We carried out this inspection over three days on the 25, 26 January and 02 February 2017. The first day of the inspection was unannounced.Church View Nursing home is registered to accommodate and provide nursing care to up to 43 people. If the twin rooms were used for single occupancy, 36 people could be accommodated. On the day of our inspection, there were 34 people living at the home. Church View Nursing Home has bedrooms on the ground and first floor. All rooms have en-suite facilities. A passenger lift is available for people with mobility difficulties. There is a communal lounge and dining area on each floor with a central kitchen and laundry room.
In May 2015, a comprehensive inspection identified the service was not meeting a number of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because care was not consistently delivered in a safe and effective way and there were not always enough staff to effectively meet people's needs. In addition, quality auditing systems were not identifying shortfalls in the service. We issued four warning notices to the provider, as a result of the concerns we identified and the service was rated as inadequate. The service was placed into special measures. Special measures provides a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
In October 2015, we completed a focussed inspection to ensure improvements had been made. We found the provider had taken the immediate action necessary to improve the service. Another comprehensive inspection was undertaken in March 2016. Not all improvements had been sustained and further shortfalls were identified. Insufficient improvement had been made to enable the service to come out of special measures. As a result of this, we imposed a condition on the home’s registration. This required the provider to undertake regular monitoring of the service and inform us of their findings.
The registered manager who was in post at the last inspection, left the company in October 2016. A new manager was recruited and started employment shortly after the previous manager left. This manager was available throughout the inspection and was in the process of registering with the Care Quality Commission, to become the registered manager. In addition to the manager, two senior managers including the Director of Operations and a supporting manager, were present during the inspection.
During this inspection, clear improvements had been made to the service. The manager and senior managers had taken the home “back to basics” and were confident the service was now safe, with effective leadership. Time was required to embed the changes and further work was being undertaken to offer care, which was more person centred. There had been additional training to develop staff’s knowledge and more sessions were planned. Staff had been given an area of specialism, such as end of life care, which they were in the process of developing. Focus was being given to recruitment, to minimise the use of agency staff.
New systems and processes had been implemented. This included a comprehensive range of audits and on-going monitoring. The audits were working well and clear action plans were in place to ensure any shortfalls, were appropriately addressed. However, some aspects of service provision had not been identified as requiring additional focus. This included ensuring those people, who did not have the capacity to make certain decisions, were appropriately supported in line with the principles of the Mental Capacity Act 2005. After the inspection, the manager sent us documentation to show arrangements had been made for mental capacity assessments and best interest meetings to be undertaken.
A range of meetings had been introduced to ensure staff were fully informed and aware of their responsibilities. Staff felt well supported and were appreciative of the improvements, which had been made.
Improvements had been made to the management of risk and people’s safety. This was particularly apparent in the monitoring of people’s food and fluid intake. There were assessments, which identified potential risks and what action was required to manage them. However, one person was given an ‘ordinary’ meal at lunch time, when they required a soft diet. This increased the risk of them choking. Another person was prescribed a thickener for their drinks but this was not stated on their care plan. Clear focus had been given to the management of people’s skin and the prevention of pressure ulceration. Records showed effective management of any wounds.
The planning and delivery of care had been improved upon. People looked comfortable and well supported although one person had stained clothing and another had fallen asleep over their breakfast. Staff had not provided these people with the support they needed. Care plans had been updated and were generally reflective of people’s needs. However, information about continence and the care people wanted, whilst nearing the end of their life, lacked detail. This gave staff limited information about people’s needs in these areas.
Improvements had been made to the management of people’s medicines. However, there had been two errors in November 2016, where people had been given the wrong dose of their medicines. In addition, a relative stopped a member of staff from administering a dose of insulin, when it had already been given. All errors were appropriately managed although it was clear that staff had not followed procedures, for the errors to have occurred.
There were sufficient staff available to meet people’s needs. The numbers of staff required during the day and night had been reviewed and amendments made. Consideration had been given to the deployment and skill mix of staff. Staff confirmed additional staff were deployed or the manager worked “on the floor” to assist, when required. Staff answered call bells and undertook people’s requests, in a timely manner. They went about their work without rushing.
People told us they liked the food and had enough to eat and drink. There were positive comments about the quality and variety of food. Focus was given to those people at risk of losing weight. People told us they felt safe and liked the staff. Established relationships had been built and staff spoke about people with fondness. Staff gave people time and interacted in a friendly, caring and attentive manner. People’s rights to privacy and dignity were maintained.
We found one breach in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we required the provider to take at the end of this report. However, due to the overall improvements which had been made, the service has been removed from special measures.