St Vincent House - Gosport

St Vincent House Gosport is a residential care home providing personal care for up to 34 people in one adapted building. The service provides support to older people and those living with dementia. At the time of our inspection there were 24 people using the service.

People’s experience of using this service and what we found

Risks associated with people's care were not always fully assessed and care plans lacked detail. This included management of known health needs and risks from falls. The provider took immediate action to improve these.

Recruitment practices were safe and there were enough staff available to meet people’s needs. However, a review of where staff were located within the service at any one time, was required. This was so the management of known risks could be improved.

People received their medicines safely and as prescribed. Arrangements were in place for obtaining, recording, administering and disposing of prescribed medicines, but improvements were needed to ensure topical creams were used safely.

People told us they felt safe and were supported by kind, caring staff. Staff knew how to keep people safe from harm. The provider had a policy and procedure for safeguarding adults and the manager and staff understood the signs to look for.

Environmental risks had been considered and acted on where required. Infection, prevention and control processes and up to date policies were in place. The provider, management and staff adhered to the latest government guidance in relation to infection, prevention and control.

There was a clearly defined management structure and regular oversight and input from the provider. There were governance systems in place to identify concerns in the service and drive improvement. However, these had not identified all the concerns we found or ensured action was taken in a timely way.

People, relatives and staff were positive about the management of the service. Staff told us the manager was supportive and approachable.

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

Rating at last inspection

The last rating for this service was good (21 September 2018).

Why we inspected

We undertook a focused inspection to review the key questions of safe and well-led only. The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk from falls. This inspection examined those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Vincent House Gosport on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

This comprehensive inspection was unannounced and took place on 16 and 18 July 2018. St Vincent House provides personal care and accommodation for older people including older people living with dementia. The home is registered to accommodate up to 34 people. At the time of the inspection there were 29 people living at the home.

The home provides accommodation over three floors. There was a choice of communal areas where people could socialise or sit quietly. People’s bedrooms were arranged over all three floors. Some bedrooms had en-suite facilities and there were communal bathrooms.

The last comprehensive inspection of this home was in February 2017 when it received an overall rating of requires improvement. At that time, we found the provider was in breach of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to assessing risks to people, the amount of staff available to support people, mental capacity assessments, person centred care plans, quality assurance systems and record keeping. We made five requirements and the provider wrote to us detailing the action they planned to take. During this inspection we found that improvements had been made and the provider was no longer in breach of regulations.

There was a registered manager in post at the service. 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 and associated Regulations about how the service is run.

Potential risks to people were assessed and action taken to minimise them. Risk assessments were personalised and provided sufficient information to allow staff to protect people whilst promoting their independence.

Environmental risk assessments had been completed. The provider had a contingency plan to deal with foreseeable emergencies. Staff knew what to do in the event of a fire and had been trained to administer first aid.

Where accidents, incidents, and near misses had occurred there was an effective system in place to analyse what had happened so that appropriate action was taken to mitigate any risks or prevent reoccurrence.

There were quality assurance systems in place based on a range of audits. Action plans identified ongoing improvements, with a clear process for planned work to be completed.

There was enough staff to meet people's needs and to enable them to engage with people in a relaxed and unhurried manner.

People felt the staff were kind and caring. They knew how to complain and any complaints made were addressed. There was a range of activities and entertainment which people could choose to take part in.

The home was clean and there were systems in place to protect people from the risk of infection. Plans were in place to redecorate some bedrooms to make them easier to keep clean

Recruitment checks had been completed before staff commenced work to help ensure staff were suitable for their role.

There were suitable systems in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training. Healthcare professionals, such as nurses, chiropodists, opticians and GPs were involved in people's care when necessary.

There were effective systems and processes to protect people at risk of abuse. Staff understood their safeguarding responsibilities.

Staff received training and supervision to equip them for their role. Where people had specific health needs, additional training was provided, so that staff could meet their needs.

People's nutritional and hydration needs were monitored and met. People had been consulted about when the main meal was provided and there was a good choice of food for people.

Staff knew people well and had developed positive relationships with them. Staff sought consent from people before providing care and followed legislation designed to protect people's rights.

People's needs were assessed and staff were aware of people's individual needs and preferences. People and their representatives were involved in planning their care as much as they were able and wished to be. People's end of life wishes were explored with them and recorded.

This inspection was prompted by a notification of an incident where a person using the service died. At the time of the inspection, there was an ongoing criminal investigation into the death and as a result, this inspection did not examine the circumstances of that incident. However, the information shared with CQC about the incident did indicated potential concerns about the management of the risk of choking. This inspection examined those risks.

The home did not have a registered manager in place at the time of this inspection. This was because the previous registered manager had left in June 2017 and the current manager was still in the process of registering with CQC. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

All of the care plans and risk assessments were digital and recorded onto the provider’s electronic systems. Each member of staff on duty had an individual tablet computer, which allowed them to access and update people’s information and records during the day when support was provided.

People’s care plans and associated risk assessments in respect of choking were detailed and provided clear guidance to staff on how to reduce those risks.

Staff knew the people who were at risk of choking and were able to explain how to help reduce those risks and the action they would take if someone started to choke.

The manager sought specialist advice from the Speech and Language Therapists (SALT) when people were identified as being at risk of choking.

Staff had received appropriate first aid training, which was managed through the provider’s electronic monitoring system.

There was sufficient staff to meet people’s needs. Those staff who prepared people’s food knew which people were at risk of choking and their dietary needs.

There was a clear management structure and the provider was fully engaged with the home through the executive advisor.

There was a structured approach to the quality assurance of care plans and risk assessments.

Accidents and incidents were recorded; analysis and the lessons learnt fed back through staff meetings and training sessions.

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.

The service was last inspected in March 2016 and at this inspection they were given the overall rating requires improvement. At that time we had found the provider was in breach of five regulations regarding the lack of personalised care, risk assessments and mental capacity assessments. Records were not well maintained, staff had not received regular supervision or been given the training they needed to ensure they could meet all people’s needs. During this inspection we found there had been some improvements but breaches of three regulations remained and a further two regulation breaches were identified.

Staff understood the principle of keeping people safe, but we witnessed examples of where not all people were safe. This was not due to staff awareness but more of an issue regarding there not being enough staff to meet people’s diverse needs. Risk assessments had been completed but these had not been updated as people’s needs and subsequent risks changed. For example, people had a risk assessment for falls, but if a person had regular falls this had not been updated to take into account the elevated risk.

Recruitment checks had been completed before staff started work to ensure the safety of people. Medicines were administered and stored safely.

Staff had knowledge of the Mental Capacity Act and people’s records showed people’s capacity to make specific decisions had been assessed. There was room for improvement as the decisions needed to be incorporated into the specific sections of the care plan.

People enjoyed their meals and were offered a choice at meal times. People were supported to access a range of health professionals, although there was concern staff were not always taking on board the learning offered by health professionals.

People did not always have their needs planned in a personalised way, which reflected their needs were being considered and met. This meant staff may not always have the best information on how to meet an individual’s needs and preferences.

People felt confident they could make a complaint and it would be responded to. Complaints were logged and there were recordings of investigations into complaints.

People felt the staff were caring, kind and compassionate. However, we made some observations where staff could not be consistently caring in their approach, mostly due to staffing levels. The home had an open culture where staff felt if they raised concerns with the registered manager she would listen; although there were concerned the manager did not have the authority to make necessary changes. Staff were clear about their roles. Records were not always accurately maintained and this was a reflection of an ineffective quality audit process.

We found three repeated breaches and two new 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.

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.

The service was last inspected in January 2015. At this time the provider had four requirements relating to breaches in regards to medicines, risk management, supporting staff and quality assurance processes. At this inspection we followed up on these concerns. We found that although improvements had been made in all these areas, there remained some repeated and some new breaches.

Some people had risk assessments but these had not always been completed when a risk had been identified. This meant people could have risks, but staff maybe not have been aware of the risks to people. Staffing levels were consistent and staff had the skills to be able to meet people’s needs. There was a training programme but not all staff had in date training in all area, which meant all staff may not have the knowledge to meet people’s needs . Recruitment checks had been completed before staff started work to ensure the safety of people. Staff had a good understanding of how to keep people safe and what action they should take if they had any concerns. Medicines were administered and stored safely.

Staff had a limited knowledge of the Mental Capacity Act and people’s records did not show people’s capacity to make specific decisions had been assessed. This meant people did not have their mental capacity assessed and restrictions may have been placed on people without an assessment. Most people enjoyed the meals and were offered a choice at meal times, although this was limited at lunchtime. People were supported to access a range of health professionals.

People did not always have their individual needs met in a personalised way, which reflected their choices had been considered. This meant staff may not always have the best information on how to meet an individual’s needs to meet the person’s preferences and needs. People felt confident they could make a complaint and it would be responded to. Complaints were logged and there were recordings of investigations into complaints.

The home had an open culture where staff felt if they raised concerns they would be listened to. Staff felt supported by the registered manager and were clear about their roles and the values of the home. Records were not always accurately maintained and this was not an effective part of the quality audit process.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask: Is the service safe, effective, caring, responsive and well led.

This is a summary of what we found-

Is the service safe?

People told us they felt safe in the home and when being cared for by staff. Records showed most staff had received training in the safeguarding of vulnerable adults. Staff demonstrated a good awareness of abuse and the many forms in which it can present. They knew how to report any concerns they had.

The home did not have appropriate procedures in place to support people who could not make decisions about their care and treatment. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw the home had made one application for DoLS without assessing the capacity for this person. The nominated individual told us the deputy manager was working with the local authority on identifying the needs of other people who may be vulnerable and unable to make informed decisions.

We saw the home had appropriate policies and procedures in place to ensure the safety and welfare of people who were supported with their medicines.

Is the service effective?

We saw that people received care which was individualised and planned in line with their needs. People told us they received the care they needed to maintain their independence and dignity. It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and that they knew them well.

Is the service caring?

People told us they were supported by kind and attentive staff. Staff treated people as individuals and people told us staff were responsive to their needs at all times. We saw that people's needs were supported in a calm, dignified and respectful way. This meant people were cared for in a kind, caring and respectful manner.

Is the service responsive?

People's needs were assessed to ensure their needs were met. People were able to express their views of the care they received and have them acted upon. People and their representatives were encouraged to participate in care planning and reviews. However, we found extensive duplication of care records meant information available to staff did not always reflect up to date plans of care which had been agreed with the person. The nominated individual for the service told us a new system for care records was being introduced at the time of our visit.

Is the service well-led?

Staff told us the recent changes to the management structure at the home meant they were supported to carry out their roles. People told us the manager, provider and senior staff were very approachable. They told us the staff team worked well together and were very responsive to any concerns or issues they raised.

The provider ensured all staff received appropriate training for their roles and sufficient staff were available at the home to meet the needs of people.

All the people we spoke with were satisfied with the support they received. They told us staff were caring and responsive to their needs. One said, “The carers are brilliant and caring. They attend to my every need and nothing is too much trouble. They are so patient with everybody.” People told us they were given choices and staff respected their privacy and dignity. One said, “They are kind and respectful, and yes they knock on the door before they come in my room and close the curtains or doors when they are helping me.” People told us they were listened to and were involved in decisions about their care.

The nine comment cards returned contained positive feedback. Comments ranged from "generally satisfactory" to "all aspects of care have been excellent and the staff are brilliant".

People were supported to access other healthcare services to ensure their needs were met.

The provider was aware of the specific needs of people living with dementia and was in the process of making suitable changes to the decoration and facilities. Information about dementia was available to people using the service and their relatives. The quality of service provided was monitored and assessed.

In this report the name of a registered manager appears who was not in post and not managing the regulated activity at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time. The deputy manager was managing the regulated activity with the support of the registered manager from another of the provider’s services. We spoke with the supporting manager during our inspection and they are referred to as “the manager” in this report.

We visited the home at 5.50am and found that the four people were told were raised by staff at 4.30am were asleep in bed.

We spoke to staff. There was a lack of clarity about the morning routines for individual people. One staff member said they were told by the home’s management to get people up at 5.30am if the people needed support from two staff, and, that this should take place even in if the person was asleep. Another staff member said this was not the case and that people were only supported with personal care to get up if they were already awake. Staff told us there were insufficient night time staff to get people up in the morning especially for those with higher care needs.

Staff told us there was a lack of information on care plans about each person’s morning routines and preferred times for getting up. This was confirmed when we looked at care plans for four people.

We spoke to two staff and to the registered manager as well as two of the home’s administrative staff.

People told us they received the care and support they needed. Staff told us they considered the home looked after people well. People said they were consulted about their care. We saw that people had signed their care plan to acknowledge its contents. We saw that each person’s needs was assessed and a care plan recorded. Two people said they had not seen their care plan but they were aware records were made about their care.

People said they were able to make choices in the way they spent their time and in the food they ate.

Staff were said by people to be friendly and polite. People and staff said there were generally enough staff to meet people’s needs.

During the lunchtime we used our SOFI (Short Observational Framework for Inspection) tool to help us see what people's experiences at mealtimes were. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time and whether they have positive experiences. This includes looking at the support that is given to them by the staff. We spent 35 minutes observing at lunchtime and found that people had positive experiences. Staff were observed assisting people in a calm, friendly and polite manner. The meal time was calm and well organised.