We carried out an unannounced inspection of Church View Nursing Home on 29 & 30 April 2015. Church View Nursing Home provides accommodation and personal care for up to 40 people, some of whom may be living with a dementia. The service provides nursing care. At the time of the inspection there were 33 people accommodated in the home.
Accommodation is provided on the ground floor. There is a separate self-contained unit for those people living with a dementia. Both units have their own lounge and dining area. There are gardens and a car park for visitors and staff. The home is situated in a quiet residential area in Accrington and close to local amenities.
There was a registered manager in day to day charge of the home. 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.
During this inspection visit we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to ineffective quality assurance and auditing systems, failure to follow safe medicine procedures, failure to follow safe infection control procedures and failure to maintain a safe and suitable environment.
At the previous inspection on 30 April and 1 May 2014 we found the service was not meeting the regulation in relation to safe management of medicines. We asked the provider to take action to make improvements. During this inspection we found some improvements had been made but the registered provider was still not meeting the regulation. Whilst we found elements of safe practice we also found aspects of the ordering, administration and disposal of people’s medicines could result in mishandling or error. You can see what action we told the registered provider to take at the back of the full version of the report.
Prior to our inspection visit there were concerns regarding ineffective infection control systems and we were told areas of the home were not clean. During our visit we found a number of areas that presented a risk of infection that had not been noted as part of the ‘audit’ systems. They included unclean areas, torn seating and offensive odours. Cleaning schedules were in place and most staff had received appropriate training in infection control but policies and procedures had not been updated to reflect good practice. You can see what action we told the provider to take at the back of the full version of the report.
Prior to the inspection visit we were told the environment was ‘shabby’ and ‘poor’. During a tour of the home we found all areas had been redecorated but a number of areas were in need of attention to ensure the environment was safe, appropriate and comfortable for people to live in. The service did not have a development plan which meant it was difficult to determine how the home would be improved. People told us they were happy with their bedrooms and some had created a homely environment with personal effects such as furniture, photographs, pictures and ornaments. We noted the environment was not well designed for people living with dementia. For example areas were not easily recognisable and carpets were highly patterned and more could be done to provide stimulation for people walking around. We have made a recommendation about further staff training on the subject of dementia. You can see what action we told the provider to take at the back of the full version of the report.
The number of shortfalls we found indicated quality assurance and auditing processes had been ineffective. Due to current staffing vacancies the registered manager was covering additional nursing, deputy and administrative hours. Changes in the management structure had resulted in limited monitoring and support from the registered provider to ensure the registered manager was achieving the required standards in the day to day running of the home. Checks on systems and practices had been completed by the registered manager but matters needing attention had not always been recognised or addressed. This meant the registered providers had not identified risks to make sure the service ran smoothly. You can see what action we told the provider to take at the back of the full version of the report.
During our visit we observed staff responding to people in a kind and friendly manner and being respectful of people's choices. Staff were seen to knock on people’s doors before entering and doors were closed when personal care was being delivered. We saw people were dressed smartly and appropriately in suitable clothing. However, over the two days of our inspection visit we also noted examples of people’s dignity not being respected in respect of their clothing and personal hygiene. We discussed this with the registered manager at the time of the inspection. We made a recommendation that staff practice was closely monitored with regards to ensuring people were dressed and presented in a dignified manner in line with their preferences recorded in their care plan.
People told us they enjoyed the meals although they were not routinely offered a choice of meal at lunchtime. They told us, “I enjoy my meals; I always get enough to eat” and “We don’t know what we are getting until it is served; we wait and see. It’s usually very nice.” The meals were served hot, looked appetising and the portions were ample. The atmosphere was relaxed and staff chatted amiably to people throughout the meal. Care records included information about people’s dietary preferences and any risks associated with their nutritional needs and appropriate professional advice and support had been sought when needed. We made a recommendation that people were made aware they could always have a choice of meal.
Environmental risk assessments were in place and kept under review and individual risks had been assessed and recorded in people’s care plan to help ensure their safety. We noted there had been a number of reported incidents between people living in the home. We found individual assessments were not always in place to help identify any triggers or guide staff how to safely respond. In addition most staff had not received training in this area. We made a recommendation about providing training and guidance to support staff to respond appropriately and safely to behaviours that challenge the service.
From our discussions with staff and from looking at two individual training records and the training matrix, we found staff had been provided with a range of training to give them the necessary skills and knowledge to help them look after people properly. Staff had access to a range of policies and procedures although some needed to be reviewed to reflect current safe guidance. We noted some gaps in the provision of supervision for staff. There was a plan however for regular one to one supervision of staff which would help identify any shortfalls in their practice and the need for additional training and support.
We found a safe and fair recruitment process had been followed for staff and appropriate checks had been completed before they began working for the service. However, there were no records to confirm agency nursing and care staff checks had been completed by the service. Checks would help determine whether they were suitable and qualified to work in the home. We were told all agency staff received an informal basic induction. However, we could not find any records to support this. We made a recommendation the service satisfied themselves that agency staff were suitable and qualified to work in the home and records of this and of their basic safety induction were maintained.
We found there were sufficient numbers of nursing, care and ancillary staff to meet people's needs although the service was reliant on agency and bank nursing staff during the day. The registered manager told us they were actively trying to recruit permanent staff. Staff spoken with considered there were sufficient staff and told us any shortfalls, due to sickness or leave, were covered by existing staff, bank staff or agency staff. People said, “Staff are lovely” and “Staff are very good. There are enough of them but they get a bit busy to talk to us.”
During the inspection we observed people were comfortable around staff and did not show any signs of distress when staff approached them. In both units we observed staff interaction with people was kind and patient. People told us, “They do their best; I get well looked after” and “Staff are very good; I get the care I need”. A visitor said they were happy with the care their relative received but would speak up if needed. Thank you cards included positive comments such as ‘thank you for the lovely care and kindness’.
Staff had received appropriate safeguarding vulnerable adults training, had an understanding of abuse and were able to describe the action they would take if they witnessed or suspected any abusive or neglectful practice. Staff had received training about the Mental Capacity Act 2005 (MCA 2005) and Deprivation of Liberty Safeguards (DoLS). The MCA 2005 and DoLS provide legal safeguards for people who may be unable to make decisions about their care. We noted appropriate DoLS applications had been made to ensure people were safe and their best interests were considered. We made a recommendation that any conditions made under DoLS were recorded clearly in the records.
People’s healthcare needs were considered as part of ongoing reviews and records had been made of healthcare visits, including GPs, district nurses and the chiropodist. We found the service had good links with other health care professionals and specialists to help make sure people received prompt, co-ordinated and effective care.
Each person had a personal care plan which included information about the care and support they needed, their likes, dislikes and preferences and routines. The care plans had been updated by staff and a visitor told us they were kept up to date and involved in decisions about care and support. However, people living in the home told us they were not aware of their care plan and had not been involved in the review of their care which could result in them not receiving the care they needed and wanted. We made a recommendation about the importance of involving people in ongoing reviews of care.
People were supported to take part in a range of suitable activities, both inside and outside the home. On the first day of the inspection we heard laughter and friendly banter during a game of dominoes in the lounge and on the second day there was much chatter and conversations about the new curtains in the dementia unit lounge.
There was a complaints procedure in the hallway advising people how to make a complaint and how and when they would be responded to. People were encouraged to discuss any concerns during meetings and day to day discussions with staff and management and also as part of the annual survey. People told us they felt confident they could raise any concerns with the staff or managers. One person said, “I just let the manageress know if I have a problem and she will sort it out”. A relative said, “I speak to the manager if I have any concerns and am listened to.”