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Church View Nursing Home Good

Reports


Inspection carried out on 14 January 2020

During a routine inspection

About the service

Church View is a care home providing personal and nursing care to 36 older people at the time of the inspection. The service can support up to 43 people.

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

The service ensured arrangements for social activities met people’s individual needs and followed best practice guidance, so people could live as full a life as possible. The provider used a pool activity level (PAL) instrument to providing activity-based care for people with cognitive impairments, including dementia. The service had explored to find out what people had done in the past and evaluated whether it could accommodate activities.

The management team and staff ensured people received personalised care which had positive impact on their lives. Visiting professionals told us the service was focused on providing person-centred care and support and achieved excellent results. For example, one person had improved, and they were going home to live independently. Staff knew people well and quickly identified people’s changing needs.

The service worked closely with healthcare professionals and provided good end of life care. People experienced a comfortable, dignified and pain-free death. We saw feedback from relatives following end of life care was positive. There was a rapid response to people’s changing care needs and advice on care and support for people and staff at the times they needed. The home had established close links with a local hospice. Staff had the specific skills to understand and meet the needs of people and their families in relation to emotional support and the practical assistance they need at the end of the person’s life. Records showed staff had attended end of life care training. Staff told us they were supported by the management team with empathy and understanding.

People living at Church View told us they received safe care from skilled and knowledgeable staff. Staff knew how to identify and report any concerns. The provider had safe recruitment and selection processes in place.

Risks to people's safety and well-being were managed through a risk management process. There were sufficient staff deployed to meet people's needs. Medicines were managed safely, and people received their medicines as prescribed.

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. People were supported to maintain good health and to meet their nutritional needs.

People told us staff were caring. This ethos consistency enabled people to receive good care from staff who knew them well. Staff did all they could to promote independency and we saw examples of such practices.

The home was well-led by a registered manager who was focusing on improving people’s care and developing staff skills. A lot of significant changes had been implemented to support effective team working and improve people’s outcomes. The service had a clear management and staffing structure in place and staff worked well as a team. The provider had quality assurance systems in place to monitor the quality and safety of the service.

Rating at last inspection and update

The last rating for this service was requires improvement (published 15 January 2019).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

Inspection carried out on 30 October 2018

During a routine inspection

We carried out this inspection over three days on 30 and 31 October and 21 November 2018. The first day of the inspection was unannounced.

This inspection was brought forward, as we had received a high number of anonymous concerns about the service. The concerns generally related to people not having adequate food and fluids or being sufficiently repositioned, to minimise their risk of pressure ulceration. Senior managers within the organisation investigated the concerns and found them largely unsubstantiated. One concern identified shortfalls in the completion of care intervention charts. The incomplete records did not evidence people had received the care they required.

The service had a poor history of non-compliance in areas such as the planning of people’s care and the safe management of medicines. In 2015, the service was rated inadequate and placed into special measures. In 2016, we imposed a condition on the provider’s registration, as shortfalls continued and improvements were not sustained. The provider has adhered to the condition and sent us the information we required. During subsequent inspections in 2017 and January 2018, further improvements were made but these were not consistent to demonstrate a good service. Senior management told us the home was one of the services within the organisation that was not where they wanted it to be. They said the abilities of previous managers had contributed to this.

There was not 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.

A new manager had started employment at the service in September 2018. They were being supported by a manager who was the registered manager of another service, within the organisation. Both were planning to become registered managers of Church View Nursing Home. At the time of the inspection, applications to do this had not been submitted.

At this inspection, we identified some equipment which compromised good infection prevention and control. This included a shower chair that had rust on its frame and a foot operated bin that had broken. Records to demonstrate the laundering of people’s hoist slings had not been completed although the format to do so was in place. Staff addressed these areas by the end of the inspection.

There were a range of audits to assess the quality of the service. Monthly management reports were undertaken and sent to senior managers for further analysis. Whilst many areas were assessed, the audits had not identified the shortfalls found at this and previous inspections.

Improvements had been made to the safe management of people’s medicines. The medicines were stored securely, receipted and disposed of appropriately when no longer required.

Some risks to people’s safety such as those associated with falling and pressure ulceration had been identified. Records showed measures were in place to minimise the risks. Other areas, including one person’s risk of choking and accidents with equipment, had not received sufficient focus.

Each person had an electronic care plan in place. The information was generally well written and regularly reviewed. However, some aspects of people’s health care needs and the support required, was not clearly documented.

Not all staff had completed the training expected of them. Management had identified this and were reminding staff of their responsibilities to complete allocated courses. Records showed the completion of training was an “improving picture. Staff had one to one meetings with their manager to discuss their work. They were being given clear information about accountability and the standards expected of them. Action had been taken in response to any shortfalls i

Inspection carried out on 9 January 2018

During a routine inspection

We carried out this inspection over three days on 9, 11 and 18 January 2018. The first day of the inspection was unannounced.

There have been five inspections of this service since the beginning of 2015. In May 2015, four warning notices were issued, the service was rated inadequate and placed in special measures. Improvements were seen in October 2015 but at the inspection in March 2016, not all had been sustained and further shortfalls were identified. Due to this, we imposed a condition on the home's registration. This required the provider to undertake regular monitoring of the service and inform us of their findings. The provider has fully complied with the condition and sent us the information as required.

The last inspection of this service was on 25, 26 January and 2 February 2017. Improvements continued to be made but we issued a requirement notice in relation to Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations. This was because decision making, for those people who did not have capacity, was not always undertaken in line with the Mental Capacity Act 2015. At this inspection, improvement in this area had been made. However, documentation did not always clearly evidence the best interest decision making processes, which had been undertaken.

Church View Nursing Home is registered to accommodate and provide nursing care for up to 43 people. If the twin rooms were used for single occupancy, 36 people could be accommodated. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. On the day of our inspection, there were 33 people living at the home. Church View Nursing Home has bedrooms on the ground and first floor. All rooms have en-suite facilities. A passenger lift is available for people with mobility difficulties. There is a communal lounge and dining area on each floor with a central kitchen and laundry room.

There was a manager in post. They had worked at the home for approximately seven months and were in the process of registering to become the registered manager. 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 manager and another manager who was also in the process of registering, to become the registered manager, were both available throughout the inspection.

People’s medicines were not safely managed. Whilst administering medicines, the staff member did not ensure safe practice. This was because they gave the medicines to another member of staff to give to the person. One medicine was inaccurately labelled, which had not been identified and another was out of date. Another person had not received their night time medicines but staff had recorded they had been given.

A range of audits were in place to assess the quality and safety of the home. These assessed areas such as infection control, health and safety, medicines and the dining experience. There was a continuous improvement plan and the manager submitted a monthly management report to senior managers. However, whilst these structures were in place, the shortfalls we identified particularly with medicines, had not been identified.

Staff were happy with the amount of training they received and felt well supported. They were aware of their responsibilities to keep people safe and to report concerns as required. Training records were in the process of being developed as they did not effectively show what courses staff had completed.

Improvements had been made to people’s care plans. The support people required to meet their clinical needs was well written.

Inspection carried out on 25 January 2017

During a routine inspection

We carried out this inspection over three days on the 25, 26 January and 02 February 2017. The first day of the inspection was unannounced.

Church View Nursing home is registered to accommodate and provide nursing care to up to 43 people. If the twin rooms were used for single occupancy, 36 people could be accommodated. On the day of our inspection, there were 34 people living at the home. Church View Nursing Home has bedrooms on the ground and first floor. All rooms have en-suite facilities. A passenger lift is available for people with mobility difficulties. There is a communal lounge and dining area on each floor with a central kitchen and laundry room.

In May 2015, a comprehensive inspection identified the service was not meeting a number of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because care was not consistently delivered in a safe and effective way and there were not always enough staff to effectively meet people's needs. In addition, quality auditing systems were not identifying shortfalls in the service. We issued four warning notices to the provider, as a result of the concerns we identified and the service was rated as inadequate. The service was placed into special measures. Special measures provides a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

In October 2015, we completed a focussed inspection to ensure improvements had been made. We found the provider had taken the immediate action necessary to improve the service. Another comprehensive inspection was undertaken in March 2016. Not all improvements had been sustained and further shortfalls were identified. Insufficient improvement had been made to enable the service to come out of special measures. As a result of this, we imposed a condition on the home’s registration. This required the provider to undertake regular monitoring of the service and inform us of their findings.

The registered manager who was in post at the last inspection, left the company in October 2016. A new manager was recruited and started employment shortly after the previous manager left. This manager was available throughout the inspection and was in the process of registering with the Care Quality Commission, to become the registered manager. In addition to the manager, two senior managers including the Director of Operations and a supporting manager, were present during the inspection.

During this inspection, clear improvements had been made to the service. The manager and senior managers had taken the home “back to basics” and were confident the service was now safe, with effective leadership. Time was required to embed the changes and further work was being undertaken to offer care, which was more person centred. There had been additional training to develop staff’s knowledge and more sessions were planned. Staff had been given an area of specialism, such as end of life care, which they were in the process of developing. Focus was being given to recruitment, to minimise the use of agency staff.

New systems and processes had been implemented. This included a comprehensive range of audits and on-going monitoring. The audits were working well and clear action plans were in place to ensure any shortfalls, were appropriately addressed. However, some aspects of service provision had not been identified as requiring additional focus. This included ensuring those people, who did not have the capacity to make certain decisions, were appropriately supported in line with the principles of the Mental Capacity Act 2005. After the inspection, the manager sent us documentation to show arrangements had been made for mental capacity assessments and best interest meetings to be undertaken.

A range of meetings had been introduced to ensure staff were fully informed and aware of their responsibiliti

Inspection carried out on 10 March 2016

During a routine inspection

We carried out this inspection over two days on the 10 and 17 March 2016. The first day of the inspection was unannounced.

At the last comprehensive inspection in May 2015, we identified the service was not meeting a number of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because care was not consistently delivered in a safe and effective way. In addition, there were not always enough staff to effectively meet people’s needs and quality auditing systems were not identifying shortfalls in the service. We issued four warning notices to the provider as a result of the concerns we identified and the service was rated, as inadequate. The service was placed into special measures. Special measures provides a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made. The provider placed a voluntary embargo on admissions to the home, whilst they made the required improvements.

We completed a focussed inspection in October 2015 to ensure improvements had been made. We found the provider had taken the immediate action necessary to improve the service. During this inspection in March 2016, we found the provider had sustained some improvements but not all. Due to this, there was not enough evidence to enable the service to be removed from special measures. 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.

Church View Nursing Home provides accommodation to people who require nursing and personal care. The home is registered to accommodate up to 43 people. If the twin rooms were used for single occupancy, 36 people could be accommodated. On the day of our inspection, there were 28 people living at the home. Church View Nursing Home has bedrooms on the ground and first floor. All rooms have en-suite facilities. A passenger lift is available for people with mobility difficulties. There is a communal lounge and dining area on each floor with a central kitchen and laundry room.

The registered manager has worked at the home since November 2014. 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 registered manager was present throughout the inspection.

There were not enough staff to effectively meet people’s needs at all times. On the first floor, the atmosphere felt rushed. Some people received little stimulation and others needed to wait for their requests to be fulfilled. Staff told us staffing levels were often insufficient and at times, negatively impacted on the care they could give. There were occasions due to staff sickness at short notice, when staffing levels fell below the recommended level, as set by the provider. The registered manager and operations manager did not agree that staffing levels were insufficient to meet people’s needs. They had however planned to deploy an additional member of care staff each day, to meet the increased number of new people being admitted to the service.

Improvements had been made to the support people received to minimise their risk of pressure ulceration. Assessments identifying the risk of ulceration were in place although these were not all reviewed at the recommended frequency. Care plans generally identified the support people needed yet not all wounds had clear treatment plans in place. Records generally showed people were repositioned within the recommended timescales although there were some variations. Records did not show people had been sufficiently supported with their continence care and symptoms were not

Inspection carried out on 6 October 2015

During an inspection looking at part of the service

At the comprehensive inspection of this service in May 2015 we identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued the provider with four warning notices and one requirement stating that they must take action. We shared our concerns with the local authority safeguarding and commissioning teams.

This inspection was carried out to assess whether the provider had taken action to meet the four warning notices we issued. We will carry out a further unannounced comprehensive inspection in six months, to assess whether the actions taken in relation to the warning notices have been sustained, to assess whether action has been taken in relation to the requirement and provide an overall quality rating for the service.

This report only covers our findings in relation to the warning notices we issued and we have not changed the ratings since the inspection in May 2015. The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for The Church View Nursing Home on our website at www.cqc.org.uk.

At this inspection we found that the provider had taken action to address the issues highlighted in the warning notices. However, some areas required further focus.

Work had been undertaken to raise the awareness of pressure damage. Care plans, risk assessments and care charts had been reviewed. The recording of preventative measures such as supporting people to change their position was much improved. However, not all specialised equipment to minimise the risk of pressure ulceration was being properly used. Records showed a more structured approach to the management of wounds although there was some inconsistency in the description and progress of wounds. Staff had not documented the support people received in terms of managing resistance or effective continence care.

Focus had been given to people’s risk of malnutrition and dehydration. A new initiative of baking bread had been introduced to increase people’s appetite and interest in food. People enjoyed this activity and had gained weight as a result. People’s risk of malnutrition had been assessed and their plan of care updated. People received fortified foods and supplements but these were not always fully documented. Records did not show people had consistently been given snacks between meals or an alternative, if they had declined food. Improvements had been made to records showing people’s daily fluid intake.

Whilst a review of the staffing arrangements had taken place, the numbers of staff on duty had not been increased. This was because the home was not operating at full occupancy and a review conducted by the registered manager, of people’s dependency, had showed staffing levels to be satisfactory. More staff were being recruited to respond to new admissions and to enable greater flexibility with covering staff sickness. During the inspection the home was calm and people did not have to wait for assistance.

Attention had been given to ensure staff had the required knowledge and skills to support people effectively. Staff had completed a variety of training courses and were discussing their work within newly introduced supervision sessions. New staff had positively added to the skill mix of the team.

Audits had been introduced to monitor the quality of the service. Monthly management reports, which were sent to senior management, gave an overview of the service. People, their relatives and staff had been asked for their feedback about the home, by completing questionnaires. Action plans identified any suggestions made and how they were to be implemented.

Inspection carried out on 11, 12 and 15 May 2015

During a routine inspection

We carried out this inspection over three days on the 11, 12 and 15 May 2015. The inspection was unannounced. Our last inspection to the service was in June 2013. During the inspection in June 2013, we looked at people’s care and welfare, the numbers of staff on duty and the systems in place to enable staff to do their job effectively. The service was compliant in all areas considered.

We had received information regarding serious concerns, which related to the management of five people’s care. The information indicated that these people had developed significant pressure ulceration and one person was found to be lying in soiled bedding.

Church View Nursing Home provides accommodation to people who require nursing and personal care. The home is registered to accommodate up to 43 people. If the twin rooms were used for single occupancy, 36 people could be accommodated. On the day of our inspection, there were 29 people living at the home. Church View Nursing Home has bedrooms on the ground and first floor. All rooms have en-suite facilities. A passenger lift is available for people with mobility difficulties. There is a communal lounge and dining area on each floor with a central kitchen and laundry room.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

  • Ensure that providers found to be providing inadequate care significantly improve
  • Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
  • Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Staff were not consistently responsive to people’s needs and there were a high number of people with significant pressure ulceration. Proper interventions were not in place to ensure each person’s wound and skin pressure area care was managed effectively. Care plans were not person centred and were difficult to follow. Records did not demonstrate a clear understanding of the Mental Capacity Act 2015. Not all people were properly assessed in terms of the risks to their safety. Those people at risk of malnutrition were insufficiently monitored and had limited food intake. There was little evidence they had been supported to have alternate foods or high calorie snacks between meals.

There were not enough staff to meet people’s needs effectively. Whilst call bells were answered in a timely manner, some people had to wait for assistance and not all people were given the time they needed. Not all staff showed a caring approach to people. There was limited interaction and some staff talked to each other rather than to the people they were supporting. When assisting people to eat, staff did not explain the food content or make pleasantries to enable a more pleasant experience.

Staff had not consistently signed the medicine administration record to show they had administered people’s medicines as prescribed. Protocols were not in place regarding medicines to be taken “as required”. This did not ensure these medicines were administered in accordance with the prescriber’s instructions.

Staff told us the training opportunities available to them were good. However, records showed staff were not up to date with their training in key areas such as safeguarding people. There was little training in relation to older age or people’s health care conditions. Registered nurses had not been given the opportunity to develop their clinical skills. Staff told us they felt well supported by each other and the registered manager. They had received formal supervision to discuss their role and a new supervision system was in the process of being implemented.

There were detailed and comprehensive arrangements in place to ensure the safety of the environment and the equipment used. However, audits had not been undertaken to identify shortfalls in provision and to monitor the quality of the service. Prior to March 2015, there was no analysis of accidents and incidents to identify possible trends or triggers, to minimise further occurrences.

Staff were clear about their responsibility to report any suspicions or allegations of abuse. People felt safe and they would inform a member of staff if they were unhappy with the service they received. The registered manager told us people were encouraged to give their views about the service on an informal basis. More formally, surveys had been sent to people to gain their views. The information had not been coordinated, as it was expected more surveys were due to be returned.

The registered manager told us the home was not operating as well as they wanted it to be and they had an action plan in place to ensure improvement. Following our inspection, the registered manager confirmed that senior managers had agreed to place a voluntary embargo on the home. This meant there would be no more admissions to the home until improvements had been made.

You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 19 June 2013

During a routine inspection

At our previous visit in October 2012 we had found shortfalls and required that improvements were made.

People who lived in the home we spoke with told us they were well cared for and that the staff were friendly and respectful. We were told that care was carried out in an unhurried and professional manner. People told us they enjoyed the food and the activities. We saw that several new activities were being organised during the week and at the weekends.

We found that improvements had been made to the way staffing was organised to ensure people's needs were met.

We found that improvements had been made to the planning and monitoring of staff training and that regular staff meetings were being held. Staff were well supported by the senior staff, the nursing staff and the manager but some were not receiving sufficient formal supervision.

Inspection carried out on 31 October 2012

During a routine inspection

People who lived in the home told us they were well treated by the staff who were friendly and caring but that they sometimes had to wait for their needs to be attended to.

Relatives we spoke with said the staff were helpful and caring but were "often rushed off their feet" and "too busy to spend time with people".

We observed that some people were not always provided with regular drinks and that there were insufficient staff available during the morning to get everyone up at a time of their choosing.

We observed that the staff team worked hard to meet the personal care needs of people and this work was done to a good standard. However once people were brought to the communal areas of the home there was a lack of engagement and stimulation. This was partly due to a lack of activities.

We found that the home provided training for staff but was unable to provide robust evidence that all the required training had been completed and the required refreshers undertaken.

Inspection carried out on 20 March 2012

During a routine inspection

People told us they had the information they needed about the home and about the things that were happening. Relatives said they were made to feel welcome when visiting the home.

People told us they were treated with respect by staff. The staff were described as helpful, but busy. We saw staff interacting well with people and talking to people in an informal but polite way.

There was a programme of activities and �one-off� social events, which people enjoyed. Some people however were very dependant and staff did not always have the time to support them with individual activities.

Reports under our old system of regulation (including those from before CQC was created)