Churchill House

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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

This is the first assessment for this service. This key question has been rated requires improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of 2 legal regulations in relation to safe care and treatment of medicines and consent to care and treatment.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff raised incidents and accidents through the provider’s digital system. This was reviewed by the manager who completed any actions and referrals required. Details of actions taken along with any outcomes were available to review within the system. This included the outcome of any safeguardings raised. Staff and relatives felt the care and support provided to people was safe. A member of staff told us, “Yes, safe care here”. One relative told us, “Yes, safe care and support”. The provider used a quality monitoring system to review incidents and actions taken, when required.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People’s care plans contained information such as when referrals and appointments had been made and attended. People were supported to attend appointments such as dentist, GP and optician appointments. Most feedback was positive regarding people attending appointments however, feedback was provided that 1 person had missed 2 separate appointments. We shared this feedback with the service and the local authority so they could review this and take any action needed.

The provider was not always ensuring they worked with people and healthcare partners to ensure people’s care and support was provided in the least restrictive way possible. For example, we found the provider needed to make improvements to ensure people had important information within their care plan to confirm their mental capacity. This was because some people lacked capacity to make decisions about their care and support. There was limited information within some people’s care plans including any mental capacity assessments or best interest decisions undertaken. This included where people lacked capacity with their finances, medical appointments, and the environment where they lived.

During our inspection, we found people were always being supported to access the community with staff support. Staff were also supporting some people to access communal areas of the service including the kitchen and their bedrooms or flat with a key fob. There were no authorised agreements to support these arrangements or restrictions. We raised this with the providers quality team during our inspection and they took action to remove some people’s locks on their room and to review this within a risk assessment framework.

We received mixed feedback during our inspection from 2 people’s relatives. One relative raised a concern regarding how the person was being supported by staff with their finances. They felt improvements could be made to how staff were supporting them. Another relative raised concerns about how staff were supporting the person with medical appointments. We shared this information with the manager and the provider’s quality team so they could review how these people were being supported with their care and support.

In response, the manager confirmed they had requested a review of each person’s care needs from the person’s funding authority.

Although the provider’s quality assurance system had identified improvements were needed to some people’s mental capacity assessments, best interest decisions and other associated authorisations. we found actions were still required during this inspection. We raised these shortfalls with the manager and the provider’s quality assurance team, and we also raised the information with the local authority.

Staff had a good knowledge of how to identify abuse and who to raise concerns with. The provider had a quality assurance system that ensured safeguarding concerns were documented, including any actions taken. Where safeguarding concerns were raised through referrals, outcomes were documented within the provider’s quality assurance system.

The manager and support staff knew people well. Although we found some improvements were needed to people’s individual risk assessments and daily documentation. This was to demonstrate people’s risks, care and support was being managed and provided safely and as required.

People’s care plans contained important information such as how to support the person with their daily routine, care and support and any nutritional needs. Although we found some improvements were needed to ensure all people had an updated risk assessment and care plan following the changes made to staffing overnight and them accessing their rooms and communal areas of the service. This included where people were accessing their rooms and the kitchen area. Improvements were also needed to people’s daily documentation and the support provided to people overnight. We raised this with the manager and the provider’s quality team so they could review what actions were required to improve this documentation.

Comprehensive guidance was within people’s support plans to support them with their epilepsy and any positive behavioural needs. Risk assessments were in place for any dietary needs including any risk they had of choking.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The provider undertook health and safety checks within the service. This included identifying any improvements within the service such as to the garden area, the kitchen and if any electrical checks were needed or required. People had personal evacuation plans in place and a detailed description of them should this be needed in the event of an emergency.

People were not always supported by staff who had training to ensure they were suitability skilled and qualified to support people with their individual needs. Although people were supported by a regular staff team that consisted of agency staff and staff employed by the service, improvements were needed to ensure all staff were up to date with their training and the staffing arrangements overnight.

For example, we found people being supported regularly during the night by a member of staff who was on a sleeping shift. Staff confirmed they were supporting people at various times during the night. Documentation we reviewed confirmed this. We raised our concerns to the providers management team during our inspection. The provider undertook immediate action to ensure people were supported by a member of staff who was awake during the night. Staff we spoke with after these changes had been made all confirmed this action had been taken.

Staff received supervision although we found some improvements were needed to ensure all staff had received mandatory training required for their role. For example, some staff needed to undertake re-fresher training in epilepsy. We raised this during our inspection and action was taken following our inspection to provide staff with this training. We also found people were being supported with their care by agency staff. We were not assured these staff had received suitable training to enable them to support people with their individual needs. For example, training relating to epilepsy, positive behavioural support and had completed mandatory training to support people with a learning disability and autism. We raised this with the manager and the provider’s quality assurance team so they could review what training agency staff required and ensure that they completed this.

Staff received medicines administration training and competency reviews. All staff had completed the care certificate. The Care Certificate is an identified set of standards that health and care professionals adhere to in their daily working life. The provider had suitable recruitment arrangements that ensured staff had satisfactory checks undertaken before working in the service to confirm they were safe to support vulnerable people. The manager confirmed all staff were due this year’s annual appraisal.

The provider was not always ensuring arrangements were in place to prevent the risk of infection. For example, some staff were not following the provider’s dress code and appearance policy as they were wearing acrylic nails which can spread infection. The provider’s quality assurance system had identified improvements needed although we found action was still needed during our inspection. We shared this feedback with the manager who confirmed actions had been taken.

People were supported by staff who received training in how to use personal protective equipment safely. Staff had access to personal protective equipment.

The provider did not ensure people’s medicines were being managed safely. For example, we found shortfalls in the documentation of the management of medicines, guidance for staff in where to apply topical creams and where topical creams posed a flammable risk.

The provider’s quality assurance system had identified some shortfalls such as to ensuring medicines were being documented as required and shortfalls in the documentation of temperature checks for medicines. However, the governance around medicines management was not effective as these actions were still needed during our inspection. We identified shortfalls where 1 person needed a body map for their topical cream, and where risk assessments were needed for emollient creams that posed a flammable risk. Medicines had not been documented as being opened and therefore needing to be disposed of. Medicated toothpaste was not always being signed as being administered. During the inspection action was taken to ensure risk assessments were completed for emollient creams that posed a fire risk and staff had guidance on where to apply topical creams.

Although we identified shortfalls in the management of medicines, there was a positive learning culture within the service around the management of medicines. This included reviewing medicines incidents so improvements could be made.