Archived: Church View

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.

Church View was a large home, originally a domestic dwelling and reflected similar house styles and designs within the local area. Church View was registered before the Registering the Right Principles were adopted. The service supports up to eight people, and seven people were in residence at the time of our inspection. This is larger than best practice guidance. However, the size of the service having a negative impact on people was mitigated, as the house size and style reflected the surrounding residential area. There were deliberately no identifying signs, intercoms, cameras or anything to indicate it was a care home.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best outcomes that include control, choice and independence.

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

We asked a family member to share their views about Church View, told us. “I really think it’s an outstanding place. It’s structured and forward thinking, enabling each resident to move on and expand.”

People were consulted and fully involved in decisions affecting them both individually and collectively, their safety was paramount. People were aware of safety measures in the home, which included their understanding of safeguarding. Potential risks were robustly assessed, and people worked in partnership with staff to understand and minimise risk.

People were at the heart of the comprehensive assessment process and were provided with opportunities to visit and stay at Church View before deciding whether the home was the right place for them. The registered manager and staff worked closely with family members, and social care commissioners as part of the assessment process.

The registered manager and staff consistently applied the principles and values of Registering the Right Support and other best practice guidance. People were supported by staff who accessed a wide range of training, which enabled them to meet people’s needs and had a positive impact on people.

People’s comments and our observations reflected the positive impact staff had on people’s well-being, due to the trusting relationships that had developed between people and staff. Staff were committed to developing a homely and supportive environment in which people could flourish, feel safe and be supported.

Staff worked in partnership with people to develop and review their support plans. Support plans reflected people’s aspirations and goals. They provided clear guidance for staff as to their role in supporting people to live an independent life as possible, and to be active and an involved member of society. People took part in social and recreational pursuits and continued their education and voluntary work. People were encouraged and supported to develop and maintain relationships.

Church View was exceptionally well led by a dedicated registered manager who was passionate about the people who lived at the home. The culture and ethos within the service was that of transparency, inclusivity and empowerment. The governance of the service was robust, and quality outcomes were kept under continual review by the registered manager and nominated individual.

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 3 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Church View is registered to provide care and support for up to eight people with a learning disability who present behaviours which challenge. At the time of our inspection there were eight people using the service. Church View is a converted residential property which provides accommodation over three floors. Communal areas are located on the ground floor; bedrooms are all single occupancy with en-suite facilities. There is an accessible garden to the rear of the service. The service is located within a residential area with nearby shops and community facilities.

The overall rating of good, which was awarded following the CQC's previous inspection of 1 and 2 June 2015, was displayed along with a copy of the inspection report in the hallway. At this inspection we found the service was now to be 'Outstanding'.

Church View had a registered manager. 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 about how the service is run.

People told us they felt safe at Church View and that they had information about who to contact if they had any concerns. People understood potential risks and the ways in which their safety was promoted from an environmental perspective. People took an active part in the promotion of their personal safety and welfare and, where necessary, were supported by staff on a one to one basis.

People told us their rights and opinions were listened to and they were aware of the measures necessary to promote their safety, where their behaviour became challenging. Staff had a positive approach to risk taking. People’s rights and choices were promoted with staff following clear guidelines reflective of the training they had received and people’s individual needs to reduce the potential of risk. This positive approach to risk taking meant people were able to lead fulfilled lives and seek new opportunities.

People living at Church View were aware of safeguarding and had information so they could report concerns independent of staff. Staff were trained in safeguarding (protecting people who use care services from abuse) and knew what to do if they were concerned about the welfare of any of the people who used the service Medicine was safely managed in the home by staff who had received training and who had their competency to administer medicine regularly assessed.

Staff underwent a robust recruitment process, which involved people living at Church View having a say as to which staff to appoint. Staff induction was comprehensive to ensure staff had the necessary knowledge before they supported and cared for people. Staff had access to training, which was regularly reviewed and reflected changes in good practice guidance, which enabled them to meet people’s needs. Staff were committed to the rights of people and actively worked with them to promote independence, as detailed within the staff’s codes of conduct. Staff received on-going supervision and appraisal which ensured they worked to the standard expected by the registered manager to ensure people received a high quality service.

People spoke positively about the meals. We saw and open and inclusive approach between people living at the home and staff, in the shopping, preparation and cooking of meals. People living at the home viewed Church View as their home, which was reflected by offering visitors and staff, food and drink. People’s dietary needs were met and people were supported to go out so that they could enjoy food at a range of eateries.

People were aware of their health care needs and were supported by staff to make and attend appointments. We received positive feedback from a person’s relative and we heard how staff responded to people’s changing health care needs. This included how staff liaised with relevant health care professionals to promote people’s health and well-being.

People living at Church View were extremely positive about the approach of staff towards their care and support. People’s comments and our observations evidenced the positive impact this had on people’s well-being as a result of the trusting relationships that had developed between them and staff. Staff were committed to the promotion of people’s rights and supported people to celebrate their diversity. This included encouraging people to attend events held within the wider community for people with a lifestyle of their own who had shared interests. People were actively involved in the development and reviewing of their care plans. These reflected people’s individual goals and aspirations, and records and discussions reflected these were being achieved.

People's needs were comprehensively assessed and care plans gave clear guidance on how people were to be supported. Care was personalised so that each person's support reflected their preferences. We saw that people were at the centre of their care and found clear evidence that their care and support was planned with them and not for them. Each person had an 'All about me' record which had been drawn up with them and provided a clear picture of everything about the person including their needs, wishes, fears and aspirations. People were supported and encouraged to have strong links with the local community. This included attending arts and social events which included an invitation from the local Bishop to attend a garden party.

People were involved in the day to day running of their home and were encouraged to comment and influence how the home operated. People’s views were actively sought and they had elected someone living at the home to be their representative. People had a comprehensive understanding of a range of people inside and outside the home they could contact should they have any concerns. This was actively promoted and encouraged by the registered manager and staff.

Church View was exceptionally well led by a dedicated registered manager who was passionate about the people who lived at the home. The culture and ethos within the service was that of transparency and empowerment. This was achieved by encouraging people’s involvement and ensuring they had access to information which supported and promoted their equality, diversity and human rights. Best practice guidelines were followed and all staff were committed to the vision and values of the service. They had a comprehensive understanding of the legislation and policies that underpinned their approach to people’s care and support.

A robust quality assurance system meant the quality of the care people received was continually kept under review. This enabled on-going plans for further development of the service to be identified and planned for. All aspects of quality monitoring, which included the role of external agencies in monitoring quality, were known. Reports carried out by external agencies were shared with those living at the home and staff. This further supported the open, transparent and inclusive approach of the registered manager.

Some people told us that they were unhappy about how some other people using the service treated them, we looked at incident logs and these showed that there were many incidents which should have been reported to safeguarding to be investigated and then for the service to receive extra support for people with behaviour that challenges.

We were told that there were enough staff for people using the service to be able to access the community safely and when they wanted to. We looked at rotas and saw that staff were employed in sufficient numbers to support people as their plans indicated but there no first aider on each shift to ensure that should an injury occur it could be dealt with promptly.

We looked at the records for the service and these were accurate, people using the service told us that they were involved in reviewing their plans and keeping them up to date.