Background to this inspection
Updated
15 April 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
One Inspector carried out the inspection over two days.
Service and service type
Church View is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
Day one of the inspection was announced and the second day was unannounced.
Inspection activity started on 27 January 2022 and ended on 16 February 2022. We visited the location on 27 January 2022 and 16 February 2022.
During the inspection
We spoke with four people who used the service about their experience of the care provided. We spoke with eight members of staff including the registered manager. We reviewed a range of records. This included three people’s care records and three medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We spoke with one relative about their experience of the care provided. We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke to one professional who visits the service regularly.
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
Updated
15 April 2022
About the service
Church View is a residential care home providing personal care to three adults at the time of the inspection. People live in one large house which has been adapted. The service can support up to eight adults with learning disabilities and/or a variety of associated health and support needs. At the time of inspection there were three further people who lived at the service, who were not receiving personal care.
People’s experience of using this service and what we found
There were not always enough staff to support people’s needs outside the one-to-one support hours. Staff were not always trained sufficiently, and recruitment had not always been fully robust. People were not supported by effective governance systems and processes. Medicines were not always managed safely. People received their medicines on time and as prescribed. However, medicines administration records (MAR) were not always legible and an unexpected drop in the daily medicines count for one medicine had not been identified by the service.
The provider did not always ensure support was provided by staff wearing the correct personal protective equipment (PPE). Immediate action was not taken to update the infection prevention and control (IPC) policy or to put in place an IPC audit.
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
Based on our review of safe and well-led the service was not able to demonstrate they were meeting some of the underpinning principles of Right support, right care right culture. The lack of governance systems and oversight meant physical risks had not all been identified, this meant people were taking risks that they had not had choice over. People had opportunity to regularly share their views. Staff worked well with other professionals to help identify and meet people's needs.
Right Support
People and relatives told us staff supported people to take part in activities and pursue their interests in their local area. People had a choice about their living environment and were able to personalise their rooms.
Right Care
The service and provider did not have systems in place to fully monitor the quality and safety of the service. This meant they had not identified areas of concern we found on this inspection. Where appropriate, staff encouraged and enabled the person to take positive risks. However, not all physical risks for the person had been assessed.
People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. One relative said ‘[person] is happy there’.
Staff promoted equality and diversity. They understood people’s cultural needs and provided culturally appropriate care. Staff told us about one service user who was supported by staff to share a special cultural celebration with their relative through a window visit, when the home was unable to accept visitors.
People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs.
Right culture.
Staff placed people's wishes, needs and rights at the heart of everything they did. One professional told us the service was, “Very person centred and reactive to the resident’s needs”. People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. Staff turnover was very low, which supported people to receive consistent care from staff who knew them well.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was outstanding (published 29 February 2020).
Why we inspected
We initially undertook this inspection as part of CQC's response to the COVID-19 pandemic. 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. This included checking the provider was meeting COVID-19 vaccination requirements. We also asked the provider about any staffing pressures the service was experiencing and whether this was having an impact on the service.
On the first day of our inspection we identified concerns in relation to infection prevention and control. As a result, we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
The overall rating for the service has changed from outstanding to requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe and well led sections of this full report.
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 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 will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to safe care and treatment of people, good governance (leadership and oversight of the service), and staffing at this inspection.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.