Churchview Care Services (Taunton)

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Risks to people were recorded in their care plans and risk assessments were in place. Risk assessments had improved since our last inspection and further improvements were still required. Staff described how they supported people safely in line with their risk assessments and management plans. We received mixed feedback from relatives relating to how people’s risks had been managed.

There were enough staff available to meet people’s assessed hours. The provider was over delivering staffing hours to ensure people’s safety. The registered manager was solely overseeing Churchview Care Services (Taunton), which meant there was more consistency in the management structure.

There were systems in place to manage people’s medicines safely. We received mixed feedback from people’s relatives relating to how people’s medicines had been managed. A new system had been implemented which enabled a good oversight of people’s medicines.

The provider had systems and processes to manage, follow up and learn from accidents and incidents. These had not always been fully effective due to the high turnover of staff and managers.

Relatives raised concerns about people’s safety. There had been a range of safeguarding concerns raised, some of which had been substantiated. Learning and recommendations from safeguarding incidents had been implemented. People told us they felt safe. Staff knew how to recognise and report abuse.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We received mixed feedback from relatives relating to the service having a learning culture. Relatives told us there had been a lack of consistency of staff and a high turnover of managers at the service. One relative told us, “I have been meeting with staff over the last 3 years. Each meeting assurances are given, but are either not actioned, or re-discussed at the next meeting.” However, 1 relative told us, “Yes they do” when asked if the service learnt from incidents.

The concerns raised by relatives were discussed with the registered manager who acknowledged there had been concerns raised with them. The registered manager and provider gave assurances regarding how they were working with relatives to address them.

Staff told us learning was shared amongst the team. One staff member told us, “I think we learn as a team; we have monthly team meetings, and we talk to each other, we share knowledge if something has happened, we have a communication book and group chat. Any changes or modifications, appointments, everyone needs to know, and it gets communicated.”

The registered manager gave examples of how they had learnt and made improvements since our last inspection. This included improvements in people’s care plans. They also gave examples of learning and improvement from concerns or complaints that had been raised, we saw these had been discussed in team meetings.

We received feedback from a health professional who did not think the service adopted a culture of learning. They had raised concerns about the service. The registered manager was aware of the concerns and was taking action to address them.

There were processes in place to learn. With the registered manager now solely overseeing Churchview Care Services (Taunton) they were confident that changes they were implementing would address any concerns raised by people’s relatives and professionals.
The registered manager monitored complaints, concerns and accidents and incidents, to identify possible learning and ensure action had been taken to mitigate individual and service level risks. Learning from accidents and incidents was an agenda item at each staff meeting and any learning or actions was shared with staff.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they felt safe. One person told us, “The staff are very nice, yes I feel safe, and I would talk to [name of team leader] or [name of registered manager].” Another person told us, “I feel safe and able to talk to staff.”

We received mixed feedback from relatives relating to how safe their loved ones were. One relative told us, “Yes, I am happy [name of person] is safe.” However, another relative commented, “No, after referrals to safeguarding the situation remained risky. There is no cohesive management structure and frequent staff changes.” The registered manager was aware of these concerns and had taken action to address them.

The concerns raised by relatives were discussed with the registered manager who acknowledged there had been safeguarding concerns within the service that also had been raised with them. The registered manager and provider provided assurances regarding how they had worked with relatives and the local authority to address them.

The registered manager was now permanently overseeing Churchview Care Services (Taunton), which meant there was more consistency in the management structure.

Staff knew how to recognise and report abuse, including how to report concerns externally. One staff member told us, “I have had safeguarding training and would report concerns to the manager, or whistle blow to the CQC (Care Quality Commission). I have not seen anything but wouldn't hesitate to report if I did.” Another staff member commented, “Any concerns, I would elevate immediately to [name of registered manager], I am happy they would take action, they are very competent. I would also escalate to outside agencies like CQC. I have never had to, but I wouldn’t hesitate to, we want them to have the best quality of life, that's what we are here for.”

The registered manager told us where safeguarding incidents had been raised, these had been looked into and responded to.

Our observations of staff interactions with people were positive. People looked relaxed and happy in the company of staff. We observed friendly banter between people and their staff.

Since our last inspection there had been safeguarding incidents raised by a range of sources. These had been investigated and responded to in line with local safeguarding procedures. The registered manager worked with the local authority safeguarding team to investigate and take any actions needed.

We received concerns relating to how people’s finances had been managed. This had been investigated and there were improvements in the processes to manage people’s finances and staff were following these.

We received concerns from a GP relating to medicines management and the support a person was receiving with a health condition. The registered manager was aware of the concerns raised and was taking action to address them.

Safeguarding was an agenda item at each staff meeting, staff had the opportunity to discuss or raise any concerns. The registered manager gave any updates or feedback during the meetings.

Training records showed that staff had received safeguarding training.

We received mixed feedback from relatives relating to how risks had been managed. Some relatives told us that they were not confident that risks had been managed safely.

People who were able to give us feedback discussed their care plans and risk assessments with us and confirmed they were accurate and covered any risks.

The concerns raised by relatives were discussed with the registered manager who acknowledged there had been concerns raised with them. The registered manager and provider provided assurances regarding how they were working with relatives to address them.

Staff told us they understood people’s risk assessments and care plans and how to support people safely. They also told us they were made aware of any changes to people’s plans when changes were required.

Staff were aware of people’s risk assessments. They described how they supported people with specific risks, such as supporting them in line with professional guidance.

During the assessment site visit we observed people being supported in line with their care plans and risk assessments, for example when supporting people with their eating and drinking risk guidelines.

At the last inspection in October 2023, we identified a breach of Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to effectively assess and mitigate risks to people. Areas of risk management had improved at this assessment and the service was no longer in breach of regulation 12. However, there were still further improvements that needed to be fully embedded and sustained over time.

People had risk assessments and care plans in place to guide staff. However, we found 1 example of a person who had a SALT (Speech and language therapist) eating plan in place, a corresponding choking risk assessment had not been completed. Other care plans had these risk assessments in place. We discussed this with the registered manager who confirmed they would complete this. Another person’s SALT plan had been partially transcribed into their care plan; this is not best practice as it can lead to incorrect information being recorded.

Two people’s care plans stated they should be weighed weekly. For 1 person this was due to their risk of losing weight, staff were completing monthly weighs for both people. We discussed this with the registered manager who told us they would change the care plan to monthly. We found no impact on the person, and they had gained a small amount of weight over a period of 2 months.

Risk assessments were current, person centred and included the control measures in place to mitigate risk. Areas covered included, specific health conditions, accessing the community, home security, supporting people with finances, mobility and Personal Emergency Evacuation Plans (PEEPS).

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Relatives commented on the high turnover of staff, and they felt that staff had not always had the right skills and knowledge to support their loved ones.

There had been a high turnover of staff, however the registered manager told us the current staffing situation had stabilised with permanent staff now in post.

People told us they were happy with the staff supporting them. One person told us, “Staff are always around and it’s the same ones.” Another person commented, “Yes there are enough staff, I like the staff.”

Staff told us there were enough staff available to meet people’s needs. One staff member told us, “People receive their 1-1 hours. We do use agency, it does rotate a bit, we see some regular faces, shifts are covered, it’s a pretty good situation.” Another staff member commented, “Shifts are covered, we use permanent staff, last month we used agency once or twice, there has been a lot of improvement in staffing.”

Staff told us they received enough training to fulfil their role. One staff member told us, “The training has been quite comprehensive. I feel it has equipped me well to be able to work under minimum supervision to no supervision.”

The registered manager told us they had gone through a period where a lot of staff had left, however staffing had stabilised now, and this had been positive.

The provider and registered manager told us how they were over providing hours for some people to ensure their safety.

We observed there were enough staff available to meet people’s needs. People were familiar with the staff supporting them.

There was a training programme in place. Staff had received training in areas such as, first aid awareness, medication management, infection prevention and control, fire awareness, training relating to people with a learning disability and autism and safeguarding.

One person however was being supported with a clinical task that had been delegated by a health professional. Although staff had received training, competency assessments had not been completed by a health professional. The registered manager told us they would ensure these were completed.

Not all staff had received training in dysphagia. We discussed this with the registered manager who arranged for this training to be delivered to all staff during our assessment.

Staff received additional training to meet people’s needs such as diabetes, epilepsy, mental health and self-harm. Staff had also received training to undertake tasks such as administering specific medicines.

There were systems in place to ensure there were enough staff available to meet people’s needs.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they were happy with how staff supported them with their medicines. One person told us, “They [medicines] are looked after by staff, they give them to me in the morning and evening, I am happy with that.”We received mixed feedback from relatives regarding people’s medicines administration. Concerns that had been raised were being addressed by the registered manager.

The registered manager was aware of the concerns raised by people’s relatives and the GP and explained the actions they were taking to address this and mitigate any risks.

Staff told us they had medicines training, and their competencies were assessed to ensure they were competent to administer medicines.

The registered manager told us there was a new system in place to manage people’s medicines, this included an electronic app on handheld devices which would flag any omissions or concerns. The registered manager told us this system had enabled them to have better oversight of people’s medicines. Staff told us they were getting used to this system. One staff member told us, “It's been good, it alerts if meds are not given.” Another staff member commented, “Using [name of app] has made it easier.”

We observed people’s medicines were being administered safely by staff, in line with people’s prescriptions.

Records showed that people received their medicines safely as prescribed. There were systems in place to ensure the safe administration of people’s medicines. This included medicines profiles, guidance for staff, medicines risk assessments, process for reporting, investigating and learning from errors, safe storage arrangements and medicines administration records (MARs). Where people were prescribed ‘as required’ medicines (PRN), protocols were in place.

Checks were carried out on medicine stock levels and medicines were audited every month in each person’s home.

The service had ensured people's behaviour was not controlled by excessive and inappropriate use of medicines. The service understood and implemented the principles of STOMP (stopping over-medication of people with a learning disability, autism or both) and would ensure any medicines taken now or in the future were reviewed by prescribers in line with these principles.

All staff had received medicines training and an assessment of their competency. Any medicines errors were investigated, and learning was discussed, staff were retrained following any errors.