Churchill House

Churchill House is a residential care home providing personal care to up to 24 people in 1 adapted building. The service provides support to younger and older people, some of whom are living with dementia. At the time of our inspection there were 22 people using the service.

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

Safety checks of the premises and equipment were not always routinely carried out.

We have made a recommendation in relation to reviewing the maintenance / environmental safety check programme.

People received care and support, however, staff did not always have time or availability to offer any meaningful engagement.

We have made a recommendation in relation to systems to support appropriate staffing levels.

Medicine were safely ordered, stored and administered and regularly reviewed by healthcare professionals.

People had support from safely recruited staff. Staff received training in safeguarding and understood their role and responsibilities to protect people from abuse.

Quality monitoring systems were in place which helped to check various areas of the home. Any actions identified were carried out to make sure the service was continually improving.

Care plans included risk assessments for known risks and staff followed support plans to help keep people safe. Care plans were up to date and were regularly reviewed. People were happy with the care they received, they felt safe and well looked after.

Staff had positive links with healthcare professionals which promoted people's wellbeing. Records confirmed the manager worked in partnership with stakeholders.

We found the manager to be open and responsive to feedback. Visiting healthcare professionals told us that the management team and staff worked well with them.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 1 April 2020) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection the provider had evidenced some improvements in line with their action plan and was no longer in breach of regulation, however further improvements were required.

At our last inspection we recommended that the provider reviewed and updated their practice for ‘as and when’ required medicines. At this inspection we found the provider had acted on the recommendation and made the improvements to documentation relating to ‘as and when’ required medicines.

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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.

The overall rating for the service has remained requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Churchill House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Churchill House is a care home which is registered to provide accommodation and personal care to 24 younger and older people, some of whom may be living with dementia. At the time of our inspection, 22 people lived at the service.

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

Quality assurance systems had not identified and addressed all quality shortfalls.

People’s medicines were managed safely, though records were not always up to date. We have made a recommendation about medicines.

People were kept safe by appropriate numbers of knowledgeable staff with the relevant skills and experience to meet people’s needs. Staff supported people to access healthcare services and followed professional advice. People’s dietary needs were met and people were provided with a varied and heathy diet.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Appropriate records were not always in place where people lacked capacity. We have made a recommendation about recording decisions.

People’s rooms were personalised, and signs were used to help people find their way around. Activities were available for people and visitors were welcome at any time.

Staff were caring, friendly, helpful and maintained people’s dignity and promoted their independence.

Concerns and complaints were investigated and addressed to help ensure people were happy with the service provided. People and staff were included in the development of the service and staff were supported by the management team.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 29 January 2019) and there were two breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, enough improvement had not been made and the provider was still in breach of regulations. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in relation to the monitoring and addressing of quality shortfalls at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

At the last inspection, in September 2017, we rated the service as Requires Improvement. The provider was in breach of Regulation 11 HSCA (Regulated Activities) Regulations 2014. The provider had not consistently acted in accordance with the Mental Capacity Act 2005 (MCA) in relation to when people were unable to give consent because they lacked capacity. They had also not consulted with the local authority when there was the possibility some people met the criteria for a Deprivation of Liberty Safeguard (DoLS). We asked the provider to complete an action plan to show what they would do and by when, to improve the key question effective to at least good.

During our current inspection, we found improvements had been made. The provider had followed the principles of the MCA and people had DoLs in place. We found the provider had been compliant with this regulation. However, we found issues with recording in this area, and one DoLS application had been overlooked, which we refer to in the well-led section. We found new concerns including a lack of effective systems to monitor the safety and quality of the service provided and safe care and treatment.

Churchill House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Churchill House accommodates up to 24 older people in one building. Bedrooms are situated over two floors which are accessible via a lift and stairs.

There was a registered manager in post. 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.

The home was generally clean and tidy, however we found some minor issues. We saw cleaning taking place, although records to confirm this, had not been kept up-to-date. There were some issues with the safety and maintenance of the environment. Staff had not had recent fire drills and water temperatures had not been monitored, to ensure these were safe.

We found two people without appropriate bed rail protectors on one side of their bed. The risk assessment for bed rails had not been detailed enough to consider how risk would be mitigated. We found another person was missing a risk assessment for the use of bed rails.

The registered manager acted promptly when we told them about these concerns and most were addressed during the inspection or shortly afterwards. However, the quality monitoring system needed to be more robust, to ensure checks of the environment highlighted areas of risk so these could be addressed quickly. Other areas of the quality monitoring system also required development.

People did not always receive their medicines safely. We found one person’s creams had not been applied as prescribed and guidance was missing for two ‘as and when required’ medicines, also known as PRN.

Systems were in place to recruit staff safely. However, the providers recruitment policy had not always been followed which led to some shortfalls. We also found following disciplinary action, there was a lack of records to show how one staff members skills had been monitored, to ensure they continued to be competent for the role.

Staff protected people from avoidable harm, were knowledgeable about safeguarding and able to raise concerns. They supported people to meet their nutritional and healthcare needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. We found staff were aware of the MCA and followed its principles.

Staff were equipped with the necessary skills to provide effective support. They knew people well and how best to communicate with them.

Staff were caring and friendly. We observed positive interactions from staff. They supported people to maintain their independence and treated them with dignity and respect.

There was a lack of meaningful activities provided for people. The registered manager told us about plans to improve this. We recommend that the provider follow through with these plans, to ensure appropriate and meaningful activities for people living with dementia are provided.

Staff were knowledgeable about people’s needs, which meant support was provided in a person-centred way. People had care plans in place which reflected their needs.

People told us they felt able to raise any issues or concerns. The provider had systems in place to manage and respond to any complaints.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment and good governance. You can see what action we told the provider to take at the back of the full version of the report.

Churchill House is registered to provide accommodation and personal care for a maximum of 24 people. At the time of the inspection, there were 20 people using the service. Churchill House is close to local amenities and bus routes into Hull city centre; there is a car park at the rear of the property. There are two sitting rooms, one of which has a designated dining area at one end. All bar one of the bedrooms are for single occupancy and there are sufficient bathrooms and toilets on each floor which are close to communal areas.

The service 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.

We found that staff knew how to gain consent for day to day care activities with people. However, when people lacked capacity to make their own decisions the provider had not always worked within the law and best practice guidelines. Mental capacity assessments had not always been undertaken and decisions made in people’s best interest regarding restrictions placed on them had not been recorded. A deprivation of liberty safeguard (DoLS) application had been made for some people but not for all people that met the criteria. This meant some people may be deprived of their liberty unlawfully. The registered manager told us applications for people this applied to would be made to the local authority straight away. You can see what action we have asked the provider to take at the back of the full report.

We found some areas of the environment that required attention to make sure risk was minimised for people who used the service. The registered manager acted promptly when we told them about these issues and most were addressed during the inspection or shortly afterwards. However, the quality monitoring system needed to be more robust to ensure checks of the environment highlighted areas of risk so these can be addressed quickly. We have made a recommendation about this.

We saw there were some activities for people to participate in but these did not meet everyone’s needs. We have made a recommendation about this.

We found staff knew how to safeguard people from the risk of abuse and they knew who to refer any concerns. Staff had completed safeguarding training. Staff also completed risk assessments to help minimise the risk of accidents and incidents occurring. There were plans in place to guide staff should they need to evacuate the building in emergency situations.

Staff were recruited safely with employment checks carried out before they started work. There were sufficient staff on duty although they were busy. The registered manager was recruiting additional care staff, a deputy manager and an activity coordinator to complement the staff team.

We saw the staff approach was kind and caring which was confirmed in discussions with people who used the service. People told us their privacy and dignity were respected and they were able to make choices and decisions for themselves.

We found people’s health needs were met by access to a range of community health care professionals. Communication between staff and the health professionals was good. Medicines were managed safely and people received them as prescribed.

People told us they liked the meals provided to them and menus evidenced choices and alternatives were available. The support provided to people by staff at mealtimes was appropriate to their needs.

Staff had access to training, supervision and support. This enabled them to feel skilled and confident when delivering care to people. The training records indicated the courses staff had completed and when updates were due. There were training plans for the next few months.

The provider had a complaints procedure and people told us they would complain if required. Everyone spoken with said they did not have any complaints.

We found the environment was clean and tidy. Staff had equipment to use to prevent and control the spread of infection and cleaning schedules were in place. Equipment used, such as moving and handling items, was maintained and serviced appropriately.