Archived: Churchfield Care Centre

Churchfield Care Centre is a care home providing personal and nursing care to 26 people aged 65 and over at the time of the inspection. The service is registered to support up to 60 people.

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

The provider did not have effective systems and processes in place that enabled them to identify, monitor and assess risks to the health, safety and welfare of the people using the service. The provider had persistently failed to act where improvements had been required.

Risks to people had not always been identified and actions identified to mitigate risks had not always been followed. The management of people’s medicines was not robust, and the providers recruitment process had not always been followed. Staff did not always protect people from avoidable harm because safe moving and handling practices had not been followed. Staff had not always followed best practice, around infection control prevention.

People’s needs had been assessed prior to them moving into the service, though plans of care were not always accurate or up to date. Planning for people’s end of life had not always been thoroughly explored. Capacity assessments and best interest decisions were included in people’s plans of care though, shortfalls within the Deprivation of Liberty Safeguarding process were identified.

Staff were overall provided with the training they needed in a timely manner. People were supported to eat and drink enough to maintain a balanced diet and staff knew people’s preferences. The staff team supported people to access relevant healthcare professionals when they needed it.

People told us the staff were kind and caring and we observed them treating people with respect. Staff supported people to make decisions about their care whenever possible and their consent to their care was obtained. People knew how to make a complaint if they were unhappy about anything.

The staff team felt supported by the manager and their thoughts on the service were sought. The manager had reintroduced meetings providing people using the service and their relatives with the opportunity to share their thoughts on the service. The staff team worked in partnership with others to provide people with the care and support they needed.

The new manager was committed to making improvements to the service moving forward and had already identified and addressed several shortfalls found.

Rating at last inspection: The last rating for this service was requires improvement (published 9 January 2019). The service remains rated requires improvement. This is the fifth consecutive time this service has been rated requires improvement.

Why we inspected:

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvement. Please see the safe, effective, responsive and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Churchfield Care Centre on our website at www.cqc.org.uk.

Enforcement

We have identified a breach in relation to the systems and processes used to assess, monitor and improve the service.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Update 11 May 2020 - We are mindful of the impact of COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so. A serious concerns letter will be issued as a result.

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.

Churchfield Care Centre is a ‘care home with nursing’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Churchfield Care Centre accommodates up to 60 people in two separate buildings. At the time of our inspection one building was not in use. There were 22 people with nursing needs and six people with residential needs accommodated in one building that had capacity to accommodate up to 33 people.

At our previous inspection on 17 and 31 July 2017, we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 for Regulations 10, 12, 17 and 18. These related to people not being treated with dignity and respect, not receiving safe care and treatment, an inadequate deployment of staff and ineffective management of risks and governance. At this inspection we found some improvements had been made and the provider was no longer in breach. However, some improvements were still required and the service is rated as ‘Requires Improvement.’ This is the fourth consecutive time an inspection has rated the service ‘Requires Improvement.’

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are registered persons. Registered persons have the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At this inspection, people’s privacy and dignity had not always been respected. Records, including medicines administration records, required improvement. Not all staff received the support of an induction and competency checks before they were responsible for people's care. Improvements were needed in care planning when people approached the end of their lives.

People felt safe and the provider had taken steps to help ensure people were protected from harm and abuse. Staff were trained and knowledgeable on safeguarding procedures. Recruitment checks helped the provider make decisions on the suitability of staff to work at the service. Staff were deployed sufficiently to meet people’s needs in a timely way and maintain checks on people in communal areas and in their rooms.

Arrangements were in place for the safe management of medicines. Procedures, followed by staff, were in place to help reduce the risks associated with infection. The premises were suitable for people and had been adapted further to meet people’s needs.

Staff told us they felt supported by the provider and the registered manager; staff were trained in areas related to the needs of people using the service. Care needs were assessed and focussed on achieving effective outcomes for people. People had access to other healthcare professionals such as GP’s and speech and language therapists. People were supported to maintain a balanced and nutritious diet and their weight was monitored to ensure it stayed in a healthy weight range.

Staff checked people consented to their care and the principles of the MCA were followed. People contributed to their care plans and as such care plans were personalised and reflected people’s preferences.

Processes were in place to assess any specific needs associated with the Equality Act 2010 so as to help prevent discrimination. Information was provided in an accessible format to people to help them understand choices.

Staff were kind and caring to people and knew them well. People’s independence was promoted. People were supported to maintain their relationships with their relatives and relatives felt welcome when visiting.

People enjoyed how they spent their time and the activities provided at the service. Other activities and resources were available for people living with dementia.

The provider had clear aims to provide care that was centred on people’s individual needs. The provider had taken steps to gather views from people, relatives and staff. Processes were in place to manage and respond to complaints.

Accidents and incidents were reported and analysed and changes made to help prevent recurrence. Risks, including health and safety and risks in the environment were assessed and mitigated. Audits and other systems to check on the quality and safety of services were in place. Action was taken to learn from events when things had gone wrong.

This unannounced inspection was carried out on 17 and 31 July 2017. Churchfield Care Centre provides accommodation nursing and personal care for up to 60 older people. On the day of our inspection visit there were 29 people who were using the service.

The service had a registered manager in place at the time of our 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.

People were supported by staff who understood the risks people could face and knew how to keep them safe. Some risks to people’s health and safety were not being clearly identified and managed.

People may not be provided with their care and support when this was needed because there were not always enough staff on duty. People may not receive their medicines safely at the time they needed these. People were placed at risk of infection because safe practices were not being followed.

People were being cared for and supported by staff who had been trained to do so. People’s human right to make decisions for themselves was respected and they provided consent to their care when needed. Where people were unable to do so the provider followed the Mental Capacity Act 2005 legal framework to make the least restrictive decisions in people’s best interest. Staff were unaware which people had their freedom restricted lawfully and some people had been restricted by the use of locks on doors.

People were provided with support to have sufficient nutritional and fluid intake. Staff understood people’s healthcare needs and their role in supporting them with these.

People were cared for and supported by staff who respected them. People did not always have their privacy and dignity respected. Where possible people were involved in planning their own care.

People received their care and support in a task oriented manner rather than in a person centred and proactive way. People’s care plans were not always kept up to date and staff rarely referred to these. We have made a recommendation about people having greater opportunities to be involved in activities and follow their own hobbies and interests. People knew how to raise any complaints or concerns they had and these were acted upon.

The management of the service relied on the registered manager’s presence and there were not effective systems to ensure this was maintained in their absence. There were systems in place to monitor the quality of the service and make improvements.

Churchfield Care Centre provides nursing and personal care accommodation to older people. It is registered for a maximum of 60 people. There were 29 people receiving care and support at the home at the time of our visit.

On the day of our inspection there was a manager who had been in place since September 2015, but they were not registered with the Care Quality Commission. 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 received their medicines as prescribed. Medicines were stored and handled safely. People told us they felt safe at the home. They were supported by staff who understood how to report allegations of abuse. Risk assessments were in place to identify and reduce the risk to people’s safety. Staff were in place to keep people safe. Staff completed a robust recruitment process to ensure they were safe to provide care for people.

People’s rights were protected under the Mental Capacity Act 2005. People received sufficient to eat and drink, but had to wait long periods for their meal, which meant they may not always have a good experience at mealtimes.

People received effective care, preferences and choices, but staff were not always able to meet their individual needs. People were supported by trained and knowledgeable staff. People were supported to make decisions about their care and treatment. People had access to other healthcare professionals and received effective care, but their care was not always managed appropriately.

People were encouraged and supported to have positive caring relationships with each other, staff as well as their family and friends. People were treated with kindness and compassion. Staff interacted with people in a friendly and caring way. People’s privacy and dignity were protected and people felt able to contribute to decisions made about their care. Arrangements were in place for people to receive support from an independent advocate if they needed one.

People’s care records were person centred and focused on their wishes and respected their views. Staff responded to people’s needs promptly. They encouraged people to participate in activities that were available in the home which reflected their needs. A complaints process was in place and staff knew how to respond to complaints.

The service did not always follow their legal obligation to make relevant notifications to the CQC The quality of the service was sufficiently monitored to make sure people received safe and effective care. The manager supported the staff team in a positive way. Staff felt supported and that the management of the service was approachable and valued them. People and their relatives had opportunities to be involved in the development of the service and share their views.

We saw that the provider had taken action to replace carpets, mattresses and some beds. Systems were in place to ensure that people were cared for in a clean environment. We spoke with two people who were using the service and asked if they were satisfied with the standard of cleanliness in the home. One person said, 'I am happy with the standard of cleaning. My room is cleaned every day.' Another person told us, 'There are lots of new carpets. I think the home is clean enough.'

During this inspection we were also accompanied by a specialist pharmacy inspector who looked at the systems that were in place for the management of medicines. People did not always receive their medicines at the times they needed them and medicines were not kept in a safe way. Medicines were not always correctly administered and recorded properly.

During the inspection we worked to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We looked at the care plans of four people who were using the service. A care plan describes a person's care and support needs and gives guidance to staff in how to meet those needs. Where people did not have the capacity to consent, the provider had not always acted in accordance with legal requirements. Assessments of people's capacity to make a particular decision had not been carried out appropriately.

We spoke with three people who were using the service and asked if they felt safe using the service. All of the people we spoke with told us that they felt safe. We also spoke with six relatives of people who were using the service who also indicated they felt their loved ones were safe living at the service. Everybody told us that they would be confident reporting any concerns to the manager.

We carried out a tour of the premises and looked at the standard of cleanliness in several bedrooms, bathrooms and communal areas. We found that the standard of cleaning was not always of an acceptable standard.

The total number of staff employed by the home had increased since our previous inspection. We were told that this had been done so that any sickness and annual leave could be covered by the home's own staff.

Is the service effective?

We saw that care plans did not always contain sufficient guidance to support staff to be able to meet people's needs. Repositioning charts were not always completed at the frequency stated in people's care plans which meant we could not be sure people were being provided with the care and support they required.

Is the service caring?

During our inspection we spent periods of time observing the support provided to people in communal areas. We saw that staff interacted with people in a kind and considerate manner. Staff responded to people's requests for assistance in a timely manner. We saw that staff also responded quickly when a person pressed their call button in their bedroom. Some people required support to eat their lunch and this was provided in a calm and unhurried manner. The lunchtime period was generally relaxed and people appeared to have enjoyed their meals. Staff also provided one person with a birthday cake after lunch, which the person appeared to greatly appreciate.

Is the service responsive?

During our inspection we found a visit report that had been completed by a district nurse in a person's bedroom. This was dated six weeks before our inspection. We showed the report to the manager and the nurse who were not aware of the district nurse's visit or the guidance that had been provided. The district nurse had advised that the person should be regularly repositioned. This information was not in the person's care plan and there was no recorded evidence that the person was being regularly repositioned. This meant that the service had not responded effectively to guidance provided by a healthcare professional.

During our inspection we saw that staff responded in a timely manner to requests for support that people made. Staff also responded quickly when a person pressed the call button in their bedroom.

Is the service well-led?

People who were using the service were asked for their views about the service and they were acted on. We spoke with three people who were using the service and asked if they were aware of ways in which they could provide feedback about the service. One person said they had attended a resident's meeting. Another person told us, 'I know there are meetings but I haven't attended one. I would just ask to speak to the manager.' We saw that regular meetings were held for people using the service to attend.

A range of audits were being carried out by different staff to assess areas such as cleanliness and the quality of care plans. However the audits had not picked up on and dealt with the areas of concern that we have highlighted in this report.

Two relatives told us they felt their relative was being looked after safely, but we found procedures to investigate the possibility of abuse had not been followed and this meant that people were not fully protected from the risk of abuse. We also found people were not fully protected from the risk of infection because appropriate guidance had not all been followed and the environment was not adequately clean and hygienic.

We had received information of concern from two different callers about people's personal care needs not being met in a timely manner by the staff available. During our visit we saw people waiting for assistance with their meal and we found there were less staff provided on that day to meet people's needs than was planned.

There was insufficient information to show how the provider regularly assessed and monitored the quality of service that people received and we have asked the provider for more information about this.

On our previous visit where we found the provider was not fully complaint in the outcomes we inspected within the nursing unit. During the current inspection we found changes had been made.

We found improvements had been made in the way people's consent was recorded on their files and, where people did not have the capacity to consent, appropriate assessments had been carried out. Staff knew what care was needed and people were satisfied with their care.

We found that everyone received their medicines at an appropriate time in the morning. We spoke to one person, who was able to explain the morning medicines they had been given and told us they were always given on time with breakfast.

The number of permanent staff had increased since our last inspection and some staff had returned after a period of sickness. This meant there were enough staff to meet people's needs. One person told us, "They (the staff) are always around. If you want anything you just have to ask and they help."

We found improvements had been made to use systems to regularly assess and monitor the quality of service that people receive

The majority of our time during this visit was spent on the nursing unit where we found the provider was not fully complaint in the outcomes we inspected. We did however visit the residential unit and found the provider to be complaint in the same outcomes.

We found people did not give consent to their care and treatment and did not always receive care and support that met their needs. A person told us, 'I haven't talked with anyone about what care I want.'

We found there were not suitable arrangements for the management of medicines. The provider had not taken steps to ensure there were a sufficient and suitable number of staff available. One person told us' They (staff) always seem to have too much to do. I think they need more staff.'

We found the provider did not have suitable arrangements to assess and monitor the quality of the service.