Church View Residential Home

Church View Residential Home is a residential care home providing personal care to up to 30 people in a single storey adapted building. The service provides support to older people and people living with dementia. At the time of our inspection there were 20 people using the service.

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

There were not always enough staff to ensure peoples’ safety at night. Systems to identify and reduce risk were not robust enough. Risk assessments were not always in place or updated when people’s needs, or risks changed. Medicines were not always managed safely or in line with prescribers’ directions. Infection prevention and control guidance on good practice were not always being followed. People felt safe in the service. Staff were recruited safely and knew how to report and recognise safeguarding concerns.

Staff did not consistently receive training in key areas or regular supervision. The design and adaptation of the home environment needed to be improved, to ensure it met the needs of people living there, we have made a recommendation about this. People spoke positively about the care they received. They felt able to make decisions around their daily routines. People’s dietary and nutritional needs were met, and they told us they enjoyed their mealtimes. The provider worked in partnership with other agencies to support people to maintain their health and wellbeing.

Peoples were being treated with dignity and respect. We have made a recommendation about the location of call bells in people’s room to support them to maintain their independence. People and relatives told us staff were caring.

Staff provided people with person centred care. We have made a recommendation about people and their families being involved in the care planning process Activities were being offered at the service and processes and systems were in place to respond to complaints. 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 did not support this practice. We have made a recommendation around capacity and best interest. People could have visitors without restrictions and were supported to have pets to meet their emotional wellbeing needs.

Systems and processes to oversee and manage the service were not always effective. The views of people, families, staff and professionals about the care provided were not regularly being sought. Staff and residents’ meetings were not regularly occurring. Staff and people spoke highly of the registered manager and found her supportive.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 19 November 2019). At that inspection we found breaches of regulations relating to staffing levels and oversight of the service. The provider completed an action plan after that inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

At our last inspection we recommended that the provider improved their admissions process and completed staff surveys. At this inspection we found the provider had improved admissions processes however they had not implemented staff surveys.

Why we inspected

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

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.

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

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement and Recommendations

We are mindful of the impact of the 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 and will take further action if needed.

We have identified breaches in relation to staffing levels and staff training, safe management of medicines, the management of risks, and the operation and oversight of the service at this inspection. We have also made recommendations about the location and use of call bell systems, mental capacity assessments and best interests’ decisions, and around ensuring care plans are robust and people are involved in care planning.

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 view residential home is a care home. It is registered to provide personal care for up to 30 people aged 65. At the time of the inspection 22 people were receiving support.

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

People were protected from the risk of abuse and avoidable harm by staff who understood how to recognise and respond to concerns. People told us that the care provided by staff helped them to feel safe and secure.. The environment was clean and well maintained, however we found some issues with the laundry, which were addressed following inspection. People were safely supported to receive their medicines, as prescribed. Staffing levels were not always adequate and roles were not clearly defined. Staff were requested to cover ancillary roles on a regular basis.

People's needs were assessed, and care and support had been planned in partnership with them. People were provided with a nutritious and varied diet. Staff had received regular training and supervision to support them to meet people's needs. People were supported to have maximum choice and

control of their lives and staff assisted them in the least restrictive way possible; the policies and systems in the service supported this practice.

People told us staff were kind, caring, attentive and treated them with respect. They said staff respected their privacy and dignity and supported them to be as independent as possible.

People received care which was responsive to their needs. The registered manager managed people's concerns and people told us they felt listened to. The registered manager worked in partnership with a variety of agencies to ensure people received all the support they needed. Staff felt supported by the registered manager. The registered manager completed regular audits and checks, to ensure appropriate levels of quality and safety were maintained at the home.

We identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to staffing and good governance. Details of action we have asked the provider to take can be found at the end of this report.

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 23 November 2018) and there were five breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection. we found that although the service had improved in the areas of managing medication, learning from accidents and incidents, recruitment, and training, enough improvement had not been made with regard to good governance and the provider was still in breach of this regulation. We also found one breach of regulation relating to staffing. You can see what action we have asked the provider to take at the end of this full report.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Church View is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Church View is registered to provide personal care for up to 30 people. Accommodation is offered in single en-suite bedrooms. The home is a single storey building with level access. It is situated in the centre of the town of Oswaldtwistle, close to all local amenities. There were 20 people living in the home at the time of our inspection.

There was no registered manager in place at the time of this 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. A new manager had been in post since 1st October 2018 and had started the process to register with CQC.

At the last inspection in March 2017, the service was rated as good in all areas. At this inspection, the rating has deteriorated to requires improvement. This is because we found five breaches of regulations; these were in relation to the unsafe handling of medicines, the unsafe recruitment of some staff, the lack of appropriate training for staff, the lack of effective systems to ensure people received safe care and the lack of robust governance systems to monitor the quality and safety of the service.

Although there were systems in place to monitor the quality and safety of the service, these had not been effective; this had resulted in many of the shortfalls we identified during the inspection.

People told us they felt safe in Church View and that staff were kind, caring and respectful of their dignity and privacy. However, we found staff had not always been safely recruited and staffing levels did not allow for staff to continue to meet people’s needs in a timely manner should emergency situations arise. We have therefore made a recommendation that the provider reviews the number of staff deployed on each shift to ensure this is appropriate for the needs of people living in the home.

Systems and processes were in place to help ensure the safe handling of medicines. However, we found these had not always been properly followed. As a result, we identified some discrepancies between the records relating to the administration of medicines and the stock balance of some medicines. In addition, we could not be certain from the records we reviewed that topical creams had always been administered as prescribed.

The systems in place to record accidents and incidents which occurred had not been used effectively to ensure people received safe care. Although staff had recorded accidents and incidents as required, this information had not been passed on to the manager. This meant the manager had therefore not reviewed whether lessons could be learned or if further control measures needed to be put in place to manage any identified risks.

Although people told us staff were skilled and knowledgeable about their needs, we found the provider did not have a robust system in place to ensure staff received the training necessary to enable them to provide effective care.

The home did not have a domestic in post at the time of this inspection and the provider was relying on care staff undertaking additional shifts to carry out cleaning duties. As a result, we found some people’s bedrooms and bathrooms were not as clean as should be expected and arrangements to prevent cross infection needed to be improved. We have therefore made a recommendation that the service ensures it acts in accordance with best practice guidance regarding infection prevention in care homes.

Improvements needed to be made to the systems to determine whether people could consent to their care arrangements in Church View. The provider also needed to ensure necessary applications were sent to the local authority to ensure any restrictions in place were legally authorised in order to protect people’s rights.

People told us staff respected their right to privacy and dignity and encouraged them to be as independent as they could be. We observed this approach during the inspection.

People received support with eating and drinking and their healthcare needs were met. Appropriate referrals were made to community health and social care professionals, to ensure that people received appropriate support.

Records showed people’s needs were assessed and regularly reviewed. People told us they received care that reflected their needs and preferences. A weekly timetable of activities was in place to meet people’s social and spiritual needs. People told us they were generally happy with the activities available to them.

The new manager in post had begun to seek feedback from people about the service. They demonstrated a commitment to using this feedback to improve the service and ensure people received high quality care.

Church View Residential home is registered to provide personal care and accommodation for up to 30 people. The home is a single storey building with easy access for disabled people and outside space for people to use during warm weather. All of the bedrooms for people who used the service benefitted from en-suite facilities. There are three lounges and one dining room to people who use the service and visitors to use. The home is in the centre of Oswaldtwistle, close to local amenities.

At the time of our inspection there was a home manager in post who was in the process of completing their application for registered manager with the Commission. The registration requirements for the home required a registered manager in post. 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection on 18 April 2016, we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to records and on ongoing breach of the management of medicines. During this inspection we found the service was meeting the requirements of the current legislation.

People who used the service and relatives told us they felt safe in the home. Staff we spoke with understood their responsibilities when dealing with allegations of abuse.

We saw improvements in the managements of medicines. Systems were in place for the safe storage, administration and recording of medicines.

Sufficient numbers of suitably qualified staff were in place. This would ensure people who used the service received safe and effective care.

We saw people were provided with a variety of meals of their choice during our observations of people’s mealtime experience. Staff were seen engaging positively with people offering support and choice where it was required.

Records we looked at confirmed Deprivation of Liberty applications had been submitted to the relevant authority. Staff were observed seeking permission from people before undertaking any care or activity. We saw staff ensured people’s privacy and dignity was maintained and when undertaking any care or activity this was done in the privacy of their bedrooms or bathroom.

People were positive about the care they received from the staff in the home. Care files we looked at had details of people’s individual care needs. Evidence of regular reviews were seen to ensure they reflected people’s current needs.

We spoke with the activities co-ordinator who discussed the activities available for people who used the service. We saw activity equipment available for people to use and there was a singer in the home during our inspection who told us they visited the service regularly.

Complaints were managed effectively and we saw positive feedback about the home.

During our inspection people who used the service, visitors and staff were positive about the home manager and the changes made since she returned to post.

There was evidence of how the home received feedback about the service they delivered. This included questionnaires and resident and team meetings.

We saw detailed and regular audits taking place in the home. This would ensure people received care in a service that was monitored for quality.

Church View Residential Home is registered to provide care for up to 30 older people. The home was providing care for older people which included people living with a dementia; the home does not provide nursing care. At the time of the inspection there were 22 people in receipt of care.

The registration requirements for the provider stated the home should have a registered manager in place. The registered manager had recently left employment with the service and a new home manager was in post. The home manager told us they intended to commence the application process for registered managers with the 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.

At the last inspection on 18 September 2015 we asked the provider to take action to make improvements in the way medicines taken by mouth were administered and recorded. The home now carried out monthly audits. Any discrepancies, which may indicate that a person had not received all their doses of medicine, were investigated.

We watched some people being given their morning medicines and saw the senior carer gave medicines in a kind and safe way. Medication charts examined were completed in full and there were no discrepancies in the stock checks.

Medication creams were not being used safely and staff did not have access to information they required to administer these. The disposal of unwanted medicines that are controlled drugs was not recorded and witnessed in the way required by law.

People using the service and visitors told us they felt safe in the home. One person told us, “Nothing is worrying me, I feel safe.”

We saw evidence of appropriate procedures taken when dealing with allegations of abuse. Staff had access to the safeguarding and the whistleblowing (reporting bad practice) policy and procedure to guide them.

We looked at the care files for people currently in receipt of care. We saw improvements had been made. There was some evidence of care plans and risk assessment to guide staff on how to meet people’s individual need such as, personal care, behaviour monitoring and medication. There was some evidence of reviews taking place however not all had been updated recently.

Staff had access to policies to guide them on assessment and care plan as well as resident daily records and control of quality records.

During this inspection we identified breaches of regulation in relation to the management of medicines and records.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This a summary of what we found:

Is the service safe?

The manager told us there had been an application for Deprivation of Liberty Safeguards submitted to the local authority and they were waiting for the assessment from them to take place. The Mental Capacity Act 2005 [MCA[ provides a legal framework to protect people who need to be deprived of their liberty for their own safety. We spoke with staff about their knowledge of the MCA and Deprivation of Liberty Safeguards [DoLS] however we could not be confident the staff had up to date knowledge in DoLS. We looked at training matrix and did not see evidence that all staff had received up to date training in the MCA in the home.

We undertook a Short Observation Framework for Inspection [SOFI] in the dining room to see how people's needs were being met by staff. A SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We heard staff spoke respectfully with people living at the home however; we noted one person needed support from staff due to them spilling a warm drink but the dining room at that time was unsupervised by staff.

We saw medications for people living in the home were not administered safely. We saw gaps in medication charts and the fridge and clinic room temperatures were not recorded regularly.

We spoke with five care staff all were able to tell us signs of abuse and the appropriate actions they would take if they suspected abuse had taken place.

Is the service effective?

We received positive feedback from two visiting health professionals who were visiting the home. We were told staff responded quickly to any requests.

The home had recently recruited an activities co-ordinator to the home. We were told activities were taking place daily and we saw evidence of this on the day of our inspection. There was a list of the week's activities on display in a public area of the home.

We looked at staff files and saw evidence of recruitment processes in them. There was evidence that Disclosure and Baring Service [DBS] checks had been completed so people working at the home had been safely recruited.

We were told the staff had recently completed training in moving and handling and hoist training. Five of the six staff we spoke with told us they had completed this training.

Is the service caring?

We looked in two people's bedrooms and saw these had been decorated with person items and mementoes. One person we spoke with told us they were happy with their bedroom.

We spoke with people who used the service. They told us, 'The girls are very good; I have no complaints about anything. They come quickly to my buzzer and talk to me about my care'.

We looked at three care files and saw up to date evidence in two of them of care planning and risk assessments in place. The manager provided us with evidence following our inspection that the third file had been updated, this provided staff with relevant information to provide the care and support for people living at the home.

Is the service responsive?

The manager told us there had been some new staff recently employed and staffing numbers were now more stable.

We looked at a meetings file. We saw minutes from a previous staff meeting that had taken place however the most recent date for these was a carer meeting in October 2013. However staff told us staff meetings were taking place and they were able to bring their views.

Is the service well led?

We were shown an audit file which detailed recent audits taking place, such as medications, care plans and staff skills competency sheets.

We saw two accidents had occurred in the home. These resulted in two people living in the home attending the hospital for a review and treatment. We noted that the Care Quality Commission (CQC) had not been informed of these by the home as required.

There was an in house policy and procedure file however we noted this had not been updated since 2009. In one of the policies there were details relating to regulations from 2001 and old contact details for CQC.

We looked around the home and in several bedrooms. All bedrooms had ensuite facilities and had been personalised with photograph's and mementos for people who used the service.

We spoke with eight people who used the service and asked them to tell us about the care they received at the home. We were told, 'I have no problems everything is fine', 'I am happy with the care. I have seen my care file' and, 'I am happy I have no concerns'.

The CQC had been made aware of concerns in relation to people receiving night time medications. We spoke with staff about this. One person told us there was always a senior on night duty to give people who used the service their medication. The manager told us there were appropriate systems in place to cover night shifts with adequately trained staff to administer medications. All people we spoke with told us they always received their night time medication. However we noted systems were not in place to ensure people who used the service had their medications administered safely.

We spoke with eight people who used the service. All were complementary about the staff. Comments received were, 'The staff are good, the manager is very good', 'I am quite happy I have no concerns. The staff know what they are doing'. At visiting relative told us, 'I always find the staff lovely'.

We found that members of staff had a good understanding of safeguarding procedures and told us they would report any concerns immediately.

We noted that all members of staff received the training they needed in order to provide safe and effective care for people using the service.

We saw that systems were in place to monitor the quality of the service provided. There was evidence to demonstrate that people were regularly consulted about the care and facilities provided at the home.