Park View

Park View is a residential care home which provides personal care to people with a learning disability or autistic spectrum disorder.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to nine people and nine people were using the service at the time of the inspection. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, or anything else outside to indicate it was a care home. Staff also wore their own clothing to avoid wearing anything that suggested they were care staff when coming and going with people.

People’s experience of using this service and what we found

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people. The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles. We discussed with the management team about introducing a plan to demonstrate how they are aiming to reduce the use of restrictive interventions within the service.

Elements of the staff recruitment process had not been robust. There were enough staff to support people and people told us they felt safe living at Park View. Risk assessments were in place for areas of identified risk, but recognised assessment were not always used. Staff were aware of how to support people when they were experiencing periods of distress or anxiety. Professionals fed back that staff knowledge could be further developed in this area. People received their medicines as required and staff understood what actions to take if they thought somebody was at risk of abuse.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff understood the importance of seeking people’s consent.

We made a recommendation about the application of the Mental Capacity Act, ensuring that capacity assessments were completed when people had restrictions in place.

Staff received training to ensure they had the skills and knowledge to support people. Staff received regular ‘one to ones’ and had annual appraisals of their performance. These aided staff development and practice in how they supported people. The staff team had close links with health and social care professionals and sought their input and advice to help achieve good outcomes for people.

Staff were patient and caring in their approach towards people. People were relaxed with staff and felt confident in asking for their support. Staff were mindful to respect people’s privacy and promote their dignity. People were encouraged and supported to make their own day to day decisions.

Detailed, person-centred care plans were in place which provided clear information about people, their histories and needs. People and their representatives were encouraged to be involved in reviews of their support. Activities were arranged on a group or one to one basis, according to the person’s preferences. Staff understood how people communicated and information was available in a variety of different formats, according to people’s needs.

People, their relatives and staff felt confident to approach the management team with any concerns. The management team were visible and worked alongside staff in supporting people. A series of audits and checks were completed to monitor the quality and safety of the service. People’s feedback was sought to aid in the development of the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 24 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Park View provides care and accommodation for up to nine people with a learning disability. On the day of our inspection there were nine people using the service.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Park View was last inspected by CQC on 5 January 2016 and was rated Requires Improvement overall and in the Safe and Well-led domains. At this inspection we found the service was ‘Good’ in all areas and met all the fundamental standards we inspected against.

Accidents and incidents were appropriately recorded. Risk assessments were in place for people who used the service and described potential risks and the safeguards in place.

The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

Medicines were stored safely and securely, and procedures were in place to ensure people received medicines as prescribed.

The home was clean, spacious and suitable for the people who used the service and appropriate health and safety checks had been carried out.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The registered provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff.

Staff were suitably trained and training was arranged for any due or overdue refresher training. Staff received regular supervisions and appraisals.

The registered provider was working within the principles of the Mental Capacity Act 2005 (MCA) and was following the requirements in the Deprivation of Liberty Safeguards (DoLS).

People were supported with their dietary needs. Care records contained evidence of visits to and from external health care specialists.

People who used the service and family members were complimentary about the standard of care at Park View. Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

Care records showed that people’s needs were assessed before they started using the service and care plans were written in a person-centred way. Person-centred is about ensuring the person is at the centre of any care or support plans and their individual wishes, needs and choices are taken into account.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs. The service had links with the local community.

People who used the service and family members were aware of how to make a complaint however there had been no formal complaints recorded at the service.

Staff felt supported by the registered manager and were comfortable raising any concerns. People who used the service, family members and staff were regularly consulted about the quality of the service. Family members told us the management were approachable and accommodating.

At our previous inspection on 12 November 2014 there had been no registered manager working at the service. At this inspection we found that there was a registered manager. 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.

Risks to people’s health and safety had not always been identified although there were policies and procedures in place for staff to follow. Accident and incident records identified that there had been two falls in November 2015. People had tripped on the uneven paving outside the dining room leading to the smoking area and we saw that this was still a hazard for people. The dining room floor was wet and slippery on the day we inspected due to the weather and the flooring used could have resulted in further falls.

The environment was not always safe. We saw a radiator cover hanging off in a persons bedroom which was a hazard until it was replaced. In addition carpets in the lounge were frayed and worn as was the window seat.

This was a breach of Regulation 15 of the Health and Social Care Act 2008(Regulated Activities) 2014. You can see what action we told the provider to take at the back of the full version of the report.

People at the service told us that they felt safe and we saw that the risks associated with people’s physical and mental health had been recorded in their care plans.

There were policies and procedures in place which supported staff in protecting people who needed safeguarding. They reflected the local authority good practice guidance. Staff were trained in how to recognise and report abuse. The registered manager was aware of how to report any incidents of abuse.

Staffing levels at the service reflected the changing needs of the people who used the service and were flexible. We saw that staff had been recruited safely. They had the appropriate skills and knowledge needed to care for the people at this service. They had received an induction when they started working at the service and training which was appropriate to their role.

Staff worked within the principles of the Mental Capacity Act (MCA) 2005. People were assisted to make decisions for themselves where it was possible. If they required assistance to make a decision, meetings were held with the significant people in their life as well as other professionals in order to make sure they were in the person’s best interest. People who used the service made choices about the food they ate, how their rooms were decorated and what they did throughout the day.

People’s nutritional needs were being met at the service. Where there were any medical issues people were referred to their doctor who then made referrals to other health professionals if it was necessary.

Care plans were detailed and person centred. They had associated risk assessments in place and had been reviewed regularly. Staff responded promptly to people’s changing needs and made the necessary changes to care plans.

Activities were planned individually and promoted inclusion in the local community. People chose what they wanted to do each day. They worked or attended day services if they wished. People were able to go on holiday each year.

People who used the service said that the staff were caring. We observed that there was a relaxed and friendly atmosphere at the service. We saw that staff listened to people and gave them chance to express their views. Staff showed respect for people’s privacy and dignity.

Audits that had been completed did not always identify areas which required improvements, which meant that the service did not have a robust quality assurance system in place. Actions had not been identified in order to make improvements when surveys had been completed. We have recommended that the provider look at guidance on quality assurance.

Meetings between managers, staff and people who used the service were held regularly which meant that everyone involved with the service had some involvement.

People's care needs were assessed and care plans were drawn up to meet those needs. Risks were assessed and strategies were in place to minimise these. Risk assessments and care plans were kept under regular review. Specialists were consulted so that people had the benefit of expert advice.

People told us they felt safe and were confident that action would be taken in response to any concerns they might have. One person told us 'The staff are respectful and polite to me.'

The provider had an appropriate recruitment procedure in place to make sure they only employed people suitable for the role.

Effective management systems were in place to promote people's welfare and safety.

People who used the service told us 'I like it here I can talk to my key worker if I want to'. Another person said 'I am going to The Flower of May for my holiday; I planned it with my key worker'.

Staff were aware of the different types of abuse and said they were confident they would be able to identify the signs of abuse in people who used the service.

People told us that if they had a complaint they would tell a member of staff or the manager. They also told us that there were regular house meetings where they could all discuss any concerns they had. One person said "I would tell the manager if I was unhappy". Another person told us they would tell their parents when they went home if they were unhappy. Interactions observed during the visit were positive and respectful.