• Care Home
  • Care home

Archived: Church View (Nursing Home)

Overall: Requires improvement read more about inspection ratings

Princess Street, Accrington, Lancashire, BB5 1SP (01254) 386658

Provided and run by:
Church View (Nursing Home) Limited

All Inspections

27 February 2019

During a routine inspection

We carried out a comprehensive inspection of Church View (Nursing Home) on 27 February, 1 and 4 March 2019. The first day was unannounced.

Church View (Nursing Home) is registered to provide nursing and personal care for up to 40 older people, younger adults and people living with dementia. There is a separate unit for people living with dementia, which has it's own lounge and dining area. Accommodation is provided on the ground floor. There are gardens and a car park for visitors and staff. The home is situated in a quiet residential area in Accrington, close to local amenities. At the time of our inspection there were 20 people 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 time of the inspection, there was a registered manager in place who was responsible for the day to day running of the home. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how to service is run.

At the last inspection on 19 and 22 June 2018, we found a breach of the regulations relating to a failure to provide people with safe care and treatment. Following our inspection, the provider sent us an action plan and told us that all actions would be completed by 30 September 2018. We also found a breach of the regulations relating to the provider’s failure to have oversight of the service and to assess, monitor and improve the quality and safety of the service. We issued a warning notice and required the provider to be compliant by 10 September 2019.

At this inspection we found that many improvements had been made and all of the regulations reviewed were being met. However, many improvements were in the early stages and it is necessary for the provider to provide evidence that the improvements made are being sustained over time.

People told us they were happy with staffing levels at the home and never waited long when they needed support.

We found evidence that people’s medicines were administered safely and people told us they received their medicines when they should. Some minor improvements were needed to some medicines practices. Records showed that the registered manager had identified the improvements that were needed during recent audits and was in the process of introducing the necessary changes.

Staff had been recruited safely and the staff we spoke with understood how to protect people from abuse or the risk of abuse.

People received appropriate support with their nutrition, hydration and healthcare needs. Referrals were made to community healthcare professionals to ensure that people received appropriate support.

We found that people were supported and encouraged to take part in a variety of activities and some people were supported to go out. People told us they were happy with the activities and entertainment provided at the home.

Staff received an effective induction and appropriate training. People felt that staff had the knowledge and skills to meet their needs.

People told us they liked the staff who supported them and that staff were caring and respected their right to privacy and dignity. We observed staff encouraging people to be independent when it was safe to do so.

Staff communicated effectively with people. People’s communication needs were identified and appropriate support was provided. Staff supported people sensitively and did not rush them when providing care.

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 told us that they received care that reflected their needs and preferences and we saw evidence of this. Staff told us they knew people well and gave examples of people’s routines and how they liked to be supported.

The registered manager sought feedback from people living at the home about the support they received. We saw evidence that she used the feedback received to develop and improve the service.

People living at the service and relatives were happy with how the service was being managed. They found the registered manager and staff approachable and helpful.

A variety of audits and checks were completed regularly by the registered manager. We found that the audits completed were effective in ensuring that appropriate levels of quality and safety were being maintained at the home. We found that the provider had oversight of the service. He received regular reports from the registered manager and they met regularly to discuss the service, including any concerns. This meant that the provider could be assured that people were receiving safe care which met their needs.

19 June 2018

During a routine inspection

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.

4 October 2017

During a routine inspection

We carried out a comprehensive inspection of Church View Nursing Home on 4 and 5 October 2017. The first day of the inspection was unannounced.

Church View Nursing Home provides accommodation, personal care and nursing care for up to 40 people, including people living with dementia. At the time of this inspection there were 35 people living at the home.

The service is set in a detached building in a residential area in Accrington, East Lancashire. Accommodation is provided on the ground floor and there is a separate self-contained unit for people living with dementia. Both units have their own lounge and dining room. Bedrooms do not have en-suite facilities; however there is access to suitably equipped toilet and bathroom facilities on both units. There are gardens and a car park for visitors and staff. The home is close to local amenities.

At the time of our inspection the service had a registered manager who had been in post since February 2017. 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.

During a previous inspection on 21 and 22 July 2016, we found a breach of the regulations relating to the management of people’s medicines. During this inspection we found that the necessary improvements had been made and there were appropriate policies and procedures in place for the safe management of people's medicines. However, we found other areas that needed improvement.

During this inspection we found one breach of the regulations relating to the management of people’s risks. You can see what action we told the provider to take at the back of the full version of the report.

We found that there were appropriate policies and procedures in place for the safe management of people’s medicines.

People told us the home environment was safe and they received safe care. People and their relatives were happy with staffing levels at the home.

Most people who lived at the home liked the staff who supported them and felt that staff had the knowledge and skills to meet their needs.

We saw evidence that staff had been recruited safely. The staff we spoke with understood how to safeguard vulnerable adults from abuse and were clear about the action to take if they suspected abusive practice was taking place.

We found that people’s risks were not always managed appropriately. Care plans and risk assessments were not always updated when people’s needs changed. This meant that it was difficult to ensure that staff were managing people’s needs and risks effectively.

We found that staff received an appropriate induction, effective training and regular supervision. Staff told us the registered manager was approachable and they felt well supported by her.

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.

The service had taken appropriate action where people lacked the capacity to make decisions about their care and needed to be deprived of their liberty to keep them safe. We found evidence that where people lacked the capacity to make decisions about their care, their relatives had been consulted.

People were happy with quality of the meals provided and told us they had lots of choice at mealtimes.

People received support with their healthcare needs and were referred to a variety of community healthcare professionals.

We observed staff communicating with people in a kind and respectful way. People told us staff respected their privacy and dignity and encouraged them to be independent.

People were supported to take part in a variety of activities inside and outside the home. People who lived at the home and their relatives were happy with the activities available.

We saw evidence that the registered manager requested feedback about the service from people who lived at the home and their relatives and acted on the feedback received.

People who lived at the home and their relatives told us they thought the home was well managed. They felt that the staff and the management team were approachable.

The registered manager and the general manager regularly audited many aspects of the service. We found that the audits completed were effective in ensuring that appropriate standards of care and safety were maintained at the home.

20 July 2016

During a routine inspection

We carried out a comprehensive inspection of Church View Nursing Home on 20 and 21July 2016. The first day of the inspection was unannounced.

Church View Nursing Home provides accommodation, personal care and nursing care for up to 40 people, including people living with dementia. At the time of this inspection there were 26 people living at the home.

The service is set in a detached building in a residential area in Accrington in East Lancashire. Accommodation is provided on the ground floor and there is a separate self-contained unit for people living with dementia. Both units have their own lounge and dining room. Bedrooms do not have en-suite facilities; however there is access to suitably equipped toilet and bathroom facilities on both units. There are gardens and a car park for visitors and staff. The home is close to local amenities.

At the time of our inspection the service did not have a registered manager in post. 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 service was being managed by the general manager of Church View Nursing Home and another nearby nursing home, which was also owned by the service provider. The general manager told us that the service provider was in the process of recruiting a new manager for Church View Nursing Home. Additional management support was in place which had been arranged by the local authority, to assist the home with making necessary improvements.

During this inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to the management of medicines. You can see what action we told the provider to take at the back of the full version of the report.

People living at the home told us they felt safe. People living at the home and staff felt that staffing levels at the home were sufficient to meet people’s needs.

We saw evidence that staff had been recruited safely. The staff we spoke with understood how to safeguard vulnerable adults from abuse and what action to take if they suspected abuse was taking place.

There were appropriate policies and procedures in place for managing medicines. However, we found that medicines were not always managed safely.

People were happy with the care they received and felt that staff could meet their needs. We found that staff received an appropriate induction and effective training when they joined the service. Staff told us they received regular supervision.

Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The service had taken appropriate action where people lacked the capacity to make decisions about their care.

The people we spoke with told us they were involved in decisions about their care.

People living at the home and relatives were happy with quality of the food provided. They told us they had lots of choice.

We received positive feedback from community healthcare professionals who were involved with the service about standards of care at the home.

We observed staff communicating with people in a kind and caring way. People told us staff respected their privacy and dignity and encouraged them to be independent.

Activities were provided by a dedicated activities co-ordinator and people told us they were happy with the activities available at the home.

We saw evidence that the general manager requested feedback about the service from people living at the home and acted on the feedback received.

People were happy with the management of the service. However, the home did not have a full, effective management team at the time of our inspection.

Many aspects of care at the home were audited regularly to ensure that appropriate standards of care and safety were maintained. However, medicines audits had not included people’s prescribed creams, which were not always managed safely.

2 November 2015

During an inspection looking at part of the service

We carried out an unannounced inspection of Church View Nursing Home on 29 and 30 April 2015. Breaches of legal requirements were found. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches of Regulation 12, 15 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this focused inspection on 2 November 2015 to check whether the provider had followed their plan and to confirm that they were meeting legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Church View Nursing Home on our website at www.cqc.org.uk.

Church View Nursing Home provides accommodation, personal care and nursing care for up to 40 people, including people living with dementia. At the time of this inspection there were 31 people living at the home.

The service is set in a detached building in a residential area in Accrington in East Lancashire. Accommodation is provided on the ground floor and there is a separate self-contained unit for people living with dementia. Both units have their own lounge and dining room. Bedrooms do not have ensuite facilities however there is access to suitably equipped toilet and bathroom facilities on both units. There are gardens and a car park for visitors and staff. The home is close to local amenities.

At the time of our inspection the service did not have a registered manager in post. 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 service was being managed by the registered manager of another nearby nursing home, also owned by the provider. This manager told us that the provider had recently appointed a new manager for Church View Nursing Home and the Commission would receive their application for registration in due course.

At this inspection we found that the provider had followed their plan and legal requirements were being met.

We saw evidence that people’s medicines were being managed properly and safely. Medicines management policies and procedures had been updated to reflect current practice and best practice guidance. Staff had received training in medicines management and their competence to administer medicines safely had been assessed. There were appropriate processes in place for the ordering, storage, administration and disposal of medicines.

Infection control had improved at the service. Guidance relating to infection control was available to staff and an additional member of domestic staff had been recruited.

The home environment was clean and there were no unpleasant odours.

We saw that people were being offered a choice of meal at all mealtimes.

Improvements had been made to the home environment, making it more suitable for people living with dementia. Furniture had been replaced and some areas of the home had been redecorated.

We noted that people looked clean and well dressed. However, one person told us they had not been supported appropriately with their personal care.

People were involved in planning and reviewing their care.

Audits were completed in relation to many areas of the service. We saw evidence that they were effective in ensuring that appropriate levels of care and safety were achieved.

29 April & 30 April 2015

During a routine inspection

We carried out an unannounced inspection of Church View Nursing Home on 29 & 30 April 2015. Church View Nursing Home provides accommodation and personal care for up to 40 people, some of whom may be living with a dementia. The service provides nursing care. At the time of the inspection there were 33 people accommodated in the home.

Accommodation is provided on the ground floor. There is a separate self-contained unit for those people living with a dementia. Both units have their own lounge and dining area. There are gardens and a car park for visitors and staff. The home is situated in a quiet residential area in Accrington and close to local amenities.

There was a registered manager in day to day charge of the home. 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.

During this inspection visit we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to ineffective quality assurance and auditing systems, failure to follow safe medicine procedures, failure to follow safe infection control procedures and failure to maintain a safe and suitable environment.

At the previous inspection on 30 April and 1 May 2014 we found the service was not meeting the regulation in relation to safe management of medicines. We asked the provider to take action to make improvements. During this inspection we found some improvements had been made but the registered provider was still not meeting the regulation. Whilst we found elements of safe practice we also found aspects of the ordering, administration and disposal of people’s medicines could result in mishandling or error. You can see what action we told the registered provider to take at the back of the full version of the report.

Prior to our inspection visit there were concerns regarding ineffective infection control systems and we were told areas of the home were not clean. During our visit we found a number of areas that presented a risk of infection that had not been noted as part of the ‘audit’ systems. They included unclean areas, torn seating and offensive odours. Cleaning schedules were in place and most staff had received appropriate training in infection control but policies and procedures had not been updated to reflect good practice. You can see what action we told the provider to take at the back of the full version of the report.

Prior to the inspection visit we were told the environment was ‘shabby’ and ‘poor’. During a tour of the home we found all areas had been redecorated but a number of areas were in need of attention to ensure the environment was safe, appropriate and comfortable for people to live in. The service did not have a development plan which meant it was difficult to determine how the home would be improved. People told us they were happy with their bedrooms and some had created a homely environment with personal effects such as furniture, photographs, pictures and ornaments. We noted the environment was not well designed for people living with dementia. For example areas were not easily recognisable and carpets were highly patterned and more could be done to provide stimulation for people walking around. We have made a recommendation about further staff training on the subject of dementia. You can see what action we told the provider to take at the back of the full version of the report.

The number of shortfalls we found indicated quality assurance and auditing processes had been ineffective. Due to current staffing vacancies the registered manager was covering additional nursing, deputy and administrative hours. Changes in the management structure had resulted in limited monitoring and support from the registered provider to ensure the registered manager was achieving the required standards in the day to day running of the home. Checks on systems and practices had been completed by the registered manager but matters needing attention had not always been recognised or addressed. This meant the registered providers had not identified risks to make sure the service ran smoothly. You can see what action we told the provider to take at the back of the full version of the report.

During our visit we observed staff responding to people in a kind and friendly manner and being respectful of people's choices. Staff were seen to knock on people’s doors before entering and doors were closed when personal care was being delivered. We saw people were dressed smartly and appropriately in suitable clothing. However, over the two days of our inspection visit we also noted examples of people’s dignity not being respected in respect of their clothing and personal hygiene. We discussed this with the registered manager at the time of the inspection. We made a recommendation that staff practice was closely monitored with regards to ensuring people were dressed and presented in a dignified manner in line with their preferences recorded in their care plan.

People told us they enjoyed the meals although they were not routinely offered a choice of meal at lunchtime. They told us, “I enjoy my meals; I always get enough to eat” and “We don’t know what we are getting until it is served; we wait and see. It’s usually very nice.” The meals were served hot, looked appetising and the portions were ample. The atmosphere was relaxed and staff chatted amiably to people throughout the meal. Care records included information about people’s dietary preferences and any risks associated with their nutritional needs and appropriate professional advice and support had been sought when needed. We made a recommendation that people were made aware they could always have a choice of meal.

Environmental risk assessments were in place and kept under review and individual risks had been assessed and recorded in people’s care plan to help ensure their safety. We noted there had been a number of reported incidents between people living in the home. We found individual assessments were not always in place to help identify any triggers or guide staff how to safely respond. In addition most staff had not received training in this area. We made a recommendation about providing training and guidance to support staff to respond appropriately and safely to behaviours that challenge the service.

From our discussions with staff and from looking at two individual training records and the training matrix, we found staff had been provided with a range of training to give them the necessary skills and knowledge to help them look after people properly. Staff had access to a range of policies and procedures although some needed to be reviewed to reflect current safe guidance. We noted some gaps in the provision of supervision for staff. There was a plan however for regular one to one supervision of staff which would help identify any shortfalls in their practice and the need for additional training and support.

We found a safe and fair recruitment process had been followed for staff and appropriate checks had been completed before they began working for the service. However, there were no records to confirm agency nursing and care staff checks had been completed by the service. Checks would help determine whether they were suitable and qualified to work in the home. We were told all agency staff received an informal basic induction. However, we could not find any records to support this. We made a recommendation the service satisfied themselves that agency staff were suitable and qualified to work in the home and records of this and of their basic safety induction were maintained.

We found there were sufficient numbers of nursing, care and ancillary staff to meet people's needs although the service was reliant on agency and bank nursing staff during the day. The registered manager told us they were actively trying to recruit permanent staff. Staff spoken with considered there were sufficient staff and told us any shortfalls, due to sickness or leave, were covered by existing staff, bank staff or agency staff. People said, “Staff are lovely” and “Staff are very good. There are enough of them but they get a bit busy to talk to us.”

During the inspection we observed people were comfortable around staff and did not show any signs of distress when staff approached them. In both units we observed staff interaction with people was kind and patient. People told us, “They do their best; I get well looked after” and “Staff are very good; I get the care I need”. A visitor said they were happy with the care their relative received but would speak up if needed. Thank you cards included positive comments such as ‘thank you for the lovely care and kindness’.

Staff had received appropriate safeguarding vulnerable adults training, had an understanding of abuse and were able to describe the action they would take if they witnessed or suspected any abusive or neglectful practice. Staff had received training about the Mental Capacity Act 2005 (MCA 2005) and Deprivation of Liberty Safeguards (DoLS). The MCA 2005 and DoLS provide legal safeguards for people who may be unable to make decisions about their care. We noted appropriate DoLS applications had been made to ensure people were safe and their best interests were considered. We made a recommendation that any conditions made under DoLS were recorded clearly in the records.

People’s healthcare needs were considered as part of ongoing reviews and records had been made of healthcare visits, including GPs, district nurses and the chiropodist. We found the service had good links with other health care professionals and specialists to help make sure people received prompt, co-ordinated and effective care.

Each person had a personal care plan which included information about the care and support they needed, their likes, dislikes and preferences and routines. The care plans had been updated by staff and a visitor told us they were kept up to date and involved in decisions about care and support. However, people living in the home told us they were not aware of their care plan and had not been involved in the review of their care which could result in them not receiving the care they needed and wanted. We made a recommendation about the importance of involving people in ongoing reviews of care.

People were supported to take part in a range of suitable activities, both inside and outside the home. On the first day of the inspection we heard laughter and friendly banter during a game of dominoes in the lounge and on the second day there was much chatter and conversations about the new curtains in the dementia unit lounge.

There was a complaints procedure in the hallway advising people how to make a complaint and how and when they would be responded to. People were encouraged to discuss any concerns during meetings and day to day discussions with staff and management and also as part of the annual survey. People told us they felt confident they could raise any concerns with the staff or managers. One person said, “I just let the manageress know if I have a problem and she will sort it out”. A relative said, “I speak to the manager if I have any concerns and am listened to.”

30 April and 1 May 2014

During a routine inspection

The inspection was undertaken by the lead inspector for the service. We set out to answer five important questions. Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found.

The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. Safeguarding procedures were in place, staff received training in this area and understood their responsibilities in keeping people safe.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve.

There were policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. These endorsed legal protection for individuals who lacked capacity and who may be deprived of their liberty, to protect them from harm. New paperwork was being introduced regarding mental capacity assessments.

However people were not fully protected against the potential risks associated with some medicines. Some people were prescribed medication to be taken when required. There was not always guidance to inform staff when this should be given. Individual guidance would help to promote consistency of use and ensure medication was given when needed.

Is the service effective?

The individual or their representative such as a relative was involved in the assessment and support planning processes. Support plans reflected people's wishes and preferences. We saw that changes to health and wellbeing were identified and responded to.

Relatives confirmed they were able to visit at any time and that staff made them welcome.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, 'They are very good.' 'We have some nice girls here.'

Relatives told us they were satisfied with the quality of care provided.

People using the service and their relatives were able to attend meetings and told us they felt able to raise any issues or make suggestions. Surveys were also used to gain feedback. Where shortfalls or concerns were raised these were addressed.

People's preferences and interests had been recorded and care and support was provided in accordance with people's wishes.

Is the service responsive?

People could take part in a range of activities. We saw a high level of engagement in planned activities during our visits to the home.

We saw that people were listened to. One person, who was new to the home, had requested changes regarding their bedroom furniture. This person told us staff had responded willingly and swiftly to make the layout more appropriate.

Is the service well-led?

There had been changes to the management of the home. A new manager was in post. Staff told us they were clear about their roles and responsibilities and were supported in their work.

The service worked well with other agencies and services to make sure people received their care in a joined up way.

Effective quality assurance systems promoted improvements at the home.

5 June 2013

During a routine inspection

During the inspection we spoke with six people living in the home (residents), two members of staff and the newly appointed manager. We discussed all matters relating to the inspection with the manager.

Some residents we spoke with and who were able to give their views about the home said they thought generally care and support had improved since our last visit due to an improvement in the management and staffing levels in the home.

The assessment and planning of people's care and support ensured residents and/or their relatives understood and agreed to the decisions about the support needed. One person we spoke with recalled discussions about their 'assessment' of need before agreeing to move into the home for a period of respite care.

We observed staff caring for people and supporting them in a patient, kind and humorous manner. We confirmed staffing levels had been increased after the previous inspection and found there were sufficient staff on duty at the time of our inspection to meet the needs of the residents. Residents made the following comments: "It's lovely here; I'm happy, the staff are really kind", "Everyone has been very kind", "There's some lovely staff; a nice bunch at the moment" and "There's lots of activities".

Staff told us they felt the home was running better with the new manager in post. They felt better supported and thought the training opportunities would improve, as training needs were being discussed in meetings and supervision.

21 March 2013

During an inspection in response to concerns

We carried out this visit because we had concerns about the management of the home and the staffing levels. Other professionals visiting the home had told us of concerns about these matters. They also felt the care of people living there was being affected.

People living in the home (residents) we spoke with at the time of the visit told us they felt staff cared for them properly but that the home was short of staff and they sometimes had to wait a considerable time for attention. One person said they thought there was sometimes only one carer working in the part of the home where they were living and that this was not enough. The residents were also not sure about the management arrangements in the home following the departure the previous manager, and were not sure who to speak to if they had any problems.

Staff we spoke with, including senior staff from the company who were managing the home, told us staffing levels had recently been reduced, but that the work had not decreased as the dependency levels of the residents were unchanged. They felt the home was short of staff, particularly in the afternoon and evenings. Staff told us that during these times there was only one member of the care staff in one or other part of the home, depending on where staff were needed.

Staff also told us they were unsure about who was managing which matters, and who was making decisions. They felt unsupported due to there being limited management presence in the home.

19 April 2012

During a routine inspection

People living in Church View (residents) told us how they felt about living in the home. One said, 'It's alright living here; staff are pretty good' and "On the whole it's champion". Another person said, 'I'm very happy here'. Someone else said, "It's very good here; the staff are very good. The only thing is I sometimes have to wait too long to go to bed".

A relative and a person living in the home told us they thought the home had improved since the new manager was appointed. One said, "She (the manager) has knocked it into shape; it's improved 100%". However three people felt the home was short of staff at times. The manager told us new members of staff were currently being recruited, with three about to commence work in the home, and this would help ensure adequate staffing levels.

People told us they felt the staff generally treated them respectfully and encouraged their independence. One person told us of an incident when they thought a member of staff had been 'rude' to them, but that the manager had quickly sorted things out and there had been no problem since.

The residents told us they felt they had satisfactory choices in their daily lives such as in rising and retiring times, meals served and activities. There were varied and interesting activities to suit individual preferences.

People living in the home felt their views were listened to and they knew who to speak to if they were not happy with something. People had confidence the manager would 'sort things out'.

24, 26 January 2011

During an inspection in response to concerns

People living in Church View told us that in general they were happy in the home. One said that 'it's perfectly alright living here' and another said 'it's nice here'.

People spoken with were satisfied with the food served and comments were made such as 'I like the food' and 'the food is good'. One said that the food was 'good plain food just as she liked it'. Though there was only choice of one main (hot) meal on the menu alternatives were served to people who didn't like this meal. Residents were confident that the cook knew their likes and dislikes and would try to accommodate these.

The residents told us that they felt they had satisfactory choices in their daily lives such as in rising and retiring times, food eaten and activities. There were varied and interesting activities to suit individual preferences.

Residents in general spoke positively about the staff and felt they treated them properly and looked after them in a way that respected their privacy, dignity and independence. We were told of two incidents that one resident was concerned about but at the end of this review the matters had been satisfactorily resolved.

We were told that residents felt their views were listened to and that they knew who to speak to if they were not happy with something.