Church Terrace Nursing Home

Church Terrace Nursing Home is a care home providing personal and nursing care to up to 65 people. The home consists of 4 wings, 1 of which is an adapted building separate to the main care home. The service provides support to younger and older adults, some of whom were living with dementia and people with mental health concerns. At the time of our inspection there were 60 people living in the home.

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

Since the last inspection, improvements were found to the overall care and support people received. However, further improvements were identified regarding quality monitoring of equipment, such as mattresses and time was needed to monitor the success of the newly implemented quality monitoring systems.

People and relatives spoke positively about the service they received. Staff knew how to keep people safe and protect them from harm. Risks associated with people’s care and the environment were identified and assessed. People received their medicines safely, when needed, by staff trained in medicine management. Staff were recruited safely.

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 told us they felt supported by the registered manager and attended regular meetings. Relatives told us they felt included in the service and felt confident to raise concerns.

The provider and staff worked in partnership with other health and social care agencies to deliver good outcomes for people and ensure their needs were met and reviewed. A visiting professional told us the provider followed their recommendations and communicated effectively.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 6 June 2023) and there were breaches of regulation.

At this inspection we found the provider had made significant improvements and was no longer in breach of the regulations found in the previous inspection. However, there were still improvements to be made and time was needed to establish the newly implemented systems.

Why we inspected

We carried out an unannounced focused inspection of this service on 6 June 2023, during this inspection we followed up on the breaches of the previous inspection. However, at the time of our visit, the deadline we set for the provider to be compliant with regulations had not yet passed. Therefore, breaches of legal requirements continued to be in place. The provider had failed to ensure the safe care and treatment of people, to support people to consent to their care and ensure good governance of the service. These failings breached regulation and we issued 3 warning notices.

We undertook this focused inspection to check the provider had made improvements and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Church Terrace on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Church Terrace Nursing Home is a nursing home providing personal and nursing care to up to 65 people over four separate wings, one of which is an adapted building separate to the main care home. The service provides support to younger and older people living with mental health diagnoses and dementia. At the time of our inspection there were 58 people using the service, although 3 people were not present in the home on the day of our first visit. There were also people residing in the home who had a learning disability or autism, despite the home not being a specialist in supporting people with those needs.

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

Quality assurance systems in place had not always ensured actions and improvements were swiftly completed. People did not always have detailed care plans and risk assessments in place and there was a risk they would not always be protected from harm. Checks had been made on the safety of the building, however some further actions needed completing. Medicines were not always managed safely, although some improvements had been made since the last inspection. Lessons had not always been learned when things had gone wrong, although work was ongoing to address this, and we saw some improvements had been made. Improvements were needed to the cleanliness of the home; it was odour free and generally clean, however a deep clean was needed.

People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. People did not always have their health needs planned for, although people did have access to other health professionals.

People felt safe in the home. Staff understood their safeguarding responsibilities and concerns were reported. Staff were recruited safely and there were enough staff to support people. Staff received training and support to be effective. People were supported to have food and drinks of their choice. The home was suitable for the needs of the people living there. There was positive feedback about the registered manager and deputy manager. Relatives were positive about the home. There was continuous learning and improvement, although further work was needed to ensure improvements were completed and embedded. Relatives were kept informed if incidents ad occurred. The home worked in partnership with others.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 25 November 2022). At the last inspection we found breaches of regulations about medicines management, the assessing and planning to reduce risk to people and the oversight of the service.

At this inspection we found the provider remained in breach of regulations.

Why we inspected

We received concerns in relation to the alleged conduct of staff. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

The inspection was also prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk. This inspection examined those risks.

We also checked the provider’s progress against the enforcement action we issued following the last inspection.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Church Terrace Nursing Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to the assessing of risk, medicines management, supporting people to consent to their care appropriately and the oversight of the service at this inspection.

We issued enforcement following the last inspection. The deadline we set for the provider to be compliant with regulations had not yet passed at the time of our visit. However, due to the concerns we had, we could not wait until the deadline had passed. We took this into account when making any decisions.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Church Terrace Nursing Home is a nursing home providing personal and nursing care to up to 65 people over four separate wings, one of which is an adapted building separate to the main care home. The service provides support to people living with mental health diagnoses and dementia. At the time of our inspection there were 60 people using the service.

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

People did not always have care plans and risk assessments in place to provide staff with clear guidance on how to meet their needs. Potential safeguarding concerns had not all been reported to the local authority safeguarding team as required.

Care records did not always inform staff how to provide care safely including restraint techniques. For example, records did not document what interventions had been used by staff to keep people safe when this was part of their planned care.

People gave us mixed feedback about staff but overall we did not see people have to wait for their care. People who were supported on a one to one basis by staff did not always receive this as it was care planned.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, people did not always have best interest decisions recorded to ensure their care was provided in the least restrictive way. We recommend the provider consider current guidance on implementing the Mental Capacity Act and put this into practice.

Quality assurance tools did not always promote best practice as they had not identified the concerns we found at this inspection. The registered manager had not notified CQC of all potential safeguarding concerns at the service.

People told us they received their medicines as prescribed. However, people did not always have protocols in place where they were prescribed medicines on an 'as required' basis to ensure they received these as prescribed

People were supported by trained staff who had been recruited safely. People were supported by staff who understood the principles of infection control and were providing care in line with current guidance.

People were supported to eat and drink in line with their needs and preferences. People had care plans and risk assessments in place which explored their preferences. People had access to healthcare professionals when required.

People, relatives and staff gave positive feedback about the registered manager.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 21 October 2019). This service has been rated requires improvement for the last two consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service and feedback from the Local Authority. The inspection was also prompted in part due to concerns received about people’s safe care and treatment. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained the same.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Church Terrace Nursing Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified continued breaches in relation to people’s safe care and treatment, safeguarding and the governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Church Terrace Nursing Home is a care home which provides personal care and support to a maximum of 65 people. The home has four separate units, Oaklands, Maple Dene, Autumn Leaves and Blossom Court. Each unit has been developed to cater for people with varying mental health needs. There were 57 people living at the home on the day of our inspection.

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

People were supported by trained staff who were knowledgeable about the different types of abuse. However, not all potential safeguarding concerns had been reported to the local authority safeguarding team.

People were supported to receive their medicines by trained staff however not all ‘as required’ medicines had protocols to ensure these were given safely. People were not always supported in a safe environment and checks on people’s equipment had not always identified where equipment needed replacing.

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. However, the systems in the service did not always support this practice as people’s records had not always been completed.

The manager regularly reviewed the quality of the service. However, checks on people’s records, environment, equipment and medicines records had not effectively identified where improvements were required to ensure people received quality and safe support.

People were supported to maintain a balanced diet and staff offered people support where this was required. People were encouraged to access their local community and remain independent.

People were supported by safely recruited and sufficient numbers of staff. Staff knew people well and people had personalised care plans which had been completed with them, their families and professionals. This enabled people to receive support in a way they had chosen.

People were supported by caring staff who did not rush them. People felt able to give feedback about the service and this was encouraged by the registered manager.

The registered manager was committed to ensuring improvements of the service were made were made so that people received high quality care. We will check this on our next inspection.

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 03 April 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to ensuring people are supported to receive safe care and treatment, reporting of potential safeguarding concerns and the governance of the service. Please see the action we have told the provider to take at the end of this report.

During our inspection the registered manager notified us of a specific incident. Following which a person using the service died. This incident is subject to further investigation. As a result, this inspection did not examine the circumstances of the incident. The information CQC received about the incident indicated concerns about the management of choking. This inspection examined those risks.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Church Terrace Care Home with Nursing is registered to provide accommodation and personal care and support to a maximum of 71 people. The home has four separate units, Oaklands, Maple Dene, Autumn Leaves and Blossom Court. Each unit has been developed to cater for people with varying mental health needs. There were 64 people living at the home on the day of our inspection.

A registered manager was in post and was present during our inspection. 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.

People were protected from the risk of harm and abuse by staff who knew how to recognise and respond appropriately to any concerns that they had. Staff knew how to support people safely. Risks associated with people's care and support had been appropriately assessed and people had been involved in their risk assessments.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported by enough staff who had the skills to meet their needs. Staff had received training relevant to their roles and felt supported by the registered manager. Checks had been completed on new staff to make sure they were suitable to work at the home.

People had their nutritional needs assessed and people were involved in menu decisions which respected their choices. People were supported to take their medicines as prescribed by staff who knew what they were for. Medicines were ordered, stored and dispensed according to national guidelines. People were supported to access external healthcare support when required.

People received care that was personal to them because staff knew what their individual preferences and needs were. People felt staff treated them with kindness and compassion and they felt involved in their own care. Staff respected people’s dignity and privacy and supported them to keep their independence as much as possible.

People felt able to discuss any concerns with the care staff or the registered manager. The provider encouraged people and their relatives to give their opinions of the home through surveys and feedback forms. Systems were in place to monitor and check the quality of care and to make sure the environment was safe.

We saw that people's agreement was gained before staff provided care or support. When people were unable to make decisions about their care and support, systems were in place to ensure that their rights were protected and decisions were made in their best interests.

Care and support was provided to people in accordance with best practice evidence. We observed staff keeping people safe and meeting people's individual care and medication needs with care and compassion.

The service was well led as effective recruitment procedures were followed to ensure that staff who worked at the home were appropriately skilled and safe to work with the people who used the service.

The registered manager and provider were responsive to people's feedback about the service. Complaints were investigated, responded to and acted upon appropriately to improve the quality of care.

People who lived at Church Terrace told us that they were happy and satisfied with the care that they received. One person told us, 'Staff have time for you, they often ask how I am and if I need anything'. Another person told us, 'Staff are approachable, they will give you their time and help sort my problems'. This meant that people's health and wellbeing was maintained.

People we spoke with told us they felt safe living at Church Terrace. Staff we spoke with demonstrated a good level of understanding of how to keep people safe from the risk of harm.

We saw that people were cared for by staff that were supported to deliver care and treatment safely and to an appropriate standard. This meant that people were kept safe because they received care from appropriately trained people.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.