The Churchley Rest Home Limited

The Churchley Rest Home provides accommodation and personal care for up to 18 older people with a variety of care and support needs, in one adapted building. Some people are living with dementia. At the time of the inspection, the home was full.

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

People were involved in all aspects of the home and their views were listened to. However, one person told us they did not want to continue to live at the home and wished to return to their own home. They had been assessed as having capacity to make this decision, but staff were reluctant to allow the person to leave as they felt they would be unsafe living on their own. People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their bests interests; the policies and systems in the service did not support this practice.

People felt safe living at the home and their risks were identified, assessed and managed well. One person said, “I feel very safe and I like it here”. Staff had been trained in safeguarding and knew how to protect people from harm. Staffing levels were sufficient to meet people’s needs and new staff were recruited safely. Overall, medicines were managed safely, although the audit concerning medicines was not completely effective, as two medicines which should have been disposed of were still in the refrigerator. This is an area in need of improvement.

People and their relatives felt the home was well-managed and care was of a high standard. Referring to the registered manager, one person said, “She does a good job. She doesn’t interfere a lot, but she’s got her eye on things”. Feedback from people was encouraged. Staff felt supported by the management team and enjoyed working at the home. Audits had not identified the areas of concern found at this inspection.

The home was clean and smelled fresh. Staff used disposable aprons and gloves to prevent the risk of infection.

Before people came to live at the home, their care and support needs were identified and assessed. People’s needs were continually reviewed and monitored. Staff completed a range of training that enabled them to support people effectively; staff had regular supervisions.

People enjoyed the food on offer and had a choice of menu. One person said, “There’s one main meal. Staff quickly get used to what you don’t like and they provide you with something else”. People had access to a range of healthcare professionals and services.

People told us they were well treated by kind, compassionate and caring staff. One person said, “Staff are very nice, they really are. I haven’t come across one who wasn’t”. A relative told us, “Staff know people well. They know when people don’t feel so good and they give them more attention”. Staff encouraged people with their independence. One person said, “Staff help you with anything you do have difficulty with”. People were treated with dignity and respect and encouraged to be involved in decisions relating to their care.

Care was personalised and people’s likes, dislikes and preferences were recorded and catered for. A range of activities was planned and people were supported to participate in activities of interest to them. People enjoyed the activities on offer. One person said, “There’s singing and exercises. People come and entertain us. There’s musicians. They play us tunes and we have a sing-song; it’s fun. It’s enough to keep you from being bored”.

People’s communication needs were met. Families and friends were encouraged to visit people at the home. If people or their relatives had any complaints, these were listened to and acted upon.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at the last inspection

The rating at the last inspection was Good (published 22 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the Safe and Effective sections of this report. You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

Follow-up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Churchley Residential Home is located in Hove. It is registered to accommodate a maximum of 18 people. The home provides support to older people who may need assistance with their personal care and support needs. The home is a large detached property, spread over three floors. On the day of our inspection there were 15 people living at the home.

The service provider was also the manager of the home. Registered providers have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. We carried out an unannounced comprehensive inspection on 5 November 2015. Breaches of legal requirements were found. This was because we identified concerns with regard to inappropriate storage of medicines, medicines administration, gaps in medication records, no guidance for staff with regard to ‘as and when required’ medicines and the lack of a risk assessment for a person who administered their own medicines. In addition to this there were concerns with regard to the frequency in which people, who were at risk of malnutrition were weighed, the lack of food and fluid charts to monitor peoples’ intake and the lack of oversight with regard to peoples’ weight loss and risk of malnutrition. Further concerns related to the lack of audits and quality assurance processes to enable the provider to have sufficient oversight of the systems and processes within the home to ensure their effectiveness. Some policies had not been updated to reflect current practice and the provider had not submitted notifications to CQC to inform us of events that had occurred within the home. Following the inspection the provider wrote to us to say what they would do in relation to the concerns found. At this inspection, although improvements had been made, and the provider was no longer in breach of the regulations, one improvement had not yet been implemented or embedded in practice and therefore this is an area of practice needing further improvement. This related to quality assurance processes to ensure that the service people received was effective and met their needs.

The home was the only home owned by the provider and the management team consisted of the provider and a deputy manager. The home had a warm, friendly and relaxed atmosphere. The provider welcomed feedback and used this to drive improvement and change. There were quality assurance questionnaires to gain peoples’ feedback. People, relatives and staff were complimentary about the leadership and management of the home. One person told us “X is exceedingly kind and hands on”. When asked about the leadership and management of the home, a relative told us, “We have a good relationship; they’re very friendly and caring”. Staff were equally positive, they told us, “They’re easy to approach, it is run like a family home, it is lovely” and “It is managed very well, I can go to the management they are very approachable. It is a family-orientated, friendly home”. People were able to make their concerns known, the provider had a complaints policy informing people, and their relatives, of how to make a complaint.

People were protected from harm and abuse. There were sufficient quantities of appropriately skilled and experienced staff who had undertaken the necessary training to enable them to recognise concerns and respond appropriately. Peoples’ freedom was not unnecessarily restricted and they were able to take risks in accordance with risk assessments that had been devised and implemented. People told us that they felt safe. Comments included, “I feel perfectly safe here, they’re nice kindly people. I can’t ask for more” and “I didn’t feel safe in my own home, I like living here. I’m not nervous anymore”. People received their medicines on time and according to their preferences, from staff with the necessary training and who had their competence assessed. There were safe systems in place for the storage, administration and disposal of medicines. One person told us, “They bring me my medication, I would never remember. X tells me if there are any changes to my medication”.

People were asked their consent before being supported and staff had a good awareness of legislative requirements with regard to making decisions on behalf of people who lacked capacity. People and their relatives, if appropriate, were fully involved in the planning, review and delivery of care and were able to make their wishes and preferences known. A relative told us, “Six days after my relative was admitted we had an hour long meeting with X to plan their care”. Care plans documented peoples’ needs and wishes in relation to their social, emotional and health needs and these were reviewed and updated regularly to ensure that they were current.

Staff worked in accordance with peoples’ wishes and people were treated with respect and dignity. It was apparent that staff knew peoples’ needs and preferences well. Positive relationships had developed amongst people living at the home as well as with staff. People and relatives told us that staff were kind, caring and compassionate and our observations confirmed this. One person told us, “I really feel quite cherished here by people. I was somewhere else first but was not happy. I’ve been happy here from day one”. Another person told us, “They make me feel important”. A third person told us, “The staff are very kind and thoughtful, they bend over backwards”. People had access to meaningful activities and the risk of social isolation was minimised.

People’s health needs were assessed and met and they had access to medicines and healthcare professionals when required. One person told us, “They’re in touch with my doctor all the time. X normally takes me to any appointments”. People had a positive dining experience and told us that they were happy with the quantity, quality and choice of food. One person told us, “The food is very good here. I eat more in a day here than I did in a week at home. I have put on weight since I’ve been here”. Another person told us, “I’m awash with tea and coffee”.

Below is a summary of what we found. The summary describes what people who used the service and the staff told us, what we observed and the records we looked at. If you want to see evidence supporting our summary please read the full report.

Is the service safe?

We found care plans were kept up to date and reviewed on a regular basis. There were individual risk assessments in place that were reviewed and ensured that people who used the service were safe.

People we spoke with told us they felt safe at the home and they were treated with dignity and respect.

We found that there was a risk assessment in place to ensure that the environment was safe for staff to work within and for people who used the service. There was a system in place for staff to report any incident and learned from concerns raised to ensure the safety of people who used the service.

The Care Quality Commission is required by law to monitor the operations of Deprivation of Liberty Safeguards (DoLS). While no applications had been submitted, appropriate policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

We found during our inspection the service was effective. People who used the service were involved in the process of their assessment and aware of their care and treatment to be delivered by the service.

People who used the service had control over their lives, and were able to give valid consent to the care treatment they received.

Staff were supported, trained, supervised and received annual appraisals. They were encouraged to further develop their career and given opportunities to attend various relevant courses.

Is the service caring?

People we spoke with and their relative told us the following: : 'I feel safe here and I can speak to the manager and staff if I have any concern about my care', 'I am made fully aware if there is anything wrong with mum's health and they are very good at getting the doctor in early', 'It is a privileged to be here and I am well cared for', 'The home has a lovely atmosphere, food is good, manager is excellent what more do I want?'.

We found that staff were courteous, treated people with respect and supported them in maintaining their dignity.

Everyone had a personalised care plan that was reviewed on a regular basis hence ensured that the care and treatment they received were appropriate to their needs.

Is the service responsive?

We found that the service was responsive. There was a range of activity on offer at the home. We saw displayed pictures of various events during the year where people who used the service had taken part. Some people we spoke with told us that they always look forward to the quiz event. Others preferred the bingo session; some liked the art and singing sessions.

We found that the provider had a system in place to deal with comments and complaints. People felt that their views were taken into consideration and acted upon accordingly.

Is the service well-led?

We found during our inspection that the service was well led. We saw outcome of survey carried out by the provider to both people who used the service and their relatives. We found that there was an overall positive response about the quality of service delivered. There was evidence of the manager having responded to people's comment made in survey in a timely fashion.

We saw that the home had various audit tools in place to ensure that the quality of service delivered was maintained to a good standard and safe.

Staff we spoke with told us that they well supported by management and were able to express their views and concern that they had and were listened to.

During this inspection we spoke with six people who used the service and one of their relatives. We also spoke with three staff members; these were the registered manager and two care workers.

The people we spoke with told us they were happy with the staff team and the care they had received. One person told us, "I'm as happy as I can be.' Another person told us, 'They look after you well and I've got no complaints.'

Staff we observed had an understanding of the support needs of people who used the service and were confident about meeting those needs. We found that the documentation used for care planning had been reviewed recently, was detailed and person centred.

During our inspection we looked at staffing rotas and observed levels of staffing. We also spoke with staff members and people who used the service. We saw that the service had enough qualified, skilled and experienced staff to meet people's needs at all times.

Records showed that people's care needs had been assessed, planned, reviewed and delivered in line with their individual care plan. Everyone spoken with said that their care and support needs were fully met.

People were supported to access medical treatment and fully supported with all their healthcare needs. A relative commented, 'They are very efficient dealing with healthcare and contacting Dr's'. Someone else said, 'They are very good. They take you to all your appointments'.

Recruitment procedures were robust. People who used the service said that staff provided them with all the support and assistance that they needed and wanted. Comments included, 'They look after you well' and 'They are very caring'.

The service was very clean and good standards of hygiene were maintained.

There were systems in place to identify, assess and manage risks to people who used the service. People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

One person told us 'The staff are absolutely lovely'.

Another person told us 'This is a marvellous place, the staff are first class.' and "They are lovely to me, I have no complaints."

Another person told us "This place is perfect, no complaints at all."

People had access to health care professionals when needed and had received their medicines as prescribed and intended.

Appropriate identity and security checks had been completed as part of the recruitment process for all staff. Care workers were experienced and had the skills and support they needed to do their job well.

The records needed for the management of the home had been maintained and were accurate and complete. People had been given the opportunity to give their views on the running of the home and felt they had been listened to.