Churchview Care Services (Taunton) is a domiciliary care and supported living service providing personal care to people with learning disabilities and autistic people living in their own homes. Not everyone who used the service received personal care. The Care Quality Commission (CQC) only inspects where people receive personal care. At the time of the assessment, the service supported 10 people with the regulated activity personal care. We have assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted. We carried out this assessment in response to the rating of the service. At our last inspection the service was rated requires improvement. The service was in breach of 1 regulation relating to consent, from our inspection on 4 April 2023. At this assessment the service is rated good and no longer in breach of the regulation. People were supported to have maximum choice and control of their lives and the culture within the service was positive. People were involved in decisions about their care. Where people lacked capacity to make decisions, the provider followed the Mental Capacity Act (MCA) 2005 code of practice. The service provided information people could understand. People had their needs assessed when they first moved to the service. Staff worked with a range of professionals involved in people’s care. Some of the feedback we received from professionals was mixed. We identified 1 example where information was not escalated promptly to a health professional. Leaders and staff had a shared vision and culture based on listening, learning and trust. Leaders were visible and staff felt supported by them.
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Churchview Care Services (Taunton) was rated Requires Improvement overall following a focused inspection in April 2023, with breaches of Regulations 11, 12, 13 and 17 identified in relation to consent, medication management, safeguarding from financial abuse, and governance. While staff demonstrated kind, person-centred care and safe recruitment practices were in place, significant failures in MCA compliance, medication protocols, financial safeguarding oversight, and inaccurate governance audits placed people at risk of harm.
Concerns (7)
criticalMedication management: “protocols were not always in place to guide staff when to administer people's 'when required' medicines. This meant people were at risk of not receiving their medication safely”
criticalSafeguarding: “The provider did not have effective systems and processes in place to safeguard people from the risk of financial abuse.”
criticalConsent / capacity: “People's mental capacity was not always assessed in line with the MCA and the provider's own policies.”
criticalGovernance: “Medicines audits detailed protocols were in place to guide staff when to administer 'when required' medicines...During the inspection these were not always in place”
moderateCare planning: “Some care plans and risk assessments were detailed and accurate, others lacked guidance and information to ensure care was delivered safely.”
moderateRecord keeping: “Records contained contradictory information. For example, one person's risk assessment stated that the local authority managed their finances, although another document stated it was the person's parents.”
moderateCommunication with families: “Our biggest concern is there is no communication. We ask for meetings to discuss issues and the management say please contact us and we will do better but it just does not happen”
Strengths
· Staff received safeguarding training and were able to recognise signs of abuse; people felt safe with their support workers.
· Safe recruitment practices were followed with appropriate checks and references before new staff began work.
· Staff completed induction including the Care Certificate and received ongoing training across a wide range of subjects.
· People were supported to access specialist health and community services; care plans included healthcare professional contacts.
· Kind, compassionate and person-centred interactions were consistently observed between staff and people using the service.
Quality-Statement breakdown (15)
safe: Using medicines safelyRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Staffing and recruitmentGood
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Engaging and involving people using the service, the public and staffRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Continuous learning and improving care; duty of candourRequires improvement
Churchview Care Services (Taunton) is a domiciliary care and supported living service providing personal care to people with learning disabilities and autistic people living in their own homes. Not everyone who used the service received personal care. The Care Quality Commission (CQC) only inspects where people receive personal care. At the time of assessment, the service supported 11 people with the regulated activity personal care. This assessment was carried out in response to concerns we had received relating to staffing, safeguarding, risk management, medicines and governance. During this assessment we found the service had made improvements and was no longer in breach of regulations, however further improvements were still required. We carried out our onsite assessment on 6 November 2024 and 19 November 2024, off site activity started on 5 November 2024 and ended on 20 December 2024. We have assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted. We spoke to staff, people using the service and their relatives. We received feedback from a health professional. We carried out observations during the assessment visits. Relatives raised concerns with us about the service and lack of consistent management at service level, the provider had addressed this. The registered manager had been in post since 2022 and was now solely responsible for overseeing Churchview Care services (Taunton). The registered manager and provider acknowledged there had been concerns with the service in the past. They were focused on learning from this and moving the service forward, we saw evidence of the service’s improvement. At our last inspection the service was rated requires improvement. We have not changed the rating at this assessment.
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Churchview Care Services (Taunton) was rated Requires Improvement overall following a focused inspection of Safe and Well-led, with breaches of Regulation 12 (risk management) and Regulation 17 (governance) identified. While improvements since the June 2023 inspection were noted in safeguarding and medicines management, risk assessments remained inconsistent and the provider's own audit systems failed to identify the shortfalls found by inspectors.
Concerns (8)
criticalCare planning: “Information and guidance in care plans was inconsistent. For example, 1 person had a health need and staff were required to seek medical assistance at specific times. The persons care plan and risk assessment contained different information regarding this.”
criticalRecord keeping: “Their care plan stated they 'had no recorded falls for 6 months'. Other records indicated they had fallen 7 days prior to the inspection.”
criticalGovernance: “The provider's auditing of care settings for quality and safety was still not fully effective. Issues we found during our inspection had not been identified by the provider's own systems.”
moderateIncident learning: “There was a process for reporting and recording accidents and incidents and these were analysed by the provider. This hadn't always been effective in ensuring any concerns were addressed and learning shared amongst the team.”
moderateMedication management: “1 person's record stated 1 medicine was only to be taken 'as and when required', but this was being taken 3 times each day. Another person's records contained conflicting information about what medicines the person needed to take.”
moderateStaff competency: “We reviewed the training records of agency staff and not all of them had received training in dysphagia, this is where people experience difficulties in swallowing.”
moderateLeadership: “One staff member told us, 'It's difficult because we seem to be in and out with managers all the time. Honestly, no I do not feel that well supported.'”
minorCommunication with families: “One staff member told us, 'We haven't had a team meeting in 6 months.'”
Strengths
· Improvements made since last inspection in safeguarding and medicines management; provider no longer in breach of Regulation 13.
· Regular agency staff booked to ensure familiarity with people and their needs, maintaining consistency of care.
· People told inspectors they felt safe and were happy with the staff supporting them.
· Staff received safeguarding and whistleblowing training and were aware of reporting procedures.
· The regional operations manager was responsive to inspection feedback and demonstrated commitment to improvement.
Quality-Statement breakdown (10)
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongRequires improvement
safe: Systems and processes to safeguard people from the risk of abuse and avoidable harmGood
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Preventing and controlling infectionGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Working in partnership with others; Continuous learning and improving careRequires improvement
Promoting a positive culture that is person-centred, open, inclusive and empowering