Archived: Church View Care Home

Church View Care Home is a ‘care home’ providing personal and nursing care for up to 78 people. The service is provided in one adapted building which is divided into six wings, each with their own lounge and dining area. At the time of our inspection 61 people were living at the service and was currently only using five of the six wings.

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

Risk to people’s safety and well-being were not always monitored effectively. Guidance was not always available to support people with some specific conditions and behaviours and staff required support to develop skills in this area. The support people received was often task focussed and activities did not always reflect people's hobbies and interests. Individual caring interactions with people were seen. However, we found on some occasions people's dignity was not respected.

There were enough staff deployed to meet people's needs. However, we found that some staff had not always understood their responsibility in protecting people from potential abuse by not always reporting incidents and accidents.

People received their medicines safely and had access to healthcare professionals when required. A choice of foods was available, and people told us they enjoyed their meals. People spoke positively about living at the home.

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. The provider was working within the principles of the Mental Capacity Act.

People did not always have detailed care plans in place to reflect their needs. We found that although there were some good examples of care planning in place for people this was not consistent across the home. We identified significant gaps in some people’s care plans where certain specific conditions had been documented but had no further guidance or assessment.

Staff respected people's privacy when supporting them with personal care. Although we did observe one incident where this did not happen, and this was raised with the registered manager. We observed instances of staff taking time to support people to make decisions and choices regarding how they wished to spend their day.

Engagement with relatives was not always happening. Meetings had been set up however only one relative had attended a meeting in 2019. The registered manager said they were looking at other methods to advertise the meetings such as emailing relatives to try and improve awareness.

Quality assurance processes were in place however these had failed to identify the areas of concern we found on inspection. Some negative cultures had appeared with regards to staff attitudes and thinking towards how people are supported. The management team had not been robust in inflicting change to these negative cultures despite knowing there was a concern.

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 06 April 2018).

Why we inspected:

The inspection was prompted in part due to concerns received about the care people received. A decision was made for us to inspect and examine if people were receiving safe care.

Enforcement:

We have identified breaches in relation to the management of risks to people's safety, person-centred care, the activities provided and the management oversight of the service. Please see the action we have told the provider to take at the end of this report.

Follow up:

We will continue to monitor intelligence 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

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions, Safe, Effective, Caring, Responsive and Well-led to at least ‘Good’. At this inspection, we found that the provider had taken action to meet the legal requirements in all these areas. We found improvements to medicines management and risk assessments. There were also improvements to staff training and leadership at the home. People’s care was planned in a more person-centred way and the provider had found ways to involve people and relatives in the improvements that had been made.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Church View Care Home is a ‘care home’. 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.

Church View Care Home accommodates up to 78 people across three separate units, each of which have separate adapted facilities. The provider is registered to provide nursing care to people living at the home. People living at the home had physical disabilities, long term medical conditions and most people were living with dementia. At the time of our visit, there were 39 people living at the home.

There was a registered manager in post who had joined since our last inspection and had recently registered with CQC. 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 supported by trained staff that knew them well. Staff were kind and caring and took time to interact with people. Staff routinely involved people in their care and ensured that where people had specific preferences, these were addressed. Care was planned in a person centred way and care plans reflected people’s needs, wishes and routines. Staff responded appropriately to any changes in people’s needs and where any complaints had been raised, these had been investigated and addressed.

The provider had a plan to improve and develop the service. Actions had beenne taken in response to our findings at previous inspections and an ongoing plan to improve the service was underway. People, relatives and staff were involved in the running of the service. People’s wishes were taken into account when developing the service. Staff had regular meetings where they could make suggestions to improve people’s care. Staff benefitted from regular one to one supervision that was used to identify and address any training needs.

We received mixed feedback about the food on offer at the home. The provider had taken action to address this and had involved people and relatives in changes to the menu. People’s nutritional needs were met and people had access to healthcare professionals whenever this was required. Staff managed and administered people’s medicines safely. Where people had specific clinical needs, these were met by trained nurses that had ongoing support to maintain their competencies.

There were improvements to the activities on offer at the home and the registered manager was introducing further improvements in this area. Staff supported people in a way that encouraged them to maintain independence and skills. The home environment was suitable for people that used mobility aids as well as people living with dementia. People were supported to maintain important relationships and their religious and cultural needs were met. Staff were respectful of people’s privacy and dignity when providing care to them.

Individual risks were routinely assessed and regularly reviewed. The actions taken to minimise risks were effective and staff took appropriate action in response to accidents or incidents. Records were kept up to date and the registered manager regularly checked and analysed these. Staff understood their roles in safeguarding people from abuse. There were sufficient numbers of staff to keep people safe and the provider carried out appropriate checks on all new staff.

The inspection took place on 26 July 2017 and was unannounced.

There was no 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 registered manager had left the service shortly after our last inspection. An interim manager had been appointed and consideration was being given to their appointment and registration on a permanent basis. The interim manager and general manager supported us during our inspection.

At our previous inspection on 17 and 18 October 2016 continued breaches of legal requirements were found and we took enforcement action against the provider and registered manager. We issued a warning notice in relation to the governance of the service. In addition we found breaches of the regulations in relation to unsafe care, staff training and supervision, staff not following the principals of the Mental Capacity Act, a lack of safe person-centre care and a lack of respect and dignity shown towards people. Following the inspection the provider submitted an action plan to us to tell us how they planned to address these concerns.

We inspected the service again on 6 and 9 February 2017 and found that although improvements had been made in some areas they had not taken sufficient action to meet the warning notice. We identified continued breaches of the regulations in relation to safe care and treatment, person centred care, protecting people's legal rights, staff deployment, the support of staff and good governance. The service was placed into special measures. The provider submitted regular action plans to update us on the progress they were making in meeting the breaches identified. At this inspection we found that improvements had been made regarding the staffing levels in place, training and supervision of staff and meeting the principles of the Mental Capacity Act. However, continued breaches relating to safe care and treatment, dignity and respect, person centred care and good governance were identified. As a result of this Church View remains in special measures.

People’s medicines were not always administered safely by competent staff. Staff continued to administer medicines following competency assessments showing gaps in their knowledge and practice. Safe medicines were not practiced by some staff and guidance provided regarding the administration of covert medicines was not always followed. Risk assessments regarding people’s nutritional needs were not always effective in ensuring they received safe care. Monitoring forms regarding people’s nutritional intake were not monitored and action was not always taken when people’s weight fluctuated significantly.

Improvements were seen in the way people received their care although individual staff members were seen to treat people with a lack of respect. Staff were not always aware of people’s backgrounds and preferences and staff were observed to speak to people in a disrespectful manner.

People’s care plans were not always updated when their needs changed. This was a particular concern for people who were receiving end of life care. Activities provided were not always appropriate to the ages of the people living at Church View and people were left for long periods without social interaction from staff.

Auditing systems to monitor the quality of the service were in the process of being implemented although were not always effective in identifying and addressing concerns. There was a continued lack of management oversight and a lack of leadership in individual areas of the service.

Improvements were observed in the way individual risks were addressed in areas including moving and handling, skin integrity and supporting people whose behaviour challenged others. Staffing levels were now sufficient to meet people’s care needs although the high use of agency staff impacted on the care people received. Accidents and incidents were monitored and measures implemented to manage risks identified. The general manager told us that a number of staff had recently been recruited which would reduce the number of agency staff used. Safe recruitment practices were in place to ensure that only suitable staff members were employed.

People were protected from the risk of abuse as staff were knowledgeable about their responsibilities. Up to date safeguarding and whistle-blowing policies were in place and displayed in communal areas. There was a contingency plan in place to ensure that people would continue to receive care in the event of an emergency.

Staff received induction, supervision and training to support them in their role. Additional training had been provided to staff and new staff had the opportunity to shadow more experienced staff members before working alone. People told us they enjoyed the food provided and choices were available. Appropriate referrals were made to healthcare professionals and guidance provided was followed.

People’s legal rights were protected as the principles of the Mental Capacity Act 2005 were followed. Decision specific capacity assessments had been completed and staff were able to describe their responsibilities in gaining consent before providing care to people.

We observed some individual staff members treated people with respect and spent time with people. Staff were observed to knock on people’s doors before entering and people told us staff respected their dignity when supporting them with personal care. Visitors were made to feel welcome at the service and there were no restrictions on the times people could visit.

Improvements had been made in some areas of people’s care plans and personalised information was available to staff. Where people had requested additional activities such as access to community activities this had been provided.

Regular meetings were held to gain the views of people and relatives and action was taken when changes were requested. Staff told us they felt supported by the interim manager and general manager and regular staff meetings were held. A complaints policy was in place and concerns received had been addressed to people’s satisfaction.

Records were now stored securely and maintained in an organised manner. Where significant events had occurred the CQC had been notified in order to ensure the service was monitored.

The overall rating for this service is 'Requires Improvement' with an ‘Inadequate’ rating in Well-led. Therefore, the service remains in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still 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 this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to 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 so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.”

During the inspection four continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. You can see what action we have taken in the full version of this report.

There was 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 and associated Regulations about how the service is run.

At our inspection on 30 September 2015 we found breaches of two of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take action in relation to risk assessment and poor moving and handling techniques and assessing and monitoring the quality of the service provided. We last inspected Church View on 17 and 18 October 2016. Continued breaches of legal requirements were found and we took enforcement action against the provider and registered manager. We issued a warning notice in relation to the governance of the service. In addition we found breaches of the regulations in relation to unsafe care, staff training and supervision, staff not following the principals of the Mental Capacity Act, a lack of safe person-centre care and a lack of respect and dignity shown towards people. Following the inspection the provider submitted an action plan to us to tell us how they planned to address these concerns. We carried out this inspection to see if the provider had taken action in line with the warning notice and their action plan. Although we found that improvements had been made in some areas they had not taken sufficient action to meet the warning notice. We identified continued breaches of the regulations in relation to safe care and treatment, person centred care, protecting people’s legal rights, staff deployment, the support of staff and good governance.

Since 2015 there has been a lack of managerial and provider oversight of the service to make the improvements required and to recognise and take action when concerns remain. Audits and quality assurance processes were not systematic and not effective in identifying shortfalls in the care provided. There was a lack of leadership and learning from the registered manager and provider. The effect is that people continue to experience times when staff are not always caring, respectful or responsive towards them.

People were not always treated with care and compassion. Staff were observed to treat people without kindness and people’s dignity was not always respected. There was a lack of empathy and understanding shown by some staff. We did see some examples of positive and caring interactions between people and the staff supporting them.

Risks to people’s safety were not always effectively assessed and there was insufficient guidance provided to staff to enable them to provide people’s care safely. There was no clear guidance to staff on how to support people to manage their anxiety and behaviours. The advice of professionals involved in people’s care was not always consistently followed. In other areas we found improvements in the way risks were managed, including pressure care and routine moving and handling.

Sufficient staff were not always deployed to meet people’s needs. Staffing levels determined by the provider were consistently met although we found in one unit there were insufficient staff to support people during the lunchtime period. Staff received supervision and appraisal although staff concerns were not always appropriatley addressed. Staff received training to support them in their role. However, we found that this was not always effective in ensuring people received person centred care.

People’s legal rights were not always protected as staff did not have a good understanding of their responsibilities in relation to the Mental Capacity Act 2005. Although there had been some improvements in this area people’s capacity was still not routinely assessed regarding specific decisions and best interest decisions were not always recorded.

The care planning system had been reviewed although the contents of care plans was not always person centred and information regarding people’s needs was not always accurate. There was a range of activities provided for people in communal areas although people who needed to spend the majority of their time in their rooms did not have access to activities. We have made a recommendation in relation to this.

Recruitment checks were completed prior to staff starting work to ensure they were suitable to work at the service. Staff understood their responsibilities in relation to safeguarding people from potential abuse and had attended training in this area. People lived in a safe and clean environment and regular checks of equipment were completed. There was a contingency plan in place to ensure that people would continue to receive a safe service in the event that the building could not be used.

People’s medicines were managed safely and in line with people’s prescriptions. There was a wide range of healthcare professional involved in people’s care although visits were not always recorded to show the outcome of appointments. We have made a recommendation regarding this. People told us they enjoyed the food provided and were able to make choices regarding what they had to eat and drink.

There was a complaints policy in place which was displayed within the service. People and their relatives told us they would feel comfortable in speaking to the management of the home if they had any concerns.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still 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 this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to 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 so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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

The inspection of Church View took place on 17 and 18 October 2016 and was unannounced. This inspection was to follow up on actions we had asked the provider to take following the last inspection to improve the service people received.

At the time of our visit there was 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.’

At our previous inspection on 30 September 2015 we found breaches of two of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take action in relation to risk assessment and poor moving and handling techniques and assessing and monitoring the quality of the service provided. The provider sent us an action plan and provided timescales by which time the regulations would be met. They stated that the actions would be completed by 30 November 2015.

During this inspection we found that some improvements had been made. However, they were not sufficient enough to meet the requirements of the regulations. A further five breaches were also identified.

Risk assessments for some risks were in place; however we noted that there were inconsistencies in the recording of risks associated with people. Not all risks had been identified, assessed and managed to minimise the risk of harm to people. This meant that people were placed at risk of harm as appropriate guidance and best practice was not always followed. Since the inspection the registered manager has informed us that risk assessments are now in place and equipment has been purchased that should mitigate the risks for two people.

Staff did not have a clear understanding of Deprivation of Liberty Safeguards (DoLS) or the Mental Capacity Act (MCA) 2005 or their responsibilities in respect of this. Mental capacity assessments and DoLS applications had not been fully completed in accordance with current legislation.

Staff were not always competent to meet people’s needs and the support they received had not always been appropriate to ensure they worked to the expected standards. Since the inspection the registered manager has informed us that additional training has been organised. We will assess the information and how staff are using this in practice to care for people at the next inspection.

People had enough to eat and drink throughout the day and night, however there were concerns that not everyone received the support they needed or that those at risk of dehydration were supported.

People were supported to have access to healthcare services and healthcare professionals to support their wellbeing. The service worked effectively with health care professionals and referred people for treatment when necessary. However, where people had specific health care needs these had not been taken into account when planning the care or identifying what support they needed. There were inconsistencies in the monitoring of people’s health and support needs.

There were inconsistencies in the way staff involved and treated people with compassion, kindness, dignity and respect. People’s preferences, likes and dislikes were not always being taken into consideration and support was not being provided in accordance with people’s wishes.

People’s preferences, likes and wishes were not always taken into consideration as staff did not always treat people with compassion or respond to their care and support needs. Care records were not always up to date. Since the inspection the registered manager has told us that all care plans will be reviewed with support from a nurse at the clinical commissioning group. We will assess how people’s care has improved as a result of this action at the next inspection.

Although the home was generally comfortable one unit for men living with dementia was sparse and not homely. Since the inspection the registered manager has assured us that this has now improved for people.

There were quality assurance systems in place to review and monitor the quality of service provided, however they were not robust or effective enough to identify missing information or poor practices or to have made the improvements required at the last inspection. Not all safeguarding incidents had been reported to the local authority or the commission. Since the inspection the registered manager has confirmed that appropriate incidents have been notified to safeguarding and the commission. However the failure to do so prior to the inspection remains a breach of regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

People told us they felt were safe at the home, one person told us, “I feel safe here and the girls look after me and I do not have to worry about anything.” Staff had a good understanding about the signs of abuse and were aware of what to do if they suspected abuse was taking place.

Recruitment practices were safe and relevant checks had been completed before staff commenced work and we found that there were enough staff to safely support people and help keep them safe.

People received their medicines when they needed them and the administration and storage of them were managed safely. Any changes to people’s medicines were prescribed by the person’s GP.

People’s relatives and friends were able to visit. People’s privacy were respected and promoted. Staff told us they always made sure they respected people’s privacy and dignity when providing personal care.

People told us if they had any issues they would speak to the staff or the registered manager. People were encouraged to voice their concerns or complaints about the service and there were different ways for their voice to be heard. Suggestions, concerns and complaints were used as an opportunity to learn and improve the service provision.

People had access to activities that were important and relevant to them. People were protected from social isolation with the activities, interests and hobbies they were involved with. Staff supported people with their interests and religious beliefs in their local community. Religious services were conducted weekly at the home.

There was a contingency plan in place should an emergency have an impact on the delivery of care. Staff had a clear understanding of what to do in the event of an emergency such as fire, adverse weather conditions, power cuts or flooding.

We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found one breach of the Care Quality Commission (Registration) Regulations 2009.

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

We spoke with eight residents and/or their relatives in some detail during this visit, and with other relatives before and after the visit. We interviewed a visiting GP, and we also made observations in three dining rooms over the lunch period, speaking with small groups of residents whilst they were having their meal.

There were a number of positive comments made to us about the home and these included "They keep the place very nice", "Staff are very good", and "I'm quite happy here."

We also noted a number of improvements since the previous visit, and these included more social activities provision, improving the home's emergency procedures, and dealing with complaints. However, we found more work was needed in relation to medicine's management and care and welfare, specifically related to care records. In addition, we were made aware of a number of complaints, some of which related to staffing levels and staff deployment within the home.

We saw that people received care and welfare that met their needs. A person who used the service told us 'They are very good, they know what I want and need and I get it.' A social care professional told us that in their opinion Church View had 'greatly improved in regards to the care and welfare of the residents, they had definitely turned a corner.' The manager and staff we spoke to were able to describe specific needs of individuals and how they met those needs.

We found that people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We spoke to twelve residents and relatives during this visit. We asked how well staff cared for people who lived at Church View and most said "Very well." People said they received the care they needed when they needed it, though two people said there had been shortages of staff. People told us activities arrangements had improved recently and comments on the overall quality of the service included "Very good", "I think they are very attentive here", and "Not bad."

We looked at how medicines were handled at the service. Medicines were stored safely and securely but the records were not always complete therefore it was not possible to tell if people were receiving their medicines as prescribed.

We asked people if staff seemed well trained for their work, and from those who could answer this question comments included "Fairly well trained" with one person adding "They work very hard."

We received a number of positive comments on the nursing care at Church View but overall we noted that some further work was needed.

We checked if staff gained people's consent before they supported them, and we were told that they did. People told us they were well looked after, and comments on the care at this home included "Staff are very good. I wouldn't want to live anywhere else." Most people commented positively on the meals, and responses to this question included "The food is cooked well, and is fresh. There are other choices, and they do me a nice salad".

Residents and relatives made a number of positive comments about the availability and competency of staff and described them as "Very nice indeed" and told us "Carers are very good. They seem to know what they are doing." We asked people if there were sufficient numbers of staff to help them when they needed it, and the majority of comments were positive.

We found that all but one of the shortfalls from the previous inspection had been remedied, with staff training as the only area where work was not yet fully completed.

We asked people if staff gained their consent before they supported them, for example with personal care. Residents and their families agreed that staff did get their consent and comments from a relative included "They do ask her first, and they give her choices for example about her food." We were told the manager had carried out an assessment prior to their admission to the home and "Asked about her likes and dislikes, and her care needs." People told us they were well looked after, and most people commented positively on the meals, and on the cleanliness of the home. Responses included "Staff are very good, they look after them very well." We asked if there were sufficient numbers of staff to help them and several people mentioned they had to wait sometimes. One relative summed up the comments we received on this when they told us "It could be manned more. This floor isn't too bad but they are full and need more people. It runs ok but they could do with more people."

We also found some shortfalls in relation to record keeping and staff training.