Archived: Venetia Care Home

The service is located in two large adjoining houses, one located in Venetia Road, the other Lothair Road, on two floors with access to a back garden.

We previously inspected the service on 16 August 2016 and found the service was in breach of seven regulations relating to governance of the service, insufficient staffing levels, safeguarding, safe care and treatment, person centred care, need for consent and dignity and respect. As the overall rating for the service was ‘inadequate’ this service has been in Special Measures.

Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and it is no longer rated as inadequate overall or in any of the key questions. We have also had positive feedback on improvements at the service from health and social care professionals. Therefore, this service is now out of Special Measures.

At the time of the inspection there was a registered manager employed by 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 2008 and associated Regulations about how the service is run.

On the day of the inspection, the atmosphere was calm and relaxed. We saw staff were kind and caring to the people living at the service and the people living at the service confirmed staff were friendly and available to support them. We were confident people were treated with dignity and respect.

At the inspection in August 2016 we had concerns regarding the cleanliness of the service. At this inspection we found the premises were clean throughout. The kitchen was clean and the majority of food produce in the fridge was labelled and sealed. We saw there were labels available and the provider had purchased containers to store opened food. However, a new staff member had left a meat product covered but not labelled and cooked vegetables were uncovered from dinner the previous evening. This was immediately remedied.

At the previous inspection we were concerned there was insufficient staffing to safely meet the needs of people living at the service. At this inspection staffing levels had increased and new staff had been recruited. At the time of this inspection the provider and commissioners were liaising regarding increased overnight cover at the service. Three people needed supervision if they left the building, and there was no staff member awake at night at the service. In the meantime the registered manager told us she had risk assessed this situation and in her view, no-one was at risk as a result of current staffing levels.

Staff told us the increase in day staff had enabled them to support people to do more activities. People told us they had joined a choir group and sang songs they had learned accompanied by a staff member and another person who played guitar, in the evenings at the house.

Previously we had concerns related to the way the service was operating in relation to providing person centred care as set routines were in place. At this inspection we saw that people had been asked their views as to how they wanted their medicines provided, and although the kitchen remained locked for set periods, people could now make hot drinks or get fruit drinks from the open kitchen next door as they wished. A shower room previously closed off was now available for people to use when they chose to.

In the period between August 2016 and March 2017 we were notified appropriately of any safeguarding issues that had occurred and the provider had liaised appropriately with other relevant organisations.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). The service had DoLS in place for those who needed it.

At the last inspection the provider could not evidence they had the authority to restrict specific people’s liberty or their access to cigarettes. At this inspection we saw that relevant documentation was in place where required and consent was gained from people with mental capacity if the service was safekeeping their belongings, or assisting them with managing their cigarette intake.

In August 2016 we were concerned as there was an absence of effective quality monitoring systems in place for key areas, and this had impacted on the quality of the service offered. We found regular supervision and training were not taking place, many procedures and policies were outdated and quality audits, for example related to cleaning, had not prompted improvement. Between August 2016 and March 2017 records showed staff had undertaken training in key areas and had been regularly supervised. Procedures were updated and there were quality audits taking place and actions followed through as required, and this had resulted in significant improvements at the service.

We have made a recommendation in relation to person centred care at the service.

The service is located in two large adjoining houses, one located in Venetia Road, the other Lothair Road, on two floors with access to a back garden.

We previously inspected the service in September 2014 and found that the service was meeting all the requirements inspected.

At the time of the inspection the registered manager was on holiday so we met with the care workers who were working at the time and spoke with the registered manager on her return from holiday. 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.

Whilst we witnessed some kind interactions between care staff and people living at the service we had a number of concerns in relation to cleanliness of the service, the level of staffing and practices that were not respectful of people’s privacy or dignity. We were also concerned the provider was restricting people’s access to their cigarettes and the kitchen without written agreement either by the person or the person acting on their behalf, if they didn’t have capacity.

Food in the fridge was not labelled with use by dates so that people knew when it must be eaten by, and the house on Venetia Road was not clean throughout. Since the inspection the registered manager told us the service has been deep cleaned and food is now labelled and stored hygienically in the kitchen.

Staff told us there were always two staff on duty in the day, but we found the rota routinely showed only one staff member on duty on weekend mornings. When staff went on holiday we found two occasions when the registered manager did not replace them so this meant there were less staff available to support people. This meant people were at risk of their needs not being met.

People told us there were very limited resources for activities at the service and we could only find one game and some music CD’s. Since the inspection the registered manager told us they have purchased games and books which were locked away when not in use to minimise damage.

People told us the kitchen was locked outside of meal times so they could not always get drinks or snacks when they wanted.

We saw from records that supervision was not regularly taking place with staff and training was limited. People had not been trained in understanding mental health needs since 2011 and had not received training in managing people’s behaviours. This affected the staff’s ability to understand and meet people’s needs. Since the inspection training in mental health needs has taken place and the registered manager told us supervision is now taking place regularly.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS).

Neither the staff nor the registered manager understood the requirements of the MCA or DoLS. This meant they were restricting people’s liberty without any awareness of doing so. The registered manager as a result of our intervention, has since applied for assessments for DoLS for three people living at the service.

Whilst staff could tell us about safeguarding, we were aware from discussion and the lack of action in relation to a recent specific incident that safeguarding issues were not always identified by staff and acted upon. This meant people may be at risk of abuse.

At this inspection we saw that the décor was poor in one of the houses and a shower room had been closed for use.

There was an absence of quality monitoring systems in place for key areas to ensure regular supervision and training took place and care records contained documents relating to consent. Where systems were in place some of these were deficient, for example, the cleaning log. This meant that the quality of care was not properly monitored.

There were no complaints logged in the last 12 months.

Management of medicines was safe, and recruitment practices were safe. Relatives told us they were satisfied with the care provided, found staff caring at the service and appreciated the structured environment provided for their family members.

We found the provider was in breach of standards relating to the safe care and treatment of people using the service, safeguarding people from abuse and supporting staff through supervision and training. The provider was also in breach of standards relating to person centred care and dignity and respect. Lack of consent for restrictive practices and lack of effective quality monitoring systems meant there were further breaches of standards in relation to governance of the service and consent. We are considering our regulatory approach and will report on this further when complete.

We have made a recommendation in relation to the environment of the service, and in relation to making the complaints process accessible to people living at the service.

The overall rating for this service is ‘inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

You can see what action we told the provider to take at the back of the full version of the report.

During the inspection on 8 November 2013, we were concerned that people were not always protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. We were also concerned that people who used the service, staff and visitors were not protected against the risks of unsafe or unsuitable premises and that the provider did not ensure that important events that affect peoples' welfare, health and

safety were reported to the Care Quality Commission (CQC).

The follow- up inspection carried out on 15 August and 17 September 2014 found that the service had taken appropriate action to ensure that the concerns raised at our previous inspection were addressed.

People who use the service told us that they felt happy living at Venetia House and said 'they all get on.' One person said 'I'm quite happy here.' Another one told us that they liked the staff and that they could go out whenever they wanted.

People who used the service were involved in their care and we noted that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People were supported by suitably qualified, skilled and experienced staff. The provider supported staff to deliver care safely and to an appropriate standard.

We noted that people were not always protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

People who used the service, staff and visitors were not protected against the risks of unsafe or unsuitable premises. In addition the provider did not ensure that important events that affected peoples' welfare, health and safety were reported to the Care Quality Commission so that, where needed, action could be taken.