Archived: Church View Care Home

Church View Care Home is a care home providing accommodation, personal care and nursing care to 57 people aged 65 and over at the time of the inspection. The service can support up to 78 people, many of whom may be living with dementia or a learning disability. People live in one adapted building, divided into six separate living areas, each with their own lounge and dining room.

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

Risks to people were not always assessed, monitored and managed safely. Systems in place did not always protect people from the risk of abuse and improper treatment. Staff were not deployed effectively to ensure care was delivered in a safe way. Although large parts of the service were clean and well-maintained staff were not always following good infection prevention control. Improvements were also needed with the recruitment processes with staff.

Medicines required some improvements around the recording of ‘as and when medicines’ and handwritten medicine administration records were not always countersigned by a second member of staff. We have made a recommendation around this. All other aspects of the administration of medicines was undertaken in a safe way.

There was a lack of meaningful activities for people and staff lacked an understanding of people’s needs. Complaints were not always recorded or investigated appropriately. End of life care plans however were more detailed since the last inspection.

Quality assurance and governance systems were not always effective in making sure risks to people’s safety were managed safely. Staff at all levels had not always been supported to understand and fulfil their expected roles and responsibilities.

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.

Based on our review of Safe, Responsive and Well Led:

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

The model of care and setting did not always maximise people’s choice, control and independence. People were not considered and involved in the planning of their care.

Right care:

Care was not always person-centred and did not always promote people’s dignity, privacy and human rights. People did not always have access to meaningful and person-centred activities.

Right culture:

Ethos, values, attitudes and behaviours of leaders and care staff did not always ensure people using services lead confident, inclusive and empowered lives.

Rating at last inspection and update

The last rating for this service was Inadequate (published 18 January 2022) and there were 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 improvements had not been made and the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding incidents and risks associated with people’s care. A decision was made for us to inspect and examine those risks and to follow up on action we told the provider to take at the last inspection.

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, Responsive and Well Led sections of this full report.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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 the safe care and treatment, the deployment of staff, lack of meaningful activities, staff being aware of people’s care, complaints not being investigated appropriately and the lack of robust oversight of the care provision at this inspection.

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.

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.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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

Church View Care Home is a care home providing accommodation, personal care and nursing care to 69 people aged 65 and over at the time of the inspection. The service can support up to 78 people, many of whom may be living with dementia or a learning disability. People live in one adapted building, divided into six separate living areas, each with their own lounge and dining room.

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

Although we received some positive feedback about staff and were told some of them were kind, we found a lack of person-centred, individual care being provided. Staff did not always know people or take time to read their care plans to familiarise themselves with risks associated with people. This resulted in people being in danger of potential harm. Some people told us they felt unsafe with staff and we found staff did not have a good grasp of how to identify or report any safeguarding or other concerns they may have. Due to this lack of understanding we could not be confident that all potential safeguarding incidents were being identified and reported.

People said they often had to wait for staff, sometimes for a significant amount of time and we observed non-care staff sitting with people as there were insufficient care staff on the floor. Staff did not always take the time to speak in English in front of people and we found some staff were not fluent in English.

The registered provider was not checking staff were always following suitable infection control practices. This related to the wearing of personal protective equipment and handwashing practices and new staff, who were new to care, were not provided with a robust induction.

People did not receive care in line with their individual wishes and we heard that some people were, “Bored” as there was a lack of activities taking place. This was particularly relevant to those who spent a lot of time in their rooms. People’s care plans lacked information on people’s backgrounds, hobbies and preferences which meant staff could not learn about a person to use information to help build relationships.

Although accidents and incidents were recorded and analysed and action was taken in response, the registered manager had not learnt from our previous inspections where we highlighted shortfalls. They had failed to ensure people were kept safe at the service and they had failed to consistently provide a good level of care to people.

People were not given the opportunity to contribute towards the running of the service as feedback was not sought from them.

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.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

Model of care and setting did not maximise people’s choice, control and independence. We found people were not supported with individualised activities to meet their specific needs. People were not supported to access the community.

Right care:

Care was not person-centred and did not promote people’s dignity, privacy and human rights. We found a mix of people living at the service and as such people's individual characteristics and needs were not always recognised by staff. Staff did not always take time to read people's care plans and were unable to tell us about people.

Right culture:

Ethos, values, attitudes and behaviours of leaders and care staff did not ensure people using services led confident, inclusive and empowered lives. We found people received care from staff who may not know them well and staff who did not always speak English in front of them. People were admitted to the service without the registered provider considering if it was an appropriate setting for them.

Despite identifying concerns at our last inspection and the registered provider telling us they would address these by 31 March 2021, we found this not to be the case. We found continued breaches of regulation and areas of concerns which had not been identified by the registered manager through their governance processes.

We did find however, that people received their medicines correctly. Some people told us staff at Church View could not do any more for them and they were happy living at the service. In turn, staff we spoke with on the day said they enjoyed their jobs.

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 (report published 18 January 2021) where breaches of regulation were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection not enough improvement had been made and the provider was still in breach of regulations. There were also further shortfalls identified and as such the service has deteriorated to Inadequate.

Why we inspected

The inspection was prompted in part due to concerns received about people experiencing a high level of falls, lack of induction for staff, a bullying culture within the staff team, poor record keeping and lack of staff and activities. A decision was made for us to carry out a focused inspection and examine those risks. This report only covers our findings in relation to the key questions Safe, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has deteriorated to Inadequate. This is based on the findings at this inspection. 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 Care Home on our website at www.cqc.org.uk.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We will meet with the provider and work alongside them and local authority to monitor progress.

Church View Care Home is a care home providing personal and nursing care for up to 78 people. The service is provided in one adapted building which is divided into six wings, each with its own lounge and dining area. At the time of our inspection, 55 people were living at the service over six wings.

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

Risks associated with people’s care were not always being managed in a safe way, including infection control practices and the management of medicine. Appropriate action was not always taken to reduce the risk of accidents and incidents reoccurring.

There were not always enough staff deployed at the service which left people at risk. This also meant staff were not always able to spend meaningful time with people. We have made a recommendation around this. Complaints were not always recorded and investigated appropriately.

Quality assurance was not always effective. Where shortfalls in care had been identified with staff, this had not been addressed robustly. The leadership needed to be more effective in ensuring staff were able to deliver the most appropriate care.

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 supported this practice. We observed kind and gently interactions from staff with people.

We have found evidence that the provider needs to make improvements. Please see the Safe, Responsive and Well-Led sections of this report. You can see what action we have asked the provider to take at the end of this full report.

Rating at last inspection (and update)

The last rating for this service was Requires Improvement (published 22 January 2020). Since this rating was awarded the registered provider of the service has changed. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

This service was registered with us on 4 March 2020 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about the infection control practices and the management of risks associated with people’s care. A decision was made for us to inspect and examine those risks.

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 coronavirus and other infection outbreaks effectively.

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

Enforcement

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 have identified breaches in relation to the safety of care for people including infection control practices and medicines, the management of complaints and quality assurance.

For requirement actions or enforcement which we are able to publish at the time of the report being published. 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.