Park View Care Home with Nursing

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe - this means we looked for evidence that people were protected from abuse and avoidable harm. We identified breaches of legal regulations. Although we did not see any direct impact, the lack of some risk related paperwork suggested that people’s risks were not always being appropriately managed. The environment was not always managed safely. The provider failed to monitor and address concerns around fire safety, health and safety of the premises. The home was clean and tidy. Recruitment procedures were safe, though staff did not receive regular supervisions or appraisals and staff training needed to be improved. A high number of agency staff were being used to ensure appropriate staffing levels were in place. The service mostly had safe systems for appropriate and safe handling of medicines. However, people’s moisturising and barrier creams were not stored safely and some containers were not labelled with the person’s name or instructions for use. When necessary safeguarding referrals were made and following accidents and incidents lessons learned were being completed. Handovers took place at the beginning and end of each shift and were detailed and necessary referrals were being made when healthcare support was required.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s relatives told us there was an open dialogue of communication with the manager. One relative told us, “I think we need to speak to the staff about mum's medication. The manager is always willing to talk to us.”

Staff were knowledgeable about how to report accidents and incidents.

We were able to review examples of lessons learned which took place following incidents, and we were told how any learning in the group is shared across the group allowing other homes to proactively identify and manage risks before safety events happen. Though due to the multiple issues identified in this report it was not always possible to see how this always identified and drove necessary improvement in all areas.

People felt the staff team worked well together to ensure they received the care and support they needed. One person told us, “I don't need the doctor often but, if necessary, the home sorts it out.”

Staff spoke about how they get to know new admissions, by looking at care plans and risk assessments and speaking to family. One staff member said, “I go off the nursing assessment. I speak to family to identify likes and dislikes.”

Professionals provided mixed feedback around safe systems, pathways and transitions, one professional told us, “We are working together, I can say that. And working well and better as time goes by. One of the big issues was difficulty to contact them, they now have a receptionist which has improved this. They also have 2 nurses on shift all the time and these nurses are regular which allows continuity of care and safer plans.”

Handover sheets were in place and each person had their own section on the handover which was discussed. We were able to see examples where appropriate referrals had been made where people needed specific support. Due to concerns we identified around risk management in care planning, we could not be fully assured that necessary information was always shared to ensure safe systems, pathways and transitions.

People told us they felt safe, one person said, “I am very safe here at the home. I have no issues. If I did, I would talk to the manager.”

Staff told us they had access to safeguarding policies and had completed safeguarding training. They gave examples of things they may report as a safeguarding, one staff member told us, “(I would report) if I thought anyone was at risk of harm. Unexplainable injuries. Any concerns for residents.” Staff told us they had received training about mental capacity. The manager confirmed people had access to advocates if they needed this support.

On arrival, guests (including inspectors) were allowed access through keypad coded and locked doors. We were asked for our ID and were asked to sign into the home to make sure the home had a record of any visitors, which helped keep people safe.

Appropriate safeguarding referrals were being made. The service had a safeguarding policy in place which detailed necessary information. People’s capacity had been assessed and necessary Deprivation of Liberty Safeguards (DoLS) applications were in place to deprive people of their liberty, though some had been initially sent to the wrong local authority and this caused a slight delay in applying for a DoLS to the correct authority.

People told us they were able to do what they want. One person said, “I have freedom to live how I want to. I feel that this is how I would live at home, with help.” While the people we spoke to expressed that they were generally happy with their care, our assessment found elements of risk management had not considered all areas of risk relevant to each person.

Staff spoke about how they managed risks. The manager told us, "With residents that have capacity we discuss their risks with them and discuss how to prevent and mitigate risks, we involve family members as well." Staff told us how they support people with their healthcare needs. The manager recognised that risk assessments and record keeping were not always accurate and this meant people’s risk were not always appropriately mitigated.

During our walk arounds we found examples where risk was not always safely managed. For example, prescribed creams were kept on tables and other surfaces in people’s rooms and there was no risk assessment was in place. We found one person’s barrier spray in another person’s bedroom. The manager told us they had decided to have lockable cupboards in people’s rooms for creams, this had yet to be actioned. We also found one person had a drink supplement in their room, which is given to support people at risk of malnutrition, intake of this item was not being recorded. These were removed until a decision was made about how to manage this.

Necessary risk assessments were not always in place or as detailed as they should have been. We found examples where people had health conditions such as Epilepsy and diabetes but did not have a risk assessment in place. This meant staff may not always be aware of how to manage risk appropriately. One person’s falls risk assessment was incomplete, whilst another person personal evacuation plan contained incorrect information. During our inspection the management told us they would look to improve records.

People and their relatives felt their loved one was in a safe environment. One person said, “Mum’s room is cleaned by the staff, and I do the tidying up. I enjoy doing something for mum. If little jobs need done the maintenance man attends to them.” While the people we spoke to expressed that they were generally happy with their care, our assessment found elements of the environment did not meet the expected standards. For example, we found wardrobes were not always secured to the walls. During our inspection the management were working to implement improvements.

Most staff told us they attended fire drills, and staff said they had completed fire safety training. One staff member said, “I’ve had fire safety training. The service has had fire tests weekly. I can’t remember when the last fire dill took place.” Staff told us they had no concerns about the safety of the environment. Staff and leaders had not addressed or mitigated the risks we saw in the environment before our inspection.

The environment was not always safe, we found multiple items including mobility aids were discarded in hallways and communal bathrooms which could pose a risk to people trying to use these areas, these were moved to a safe place by the manager. During the inspection, the manager commissioned a cupboard to be built to store all these items safely and on day two of the inspection, work on building the cupboard had commenced.

We were initially provided with an outdated fire risk assessment. On receipt of a current fire risk assessment, we found that some of the issues from the previous year had still not been actioned. We were informed by the manager that work had started on the issues identified. There was no Asbestos survey in place, which means the provider had not considered these potential risks that may be in place. There was no whole home environmental risk assessment in place on day 1, however, this was brought in during the inspection and was being worked on.

For the most part people felt supported by staff, but people had concerns about the use of agency. People’s comments included, “Most of the agency staff are ok but there is the odd occasion when they don’t speak very good English. This makes it difficult to tell them my needs.” and “The agency staff vary. Sometimes they are fine and know their jobs others do not really engage with us.”

Staff told us they completed an induction when they started and that they felt they had the appropriate training for their role. Some staff told us they felt the staffing in the home needed to be improved, and that high levels of agency were being used. One staff member said, “Now it’s getting busier, the home could use more staff, and their own staff, rather than agency.” And “Don’t think there’s enough staff… Weekends are worse for staffing. People call in sick nearly every weekend. A lot of agency staff generally call in sick.” Staff told us they did not receive regular supervisions, one staff member said, “I’ve never had a supervision or appraisal.”

We observed staffing in place that was in line with the rotas provided. However, this included a high use of agency staff who did not interact as positively and consistently with people as permanent members of staff. The manager told us how they had recently recruited new staff that were on induction to help reduce agency usage.

Staff supervisions and appraisals were not regularly taking place and were not happening in line with the providers policy. Staff training was not up to date in all areas, the manager spoke about how they planned to address this following the inspection. Safe recruitment practices were in place and had been followed.

Relatives felt the home was clean. One relative said, “Mum’s room is very presentable. Sometimes a bit untidy but always appears clean.”

Staff were able to tell us how they try to minimise the spread of infection through appropriate use of personal protective equipment (PPE). One staff member said, “I wear PPE and make sure areas are clean and tidy at all times.”

We observed examples where cleaning products were not always securely locked away/managed. The home was mostly clean and tidy and there was a dedicated area for laundry. Appropriate PPE was in place.

Although the home was mostly clean and tidy, cleaning records were not always signed/up to date and in place and there appeared the be a lack of oversight in this area.

People received their time sensitive medicines at the right time. One person told us, “I would forget to take my tablets if the staff didn't come round with them. They never miss. I don't run out, because the staff get my prescription. If I need pain relief the staff will get it for me.” Covert medicines were administered in an appropriate and safe way. With one exception, information about people’s ‘when required’ (PRN) medicines was in place to enable staff to administer these medicines in the way intended by the prescriber. Thickening agents were managed safely.

Nurses told us they administered all medicines (apart from emollients and barrier preparations). Nurses told us they completed medicines refresher training from an external provider. The manager told us how they would deal with a medicines error. They said, " Nurses would let me know, we would fill in a form for a medicines error and we would raise a safeguarding and potentially CQC and the GP and relatives."

Medicines were stored at the right temperatures; room and medicine fridge temperatures were recorded daily. The service had a comprehensive set of medicine policies that followed national guidance on managing medicines in care homes. A comprehensive medicines management audit is conducted monthly, and an action plan formulated to address any concerns. The audit does not include non-medicated creams.