of issues had not always taken place to ensure incidents could be prevented in the future.

We set out to answer our five questions; 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. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe. Two relatives we spoke with also said they thought their relatives were safe in the service.

The service was not completely clean. We found staining to some carpets. This did not fully protect people's dignity. Lighting levels in some areas were dim. They did not protect people from the risk of accidents. We could not see that fire precautions had been properly put into place and reviewed. There was therefore a greater chance of risks to peoples’ safety.

We looked at the recruitment of new staff. This showed that required recruitment checks into qualifications and experience were being followed.

We looked at staff training. Not all staff had been trained to meet the needs of people. This put people at risk of being supported by staff without the appropriate skills.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to providing fully effective training and keeping the home safe and clean.

Is the service effective?

People’s health and care needs were assessed with them, but they were not always involved in writing their care plans. Some people were not aware of what was in their care plans. Specialist dietary needs were not always included. Care staff had not read all the care plans. Care plans were therefore not able to support staff consistently to meet people’s needs.

People’s mobility and other needs were taken into account in relation to building adaptation, enabling people to move around freely.

Relatives we spoke with confirmed that they were able to see people in private and that visiting times were flexible.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to people’s needs and involving people in planning their care.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, “staff help me when I need them. I like to be independent and staff respect that”. A relative told us; “staff are always friendly and welcoming”.

There was no evidence that people using the service, the home’s staff and other professionals involved with the service completed an annual satisfaction survey. There were some shortfalls, and some concerns had been raised by relatives. The registered manager was unable to tell us what actions they have taken to address these shortfalls. People were at risk of not having their concerns and needs properly taken into account.

People’s preferences, interests, and needs had been recorded. Because of this there was a greater chance that care and support could be provided in accordance with people’s wishes.

We asked the provider to tell us what they are going to do to meet the requirements of the law in relation to involving people in planning their care.

Is the service responsive?

We looked at the last discharge from the service where a person had been transferred from another provider’s service. Records showed that this had been reasonably well planned and preferences, interests and needs had been included in transfer reports. This means that the service was informed about the person’s needs.

We discussed with the manager the lack of dementia friendly facilities regarding the design and layout of the premises, taking account of expert bodies such as the Alzheimer’s society.

Is the service well-led?

Staff said that if they witnessed poor practice they would report their concerns.

The service had a quality assurance system to assess and monitor the quality of service provision. The provider had not taken appropriate action to address the shortfalls identified. The system did not ensure that staff were able to provide feedback to their managers, so their knowledge and experience was not being properly taken into account.

There was evidence that the service worked in partnership with key organisations, including the local authority and safeguarding teams, to support care provision and service development.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to quality assurance.

What people told us:

We spoke with 10 people who lived in the home. They all told us that staff were very friendly and always helped them.

We spoke with two relatives. Both stated they had been very satisfied with the service. One relative said; ‘’staff could not be better. They are all very friendly and caring ‘’.

We carried out a short observational framework inspection. This is an inspection method whereby we sit and observe life in the home to see if people were treated properly and their needs were met. We found that staff were friendly, kind, helpful and caring although more stimulation should have been provided to people to prevent boredom.

There were a number of suggestions: to have more staff, to have frequent residents and relatives meetings, and to have more activities and to provide more meaningful activity to people with dementia.

People using the service and their relatives told us they felt safe and well cared for. We found the environment to be welcoming and friendly and the facilities available to people using the service to be appropriate and well maintained.

We observed staff delivering care and support in a patient and efficient manner. People we spoke with told us they trusted the care staff and believed them to be well trained and capable of delivering the care they needed. The provider also took steps to ensure staff maintained their professional skills and displayed a professional approach to their duties.

The provider takes appropriate steps to ensure people's care needs are accurately indentified and fully met whilst they use the service. Members of staff and people using the service told us that they felt supported by the management and were confident any concerns they had would be addressed quickly and satisfactorily.

The provider also ensured all equipment in use by the service and the physical environment were appropriately maintained in order to ensure people using the service were in turn cared for or employed in a suitable and safe environment.

People who used the service told us that the care and treatment they received was delivered in a professional manner which respected their rights and dignity. They also told us that they felt safe and that their personal choices were respected and acted upon.

People told us that the home was kept clean. One person who used the service told us “they come and clean my room every day, they shampooed it yesterday”. Another person said “they keep it clean here”. A relative who was visiting on the day of our inspection also commented on the cleanliness. They told us “it’s always clean here, there’s the odd spillage but they are always cleaning”.

People who we asked said they felt listened to and consulted about their care. One person who used the service said “you are listened to and you can say if you want anything. They will do their best to sort it out”. A visiting relative told us “they do listen to you here and will do what you ask them to do”.

People told us they were able to make decisions about their care and consent to treatment. People were happy with the care they received, although people's hygiene needs were not always met. One person who used the service told us that staff were “very caring”. They said “I am happy here; they are very good to me”. People told us they enjoyed the food provided. One person who used the service told us “the food here is very good”.

People were exposed to preventable infection control risks because this area was not being managed or monitored effectively. Also because standards of hygiene were not being maintained.

People told us that they got the medications they needed and that staff were sufficiently trained to do their job. One person who used the service told us “I always get my tablets”.

We found that the overall monitoring of the service had not been effective in ensuring that improvements in infection control required to maintain compliance with regulations and keep people protected, had been achieved.

People who were able to express and give their opinion told us they were treated with dignity and respect. Those who were less able to communicate and those with higher levels of need were not always supported in a dignified way.

Our observations of people who were unable to express themselves verbally showed that they were not always supported to make decisions about their care and consent to care and treatment.

People told us they were happy with the care they received. One person who used the service said they got good care, another told us “I don’t think you’d get better care anywhere else”. One relative said “the staff are lovely here, they are brilliant”. Another said “one the whole they do a very good job here”. People said there was a varied social programme at the home but that they would like to get out more.

The care that people received did not always meet their needs and the planning of care was not well recorded. This meant they could be at increased risk of developing infections or pressure sores. It also meant that equipment that had a restraining effect was not always provided following proper assessment and consent.

Gaps in the monitoring and recording of medicines given to people meant they could not be assured that they would always receive their medicines. Gaps in staff training meant they did not have relevant programmes of training in areas such as person centred care. This meant that we saw some institutional practices within the home, where people were not receiving care in an individualised way.