This unannounced inspection took place on 1 December 2016. At the last inspection of this service in October 2015, we made recommendations for the service to make improvements in order to have suitable arrangements in place for obtaining and acting in accordance with the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The provider was required to appoint a suitable manager to manage the service.

At this inspection, we found that the service had a registered manager in place. 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 this inspection we also found that staff had attended training in the MCA and DoLS. At this inspection, we found that improvements had been made to the systems, to ensure that people received care and support in line with the MCA and DoLS.

Churchfields Nursing Home is registered to provide accommodation and nursing care for up to 32 older people, some of whom are living with dementia. At the time of this inspection, 28 people were using the service. Accommodation is arranged over two floors and there is a lift to assist people to access the upper floor. There are 31 single bedrooms and one double room, which two people can choose to share.

Staff understood their responsibilities to protect the people in their care. They were knowledgeable about how to protect people from abuse and from other risks to their health and welfare.

Medicines were managed and handled safely. Arrangements were in place to keep people safe in the event of an emergency. There were sufficient staff to meet people’s needs. Staff were attentive, respectful, patient and interacted well with people. People told us that they were happy and felt well cared for. Risk assessments were in place about how to support people in a safe manner.

Staff undertook training and told us that they received supervision to support them to carry out their roles effectively. Staff training records showed they had attended a variety of training.

People were supported to maintain good health. They had access to health care services when it was needed. People received a nutritionally balanced diet to maintain their health and wellbeing.

People’s needs were assessed before they moved in to the home. Care plans were person centred and were regularly reviewed. Care plans were updated when people’s needs changed.

The provider had systems in place to monitor the service provided and people were asked for their feedback about the quality of service provided.

This unannounced inspection took place on 7 October 2015. At the last inspection of this service in October 2014, we found breaches of legal requirements. This was because people were not safeguarded against the risk of abuse and were not protected against risks associated with medicines. The registered person did not have effective systems in place to monitor the quality of service delivery. They also failed to maintain accurate records in respect of each person who used the service. Care plans and risk assessments were not regularly updated and reviewed when people’s needs changed. The service did not have suitable arrangements in place for obtaining and acting in accordance with the Mental Capacity Act 2005 and the Deprivation of Liberty safeguards. The service’s recruitment practices required improvement and suitable arrangements were not in place to support staff working at the home. The provider wrote to us and told us about changes they planned to make to meet the regulations. They said they would make changes by June 2015. These included, improving the service’s quality monitoring systems, provision of training on safeguarding people, implementing a comprehensive medicines audit system to ensure the safe administration of medicines.

Churchfields  Nursing Home is registered to provide accommodation and nursing care for up to 32 older people, some of whom are living with dementia. At the time of this inspection, 28 people were using the service. Accommodation is arranged over two floors and there is a lift to assist people to access the upper floor. There are 31 single bedrooms and one double room, which two people can choose to share.

The service did not have a registered manager in place, however the provider had identified another person to manage the home.  A deputy manager had been in charge of the home since the last inspection. 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 this inspection, we found that some improvements had been made. Staff understood their responsibilities to protect the people in their care. They were knowledgeable about how to protect people from abuse and from other risks to their health and welfare. Medicines were managed and handled safely. Arrangements were in place to keep people safe in the event of an emergency.

There were sufficient staff to meet people’s needs. Staff were attentive, respectful, patient and interacted well with people. People told us that they were happy and felt well cared for. Risk assessments were in place about how to support people in a safe manner.

Staff undertook training and told us that they received supervision to support them to carry out their roles effectively. Staff training records showed they had attended training in Mental Capacity Act (2005) and Deprivation of Liberty Safeguards. However, improvements were needed to the systems in place to ensure that people received care and support in line with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People were supported to maintain good health. They had access to health care services when it was needed. People received a nutritionally balanced diet to maintain their health and wellbeing.

People’s needs were assessed before they moved in to the home. Care plans were person centred and were regularly reviewed. Care plans were updated when people’s needs changed.

The service did not have a registered manager but appropriate interim arrangements were in place. The service had not been consistently well managed but people were positive about the changes and improvements that were now taking place.

The provider had systems in place to monitor the service provided and people were asked for their feedback about the quality of service provided.

At the last full inspection of the service in August 2013, the home were found to be non compliant with Regulation 21 Requirements relating to workers. However, they met the regulation at a subsequent follow up inspection carried out in March 2014. CQC carried out an inspection of this care service on 21 October 2014. This is a summary of what we found.

Churchfields Nursing Home is registered to provide accommodation and support with personal care and nursing for up to 32 older people including people who are living with dementia. Accommodation is arranged over two floors and there is a lift to assist people to access the upper floor. There are 31 single bedrooms and one double room, which two people can choose to share. There were 29 people living at the home at the time of our inspection.

The home’s registered manager left the service in October 2013. Therefore they did not have a registered manager in post at the time of this inspection. We were informed that an interim manager had been appointed and it was their first day in the post, on the day of the inspection. They had made an application to register with the Care Quality Commission to register to manage the home. 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 staff on duty knew the people they were supporting and the choices they had made about their care and their lives. People who used the service told us that they were mostly happy with the care provided by the staff. People described staff as kind, helpful and caring. However, they told us that they and their families had not been included in planning and agreeing to the care provided. We found that some people’s needs had not been continuously assessed or their care plans updated as their needs changed. People’s choice and dignity, in terms of personal care needs had not always been respected by staff. This meant people did not always receive support in the way they needed it.

People told us that they felt safe in the home. However, during the inspection we found that staff training, knowledge and understanding of safeguarding people was not up to date. People were not fully protected against the risks associated with medicines because proper procedures for the storage, disposal and administration of medicines were not in place.

Sufficient recruitment procedures were not followed before staff began to work at the home. Applicants attended an interview to assess their suitability, however recruitment records showed that appropriate pre-employment checks had not been carried out prior to them starting work. Training was not delivered by trainers who were specialists in their fields of knowledge. There was a lack of a consistent and thorough supervision and appraisal system for staff at the service. This meant that people were not cared for by staff who received effective training, support and guidance to enable them to meet their assessed needs.

People were happy with the choice of food provided. Their dietary needs were met in a way which promoted and maintained their health and well-being. They had been included in planning menus and their feedback about the meals in the home had been listened to and acted on.

People were able to see their friends and families when they wanted. All the visitors we spoke with told us they were made welcome by the staff in the home.

People’s views about the service provided were not consistently sought. Monitoring of the service had not been effective and timely in identifying where improvements were needed. This meant the quality monitoring processes were not effective as they had not always ensured that people received care and treatment that met their needs.

You can see what action we told the provider to take at the back of the full version of this report.

When we last inspected the service, in August 2013, we found that recruitment procedures were not effective. For example, two references were not always obtained before staff began work. People were at risk of receiving support from staff who were not suitable. We asked the provider to make improvements.

On this visit we found that changes had been made. Records showed that the provider had undertaken all the required checks before staff started work. People were supported by staff who were suitably qualified, skilled and experienced.

People and their relatives were positive about the service. One person said 'I can't find a fault with it. I enjoy living here.' People said they were treated with respect by staff and they were cared for safely and effectively. Relatives told us they had been involved in planning and reviewing people's care to ensure the service met their needs. We saw evidence that the service had involved health professionals such as the GP and the tissue viability nurse to ensure that any risks to people's health were minimised. There were systems in place to monitor the quality of the care people received. When we inspected the service in March 2013 we found that there was not always sufficient staff on duty. Since then the provider has recruited staff. On this visit there was enough staff to meet people's needs. A person told us 'there are regular staff who know you and if you want a little word with them you can.' However, we were concerned that the provider had not undertaken all the required pre-employment checks to ensure the suitability of new staff. We have asked the provider to take action to ensure that their recruitment process is safe and effective.

People were treated with respect and their care and welfare needs were being met. People who used the service and their relatives said they were happy with the service and staff were “very friendly”, and responded quickly when they rang their call bell. They told us they were getting the care and help they needed. There were systems in place to ensure that people received their prescribed medication safely.

People were accommodated in an environment that was appropriately maintained and suitable for their needs. Specialised equipment was available to assist people with mobility difficulties and equipment and services were serviced regularly and checked to ensure that they were in good working order and safe to use.

We found that there were not always enough qualified, skilled and experienced staff to meet people’s needs and this placed people at risk of receiving an unsafe or inappropriate service.

With the exception of one person who did not want to be at the service people told us that they were happy there. They also told us that staff were kind, gentle, caring and helpful. People told us that they could choose what and where they wanted to eat and where they spent their time. One person said that the proprietor came and asked her about the service and if there were any problems. A relative said that the service was very good and the community matron said that she was happy with the service.