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Church View (Nursing Home) Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 7 September 2018

We carried out an unannounced inspection of Church View (Nursing Home) on 19 and 22 June 2018.

The service is registered to provide accommodation, personal care and nursing care for up to 40 people. Accommodation is provided over two units, Lavender Lane and Poppy Way. Lavender Lane is specifically for people living with dementia. At the time of our inspection 28 people were living at the home.

The service 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 we looked at both during this inspection.

At the last inspection on 4 and 5 October 2017, we found a breach of the regulations relating to the provider’s failure to assess and appropriately manage people’s risks. People who had experienced significant weight loss had not been referred to a dietitian or their GP for review and their care plans and risk assessments had not been updated appropriately. At this inspection we found that improvements had been made. However, we found three breaches of the regulations, relating to a failure to provide people with safe care and treatment, a failure to monitor and improve the service and a failure to notify CQC of events that had taken place.

We are considering what action to take in relation to these breaches. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

At the time of the inspection, the service was not being managed by a registered manager. The home was being managed by the general manager, who had oversight of this home and another home in Accrington owned by the provider. The registered manager had stepped down from her role on 8 June 2018. Before the inspection, numerous complaints, whistle blowings and safeguarding concerns had been raised about deteriorating care standards and a lack of effective management at the home. Many of these concerns and complaints had been substantiated or upheld. We found that the provider had failed to take action to address these concerns in a timely way.

Before the inspection the provider had made a decision to voluntarily suspend new admissions to the home, to ensure that concerns were addressed and standards of care improved before new people came to live at the home. Following the inspection, the service was placed under the local authority's Quality Performance and Improvement Planning (QPIP) process, due to a failure to provide people with safe, effective care.

Most people who lived at the home and their relatives felt there were enough staff available to meet their needs. People told us they did not wait long for support. However, a number of concerns had been raised about delays in staff providing people with appropriate support.

Before our inspection, we had received numerous complaints, whistle blowings (Staff reporting poor practice) and safeguarding concerns relating to abuse and neglect, many of which related to the care provided on the Lavender Lane unit, where people had more complex needs. Following investigation by the local safeguarding authority, many of the concerns and complaints had been substantiated and recommendations had been made about the improvements needed at the home. At the time of our inspection, a number of safeguarding investigations were in the process of being completed by the local authority and outcomes had not yet been received.

Most people told us the staff who supported them were kind and caring and respected their right to privacy and dignity. However, before the inspection we had received concerns about poor staff attitude and behaviour towards people living at the home.

People told us that they received care that reflected their individual needs and preferences and we saw evidence of this during our inspection. Staff knew the people they supported well. However, a number of concerns had been raised about staff failing to meet people’s needs in a timely way.

We found some evidence of safe medicines processes and practices. However, some improvements were needed.

Staff received regular supervision. However, the supervision notes we reviewed were brief and lacked detail about what had been discussed during supervision sessions.

We saw that complaints had been managed in line with the complaints policy. However, we found that improvements made in response to complaints were not always sustained.

We found that people received support with eating and drinking. They were supported with their healthcare needs and were referred to community healthcare professionals. However, concerns had been raised that this was not always done in a timely way.

A variety of audits of quality and safety had been completed by the general manager. However, the audits completed had not been effective in ensuring that appropriate levels of quality and safety were being maintained at the home.

This the fourth time the service has been rated Requires Improvement.

People told us staff encouraged them to be as independent as they could be and we saw evidence of this during the inspection.

Records showed that staff had been recruited safely and the staff we spoke with were aware of how to report any safeguarding concerns.

Staff received an effective induction and appropriate training. People who lived at the service and their relatives felt that staff were competent and had the knowledge and skills to meet their needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way; the policies and systems at the service supported this practice. Where people lacked the capacity to make decisions about their care, the service had taken appropriate action in line with the Mental Capacity Act 2005.

People were supported to take part in a variety of activities and events. They told us they were happy with the activities that were available at the home.

Staff communicated effectively with people. We observed them supporting people sensitively and patiently. People’s communication needs were identified and appropriate support was provided.

The service sought feedback from people living at the home about the support they received through questionnaires and regular residents meetings. We saw evidence that positive feedback was received and action was taken when concerns were raised or suggestions made.

People living at the home, relatives and staff told us they found the staff and the general manager approachable and helpful.

Inspection areas

Safe

Requires improvement

Updated 7 September 2018

The service was not consistently safe.

We found that people had not always been provided with safe care. Many safeguarding concerns, whistle blowings and complaints had been raised about the service and had been substantiated by the local safeguarding authority.

There were some safe policies and practices in place for the administration of medicines. However, some improvements were needed.

Most people who lived at the service and their relatives were happy with staffing levels. Staff felt that staffing levels were appropriate to meet people’s needs.

Standards of hygiene at the home were good. We found evidence of effective infection control processes and practices.

Effective

Requires improvement

Updated 7 September 2018

The service was not consistently effective.

The people we spoke with felt that staff had the knowledge and skills to meet their needs. However, a number of safeguarding concerns and complaints about staff failing to meet people’s needs had been substantiated.

Staff received an appropriate induction and most staff training was up to date. Staff received regular supervision, however, some of the supervision records we reviewed were very brief.

People’s capacity to make decisions about their care had been assessed in line with the Mental Capacity Act 2005. Applications had been submitted to the local authority where people needed to be deprived of their liberty to keep them safe.

We saw evidence that people received support with their healthcare, nutrition and hydration needs and were referred to community healthcare professionals. However, concerns were raised that this was not always done in a timely way.

Caring

Requires improvement

Updated 7 September 2018

The service was not consistently caring.

The people we spoke with told us they liked the staff who supported them and told us staff were caring. We observed staff treating people with respect during the inspection. However, before the inspection, a number of concerns and complaints had been raised about staff attitude and behaviour at the home. Many of the concerns had been substantiated.

The people we spoke with and their relatives told us staff respected their right to privacy and dignity and we saw examples of this during out inspection.

People told us they were encouraged to be as independent as possible.

Responsive

Requires improvement

Updated 7 September 2018

The service was not consistently responsive.

People told us they received care that reflected their needs and preferences. However, a number of concerns and complaints about delays in staff providing people with support had been substantiated.

People were encouraged and supported to take part in a variety of activities and events at the home. They told us they were happy with the activities available.

People’s needs and risks were reviewed regularly and care records were updated to reflect any changes. This meant that staff had up to date information to enable them to meet people’s needs effectively.

Well-led

Inadequate

Updated 7 September 2018

The service was not well-led.

There was no registered manager in post at the time of the inspection. A number of concerns had been raised about poor standards of care and a lack of leadership and oversight at the service. Appropriate action had not been taken by the provider to address these concerns in a timely way.

Audits had been completed in respect of many aspects of the service. The audits completed had not been effective in ensuring that appropriate levels of care and safety were being maintained at the home.

Regular staff meetings took place and staff felt able to raise any concerns with the general manager.