Churchview Care Home is registered to provide accommodation and personal care for 30 older people, some of whom may be living with dementia. The home is a detached property which has been extended since it was built. It is situated in the village of Great Coates close to Grimsby. On the day of the inspection there were 20 people using the service.

We undertook this comprehensive inspection on the 15 December 2016. At the last inspection on 7 and 8 December 2015 we found the registered provider was in breach of two of the regulations we assessed. We issued requirement notices for concerns around the management of risks to people’s safety and shortfalls with the governance systems in place.

During this comprehensive inspection we found improvements had been made in all areas so that the overall rating for the service is now 'Good'. We have kept the rating for ‘Caring’ as Good and changed the rating in the individual domains for ‘Safe’, ‘Effective’, ‘Responsive’ and ‘Well- led’ to Good, because of the improvements made.

The service had 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.

We found improvements in the way the service was managed. The quality monitoring system had been reviewed and strengthened. The registered manager had more oversight and involvement in the day to day running of the service and people who used the service and staff benefitted from the organisational changes. Staff confirmed morale had improved.

We found risk assessments were completed more accurately and updated when people’s needs changed. This enabled staff to protect people’s safety and minimise risk more effectively.

Improvements had been made throughout the service with redecoration, refurbishment and everywhere was clean and fresh.

People told us they felt safe living in the service. We saw staff interacting with people and they did so in a kind, caring and sensitive manner. Staff showed good knowledge of safeguarding procedures and were clear about the actions they would take to protect people. People’s medicines were stored safely and administered as prescribed.

Overall, we saw there was enough skilled and experienced staff on duty to meet people’s needs. Following the inspection the operations director confirmed they had reviewed the deployment of staff ensuring staff breaks were properly planned and communal areas were monitored more effectively. An additional member of staff would be provided at tea-times.

We found staff were recruited safely although some documentation could be improved regarding the decisions made. For example, when there were issues on disclosure and barring service checks but employment still went ahead.

Staff had received a structured induction and essential training at the beginning of their employment. This had been followed by regular refresher training to update their knowledge and skills. Staff told us they felt supported by the registered manager and confirmed they had received formal supervisions and appraisals of their work.

We found staff ensured they gained consent from people prior to completing care tasks. They worked within mental capacity legislation when people were assessed as not having capacity to make their own decisions.

People told us they were supported by kind and caring staff who knew their preferences for how care and support should be delivered. During observations it was clear caring relationships had been developed between the people who used the service and staff. People’s privacy and dignity was respected by staff who encouraged people to be independent and make choices and decisions in their daily lives.

People’s needs had been assessed before they m

The inspection was carried out by one inspector over one day. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with staff and relatives, and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Observations during the day showed that there were periods of time when staff were not available in the communal rooms. Also, some of the practices we observed during the day in terms of availability of staff at mealtimes and the lack of one to one time, could be attributed to lack of organisation of the shift. The provider identified the lack of staff availability during the visit and took action to increase the staffing numbers. This ensured safer care and supervision.

People had their medicines managed well so that they received them on time and as prescribed.

Risk assessments and behaviour management plans ensured staff had guidance to support people when they had behaviours that could be challenging to themselves, other people and the service. Although we found these were not always followed.

We found the provider could be more effective at identifying, assessing and managing risks related to the health, welfare and safety of people who used the service. Information in audits was not always used to manage risks related to people who used the service.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring risks to the health, welfare and safety of the people who use the service are properly assessed and managed.

Is the service effective?

People were asked for their consent prior to care and support and were asked for their views about activities of living on a daily basis. Care records we viewed showed consideration of the Mental Capacity Act 2005(MCA). Mental capacity assessments were carried out and best interest meetings held when people lacked capacity and important decisions were required.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager was arranging to discuss specific people who used the service with the local authority to gain advice about the need for applications, in light of a recent Supreme Court Judgement about DoLS.

There were gaps in the staff training and development programme as some staff had not received updates to their essential training. We also found training had not been provided for staff to inform them how to safely manage behaviours that may challenge the service, even though some of the people who used the service regularly demonstrated these behaviours. From observations during the day and discussions with members of staff we found that some staff were not confident with this aspect of care.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring staff are properly trained and supported in meeting people’s needs confidently and safely.

Is the service caring?

People were supported by kind staff. Although we saw that staff showed encouragement and patience when supporting people, some of the care support was disjointed and levels of engagement when interacting with people with dementia required improvement.

People’s preferences, routines, likes and dislikes had been recorded and staff demonstrated they knew the people who used the service well. We observed some positive interaction between staff and people who used the service.

Relatives spoken with were happy with the care provided to people. They told us they could visit at any time.

Is the service responsive?

People's health and care needs were assessed and plans of care were in place. However, people’s care plans had not always been updated when their care needs changed. We also found that care was not always personalised, had not been consistently provided and that there was a lack of supervision at times.

People had access to a range of health and social care professionals such as GPs, psychiatrist, dieticians, speech and language therapists, social workers, dentists, opticians and podiatrists. There was evidence the staff team sought appropriate advice, support and guidance both routinely and during emergency situations.

We received mixed comments from visiting health professionals during the visit. Some told us they had to direct staff on improvements to their care practices which staff had then maintained. Other visiting professionals found the consistency of recording and staff feedback when they visited could still be improved.

Staff responded to people’s dementia care needs. They provided visual choices for people in order for them to make decisions about, for example, meals and clothes. Improvements could be made in the provision of activities, social stimulation and aspects of personalised support.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to monitoring personal care tasks and meeting people’s changing needs.

Is the service well-led?

There was a quality monitoring system in place that consisted of audits and the seeking of people’s views but we found it had not been wholly effective in some areas.

The new manager had been in post four days at the time of the visit. Discussions with the provider during the inspection confirmed that senior level support would be provided for the manager on a regular basis. This would facilitate a positive induction, ongoing direction and guidance with the improvement programme.

The service worked in partnership with key organisations, including the local authority and safeguarding teams, to support care provision and service development.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to monitoring the quality of the service provided.

What people who used the service, and those that matter to them, said about the care and support they received: -

The people we spoke with said staff respected their decisions and included them in the planning of their care. One person told us, “I generally have the same routines, but staff always ask how I would like to be helped.”

A relative told us they were kept informed about their relation’s wellbeing and had their views sought as their member of family lacked capacity to make decisions for themselves.

People we spoke with were satisfied with the care they received. Comments included, “The carer’s are very good, they look after us”, “Very good care, I’m happy with everything” and “I am well looked after here.”

Relatives said they were very happy with the service. Comments about health care included, “I am very pleased with all aspects of my husband’s care, but they do seem to forget his nails,” “The care here is very good, they always call the GP and keep me informed of any changes”, “I find the care excellent; my relative is happy and I have no concerns.”

People who used the service and their relatives were complimentary about the staff team. They commented on the friendliness of the staff and we observed staff talking to people in a kind and respectful way. Comments about the staff included, "The girls are very good and kind; do anything for you” and “Excellent staff, they couldn't be better." One relative told us, “My wife isn’t able to speak but she always smiles when the staff approach her, she clearly likes them and feels safe.”

Care and treatment was planned and delivered in such a way that was intended to ensure people’s safety and welfare. We saw members of staff explained activities and tasks to people. Staff acknowledged people’s gestures and expressions if they were unable to communicate verbally. One person told us, “The staff are very good with people, especially those who can’t talk, they still try to find out what they want to do.”

People’s care plans showed that a variety of health professionals were involved with their care. The four care plans we reviewed showed people received regular care from the district nurse team. One member of staff told us, “We know the district nurses quite well now and I think there is a good working relationship.”

We saw medication was stored in a locked trolley which was secured to the wall of the dedicated medication room on the first floor.

Each person’s care file contained an assessment of their ability to administer medication themselves and maintain their independence in this area. Records showed these assessments were reviewed monthly.

We found the building had been maintained effectively. The standard of decor was good. Fixtures and fittings were of a high standard. The home was warm and comfortable. One person said, “It’s really nice here.”

We reviewed the staff rotas. We saw all shifts for the next month had been covered. People looked relaxed in the company of the staff. One person said, “The staff are good, very nice girls.”

People told us they had made a positive decision about moving into the home. People told us they were “Very comfortable” and were able to spend time in their rooms when they wanted, to ensure their wishes for privacy were respected.

We found there was a pleasant and welcoming atmosphere throughout the service on the day of our visit, which we observed was inviting and homely. We saw that people who used the service looked clean and well cared for and that staff interacted with them in a caring and positive way. We observed that staff spoke sensitively with people and involved them in decisions and choices about their support.

People told us that they liked their food and were give a range of choices and alternatives about these.

People who used the service told us they felt “Safe” in the home and that staff were “Kind and considerate.”

We found the home was warm and clean and we observed staff working hard to ensure it was kept neat and tidy and had no unpleasant smells.

We saw that recruitment checks had been carried out on staff, before they had begun working in the home.

People told us they were “Happy” with the service they received. One person told us they had made some complaints when they first moved into the home. However, they said this was along time ago and that they had “No concerns” now and were satisfied appropriate action would be taken to follow up any concerns they might have.

People who use the service told us they were happy with the care they received and felt supported by staff. They were complimentary about the attitude of staff and told us they could approach staff at any time. People told us they felt able to contribute to the running of the home by attending meetings and completing questionnaires as well as the meetings held to discuss their individual needs.

We undertook this unannounced inspection on the 7 and 8 December 2015. The last full inspection took place on 6 May 2014 and we found the registered provider was non-compliant in three outcome areas which were: care and welfare, supporting workers and quality monitoring. We completed a follow up inspection on 11 September 2014 and the registered provider was compliant in all the areas we assessed.

Churchview is registered to provide accommodation and personal care for 30 older people, some of whom may be living with dementia. The home is a detached property which has been extended since it was built. It is situated in the village of Great Coates close to Grimsby. On the day of the inspection there were 27 people using the service.

The service had 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 did not have accurate and up to date risk assessments in place for specific concerns such as moving and handling, pressure damage prevention and malnutrition. The risk rating for some people should have been higher, which would have prompted staff to increase monitoring and make referrals to health care professionals in some circumstances.

We found the quality monitoring system had not been effective in highlighting areas to improve such as the care records and environment. Action plans had not been consistently produced in order to address shortfalls. Incidents and accidents were not all recorded properly or analysed thoroughly to help find ways to reduce them.

These issues meant the registered provider was not meeting the requirements of the law regarding keeping people safe from risks to their safety and having an effective monitoring system. You can see what action we told the registered provider to take at the back of the full version of the report.

People told us they liked the meals; their nutritional needs were met and there was a variety of choice on the menus. On some occasions the monitoring of people’s weight had not always been carried out effectively so that changes could be highlighted and discussed with health professionals for advice. The registered manager told us they would address this with staff.

Although some redecoration and refurbishment had taken place we found items of worn furniture and areas which required redecoration. We have made a formal recommendation that the service seek advice and guidance from a reputable source, about environmental adaptations to promote the orientation and safety of people living with dementia.

We saw arrangements were in place that made sure people's health needs were met and systems were in place to ensure people’s medicines were administered safely. Review meetings were held regularly which gave people and their relatives the opportunities to discuss their care and any changes they wanted. However, feedback from one person’s relatives identified these meetings did not always support effective discussions about issues that mattered to them. The registered manager confirmed they would address this with the senior staff.

People told us they found the staff caring and said they liked living at the home. Relatives gave us positive feedback about the care and support their family members received. Staff approached people in a kind and caring way which encouraged them to express how and when they needed support. Staff demonstrated good communication skills and distraction techniques when managing people who may need additional support to manage their behaviours. Staff had developed positive relationships with people and their families. We saw people were encouraged to participate in activities and to maintain their independence where possible.

We saw there was enough skilled and experienced staff on duty to meet people’s needs. We found staff had been recruited using a robust system that made sure they were suitable to work with vulnerable people. Staff had received training relevant to their roles.

We found people who used the service were protected from the risk of harm and abuse because staff had received safeguarding training and they knew what to do should they have any concerns.

Staff were careful to protect people’s privacy and dignity and people told us they were treated with dignity and respect. We saw information relating to people’s care and treatment was treated confidentially and personal records were stored securely.

We saw the complaints policy was available to everyone who used the service. The policy detailed the arrangements for raising complaints, responding to them and the expected timescales within which and investigation would be completed.