Archived: Viewpark Care Home Limited

Updated 1 November 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 03 and 04 January 2018 and was unannounced. The inspection team consisted of two adult social care inspectors, a medicines 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.

Prior to the inspection we reviewed information we held about the service. This included notifications the provider was required to send us in relation to serious injuries, safeguarding and other significant events that can occur whilst providing a service. We reviewed feedback we had received about the service, which included information from whistleblowers and relatives of people using the service. Feedback received from people’s relatives was both positive and negative in nature. The feedback from whistleblowers led to us exploring how the service manage medicines safely, how they protected people from the risks of financial abuse, and the services procedures in relation to whistleblowing and supporting staff.

We contacted Healthwatch Manchester, and the local authority commissioning and quality monitoring team for feedback prior to the inspection. The local authority shared concerns with us in relation to the performance of the service, which we have reflected in the main section of this report. They also confirmed the local authority currently had a block on admissions to the service due to concerns they had about its quality and safety.

We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection we spoke with eight people living at the home. We also spoke with nine relatives or visitors who were at the home at the time of our site visit. We carried out observations of the care and support staff provided in communal areas. We spoke with six members of staff. This included one of the directors of the service, the chef and four care staff.

We reviewed records relating to the care people were receiving. This included daily records of care, medication administration records (MARs) and eight people’s care plans. We looked at other records related to the running of a care home, including; five staff personnel files, records of training and supervision, audits and quality assurance checks, and records of the servicing and maintenance of equipment, utilities and premises.

Updated 1 November 2018

This inspection took place on 23 and 24 May 2018 and was unannounced.

Viewpark Care Home Limited (Viewpark) is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Viewpark accommodates up to 27 people in one adapted building. Bedrooms are located on two floors, with a passenger lift between floors. There are two dining rooms, two lounges, and a conservatory. The home is situated in a residential area of Moston in north Manchester. At the time of our inspection there were 13 people living at the home.

Our last inspection of Viewpark took place in January 2018 when we rated the home Inadequate overall, and identified multiple breaches of the regulations. At this inspection we again found evidence of limited improvements. However, there were still considerable improvements that needed to be made to the service. We found improvements had been made and the provider was now meeting the requirements of the regulations in relation to employment of fit and proper persons, safeguarding, need for consent and the duty of candour. However, there remained ongoing breaches of regulations, including in relation to staff training, person-centred care, good governance and multiple breaches in relation to safe care and treatment. We also identified a new breach of the regulations in relation to treating people with dignity and respect. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to the back section of reports after any representations and appeals have been concluded. We also made a recommendation that the service strengthens their practice in relation to implementation of the Mental Capacity Act 2005.

There was no registered manager in post. The former registered manager had left the service in March 2018. Shortly after this CQC completed enforcement action to cancel their registration as a manager at this home. The provider had employed a new manager. However, they told us they did not intend to register as the manager of the home, and did not plan on staying in post long-term. 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.

The directors of the company that owns Viewpark were not actively involved in the day to day running of the home, and a family member of the directors was acting on their behalf. The manager told us they did not feel they were provided with enough support or resource to enable them to make the significant improvements required at the home. Whilst the provider’s representative was actively involved in the running of the home, they did not have a background in social care provision and so were still learning about how to run a care home.

We found the provider had made some improvements to procedures in place to help ensure people were kept safe. For example, risk management in relation to pressure ulcers and providing the correct consistency of food and fluids to people had improved. However, we continued to find examples of when staff had not taken reasonable actions to reduce potential risks. An inspection of a bath chair had found it to be unsafe to use. However, there was nothing in place to inform staff or others of this, and there was a risk it could have been used inadvertently. Water temperature records showed some outlets were too hot, and could present a risk of scalding. There was no evidence that staff had taken any action to address this issue, or control the risk this presented to people prior to us raising the concern.

Recording and monitoring of accidents and incidents had improved. However, there was scope for monitoring of any trends or patterns in accidents to be strengthened. Staff identified ways to help keep people safe and prevent a re-occurrence of any accident. However, staff followed identified risk reduction measures inconsistently. For example, one person should have had hourly observations from staff to help manage their falls risk. However, staff had incorrectly understood that these checks had been discontinued.

There were continued concerns in relation to the way the service managed medicines. We found some people had run out of stock of pain relief, and staff did not have sufficient knowledge about how people’s medicines should be given. For example, staff did not understand requirements in relation to rotation of medicines applied by a patch, which is required to reduce the risk of skin irritation. Staff had also failed to ensure there were adequate gaps between administration of doses of paracetamol, which could have a negative impact on people’s health.

We found some areas of the home where good standards of cleanliness had not been maintained. We also found a seat protector that appeared to be wet with urine was left in communal areas for several hours until we brought this to the attention of staff. We found few, and at some points in the inspection, none of the hand sanitiser dispensers were working. This would increase the risk that good hand hygiene would not be maintained, resulting in an increased risk of spread of infection.

There had been a continued embargo on placements at the home by the local authority since our last inspection. The manager told us they had found it hard to recruit staff with the required skills for the job, and the home was using agency staff to cover any shortfalls on the rota. During the inspection we saw staff were attentive and had time to spend with people. However, on the afternoon of the second day of our inspection there were two agency staff on duty, along with a senior member of care staff and a newly recruited member of staff. One member of agency staff needed a lot of direction from the senior carer, and we questioned the skill mix of the staff team at that time. The provider told us this was not usual to have such a staff team on duty, and rotas confirmed this.

Staff had received training in a variety of relevant topics, including recent training in use of thickening agents and pressure care. However, not all staff had received training that it would be important for them to receive to help ensure people received safe and effective care, such as safeguarding and infection control training. No progress had been made since our previous inspections in relation to providing staff with training in end of life care.

We also identified concerns with the way the provider had promoted staff to new roles. We reviewed records relating to one staff member and found no evidence that the provider had given reasonable consideration as to whether the staff member was competent and had the skills to undertake the new role. They had also not assessed whether the staff member required any additional training or support to enable them to work effectively in this new role.

Staff understood the principles of the Mental Capacity Act 2005. We saw staff asked people for their consent before providing any care, and respected people’s wishes. Staff routinely offered people choices such as what they had for their meals. However, documentation in relation to best-interests decisions needed to be strengthened.

There were several adaptations to the home to make it more accessible to people living with dementia. However, limited opportunities were made available for people to access any outside areas during warm weather. Staff also told us the large garden at the rear of the home was not used as the ground was uneven and presented a trip hazard.

Entertainers visited the home, and staff supported people to take part in ad-hoc activities such as ‘singalongs’ or they provided colouring materials for example. However, there were limited opportunities for people to access their local community or activities outside the home.

The manager was in the process of re-designing people’s care plans. We found there were multiple versions of care plans, which made it hard to tell which was the most up-to-date information. Whilst people’s care plans contained information regarding their preferences and social histories, there was no evidence to support that such information was used in a meaningful way to enable staff to provide person-centred care.

Permanent staff knew the people living at the home well. We saw staff interaction with people had improved, and we observed staff acting in kind and caring ways that showed consideration for people’s wellbeing. However, improvements were needed to the way staff upheld people’s privacy and dignity. For example, we found people did not have their own personal toiletries, and instead used stock from a communal supply. We also observed one person was spoken to in a derogatory manner by another person living at the home. Staff did not appear to be aware of this and did not intervene.

Whilst there had been some improvements to how the provider and manager monitored the safety and quality of the service, there remained concerns in this area. The audits and checks carried out had not identified all the issues we found, such as in relation to medicines management. Other audits had identified issues, but had not resulted in improvements.

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 time