The inspection took place on 19 February 2018 and was unannounced. Our last inspection was in July 2017 where we identified four breaches of the legal requirements. These related to medicines, risk management, dignity and respect, person-centred care and governance.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions, Safe, Effective, Caring, Responsive and Well-led to at least ‘Good’. At this inspection, we found that the provider had taken action to meet the legal requirements in all these areas. We found improvements to medicines management and risk assessments. There were also improvements to staff training and leadership at the home. People’s care was planned in a more person-centred way and the provider had found ways to involve people and relatives in the improvements that had been made.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Church View Care Home 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.

Church View Care Home accommodates up to 78 people across three separate units, each of which have separate adapted facilities. The provider is registered to provide nursing care to people living at the home. People living at the home had physical disabilities, long term medical conditions and most people were living with dementia. At the time of our visit, there were 39 people living at the home.

There was a registered manager in post who had joined since our last inspection and had recently registered with CQC. 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 were supported by trained staff that knew them well. Staff were kind and caring and took time to interact with people. Staff routinely involved people in their care and ensured that where people had specific preferences, these were addressed. Care was planned in a person centred way and care plans reflected people’s needs, wishes and routines. Staff responded appropriately to any changes in people’s needs and where any complaints had been raised, these had been investigated and addressed.

The provider had a plan to improve and develop the service. Actions had beenne taken in response to our findings at previous inspections and an ongoing plan to improve the service was underway. People, relatives and staff were involved in the running of the service. People’s wishes were taken into account when developing the service. Staff had regular meetings where they could make suggestions to improve people’s care. Staff benefitted from regular one to one supervision that was used to identify and address any training needs.

We received mixed feedback about the food on offer at the home. The provider had taken action to address this and had involved people and relatives in changes to the menu. People’s nutritional needs were met and people had access to healthcare professionals whenever this was required. Staff managed and administered people’s medicines safely. Where people had specific clinical needs, these were met by trained nurses that had ongoing support to maintain their competencies.

There were improve

Church View provides accommodation with nursing for up to 78 older people, some of whom were living with dementia. The home is purpose built and set over three floors with six units each containing their own communal lounge and dining areas. At the time of our inspection there were 59 people living at the service.

The inspection took place on 26 July 2017 and was unannounced.

There was no 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 registered manager had left the service shortly after our last inspection. An interim manager had been appointed and consideration was being given to their appointment and registration on a permanent basis. The interim manager and general manager supported us during our inspection.

At our previous inspection on 17 and 18 October 2016 continued breaches of legal requirements were found and we took enforcement action against the provider and registered manager. We issued a warning notice in relation to the governance of the service. In addition we found breaches of the regulations in relation to unsafe care, staff training and supervision, staff not following the principals of the Mental Capacity Act, a lack of safe person-centre care and a lack of respect and dignity shown towards people. Following the inspection the provider submitted an action plan to us to tell us how they planned to address these concerns.

We inspected the service again on 6 and 9 February 2017 and found that although improvements had been made in some areas they had not taken sufficient action to meet the warning notice. We identified continued breaches of the regulations in relation to safe care and treatment, person centred care, protecting people's legal rights, staff deployment, the support of staff and good governance. The service was placed into special measures. The provider submitted regular action plans to update us on the progress they were making in meeting the breaches identified. At this inspection we found that improvements had been made regarding the staffing levels in place, training and supervision of staff and meeting the principles of the Mental Capacity Act. However, continued breaches relating to safe care and treatment, dignity and respect, person centred care and good governance were identified. As a result of this Church View remains in special measures.

People’s medicines were not always administered safely by competent staff. Staff continued to administer medicines following competency assessments showing gaps in their knowledge and practice. Safe medicines were not practiced by some staff and guidance provided regarding the administration of covert medicines was not always followed. Risk assessments regarding people’s nutritional needs were not always effective in ensuring they received safe care. Monitoring forms regarding people’s nutritional intake were not monitored and action was not always taken when people’s weight fluctuated significantly.

Improvements were seen in the way people received their care although individual staff members were seen to treat people with a lack of respect. Staff were not always aware of people’s backgrounds and preferences and staff were observed to speak to people in a disrespectful manner.

People’s care plans were not always updated when their needs changed. This was a particular concern for people who were receiving end of life care. Activities provided were not always appropriate to the ages of the people living at Church View and people were left for long periods without social interaction from staff.

Auditing systems to monitor the quality of the service were in the process of being implemented although were not always effective

Church View provides accommodation with nursing for up to 78 older people, some of whom were living with dementia. The home is purpose built and set over three floors with six units each containing their own communal lounge and dining areas. At the time of our inspection 72 people were living in the home.

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 and associated Regulations about how the service is run.

At our inspection on 30 September 2015 we found breaches of two of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take action in relation to risk assessment and poor moving and handling techniques and assessing and monitoring the quality of the service provided. We last inspected Church View on 17 and 18 October 2016. Continued breaches of legal requirements were found and we took enforcement action against the provider and registered manager. We issued a warning notice in relation to the governance of the service. In addition we found breaches of the regulations in relation to unsafe care, staff training and supervision, staff not following the principals of the Mental Capacity Act, a lack of safe person-centre care and a lack of respect and dignity shown towards people. Following the inspection the provider submitted an action plan to us to tell us how they planned to address these concerns. We carried out this inspection to see if the provider had taken action in line with the warning notice and their action plan. Although we found that improvements had been made in some areas they had not taken sufficient action to meet the warning notice. We identified continued breaches of the regulations in relation to safe care and treatment, person centred care, protecting people’s legal rights, staff deployment, the support of staff and good governance.

Since 2015 there has been a lack of managerial and provider oversight of the service to make the improvements required and to recognise and take action when concerns remain. Audits and quality assurance processes were not systematic and not effective in identifying shortfalls in the care provided. There was a lack of leadership and learning from the registered manager and provider. The effect is that people continue to experience times when staff are not always caring, respectful or responsive towards them.

People were not always treated with care and compassion. Staff were observed to treat people without kindness and people’s dignity was not always respected. There was a lack of empathy and understanding shown by some staff. We did see some examples of positive and caring interactions between people and the staff supporting them.

Risks to people’s safety were not always effectively assessed and there was insufficient guidance provided to staff to enable them to provide people’s care safely. There was no clear guidance to staff on how to support people to manage their anxiety and behaviours. The advice of professionals involved in people’s care was not always consistently followed. In other areas we found improvements in the way risks were managed, including pressure care and routine moving and handling.

Sufficient staff were not always deployed to meet people’s needs. Staffing levels determined by the provider were consistently met although we found in one unit there were insufficient staff to support people during the lunchtime period. Staff received supervision and appraisal although staff concerns were not always appropriatley addressed. Staff received training to support them in their role. However, we found that this was not always effective in ensuring people received person centred care.

People’s legal rights were not always p

Church View Care Home is a care home which provides accommodation and nursing care for up to 78 older people, some of whom are living dementia. At the time of our inspection there were 75 people who lived there. The home is purpose built and set over three floors, with a lift to all floors. The home is divided in to six units with a variety of communal areas including lounges, dining rooms, and quiet areas.

The inspection of Church View took place on 17 and 18 October 2016 and was unannounced. This inspection was to follow up on actions we had asked the provider to take following the last inspection to improve the service people received.

At the time of our visit 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.’

At our previous inspection on 30 September 2015 we found breaches of two of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take action in relation to risk assessment and poor moving and handling techniques and assessing and monitoring the quality of the service provided. The provider sent us an action plan and provided timescales by which time the regulations would be met. They stated that the actions would be completed by 30 November 2015.

During this inspection we found that some improvements had been made. However, they were not sufficient enough to meet the requirements of the regulations. A further five breaches were also identified.

Risk assessments for some risks were in place; however we noted that there were inconsistencies in the recording of risks associated with people. Not all risks had been identified, assessed and managed to minimise the risk of harm to people. This meant that people were placed at risk of harm as appropriate guidance and best practice was not always followed. Since the inspection the registered manager has informed us that risk assessments are now in place and equipment has been purchased that should mitigate the risks for two people.

Staff did not have a clear understanding of Deprivation of Liberty Safeguards (DoLS) or the Mental Capacity Act (MCA) 2005 or their responsibilities in respect of this. Mental capacity assessments and DoLS applications had not been fully completed in accordance with current legislation.

Staff were not always competent to meet people’s needs and the support they received had not always been appropriate to ensure they worked to the expected standards. Since the inspection the registered manager has informed us that additional training has been organised. We will assess the information and how staff are using this in practice to care for people at the next inspection.

People had enough to eat and drink throughout the day and night, however there were concerns that not everyone received the support they needed or that those at risk of dehydration were supported.

People were supported to have access to healthcare services and healthcare professionals to support their wellbeing. The service worked effectively with health care professionals and referred people for treatment when necessary. However, where people had specific health care needs these had not been taken into account when planning the care or identifying what support they needed. There were inconsistencies in the monitoring of people’s health and support needs.

There were inconsistencies in the way staff involved and treated people with compassion, kindness, dignity and respect. People’s preferences, likes and dislikes were not always being taken into consideration and support was not being provided in accordance with people’s wishes.

People’s preferences, likes and wishes were not alwa

The inspection of Church View Care Home took place on 30 September 2015 and was unannounced.

Church View Care Home is a care home which provides accommodation and nursing care for up to 78 older people, some of whom are living dementia. At the time of our inspection there were 74 people who lived there. The home is purpose built and set over three floors, with a passenger lift to all floors. The home is divided in to six units with a variety of communal areas including lounges, dining rooms, and quiet areas.

At the time of our visit 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.’

People were supported by staff that had the necessary skills and knowledge to meet their assessed needs. However during the inspection we identified a concern around how competent staff were when moving and handling people safely in and around the home. Staff did not always adopt best practice in the use of moving and handling people safely around the home.

Risk assessments in place, however we noted that there were inconsistencies in the recording of risks associated with people using bed rails, covert medicines and developing pressure sores. This meant that people were placed at risk of harm as appropriate guidance and best practice was not always followed.

There were quality assurance systems in place, to review and monitor the quality of service provided, however they were not robust or effective at correcting poor practice.

People told us they felt were safe at the home, one person told us, “I feel safe here and the girls look after me and I do not have to worry about anything.” Staff had a good understanding about the signs of abuse and were aware of what to do if they suspected abuse was taking place.

Recruitment practices were safe and relevant checks had been completed before staff commenced work and we found that there were enough staff to safely support people and help keep them safe. Staff worked within good practice guidelines to ensure people’s care, treatment and support promoted a good quality of life. People received their medicines when they needed them and the administration and storage of them were managed safely. Any changes to people’s medicines were prescribed by the person’s GP.

Staff had basic understanding of Deprivation of Liberty Safeguards (DoLS) or the Mental Capacity Act (MCA) or their responsibilities in respect of this. Mental capacity assessments and DoLS applications had not been fully completed in accordance with current legislation. We made a recommendation to the provider to review their documentation in line with current legislation.

People had enough to eat and drink throughout the day and night and there were arrangements in place to identify and support people who were nutritionally at risk. People were supported to have access to healthcare services and were involved in the regular monitoring of their health. The home worked effectively with healthcare professionals and was proactive in referring people for treatment.

Staff involved and treated people with compassion, kindness, dignity and respect. People told us, “The staff are very caring here because they like their job and they are nice people.” People’s preferences, likes and dislikes had been taken into consideration and support was provided in accordance with people’s wishes. People’s relatives and friends were able to visit. People’s privacy and dignity were respected and promoted. Staff told us they always made sure they respected people’s privacy and dignity when providing personal care.

The home was organised to meet people’s changing needs. People’s needs were assessed when they entered the home and on a continuous basis.

People told us if they had any issues they would speak to the staff or the registered manager. People were encouraged to voice their concerns or complaints about the service and there were different ways for their voice to be heard. Suggestions, concerns and complaints were used as an opportunity to learn and improve the service provision.

People had access to activities that were important and relevant to them. People were protected from social isolation with the activities, interests and hobbies they were involved with. Staff supported people with their interests and religious beliefs in their local community. Religious services were conducted weekly at the home.

The provider actively sought, encouraged and supported people’s involvement in the improvement of the service. People’s care and welfare was monitored regularly to make sure their needs were met within a safe environment. The provider had systems in place to regularly assess and monitor the quality of the service provided.

People told us the staff were friendly and management were always visible and approachable. Staff were encouraged to contribute to the improvement of the service. Staff told us they would report any concerns to their manager. Staff told us the managers of the home were very good and supportive.

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

We visited Church View Care Home to see if they had made improvements following our previous visit on 18 and 19 February 2014. During that visit we identified a number of concerns which related to the care and welfare of people who used the service and management of medicines.

We saw that people received care and welfare that met their needs. A person who used the service told us “They are very good, they know what I want and need and I get it.” A social care professional told us that in their opinion Church View had “greatly improved in regards to the care and welfare of the residents, they had definitely turned a corner.” The manager and staff we spoke to were able to describe specific needs of individuals and how they met those needs.

We found that people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We carried out this visit on 10th September 2013 to check if improvements had been made following our last inspection in July 2013. During this September visit we spoke in detail with five people who lived at the service, and carried out observations and discussions over the lunch period. We made observations throughout the day about how people were being cared for. We interviewed three relatives about the home and about the day to day lives of residents, many of whom had dementia.

We checked if staff gained people's consent before they supported them, and we were told that they did. People told us they were well looked after, and comments on the care at this home included "Staff are very good. I wouldn't want to live anywhere else." Most people commented positively on the meals, and responses to this question included "The food is cooked well, and is fresh. There are other choices, and they do me a nice salad".

Residents and relatives made a number of positive comments about the availability and competency of staff and described them as "Very nice indeed" and told us "Carers are very good. They seem to know what they are doing." We asked people if there were sufficient numbers of staff to help them when they needed it, and the majority of comments were positive.

We found that all but one of the shortfalls from the previous inspection had been remedied, with staff training as the only area where work was not yet fully completed.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care.

They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector and joined by a practising professional.

We spoke to three people who used the service who told us that they liked living at the home. One told us that the staff “Look after me quite well” and that the care was “Not too bad.”

We also spoke to two relatives who told us that they were very happy with the care provided. One relative told us that they thought that staff were “Lovely” and that the food was “Good”. Another told us that the care was “Pretty good.”

Relatives we spoke to said that they thought that there were sufficient staff to meet peoples needs. One person who used the service told us that "Staff were busy".

We carried out a follow up visit to Church View Care Home on 18 and 19 February 2014. We wanted to review improvements related to care and welfare, and medicines administration, as these had outstanding compliance actions from the previous visit in November 2013. During this follow up visit in February 2014 we also reviewed complaints management. The compliance inspector was accompanied by a specialist nurse advisor, and by a CQC pharmacist inspector.

We spoke with eight residents and/or their relatives in some detail during this visit, and with other relatives before and after the visit. We interviewed a visiting GP, and we also made observations in three dining rooms over the lunch period, speaking with small groups of residents whilst they were having their meal.

There were a number of positive comments made to us about the home and these included "They keep the place very nice", "Staff are very good", and "I'm quite happy here."

We also noted a number of improvements since the previous visit, and these included more social activities provision, improving the home's emergency procedures, and dealing with complaints. However, we found more work was needed in relation to medicine's management and care and welfare, specifically related to care records. In addition, we were made aware of a number of complaints, some of which related to staffing levels and staff deployment within the home.