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.