Park View

The service did not have a registered manager in post. At the time of the inspection there had not been a registered manager in post for 100 days. 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.

At our last inspection on 18, 19, 21 and 28 July 2017, the service was rated 'Requires Improvement'. We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider did not always have plans in place for managing risks people faced. The provider did not always manage and administer medicines safely, and guidance for how to administer medicines covertly was not always clear and some decision forms were incomplete. There was not enough suitably qualified, competent, skilled and experienced staff in place to meet the requirements of people using the service. The provider did not ensure staff received appropriate support, training, professional development and supervision necessary to enable them to carry out their duties. Quality assurance systems and audits had not operated to assess and improve the quality and safety of the service provided.

At this inspection we found that these breaches had been addressed.

People using the service and their relatives said the service provided safe care and treatment. The service managed medicines safely. However, not all 'decision to administer' forms were updated to match people's changing prescriptions and not all medicines were disposed of appropriately. The acting manager addressed these concerns following the inspection. There were sufficient numbers of suitable staff employed by the service. Staff had been recruited safely with appropriate checks on their backgrounds completed. People were protected by the prevention and control of infection. There were robust procedures in place to protect people from harm and staff were clear on how to recognise and report abuse. The provider assessed and managed risks to people in a way that considered their individual needs.

Staff understood the Mental Capacity Act 2005 (MCA). MCA is law protecting people who are unable to make decisions for themselves and where people were not able to do this, the appropriate authorisation procedures had been completed. These are referred to as the Deprivation of Liberty Safeguards (DoLS).

Staff undertook training and received regular supervision to help support them to provide effective care. People were encouraged to live a healthy lifestyle and received holistic support from various health and social care professionals.

People and their relatives told us staff supported them or their relative with dignity and respect. They ensured people's privacy was maintained particularly when being supported with their personal care needs. People were supported to be as independent as possible and staff supported them in the least restrictive way possible. People and their relatives felt involved in the running of the service and could have an input into the care provided.

Each person had an individual care plan. However, these care plans were not always up to date and did not always reflect people's support needs. The acting manager advised the care plans were being reviewed. The service did not always have enough meaningful activities in place to ensure people were engaged. The acting manager advised they were addressing this. People and their relatives felt comfortable raising any issues they might have about the service and there were arrangements in place to deal with people's complaints. The service supported people with their end of life wishes.

The service and provider demonstrated an open and transparent culture. They routinely gathered feedback from people, relatives and staff. This feedback alongside the acting manager's audits and quality checks were used to continually assess, monitor and improve the safety and quality of the service. Staff felt valued and supported by the acting manager who was approachable and knowledgeable.

The five questions we ask about services and what we found