About the service:

Churchill House is a residential care home providing accommodation and personal care to 12 people with mental health needs, aged 18 and over at the time of the inspection. The home can support a maximum of 12 people. The care home accommodates people in two separate wings, with six people in each wing, which have separate adapted facilities.

People’s experience of using this service:

People were safe in the home and there were procedures to protect them from abuse. Risks associated with people’s needs were assessed.

The premises and environment were safe for people and well maintained. We made a recommendation for the provider to look into installing window restrictors as an additional safety mechanism and to prevent unauthorised access to the home.

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.

People were provided their medicines as prescribed. People were supported with their nutritional needs and had choices with meals. They had access to health care professionals, such as GPs when required. They received care and support from staff who were kind and compassionate.

Staff treated people with dignity and respected their privacy.

Staff were recruited safely and were supported with training and supervisions for their development. Staff maintained positive relationships with the people they supported. They understood people’s needs, preferences and what was important to them. People’s independence was promoted.

Care plans were person centred and detailed people’s support needs. People's end of life wishes were explored. People and relatives were supported with complaints they wished to make. They were able to provide their feedback about the home.

Staff felt supported by the management team and told us there was a positive culture within the home.

The registered manager carried out audits and checks to ensure the home was providing a good standard of care. They were committed to make continual improvements and there was a clear management structure in place.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

At the last inspection on 30 August 2016 (report published 26 October 2016), the service was rated ‘Good’.

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This inspection took place on 30 August 2016 and was unannounced.

We previously inspected Churchill House on 30 July 2015 and found breaches of legal requirements in relation to protecting people against abuse, the risks associated with assessments, planning and delivery of care and treatment, effective mechanisms for people to make complaints and maintaining up to date, accurate records.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this inspection to look comprehensively at the whole service again and check that they had followed their action plan, confirming that they now met legal requirements.

The service is registered to provide personal care and accommodation for up to 12 adults with mental health needs. On the day of our inspection there were 10 people living in the service. The accommodation is a conversion of two adjoining houses merging into one large house. The service did not have a registered manager in place at the time of our inspection.

A registered manager is a person who has registered with the 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.

We have asked the provider to clarify what action they will be taking to ensure there is a registered manager in future because we were concerned that there had not been a registered manager in the service for over twelve months.

At this inspection we found there were improvements to record keeping, risk assessments and procedures relating to safeguarding people from abuse and complaints. The service was meeting these legal requirements. Care 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.

The service provided care and support to people to enable them to become more independent. We found that people were cared for by sufficient numbers of qualified and skilled staff. Staff also received one to one supervision and received regular training. People were supported to consent to care and treatment. The service operated in line with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People’s needs were assessed. Care and support was planned and delivered in line with their individual care needs. The care plans contained a good level of information setting out how each person should be supported to ensure their needs were met. The care plans included risk assessments as some people had restrictions placed upon them by the Ministry of Justice. People were supported to take their medicines on time and medicine records were up to date.

People were given choices about what they wanted to eat and drink and they were supported to access healthcare professionals. People’s finances were managed and audited regularly by staff so that people’s money was kept safely and securely.

Staff had good relationships with people living at the service and we observed positive and caring interactions. Staff respected people’s wishes and their privacy. They were supported to express their views. People pursued their own individual activities and interests, with the support of staff. The environment was safe and clear of any health and safety hazards.

There was a structure in place for the management of the service. People, relatives and visitors could identify who the area manager and proprietor were. People felt comfortable sharing their views and speaking with the managers if they had any concerns. The management team demonstrated a good understanding of their role and responsibilities. Staff and people told us the management team were supportive, approachable and friendly. There were systems to routinely mon

People in the service said they were happy there. One told us 'the staff are alright and we get the chance to go out.' People told us they had a choice about what they did and were treated with respect by staff. People using the service were able to meet their religious and cultural needs. The provider promoted people's health by supporting them to eat a healthy diet. One person said 'I wanted to lose quite a bit of weight and I have.' Staff worked with health professionals to support people to maintain good mental health. The provider had made sure that the premises, furnishings and equipment were safe and well maintained. There were enough staff in the service and they had the skills to meet people's needs.

This inspection visit took place to compliment a review of compliance we carried out in November 2012. We did not speak to people who use services on this occasion. We found that staff received appropriate training and supervision and regular checks were taking place on the quality of services provided to people. There was an effective system in place for comments and complaints to be listened to and acted on.

People told us that they liked living at Churchill House. They told us “I am happy here because the staff are alright”, “I feel safe in the home because the care is good” and “I enjoy my one to one sessions with my key worker because I get to talk about how I feel”.

Some people also told us that they enjoyed the activities they attended both in and outside of the home. One person gave examples of the activities they enjoyed externally which included ten pin bowling, cycling and using the local gymnasium. Another told us “I enjoy the art sessions in the home, the board games and occasionally an interactive game on the telly”.

People were settled and going about their daily routines in a happy manner.

Some people were taking parting an art activity, while others were relaxing either in the garden or in one of the lounges.

We spoke with people using the service who told us that they were happy in the home. They were clear that they liked their environment and the support that staff were giving to them. One person told us, “The staff are really alright”. Another told us, “The staff help me to do things that I can’t do for myself”.

People were comfortable in their environment as they went about their individual and daily routines. They told us that the home was usually clean and that they sometimes helped in this respect. They said that staff did most of the cleaning and made a good job of it.

However, staff told us that there was a strong scent of urine on the first floor landing in House 50, which had been reported to the manager but the actions taken did not improve the smell in that area. We checked the area concerned and found the urine scent. We discussed it with the manager who told us that he would take action to improve the unpleasant odour.

People using services told us that the home was good in that they were getting the care and support that they needed. They were generally happy in the home, although not everybody had the confidence to complain. People using services told us that they get to do things that they like and were involved in planning their care. They also told us that they felt safe living in the home. One of the professionals involved with the home told us that despite the complex needs of people using services at Churchill House, they do get a good service.

We carried out an inspection of Churchill House on 11 and 12 May 2015 and it was unannounced. When we last inspected Churchill House on 15 August 2013 we found the service to be meeting all regulations inspected.

Churchill house provides personal care and accommodation for up to 12 adults with mental health needs. At the time of our inspection there were 12 people using the service. The service is a conversion of two adjoining houses knocked into one large house.

The service did not have a registered manager in place at the time of our visit. 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 manager currently employed by the service has been in situ since August 2014, the provider and manager told us that the manager will be applying for registration in the coming month.

People told us that they felt safe living at the service. One person told us “I feel safe here 24 hours a day, ten out of ten for safety.” Another person told us, “Generally it is safe here”. However, not all staff were aware of how to raise a safeguarding concern. Documentation held by the service showed allegations were not investigated fully.

We found evidence that not all complaints raised were responded to appropriately.

We found evidence that staff were thoroughly vetted prior to commencing employment .We saw staff received on-going comprehensive training in order to carry out their role effectively. We observed staff interacting with people in a kind and compassionate manner giving explanations on what was occurring, and saw staff encouraging people to make decisions about the care provided.

We saw evidence of good practice around the recording, administration and storage of medicines.

Care plans and risk assessments were not always completed. One person did not have a completed care plan or risk assessments. We also found evidence that the service was not fully aware of the conditions imposed upon one person by the Home Office which governed their care and treatment in the community, which left the person and others at risk of harm.

People were supported to access health care specialists as and when required. We saw evidence that referrals to heath care professionals were made as and when required.

Staff received Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) training. Deprivation of Liberty Safeguards is where a person can be lawfully deprived of their liberties where it is deemed to be in their best interests or for their own safety.

We found several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report.