Archived: Churchview Care Home

Churchview Care Home is a residential care home spread over two floors. The service provided personal and nursing care to 23 older people, younger adults, and people living with dementia and sensory impairment. The service can support up to 30 people.

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

Systems and processes including governance systems, failed to identify and assess all risks to the health, safety and/or welfare of people who use the service.

For example, certified safety checks had not been completed following the supplier’s guidance and additional monthly checks required further information to assure continued safe use and operation of bed rails to mitigate known risks.

People received support with their medicines as assessed. However, staff had failed to follow policy guidance to ensure medicines prescribe as creams or patches were safely administered with appropriate associated records implemented and maintained. Monthly audits were completed but daily checks failed to implement corrective actions within reasonable timescales to mitigate known risks.

Staff received induction, training and support to carry out their duties. However, there was no evidence of a formal process in place for ongoing or periodic reviews to record where staff were assessed for their competency. For example, to manage and administer peoples medicine. Checks failed to ensure records of supervisions captured how staff were supported in their role and to meet their aspirations.

People’s needs were assessed as required to maintain compliance with the Mental Capacity Act 2005. Some risk assessments and support plans required implementation and updating. For example, where it was agreed to restrict access outside of the home.

People were supported with their health and wellbeing. Records included evidence of involvement from health professionals. This included input from GP’s, occupational therapists, physiotherapists and psychiatrists.

Staff understood how to keep people safe from abuse. People were supported to remain involved with any religious preferences and staff confirmed supporting any diverse needs and treating people equally was embedded into their roles.

People spoke with enthusiasm about the meal time arrangements and the quality of food and support they received. Where people had any dietary requirements, these were supported, and people were monitored to ensure they achieved positive outcomes.

The provider ensured people were supported to enjoy meaningful activities. These included regular trips out, daily events, shows and where people choose to remain in their rooms, daily support and interaction tor remain free from social isolation.

Staff were caring. They understood how to empathise with people who showed signs of confusion due to their dementia. Staff were patient and treated people with dignity and respect.

The registered manager and the provider were passionate about providing a safe service that was based around the needs of the individual person. They were responsive to the concerns we raised during the inspection. Where appropriate some actions were implemented immediately to maintain people’s safety. Other actions were planned for implementation on an action plan to determine the required improvements.

People and their relatives told us they were able to contribute their feedback to maintain and improve standards of care and support. They told us they were confident if they had any complaints the registered manager would address them appropriately.

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 30 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach of Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because where quality and safety concerns were found during the inspection associated governance did not ensure all corrective actions were implemented without unnecessary delay. This placed people at risk of harm.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for 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.

We undertook this comprehensive inspection on the 15 December 2016. At the last inspection on 7 and 8 December 2015 we found the registered provider was in breach of two of the regulations we assessed. We issued requirement notices for concerns around the management of risks to people’s safety and shortfalls with the governance systems in place.

During this comprehensive inspection we found improvements had been made in all areas so that the overall rating for the service is now 'Good'. We have kept the rating for ‘Caring’ as Good and changed the rating in the individual domains for ‘Safe’, ‘Effective’, ‘Responsive’ and ‘Well- led’ to Good, because of the improvements made.

The service had 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.

We found improvements in the way the service was managed. The quality monitoring system had been reviewed and strengthened. The registered manager had more oversight and involvement in the day to day running of the service and people who used the service and staff benefitted from the organisational changes. Staff confirmed morale had improved.

We found risk assessments were completed more accurately and updated when people’s needs changed. This enabled staff to protect people’s safety and minimise risk more effectively.

Improvements had been made throughout the service with redecoration, refurbishment and everywhere was clean and fresh.

People told us they felt safe living in the service. We saw staff interacting with people and they did so in a kind, caring and sensitive manner. Staff showed good knowledge of safeguarding procedures and were clear about the actions they would take to protect people. People’s medicines were stored safely and administered as prescribed.

Overall, we saw there was enough skilled and experienced staff on duty to meet people’s needs. Following the inspection the operations director confirmed they had reviewed the deployment of staff ensuring staff breaks were properly planned and communal areas were monitored more effectively. An additional member of staff would be provided at tea-times.

We found staff were recruited safely although some documentation could be improved regarding the decisions made. For example, when there were issues on disclosure and barring service checks but employment still went ahead.

Staff had received a structured induction and essential training at the beginning of their employment. This had been followed by regular refresher training to update their knowledge and skills. Staff told us they felt supported by the registered manager and confirmed they had received formal supervisions and appraisals of their work.

We found staff ensured they gained consent from people prior to completing care tasks. They worked within mental capacity legislation when people were assessed as not having capacity to make their own decisions.

People told us they were supported by kind and caring staff who knew their preferences for how care and support should be delivered. During observations it was clear caring relationships had been developed between the people who used the service and staff. People’s privacy and dignity was respected by staff who encouraged people to be independent and make choices and decisions in their daily lives.

People’s needs had been assessed before they moved into the service and they had been involved in formulating and updating their care plan. The care files we checked were individualised and reflected people’s needs and preferences in good detail. They had been reviewed and updated on a regular basis.

People liked the meals provided to them and their nutritional needs were met. Staff worked closely with health and social care professionals to ensure people received effective care.

We saw people were encouraged to participate in a range of activities at Churchview Care Home and to maintain their independence where possible. Relatives told us they could visit at any time and we saw staff supported people who used the service to maintain relationships with their family.

No complaints had been made to the registered manager or registered provider. People we spoke with knew how to raise concerns and told us they would be confident to do so. There were systems in place to enable people to share their opinion of the service provided and the general facilities at the home.

' Is the service safe?

' Is the service effective?

' Is the service caring

' Is the service responsive?

' 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 who used the service and the staff who supported them, and from looking at records.

Is the service safe?

The manager had introduced a new member of staff whose role was to sit with people and interact with them. This staff member also worked to prevent people from falling and having other accidents.

Is the service effective?

The manager had organised a number of training sessions to address previously identified shortfalls.

Training had been provided in how to safely manage behaviours that may challenge the service.

Is the service caring?

People who lived in the home were supported by staff that showed encouragement and patience when supporting them.

The introduction of an extra member of staff in the communal areas to chat to people meant people felt they mattered.

Is the service responsive?

Care plans had been updated when people's needs had changed. 75% of the care files had been re-written to ensure they were relevant to people's needs.

Is the service well-led?

The manager had introduced a number of quality monitoring systems which provided a clear analysis of any falls, accidents and incidents a person living in the home may have had.

The manager had developed a system to analyse any trends and patterns in relation to people's weights.

A new daily checklist for both bedrooms and communal areas had been introduced to ensure people lived in a clean and hygienic environment.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' 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 staff and relatives, and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Observations during the day showed that there were periods of time when staff were not available in the communal rooms. Also, some of the practices we observed during the day in terms of availability of staff at mealtimes and the lack of one to one time, could be attributed to lack of organisation of the shift. The provider identified the lack of staff availability during the visit and took action to increase the staffing numbers. This ensured safer care and supervision.

People had their medicines managed well so that they received them on time and as prescribed.

Risk assessments and behaviour management plans ensured staff had guidance to support people when they had behaviours that could be challenging to themselves, other people and the service. Although we found these were not always followed.

We found the provider could be more effective at identifying, assessing and managing risks related to the health, welfare and safety of people who used the service. Information in audits was not always used to manage risks related to people who used the service.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring risks to the health, welfare and safety of the people who use the service are properly assessed and managed.

Is the service effective?

People were asked for their consent prior to care and support and were asked for their views about activities of living on a daily basis. Care records we viewed showed consideration of the Mental Capacity Act 2005(MCA). Mental capacity assessments were carried out and best interest meetings held when people lacked capacity and important decisions were required.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager was arranging to discuss specific people who used the service with the local authority to gain advice about the need for applications, in light of a recent Supreme Court Judgement about DoLS.

There were gaps in the staff training and development programme as some staff had not received updates to their essential training. We also found training had not been provided for staff to inform them how to safely manage behaviours that may challenge the service, even though some of the people who used the service regularly demonstrated these behaviours. From observations during the day and discussions with members of staff we found that some staff were not confident with this aspect of care.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring staff are properly trained and supported in meeting people's needs confidently and safely.

Is the service caring?

People were supported by kind staff. Although we saw that staff showed encouragement and patience when supporting people, some of the care support was disjointed and levels of engagement when interacting with people with dementia required improvement.

People's preferences, routines, likes and dislikes had been recorded and staff demonstrated they knew the people who used the service well. We observed some positive interaction between staff and people who used the service.

Relatives spoken with were happy with the care provided to people. They told us they could visit at any time.

Is the service responsive?

People's health and care needs were assessed and plans of care were in place. However, people's care plans had not always been updated when their care needs changed. We also found that care was not always personalised, had not been consistently provided and that there was a lack of supervision at times.

People had access to a range of health and social care professionals such as GPs, psychiatrist, dieticians, speech and language therapists, social workers, dentists, opticians and podiatrists. There was evidence the staff team sought appropriate advice, support and guidance both routinely and during emergency situations.

We received mixed comments from visiting health professionals during the visit. Some told us they had to direct staff on improvements to their care practices which staff had then maintained. Other visiting professionals found the consistency of recording and staff feedback when they visited could still be improved.

Staff responded to people's dementia care needs. They provided visual choices for people in order for them to make decisions about, for example, meals and clothes. Improvements could be made in the provision of activities, social stimulation and aspects of personalised support.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to monitoring personal care tasks and meeting people's changing needs.

Is the service well-led?

There was a quality monitoring system in place that consisted of audits and the seeking of people's views but we found it had not been wholly effective in some areas.

The new manager had been in post four days at the time of the visit. Discussions with the provider during the inspection confirmed that senior level support would be provided for the manager on a regular basis. This would facilitate a positive induction, ongoing direction and guidance with the improvement programme.

The service worked in partnership with key organisations, including the local authority and safeguarding teams, to support care provision and service development.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to monitoring the quality of the service provided.

What people who used the service, and those that matter to them, said about the care and support they received: -

The people we spoke with said staff respected their decisions and included them in the planning of their care. One person told us, 'I generally have the same routines, but staff always ask how I would like to be helped.'

A relative told us they were kept informed about their relation's wellbeing and had their views sought as their member of family lacked capacity to make decisions for themselves.

People we spoke with were satisfied with the care they received. Comments included, 'The carer's are very good, they look after us', 'Very good care, I'm happy with everything' and 'I am well looked after here.'

Relatives said they were very happy with the service. Comments about health care included, 'I am very pleased with all aspects of my husband's care, but they do seem to forget his nails,' 'The care here is very good, they always call the GP and keep me informed of any changes', 'I find the care excellent; my relative is happy and I have no concerns.'

People who used the service and their relatives were complimentary about the staff team. They commented on the friendliness of the staff and we observed staff talking to people in a kind and respectful way. Comments about the staff included, "The girls are very good and kind; do anything for you' and 'Excellent staff, they couldn't be better." One relative told us, 'My wife isn't able to speak but she always smiles when the staff approach her, she clearly likes them and feels safe.'

People's care plans showed that a variety of health professionals were involved with their care. The four care plans we reviewed showed people received regular care from the district nurse team. One member of staff told us, 'We know the district nurses quite well now and I think there is a good working relationship.'

We saw medication was stored in a locked trolley which was secured to the wall of the dedicated medication room on the first floor.

Each person's care file contained an assessment of their ability to administer medication themselves and maintain their independence in this area. Records showed these assessments were reviewed monthly.

We found the building had been maintained effectively. The standard of decor was good. Fixtures and fittings were of a high standard. The home was warm and comfortable. One person said, 'It's really nice here.'

We reviewed the staff rotas. We saw all shifts for the next month had been covered. People looked relaxed in the company of the staff. One person said, 'The staff are good, very nice girls.'

We found there was a pleasant and welcoming atmosphere throughout the service on the day of our visit, which we observed was inviting and homely. We saw that people who used the service looked clean and well cared for and that staff interacted with them in a caring and positive way. We observed that staff spoke sensitively with people and involved them in decisions and choices about their support.

People told us that they liked their food and were give a range of choices and alternatives about these.

People who used the service told us they felt 'Safe' in the home and that staff were 'Kind and considerate.'

We found the home was warm and clean and we observed staff working hard to ensure it was kept neat and tidy and had no unpleasant smells.

We saw that recruitment checks had been carried out on staff, before they had begun working in the home.

People told us they were 'Happy' with the service they received. One person told us they had made some complaints when they first moved into the home. However, they said this was along time ago and that they had 'No concerns' now and were satisfied appropriate action would be taken to follow up any concerns they might have.