Churchview Nursing and Residential Home

Churchview nursing and residential home provides personal and nursing care for up to 47 people, some of whom are living with dementia. At the time of the inspection there were 35 people living in the home.

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

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.

The premises were not always safe. On the first day of inspection we found unlocked/unlockable doors, furniture in disrepair and areas of the home to be unclean or unfit for effective cleaning. The provider took immediate action to address the concerns which were significantly noticeable on the second day of inspection, which mitigated any risk and kept people safe. Improvements were being made to fire safety systems following an inspection from the Fire Service. Records about people’s care were not always clear, with some containing conflicting information. We have made a recommendation about this.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The systems in place for checking on the quality and safety of the service were not always effective as they failed to identify shortfalls around infection control, the management of risk, care plans, consent and fire safety found during this inspection.

People were safeguarded from abuse. Risks to people’s health, safety and wellbeing were assessed and managed. There were enough staff to meet people’s needs and safe recruitment practices were followed. The provider learned from accidents and incidents to mitigate future risks. Medicines were safely administered and managed.

People’s needs were assessed before they moved into the home. Staff were suitably trained and received regular supervisions. People were supported with their nutritional needs and to access a range of health care professionals.

The home did not have a registered manager at the time of inspection. The provider was in the process of recruiting a new manager. The home was being overseen by a manager from another of the provider’s homes with the support of the clinical lead. The atmosphere in the home was calm and relaxed. Relative’s told us, “I just think it terms of the staff, they make the place great, the staff are really lovely. it’s really nice to see [family member] interact positively with them” and, “The general atmosphere is good and they (staff) are encouraging towards my [family member]. A system was in place to involve people, relatives and staff in the running of the home.

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 requires improvement (published 11 December 2019).

Why we inspected

The inspection was prompted in part due to concerns received in relation to staffing, fire safety, the culture and the overall management of the home. As a result, we decided to undertake a focused inspection to review the key questions of safe and well-led only.

During the inspection we found areas of potential concern relating to consent and restrictive practices. We therefore decided to also inspect the key question effective.

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 requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

We have approached the provider and requested immediate assurances around their improvement plan. As a result of this an action plan has been produced detailing how they would address the shortfalls identified and work to complete this had begun.

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

Enforcement and Recommendations

We have identified breaches in relation to consent and good governance at this inspection.

We have made a recommendation about care plans.

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

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.

Churchview Nursing and Residential Home is a care home providing personal and nursing care to 46 people of different ages at the time of the inspection. The service can support up to 47 people with different health and care needs, including those living with the early stages of dementia. The service is situated within central Stockton-on-Tees and accommodates people across two adapted floors.

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

It was clear at our inspection that the service had recently experienced a period of unsettlement. There had been a significant change in staff, which people and relatives felt had led to inconsistencies in the quality of care. We found deterioration across the service, however it was also positive to see that the new registered manager, who had only been in post for a few months, had started to make improvements. Comments from people and relatives confirmed that following a significant dip, the service was settling and getting better again. People told us, “It is improving. I was pretty appalled at the time of the transition. The atmosphere was awful. But the staff seem to be working well together now and the atmosphere has improved” and “On the up again I would say. “

People felt safe living at Churchview, however people often commented there were not always enough staff and they at times had to wait to be helped. This was echoed by staff. The provider was reviewing staff support and we made a recommendation regarding this.

Since the last inspection, electronic care plans had been introduced. The standard of these new care plans varied. However, where these had been reviewed by the registered manager, there was more person-centred detail and effective information. Some care plans had received positive feedback from professionals. Others, particularly risk, health and end of life related care plans did not always provide up-to-date, detailed, person-centred guidance. We made a recommendation regarding person-centred record-keeping.

Considering there had been significant changes at the service, communication with and involvement of people, families and staff needed to be improved. Although the service has dropped in ratings across the key questions we ask and overall, we were also reassured that the new registered manager and the provider were addressing issues.

People felt that generally staff treated them with respect and knew them well. As there were many new staff this knowledge needed to become more robust again, however we also found positive examples of person-centred care. Staff felt overall well supported and a variety of training was on offer, although completion of this at times needed to be improved.

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.

A real strength and source for compliments were the activities on offer at the service, which helped people to engage and reduced isolation.

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 9 June 2017).

Why we inspected

This was a planned inspection based on the previous rating. We checked to see if the service had maintained its good rating but found that it had not.

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.

At the last inspection on 15 July 2014, the service was rated Good. At this inspection we found the service remained Good.

Medicines were managed safely overall with people receiving their prescribed medicines on time. We found some minor issues with medicines records but these had not impacted on people who used the service.

There were systems and processes in place to protect people from the risk of harm. Staff were aware of types of abuse, signs to look for and how to report any concerns. The registered provider had a whistleblowing (telling someone) policy in place and a hotline for staff to use if necessary.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.

Risks to people’s safety had been assessed and risk assessments were personalised to each individual. The risk assessments we looked at covered areas such as managing medicines, maintaining a healthy diet and mobility. Accidents and incidents were appropriately recorded and regularly analysed to minimise the risk of reoccurrence.

We found that safe recruitment and selection procedures were in place and appropriate checks were undertaken prior to staff starting work.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. Staff were given effective supervision and a yearly appraisal.

Staff understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivations of Liberty Safeguards (DoLS) which meant they were working within the law to support people who may lack capacity to make their own decisions.

People were supported to maintain a healthy diet and people’s dietary needs and preferences were catered for.

We saw evidence of exceptionally caring practice. We observed positive interactions between staff and people using the service. People were supported in a respectful dignified manner by kind and attentive staff.

We looked at peoples care plans and found they were individualised and person centred. They contain a high level of detail about people’s needs and preferences, were regularly reviewed and updated when necessary.

People were supported to take part in activities that were meaningful to them such as drawing and listening to music. Staff also encouraged and supported people to access activities within the community. These included sporting events and college courses.

Staff felt supported by an approachable management team and the registered manager told us that they were well supported by the registered provider’s team of directors.

All of the people we spoke with were very satisfied with the care they received. Comments included, "I am quite independent but I get help and support when I need it. Any care that is delivered by staff is most certainly done with dignity and respect." "I am very well looked after, I get the help and support that I need."

We saw that staff were attentive and treated people with dignity and respect. Staff responded quickly when people called for help. We saw that staff communicated well with people and explanations of care were given.

We found that people had nursing and care plans in place that were up to date and reflected their nursing and care needs. We also found that staff worked in collaboration with other health and social care professionals.

We found that effective systems were in place for the maintenance and servicing of equipment.

We found that people’s needs were generally met by sufficient staff, although additional recruitment was underway for registered nurses.

We found that people had their health and care needs appropriately assessed and this was effectively planned and delivered.

We found the premises that people, staff and visitors used were safe and suitable.

We found that appropriate recruitment procedures were in place.

We found there was an effective complaints system in place at the home.