This comprehensive inspection took place on 30 and 31 October 2018; the first day of the inspection was unannounced.

Church View is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Church View is registered to provide personal care for up to 30 people. Accommodation is offered in single en-suite bedrooms. The home is a single storey building with level access. It is situated in the centre of the town of Oswaldtwistle, close to all local amenities. There were 20 people living in the home at the time of our inspection.

There was no registered manager in place at the time of this 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. A new manager had been in post since 1st October 2018 and had started the process to register with CQC.

At the last inspection in March 2017, the service was rated as good in all areas. At this inspection, the rating has deteriorated to requires improvement. This is because we found five breaches of regulations; these were in relation to the unsafe handling of medicines, the unsafe recruitment of some staff, the lack of appropriate training for staff, the lack of effective systems to ensure people received safe care and the lack of robust governance systems to monitor the quality and safety of the service.

Although there were systems in place to monitor the quality and safety of the service, these had not been effective; this had resulted in many of the shortfalls we identified during the inspection.

People told us they felt safe in Church View and that staff were kind, caring and respectful of their dignity and privacy. However, we found staff had not always been safely recruited and staffing levels did not allow for staff to continue to meet people’s needs in a timely manner should emergency situations arise. We have therefore made a recommendation that the provider reviews the number of staff deployed on each shift to ensure this is appropriate for the needs of people living in the home.

Systems and processes were in place to help ensure the safe handling of medicines. However, we found these had not always been properly followed. As a result, we identified some discrepancies between the records relating to the administration of medicines and the stock balance of some medicines. In addition, we could not be certain from the records we reviewed that topical creams had always been administered as prescribed.

The systems in place to record accidents and incidents which occurred had not been used effectively to ensure people received safe care. Although staff had recorded accidents and incidents as required, this information had not been passed on to the manager. This meant the manager had therefore not reviewed whether lessons could be learned or if further control measures needed to be put in place to manage any identified risks.

Although people told us staff were skilled and knowledgeable about their needs, we found the provider did not have a robust system in place to ensure staff received the training necessary to enable them to provide effective care.

The home did not have a domestic in post at the time of this inspection and the provider was relying on care staff undertaking additional shifts to carry out cleaning duties. As a result, we found some people’s bedrooms and bathrooms were not as clean as should be expected and arrangements to prevent cross infection needed to be improved. We have therefore made a recommendation that the service ensures it acts in accordance with

This inspection took place on 1 March 2017 and was unannounced.

Church View Residential home is registered to provide personal care and accommodation for up to 30 people. The home is a single storey building with easy access for disabled people and outside space for people to use during warm weather. All of the bedrooms for people who used the service benefitted from en-suite facilities. There are three lounges and one dining room to people who use the service and visitors to use. The home is in the centre of Oswaldtwistle, close to local amenities.

At the time of our inspection there was a home manager in post who was in the process of completing their application for registered manager with the Commission. The registration requirements for the home required a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 the last inspection on 18 April 2016, we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to records and on ongoing breach of the management of medicines. During this inspection we found the service was meeting the requirements of the current legislation.

People who used the service and relatives told us they felt safe in the home. Staff we spoke with understood their responsibilities when dealing with allegations of abuse.

We saw improvements in the managements of medicines. Systems were in place for the safe storage, administration and recording of medicines.

Sufficient numbers of suitably qualified staff were in place. This would ensure people who used the service received safe and effective care.

We saw people were provided with a variety of meals of their choice during our observations of people’s mealtime experience. Staff were seen engaging positively with people offering support and choice where it was required.

Records we looked at confirmed Deprivation of Liberty applications had been submitted to the relevant authority. Staff were observed seeking permission from people before undertaking any care or activity. We saw staff ensured people’s privacy and dignity was maintained and when undertaking any care or activity this was done in the privacy of their bedrooms or bathroom.

People were positive about the care they received from the staff in the home. Care files we looked at had details of people’s individual care needs. Evidence of regular reviews were seen to ensure they reflected people’s current needs.

We spoke with the activities co-ordinator who discussed the activities available for people who used the service. We saw activity equipment available for people to use and there was a singer in the home during our inspection who told us they visited the service regularly.

Complaints were managed effectively and we saw positive feedback about the home.

During our inspection people who used the service, visitors and staff were positive about the home manager and the changes made since she returned to post.

There was evidence of how the home received feedback about the service they delivered. This included questionnaires and resident and team meetings.

We saw detailed and regular audits taking place in the home. This would ensure people received care in a service that was monitored for quality.

We undertook a focused inspection on 26 April 2016. The inspection was unannounced which meant they did not know we were coming.

Church View Residential Home is registered to provide care for up to 30 older people. The home was providing care for older people which included people living with a dementia; the home does not provide nursing care. At the time of the inspection there were 22 people in receipt of care.

The registration requirements for the provider stated the home should have a registered manager in place. The registered manager had recently left employment with the service and a new home manager was in post. The home manager told us they intended to commence the application process for registered managers with the Commission. 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 the last inspection on 18 September 2015 we asked the provider to take action to make improvements in the way medicines taken by mouth were administered and recorded. The home now carried out monthly audits. Any discrepancies, which may indicate that a person had not received all their doses of medicine, were investigated.

We watched some people being given their morning medicines and saw the senior carer gave medicines in a kind and safe way. Medication charts examined were completed in full and there were no discrepancies in the stock checks.

Medication creams were not being used safely and staff did not have access to information they required to administer these. The disposal of unwanted medicines that are controlled drugs was not recorded and witnessed in the way required by law.

People using the service and visitors told us they felt safe in the home. One person told us, “Nothing is worrying me, I feel safe.”

We saw evidence of appropriate procedures taken when dealing with allegations of abuse. Staff had access to the safeguarding and the whistleblowing (reporting bad practice) policy and procedure to guide them.

We looked at the care files for people currently in receipt of care. We saw improvements had been made. There was some evidence of care plans and risk assessment to guide staff on how to meet people’s individual need such as, personal care, behaviour monitoring and medication. There was some evidence of reviews taking place however not all had been updated recently.

Staff had access to policies to guide them on assessment and care plan as well as resident daily records and control of quality records.

During this inspection we identified breaches of regulation in relation to the management of medicines and records.

We looked at the information we had gathered under the standards 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?

This a summary of what we found:

Is the service safe?

The manager told us there had been an application for Deprivation of Liberty Safeguards submitted to the local authority and they were waiting for the assessment from them to take place. The Mental Capacity Act 2005 [MCA[ provides a legal framework to protect people who need to be deprived of their liberty for their own safety. We spoke with staff about their knowledge of the MCA and Deprivation of Liberty Safeguards [DoLS] however we could not be confident the staff had up to date knowledge in DoLS. We looked at training matrix and did not see evidence that all staff had received up to date training in the MCA in the home.

We undertook a Short Observation Framework for Inspection [SOFI] in the dining room to see how people’s needs were being met by staff. A SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We heard staff spoke respectfully with people living at the home however; we noted one person needed support from staff due to them spilling a warm drink but the dining room at that time was unsupervised by staff.

We saw medications for people living in the home were not administered safely. We saw gaps in medication charts and the fridge and clinic room temperatures were not recorded regularly.

We spoke with five care staff all were able to tell us signs of abuse and the appropriate actions they would take if they suspected abuse had taken place.

Is the service effective?

We received positive feedback from two visiting health professionals who were visiting the home. We were told staff responded quickly to any requests.

The home had recently recruited an activities co-ordinator to the home. We were told activities were taking place daily and we saw evidence of this on the day of our inspection. There was a list of the week’s activities on display in a public area of the home.

We looked at staff files and saw evidence of recruitment processes in them. There was evidence that Disclosure and Baring Service [DBS] checks had been completed so people working at the home had been safely recruited.

We were told the staff had recently completed training in moving and handling and hoist training. Five of the six staff we spoke with told us they had completed this training.

Is the service caring?

We looked in two people’s bedrooms and saw these had been decorated with person items and mementoes. One person we spoke with told us they were happy with their bedroom.

We spoke with people who used the service. They told us, “The girls are very good; I have no complaints about anything. They come quickly to my buzzer and talk to me about my care”.

We looked at three care files and saw up to date evidence in two of them of care planning and risk assessments in place. The manager provided us with evidence following our inspection that the third file had been updated, this provided staff with relevant information to provide the care and support for people living at the home.

Is the service responsive?

The manager told us there had been some new staff recently employed and staffing numbers were now more stable.

We looked at a meetings file. We saw minutes from a previous staff meeting that had taken place however the most recent date for these was a carer meeting in October 2013. However staff told us staff meetings were taking place and they were able to bring their views.

Is the service well led?

We were shown an audit file which detailed recent audits taking place, such as medications, care plans and staff skills competency sheets.

We saw two accidents had occurred in the home. These resulted in two people living in the home attending the hospital for a review and treatment. We noted that the Care Quality Commission (CQC) had not been informed of these by the home as required.

There was an in house policy and procedure file however we noted this had not been updated since 2009. In one of the policies there were details relating to regulations from 2001 and old contact details for CQC.

The home had a homely and relaxed atmosphere, and there appeared to be a good rapport between people who used the service and staff.

We looked around the home and in several bedrooms. All bedrooms had ensuite facilities and had been personalised with photograph's and mementos for people who used the service.

We spoke with eight people who used the service and asked them to tell us about the care they received at the home. We were told, “I have no problems everything is fine”, “I am happy with the care. I have seen my care file” and, “I am happy I have no concerns”.

The CQC had been made aware of concerns in relation to people receiving night time medications. We spoke with staff about this. One person told us there was always a senior on night duty to give people who used the service their medication. The manager told us there were appropriate systems in place to cover night shifts with adequately trained staff to administer medications. All people we spoke with told us they always received their night time medication. However we noted systems were not in place to ensure people who used the service had their medications administered safely.

We spoke with eight people who used the service. All were complementary about the staff. Comments received were, “The staff are good, the manager is very good”, “I am quite happy I have no concerns. The staff know what they are doing”. At visiting relative told us, “I always find the staff lovely”.

People using the service told us that they liked living at Church View Residential Home and were satisfied with the care provided. One person said, “It’s lovely here, the staff are very helpful, if you ask them to do anything they’re pleased to do it.” Another person said, “The care’s very good, I like being looked after.” We saw that people were treated with respect and a variety of leisure activities were organised for them.

We found that members of staff had a good understanding of safeguarding procedures and told us they would report any concerns immediately.

We noted that all members of staff received the training they needed in order to provide safe and effective care for people using the service.

We saw that systems were in place to monitor the quality of the service provided. There was evidence to demonstrate that people were regularly consulted about the care and facilities provided at the home.

We carried out an unannounced inspection on 18 and 21 September 2015, which meant the provider and staff, did not know we were going to inspect.

Church View Residential Home is registered to provide care for up to 30 older people. The home was providing care for older people which included people living with a dementia; the home does not provide nursing care. The registration requirements for the provider states that the registered provider should ensure that a registered manager is in place.

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.

Prior to this inspection we had carried out unannounced inspection on 5 and 20 March 2015 and found evidence of several breaches of regulations for monitoring the quality of the service, records, care and welfare, safe and suitable equipment, nutrition and diet, consent, staffing, infection control, safeguarding and medicines. The provider sent us an action plan to tell us how they would ensure people using the service were protected against the risks associated with an inadequate service. We reviewed this action plan as part of this inspection to check if the provider had met the requirements of the regulations

During this inspection we found an ongoing breach of Regulation 17 of the Health and Social Care Act (RA) Regulations 2014. This was because the provider failed to ensure records relating to people’s individual care needs were completed and up to date. There was also an ongoing breach of Regulation 12 of the Health and Social Care Act (RA) 2014 Regulations. People using the service were not protected against the risks associated with the administration, use and management of medicines. People did not always receive their medicines when they needed them or in a safe way. You can see what action we told the provider to take at the back of the full version of this report.

We undertook a tour of the building and saw improvements in infection control since our last inspection. Such as areas were clean and tidy and guidance for staff, people who used the service and visitors to follow were on display in the public area of the home. The registered manager told us a deep cleaning programme had been undertaken since our last inspection and the staff we spoke with confirmed this had taken place. We saw hand washing advice was on display and staff were seen wearing gloves and aprons when caring for people to prevent cross infection.

We discussed the staffing numbers and the recruitment with the registered manager. We were told there was now a full team of staff in post with two new staff waiting for a start date following relevant checks being completed. The home had increased staffing numbers to support effective care delivery and staff told us that the increase in staffing numbers had made a positive improvement to their ability to meet people care needs in a timely manner.

We looked at how the service monitored, reported and recorded safeguarding concerns in the home since our last inspection. We saw improvements had been made. The registered manager had introduced a safeguarding file that had details on how to report safeguarding to the appropriate agencies. There were notes relating to safeguarding investigations that had taken place and a summary sheet so that reference could be made of all the safeguarding alerts in progress. Staff we spoke with confirmed they had received safeguarding training and we were confident staff would act in an appropriate way in dealing with concerns safely. We saw evidence of safeguarding training taking place in the staff files we looked at.

Following our last inspection the provider sent us an action plan that detailed how they would ensure people received their meals in a safe and appropriate manner. We undertook an observation of the dining room during the lunchtime service and noted improvements had been made. We saw people received meals that met their individual needs such as soft diet. People using the service told us they enjoyed the meals but would like more variety and choice such as a seasonal menu.

The provider told us in their action plan following the last inspection that they had introduced the use of the serving hatch during meal times and had put a key pad on the kitchen door to prevent people who used the service or staff entering the kitchen during meal times. However during our observations we noted the door had been left open and staff were seen entering the kitchen to service the meals.

Care records indicated nutritional assessment had taken place, however Malnutritional Universal Screening Tool (MUST) assessments had not been completed in line with the guidance which stated weights should be obtained each month however these had only been recorded every two months.

During our inspection we undertook a tour of all areas of the home to check what improvements had been made by the provider in relation to equipment the environment for people who used the service since our last inspection. We saw positive improvement. We observed equipment such as new toilet surrounds and grab rails had been purchased. The repairs to the bathroom wall had been undertaken and the shower tray had been repaired. The registered manager told us a new heating and water system had been introduced, staff we spoke with confirmed the home was much warmer now. We asked about water temperatures in peoples bedrooms as one bedroom ensuite sink took over two minutes to run warm. The registered manager checked all bedrooms and confirmed all people had access to hot water.

We saw evidence of a maintenance book in the home that detailed works that required action by the provider. The registered manager confirmed all work documented had been completed. People using the service and their relatives told us they were happy with the environment in the home and told us that the provider had invested a lot of money in the home since they took over.

People we spoke with told us they we happy with their care but could not confirm if they had been asked permission relating to their care needs. We observed staff speaking kindly with people who used the service and staff knocking on peoples doors before entering bedrooms. The care files we looked at had details relating to consent to care and treatment in them which had been signed and dated.

Staff were positive about the changes in training and delivery and commented that the face to face training for moving and handing was an improvement in training delivered to them. We saw evidence of training in the staff files we looked at and the registered manager told us training for all staff had been organised to ensure staff had the knowledge to care for people safely and effectively. Staff we spoke with confirmed supervision was now occurring regularly and we saw evidence of plans for supervision and records detailing supervision had taken place.

Since our last inspection the registered manager had introduced a Deprivation of Liberty Safeguards (DoLS) file that had guidance for staff to following and details of current emergency and standard DoLS requests to the Local Authority. We discussed DoLS and Mental Capacity Act (MCA) with staff that had a limited understanding of DoLS. The registered manager told us they had requested further training for all staff to ensure the met individual needs.

During our inspection we observed staff responding in a timely manner to people’s individual needs staff were seen talking kindly to people and interacting well with them. People who used the service told us they were happy with the care they received and visiting relatives also confirmed they were happy with the care in the home.

We looked at the care records for five people who used the service. We noted there had been some improvements in them such as; care plans were detailed and individualised to ensure they reflected people’s needs and records indicated risk assessments were in place and up to date. However we saw that there were still gaps in records such as; a care had no care plan for medications and a missing person profile as well as the resident profile was missing. Documents such as positional changes, diet and fluid intake, and creams application had gaps in their recording.

We saw there was a complaints, compliment and comments file in place which detailed the actions taken as a result of the complaints. However we saw two complaints that had no details relating to the action that had been taken. We discussed these with the registered manager who confirmed what actions had been taken. It is important to ensure records are kept up to date and reflected all actions that had been taken by the service. People who used the service and relatives told us they had no complaints and felt confident to raise any concerns with the home.

There was a complaints policy on display in the public areas of the home as well as in people’s bedrooms.

Records relating to activities had improved since our last inspection; however we noted that these had not been completed for a number of days prior to our inspection. Staff and people using services told us activities were taking place and we saw evidence of activities on display in the public areas of the home such as, sing a long, bingo and plans to visit Blackpool illuminations. The registered manager told us they had introduced a dementia champion and there were plans to introduce rummage boxes and memorabilia into the home.

People who used the service, relatives and staff were positive about the registered manager and the changes that had been introduced since they came in to post. We were shown feedback from a recent questionnaire that detailed some positive results as well as feedback that required further investigation. We discussed this with the registered manager who told these had only recently been returned and would be analysed promptly.

We looked at how the service monitored the quality of the service. We saw improvements had been made since our last inspection. There was evidence of regular audit monitoring taking place such as falls, medication and infection control and these had been completed regularly and recently.