Archived: Churchfields

This focused inspection took place on 27 January 2016. Churchfields is run and managed by Methodist Homes. The service provides accommodation and nursing care for up to 70 people. On the day of our inspection 50 people were using the service. The service is provided across two buildings. People requiring nursing care were accommodated in one building over two floors with a passenger lift connecting the two floors. People requiring residential care were accommodated in a separate building over three floors with a lift connecting all floors.

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 and associated Regulations about how the service is run.

People were protected from the risk of abuse. Staff were aware of the types of abuse people who lived in the home may be exposed to and they understood their responsibilities in relation to protecting people in their care.

Although individual risks to people were assessed and recorded in their care plans the provider could not demonstrate people were fully protected from the use of faulty equipment as processes for monitoring cleaning and checking of equipment in use were not robust. People were not always protected from preventable risks as the provider did not always respond to safeguarding incidents in a timely way. Staff recruitment was safe and the distribution of appropriately trained staff to each area was appropriate.

Although staff had received training to develop their knowledge and skills in relation to their job role

there was a lack of assessment of their competency to check their learning.

People were protected under the Mental Capacity Act 2005 [MCA]. Individual mental capacity assessments and appropriate Deprivation of Liberty Safeguarding [DoLS] applications had been made.

People received personalised care from staff who knew their needs. People felt they could report any concerns to the management team and felt they would be taken seriously.

People could not be assured that internal company processes were fully effective as the provider’s response to a serious incident had been slow. In addition to this, feedback to staff about the outcome of this incident and any changes required was not robust. This resulted in lessons learned being slow and communication between the different units not always being effective.

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

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

We used different methods to help us understand the experiences of some people who use the service, because they had complex needs which meant they were not able to tell us their experiences.

During our visit we spoke with eight people who used the service, three relatives of people who used the service, two healthcare professionals and twelve staff including the deputy manager and the person in charge.

The home is registered for seventy beds. The person in charge told us there were twenty eight people living in Churchfields Court wing of the home and fourteen people living in Churchfields Park wing of the home, with a total of forty two persons living at the home.

We found there was no registered manager at the time of our visit. The home has been running without a registered manager for 529 days. Information we have received from the provider told us that a new manager had been employed and will submit an application to register. We will continue to monitor the service and take appropriate action when required.

Is the service safe?

We found most staff were respecting people by knocking on their bedroom doors before entering. However we found concerns when we saw one member of staff didn't knock on one person's bedroom door before entering and the staff member handled the person prior to them explaining what they were about to do. This meant the person did not have their dignity respected.

We saw policies and procedures were in place to ensure people were kept safe. One person told us they liked to have a cigarette, but they had to go outside to the designated area for smoking. We found appropriate risk assessments had been completed to ensure the person was kept safe.

We spoke with four staff about adult safeguarding. They confirmed they had received safeguarding training along with challenging behaviour training. This was reflected in the training programme.

Appropriate Mental Capacity Assessments and Deprivation of Liberty referrals had taken place.

There were effective systems in place to reduce the risk and spread infection we spoke with three people who told us they felt the home was clean and tidy. One relative of a person who used the service we spoke with said. 'The environment people live ins clean and well kept.' Another relative told us they felt the home was clean and safe.'

Is the service effective?

We saw there were policies and procedures in place for autonomy and choice. We looked at eleven care files and found information identifying each person had a key worker.

Staff we spoke with told us they read and signed people's care plans before they provided care and support. We found the not all staff had signed to identify they had read the care plans. We also found not all the staff we spoke with were knowledgeable about the people they were caring for. This meant there was a risk that staff were not meeting the person's needs.

We found the provider had put systems in place to ensure people's rights and choices were adhered to. We saw advocacy services were in place and this service was being used by people who used the service.

We saw one person who was on one to one support had been left seated alone by the staff member who was supporting them.

We observed staff offering frequent drinks to people who used the service and recording fluid and nutritional charts, one staff member was going to administer thickened fluids to a service user who did not require thickened fluids, but another carer stopped her and explained that the service user was able to take normal fluids and diet.

Is the service caring?

We found most staff had a good understanding of people's needs. One relative told us they felt the staff had been very supportive to them and their family member. They said, 'The staff are very respectful and I feel they support and listen to my mum if she needs anything.'

Staff we spoke with told us they had read and signed people's care plans before they provided care and support. However we found that not all staff had signed to identify they had read the care plans. This meant there was a risk that staff were not meeting the person's needs. We spoke with the manager regarding this issue.

We saw there was staff available to give assistance where needed. They supported people and promoted independence to people who had the capacity to make decisions for themselves. This meant people were supported.

We saw people who use the service were participating in different activities when we arrived at the home. One person we spoke with said, 'I am going out on a boat. Staff told us they had arranged a boat trip for those people who wanted to participate.

Is the service responsive?

We saw one person who used the service was not well a member of staff responded to the persons call for help. They immediately requested a district nurse to check the person who had become unwell. This meant staff responded accordingly in an emergency situation.

Is the service well-led?

We found staff handed over information regarding each person who used the service at the end of each shift. We found conflicting answers from staff we spoke with. One staff member told us the hand over information is very good. They said, 'I know who is not well, who has had a fall and who may want to see a doctor. We have to complete handover sheets for each shift. Another member of staff told us they felt the handover details did not contain enough information and they felt more information about the person who used the service was needed.

Eight people we spoke with told us they felt there was sufficient staff to meet their needs. One relative told us the staff were very supportive they also said, 'Staffing levels are good now.' Another relative said, 'The staff are patient and supportive. There always seems enough around when I visit.

We received six safeguarding notifications since December 2013 of which three were substantiated. The provider responded to recommendations and advice given by the local authority and put appropriate equipment in place. This meant the provider responded appropriately to allegations of abuse.

We saw a number of audits had taken place since our last visit, such as infection control in April 2014 and health and safety audits. This meant the provider had systems in place to monitor the quality of the environment.

Not all records we looked at were accurate and up to date. We found records for people who were required to be repositioned, monitored for food and fluid intake were not stored safely or appropriately.

We were concerned that care and treatment was not always planned and delivered in line with each person's individual care plan.

We found that the provider had taken action to comply with the enforcement action we had taken. However, we were concerned that people were not always protected from the risk of abuse because appropriate action was not always taken to protect people from harm.

We were concerned about the quality and accuracy of the records kept by the service.

We were told by the manager and nursing staff that the arrangements for medicine management sometimes caused the service problems. In particular we were told that medicines were not always delivered in time for people to have. We were shown copies of daily checks that the service received from the supplying pharmacy, which identified any problems with people's medicines. However despite these daily checks it was not always clear what action was being taken to prevent errors happening again or what lessons were being learnt.

We found that appropriate arrangements were not being undertaken in order to manage the risks associated with the unsafe use and management of medicines.

During our inspection we spoke with fifteen people who used the service and the relatives of twelve people who used the service. We also spoke with ten members of staff and the advocate of one person. We looked at the care records for six people using the service and observed the care people were receiving.

We found people were not always involved in their care and treatment and they did not always receive care which met their needs. Some people spoke positively about the care they received and some relatives praised the care their relative was getting. However we found that care was not always being delivered as it was planned.

We found that people were not always protected from the risk of harm or from the risk of excessive or unplanned restraint. We found that staff were not clear about whether they were able to use authorised and planned restraint when people resisted care. We found this was because care plans lacked instructions for staff and staff were not aware of when restraint had been authorised.

The environment was not always clean and hygienic. The way staff had been deployed in the home left some areas of the home insufficiently covered by staff and this meant there were not always enough staff to meet the needs of people using the service.

The provider was not monitoring the service provided to make sure it was safe and effective. Records were not always kept confidential and staff were not always recording the care people received.