This comprehensive inspection was unannounced and took place on 14 and 15 November 2018.

At the last inspection, in September 2017, we rated the service as Requires Improvement. The provider was in breach of Regulation 11 HSCA (Regulated Activities) Regulations 2014. The provider had not consistently acted in accordance with the Mental Capacity Act 2005 (MCA) in relation to when people were unable to give consent because they lacked capacity. They had also not consulted with the local authority when there was the possibility some people met the criteria for a Deprivation of Liberty Safeguard (DoLS). We asked the provider to complete an action plan to show what they would do and by when, to improve the key question effective to at least good.

During our current inspection, we found improvements had been made. The provider had followed the principles of the MCA and people had DoLs in place. We found the provider had been compliant with this regulation. However, we found issues with recording in this area, and one DoLS application had been overlooked, which we refer to in the well-led section. We found new concerns including a lack of effective systems to monitor the safety and quality of the service provided and safe care and treatment.

Churchill House 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.

Churchill House accommodates up to 24 older people in one building. Bedrooms are situated over two floors which are accessible via a lift and stairs.

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.

The home was generally clean and tidy, however we found some minor issues. We saw cleaning taking place, although records to confirm this, had not been kept up-to-date. There were some issues with the safety and maintenance of the environment. Staff had not had recent fire drills and water temperatures had not been monitored, to ensure these were safe.

We found two people without appropriate bed rail protectors on one side of their bed. The risk assessment for bed rails had not been detailed enough to consider how risk would be mitigated. We found another person was missing a risk assessment for the use of bed rails.

The registered manager acted promptly when we told them about these concerns and most were addressed during the inspection or shortly afterwards. However, the quality monitoring system needed to be more robust, to ensure checks of the environment highlighted areas of risk so these could be addressed quickly. Other areas of the quality monitoring system also required development.

People did not always receive their medicines safely. We found one person’s creams had not been applied as prescribed and guidance was missing for two ‘as and when required’ medicines, also known as PRN.

Systems were in place to recruit staff safely. However, the providers recruitment policy had not always been followed which led to some shortfalls. We also found following disciplinary action, there was a lack of records to show how one staff members skills had been monitored, to ensure they continued to be competent for the role.

Staff protected people from avoidable harm, were knowledgeable about safeguarding and able to raise concerns. They supported people to meet their nutritional and healthcare needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. We found staf

This inspection took place on 19 September 2017 and was unannounced. This was the first inspection of the service since registration with the new provider.

Churchill House is registered to provide accommodation and personal care for a maximum of 24 people. At the time of the inspection, there were 20 people using the service. Churchill House is close to local amenities and bus routes into Hull city centre; there is a car park at the rear of the property. There are two sitting rooms, one of which has a designated dining area at one end. All bar one of the bedrooms are for single occupancy and there are sufficient bathrooms and toilets on each floor which are close to communal areas.

The service had a registered manager. 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 that staff knew how to gain consent for day to day care activities with people. However, when people lacked capacity to make their own decisions the provider had not always worked within the law and best practice guidelines. Mental capacity assessments had not always been undertaken and decisions made in people’s best interest regarding restrictions placed on them had not been recorded. A deprivation of liberty safeguard (DoLS) application had been made for some people but not for all people that met the criteria. This meant some people may be deprived of their liberty unlawfully. The registered manager told us applications for people this applied to would be made to the local authority straight away. You can see what action we have asked the provider to take at the back of the full report.

We found some areas of the environment that required attention to make sure risk was minimised for people who used the service. The registered manager acted promptly when we told them about these issues and most were addressed during the inspection or shortly afterwards. However, the quality monitoring system needed to be more robust to ensure checks of the environment highlighted areas of risk so these can be addressed quickly. We have made a recommendation about this.

We saw there were some activities for people to participate in but these did not meet everyone’s needs. We have made a recommendation about this.

We found staff knew how to safeguard people from the risk of abuse and they knew who to refer any concerns. Staff had completed safeguarding training. Staff also completed risk assessments to help minimise the risk of accidents and incidents occurring. There were plans in place to guide staff should they need to evacuate the building in emergency situations.

Staff were recruited safely with employment checks carried out before they started work. There were sufficient staff on duty although they were busy. The registered manager was recruiting additional care staff, a deputy manager and an activity coordinator to complement the staff team.

We saw the staff approach was kind and caring which was confirmed in discussions with people who used the service. People told us their privacy and dignity were respected and they were able to make choices and decisions for themselves.

We found people’s health needs were met by access to a range of community health care professionals. Communication between staff and the health professionals was good. Medicines were managed safely and people received them as prescribed.

People told us they liked the meals provided to them and menus evidenced choices and alternatives were available. The support provided to people by staff at mealtimes was appropriate to their needs.

Staff had access to training, supervision and support. This enabled them to feel skilled and confident when delivering care to people. The training records indicated the co