The inspection took place on 11 January 2017.

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

The inspection took place on 5 November 2015.

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 16 people living at the home.

The service provider, Mrs Lewis, also works as the manager. 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.

People’s consent was gained before being supported with medication, they were provided with drinks to enable them to take their medication and were happy with the support provided. One person told us “They bring my tablets to me in the morning with my breakfast – they are never late.” However despite peoples positive experience medicines were not managed safely in accordance with current good practice guidance and regulations. A medication policy was in place, however this hadn’t been updated for several years. There were no guidelines on the use of ‘when required’ medication, staff were unaware of what this meant and which person had pain relief prescribed on an ‘as and when required’ basis. People who administered their own medication had no assessments in place to assess and mitigate any risks. Medicines were not always stored securely and there were gaps in medication administration records leading to confusion as to whether people had taken their medication or not. Medicines were not always dispensed and administered in a safe manner.

People spoke highly of the registered manager and the leadership within the home, there was an open culture where people, relatives and staff felt able to approach the registered manager if they had any concerns. However people’s safety could have been compromised as there were not effective, documented systems to monitor and audit the quality of systems and processes in place around medication administration. Audits ensure that any trends and areas for improvement are identified and used to drive change. This is an area of concern.

People’s independence was promoted, their rights were respected and their privacy and dignity maintained. People were able to make their opinions and feelings known on a daily basis, for example people had said that they didn’t like one of the menu options, this was listened to and the menu changed. Consent was obtained before people were supported and they were encouraged to make their own decisions. For people that lacked capacity relevant assessments had been undertaken and procedures followed to ensure that restrictions on their freedom complied with legal requirements. However an area of concern is that the registered manager had not informed CQC of these, not being informed of restrictions on people’s liberty meant that CQC were not able to assess or ensure that the appropriate actions had been taken to ensure that people were not deprived of their liberty illegally.

People were encouraged to eat and drink nutritious, home-cooked meals, people enjoyed the food and were able to choose alternative options if they didn’t like the meals offered. For people who had been assessed as being at risk of malnutrition, effective action had been taken to improve this, however they didn’t have their weight or food and fluid intake regularly recorded. Therefore staff lacked oversight as to the person’s intake throughout the day and of their weight over a period of time. We have made a recommendation about the monitoring of peoples weights and food and fluid intake.

Organisational policies were not up to date and didn’t reflect current legislation, therefore staff were not provided with relevant information in order for them to support people in line with current best practice or legal requirements. This is an area in need of improvement.

People were happy at the home, they felt safe and able to maintain their independence, one person told us “The staff help me when I need it, if they think I’m at risk that is, but other than that I manage alone.” Staff that were suitable to work within the health and social care sector were recruited and their employment history and suitability to work in the sector were checked prior to them starting work. Staff received training that ensured that they were able to meet people’s needs and ensure their safety and protection from abuse.

Staff had received essential training and there were opportunities for additional training specific to the needs of the people living at the service. Staff had received regular supervision meetings with their manager as well as annual appraisals.

People felt well looked after and supported and we observed positive, warm affection and genuine relationships. One person told us “The staff are all very jolly. It’s just like family really.” People had their needs assessed and their needs, abilities and preferences were made known to staff as there were care plans in place detailing these.

We found a number of 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 the report.

Our inspection team was made up of one adult social care inspector. We answered our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

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.

We carried out a responsive inspection at The Churchley Rest Home following receipt of concerning information about the delivery of safe care and claims that there were insufficient numbers of staff to meet the needs of the people who used the service.

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.

We observed the care provided and looked at supporting documentation. We talked with two care staff, the manager, five people who used the service and a relative.

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.

People’s needs had been assessed and care and treatment had been planned and delivered in line with their individual care plan. It was clear from speaking with care workers and management that they had a good understanding of the needs of the people living there and that they knew them well. People, who lived in the home, spoke very highly of the care workers and the quality of the support they had provided. They told us they were very happy with the support they had received and that they felt they had been supported safely and consistently. They told us that they were supported in the way they preferred.

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.