Church Rose Nursing Home

Church Rose is a care home, providing personal and nursing care to up to 48 people, in a purpose built building. The service provides support to older and younger adults, people living with dementia and learning disabilities. At the time of our inspection there were 44 people using the service.

People’s experience of the 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.

Right Support

Risks to people were well managed which meant risk of harm to people had been considered .There was evidence to demonstrate people had been supported with things which were important to them such as maintaining contact with family and their hobbies, and staff knew people well. Medicines were well managed.

Repairs and general maintenance were dealt with promptly, which decreased risks to people.

People lived in a purpose built building with a safe outside space which we saw people enjoy. The home was situated in a residential area with facilities close by which people could access. There were adequate numbers of staff to support people.

Right care

People’s care plans and risk assessments reflected their current needs and what was important to them. Staff received appropriate training to meet people’s needs. People were supported and encouraged, promoting their independence.

There was a stable team of staff who knew people's needs and were kind and caring.

Right Culture

The registered manager and other staff members told us how the manager had worked hard to ensure the culture within the service was open and inclusive .

People were not consistently 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 provider had systems in place to monitor the quality and safety within the service. However, these needed some improvement as they had not highlighted some of the issues we found. For example, concerns about the implementation of authorised conditions for people with Deprivation of Liberty Safeguards (DoLS) and infection control practices. Where the provider’s systems had highlighted concerns, at times there was a delay in completing the required actions.

The provider acted during the inspection to rectify the concerns in relation to authorised DoLS not being actioned.

We observed some infection control concerns such as, lack of evidence that equipment such as hoists had consistently been cleaned after use, staff wearing jewellery and long acrylic nails and clothing items which hung down, tables laid for meals where staff sat for handover, toilet rolls on top of toilet cisterns, un-used continence pads hanging on the dirty linen trollies, aprons hung over handrails. These issues were addressed by the management team at the time of the inspection.

People were supported to maintain links with loved ones. People had access to a variety of in-house activities to engage in, although some people told us these activities were not of interest to them. Although staff knew people well and how to meet their needs, this was not always supported by the daily records completed by staff members following the activity they had been involved in. The information around people's interests in care plans and risk assessments were detailed.

People and relatives knew how to raise concerns and most felt confident any issues would be addressed. However, two relatives told us they had raised concerns, which the registered manager said they would address but felt they had waited a long time before this has been actioned. The registered manager addressed these concerns when brought to their attention.

People were supported by staff who were trained and knowledgeable about how to identity and minimise risks regarding their safety and wellbeing.

Most staff felt supported in their role and described the management team as approachable, caring, and responsive. Some staff however, told us they felt they were not listened to.

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 15 May 2018). At this inspection we found the service required improvement.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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

Church Rose accommodates 48 people in one adapted building. Church Rose accommodates 48 people across two floors.

There was a registered manager at the home who had joined the home shortly after the last inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The registered manager had been at the home for a short period of time but had worked with staff to change practices within the home and promote a more team based way of working.

People at the home liked and felt safe around staff they knew. Staff understood how to keep people safe and how to report any concerns they had. Staff also understood the health needs people lived with and how people required support. Staffing at the home was stable and the provider had reduced their reliance on agency staff so that people had more consistent care. Recruitment process included reviewing a staff member’s background to ensure they were suitable to work at the home. People received support with their medicines. Regular checks were made to ensure medicines were given and stored correctly.

People were supported by staff that had been supported with training and supervision. Both nursing and staff explained they were encouraged to keep their knowledge up to date. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. People were offered a variety of choices in their food and drink and where necessary were offered support. Staff worked with a number of healthcare professionals to support people and ensure they received the right care which was based on best practice.

People liked and valued the staff supporting them. People found staff understood their care and cultural needs and responded in a way in which they wanted. People were treated with dignity and respect.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. People and their families were involved in discussions about their care which was updated in response to people’s changing needs. People were supported to have interests and were encouraged to participate in both communal and individual interests. People had not raised any complaints but we saw there was a process in place for investigating and responding to complaints should they arise.

The registered manager had acted upon improvements identified in previous inspections and had worked with staff to share learning. The registered manager undertook regular checks of the quality of care being offered and worked with stakeholders to improve learning about best practice in caring and supporting people. The registered provider explained how they had improved reporting and quality assurance processes within the home so that they had a better understanding of the care being delivered.

There were systems in place to ensure people received their medicines safely, most people received the support they needed with their medicines. However, some people had concerns about the way their medicines were handled. People’s concerns indicated that staff practice did not always ensure people received their medicines as prescribed.

People did not always feel their needs were met in a consistent way. The provider had clear systems in place for handling complaints. However, people were not confident that their concerns were listened to and addressed.

People’s rights were not fully protected. This was because staff were lacking in knowledge about how to ensure people’s rights were consistently protected in regards to certain aspect of their care.

Whilst there were procedures in place to monitor the quality of the service, some people did not experience a quality service. There had been several changes of registered managers since we last inspected the service; this had led to some instability within the service. This had impacted on the provider’s ability to secure and sustain the necessary improvements to the quality of care people received.

Risks to people’s care was not always updated where people’s needs had changed. People did not always feel there were sufficient staff to meet their needs. However, the provider had recognised this and had recently increased the staffing numbers and had plans in place to ensure this did not happen again.

Where incidents relating to people’s care had happened the provider investigated and analysed the incidents and took action to reduce the risks of them happening again.

Staff were safely recruited to work with people and received training to do their job. The provider had recognised that the training provided was not always reflected in staff’s practice and plans were in place to supplement the training. Staff were currently not consistently supervised and supported to undertake their role.

People had a choice of food and drink and were supported to maintain a healthy diet. People had access to health care professionals to ensure their health care needs were met.

Most people felt staff were caring towards them and respected their privacy and dignity. There were some people who felt they were not showed care and compassion by some staff and that their dignity was not consistently maintained.

People were encouraged and supported to be as independent as possible. A range of activities were available for people to participate in if they wished and visitors were welcomed at the service. This enabled people to maintain contact with relatives and friends.

We found that the provider had made improvements to ensure that appropriate processes were in place to ensure that people living at the home were able to give informed consent to their care and treatment. Where people lacked capacity systems had been put in place to ensure that their rights were protected.

We found that staff training had improved and the provider had put systems in place to demonstrate that new staff employed received a basic induction into their role.

The people that we spoke with had no complaints and felt that they were being looked after. One person told us, 'I am being looked after.' Another person said, 'Oh yes, they are looking after me well, so I have no complaints.' We found that the provider had improved the systems to ensure that people's views and experiences would influence improvements in the home.

We saw that people gave their consent to care and treatment and people told us that staff talked to them about their care. We found that where people did not have the capacity to consent, the provider was not acting fully in accordance with legal requirements.

The overwhelming majority of people that we spoke with told us that their needs were being met. One person told us, 'No problems, they are looking after me." We found that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

All the people that we spoke with told us that they were treated well by the staff. We found that people were cared for, by staff that were suitable recruited.

Everyone that we spoke with said they thought there was enough staff to care for them. We found that there were enough staff to meet people's needs, but all staff employed may not be sufficiently skilled and experienced.

Majority of the people that we spoke with had no concerns about the quality of care that they received. One person told us, 'It's not a bad home, in my opinion it's one of the better places.' We found that the provider had a system to regularly assess and monitor the quality of service that people receive but it was not being maintained to ensure it was fully effective at all times.