Vauxhall Court Care Home

Vauxhall Court Care Home is a residential care home providing accommodation for persons who require nursing or personal care to up to 33 people. The service provides support to older people, including people living with dementia. At the time of our inspection there were 28 people using the service.

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

Medicines were not always managed safely. Prescribed medicines were not always in stock which meant at times people had not been administered all their medicines.

Risk assessments were not in place to mitigate risk to staff and people receiving care and support.

Care plans did not always contain the most up to date information to ensure staff were meeting people’s needs.

The provider's mandatory training was not completed by all staff. Staff did not recognise the importance of having the appropriate training and skills to safely support people.

The management team completed regular spot checks including at night. This supported ongoing improvements in the quality of care people were receiving.

There were procedures to identify when people needed safeguarding and staff understood their responsibilities to keep people safe.

Improvements had been made since our last inspection. There were systems in place to improve the quality of the service.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 31 May 2022) and there were breaches of regulation. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We undertook a focused inspection to follow up the Warning Notices we previously served to check whether the provider now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Vauxhall Court Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, consent and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Vauxhall Court Care Home is a residential care home providing accommodation and personal care for up to 33 older people living with dementia. All people living at the service are accommodated on the ground floor. There were 24 people living at the service at the time of the inspection.

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

People were not always protected from the risk of harm and abuse. Risks associated with peoples care and support had not always been updated when their care needs had changed, or incidents had occurred. Medicines were not always managed safely by suitable trained staff.

Not all staff had received mandatory training in safeguarding. This meant staff were not always able to recognise safeguarding’s or effectively report them to the local authority. Despite these concerns people and their relatives told us they felt safe at the service and were cared for by kind friendly staff.

The manager had worked with the provider to improve staffing levels at the service. However, these levels had been achieved by the staff and managers working additional hours. Recruitment is ongoing at the service.

The service was clean with ongoing maintenance. However, not all maintenance had been identified prior to the inspection.

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The manager at the service had not received enough support from the provider and we found further training was required in order for the manager to fulfil their role. Governance systems were not effective. Not all audits had been completed or identified issues at the service. The provider did not have oversight of the quality of the service.

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 (published 14 June 2019)

Why we inspected

We received concerns in relation to the safety of people living at the service as well as the governance at the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We found there was a concern with consent to treatment, so we widened the scope of the inspection to include the key question of effective.

We looked at infection prevention and control measures under the Safe key question. 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.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Vauxhall Court Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

¿ Effective systems were in place to ensure visitors to the service followed government guidelines for wearing Personal Protective Equipment (PPE). Facilities were available to wash and sanitise their hands and visitors were provided with PPE. Screening questions and a temperature check were standard requirements for all visitors.

¿ There was plenty of personal protective equipment (PPE) including masks, gloves, aprons, gowns and hand sanitiser available. PPE stations and hand sanitiser dispensers were located around the service. Additional facilities for handwashing had been installed.

¿ All staff had been trained in current Infection Prevention and Control (IPC) guidance and in the use of PPE. There were designated areas for donning and doffing of PPE and handwashing facilities were easily accessible to people and staff. We observed staff followed current guidance and practice throughout our visit.

¿ A regular programme of testing for COVID-19 was in place for staff and people who lived in the service. The provider was in the process of developing a programme of testing for visitors.

¿ Enhanced cleaning took place daily. The environment was clean and hygienic. A ground floor room had been converted to allow safe visiting for relatives and friends of people. Visitors could access this room without walking through the main building.

¿ The service had implemented zoned areas, so people who needed to isolate could do so safely. Staff were deployed to work in specific zones to reduce the risk of spreading infection.

¿ Regular audits to make sure staff complied with current guidance and practice took place regularly. Any concerns picked up through these checks were acted on without delay.

¿ The service's IPC policy was up to date and in line with current guidance. The service had plans in place and knew how to respond to an outbreak of infection to ensure the safety of people and staff.

¿ People admitted to the service were supported following government guidance on managing new admissions during the COVID-19 pandemic.

Further information is in the detailed findings below.

The service provides accommodation and personal care for up to 33 older adults and people living with dementia. There were 30 people living in the service on the day of our inspection.

People’s experience of using this service

People were kept safe from avoidable harm and abuse. Systems were in place to support this. Risks were assessed and managed. People received their medicines safely, procedures, systems and checks were in place. Accidents and incidents were recorded and reflected upon to ensure that lessons were learnt.

Assessments were undertaken to ensure that people’s needs, and wishes were captured and acted upon. People and relatives told us that the food was good. The cook had systems in place to ensure that people got to eat and drink what they wanted and liked. Fresh fruit and snacks were available. Staff told us that they received the training they need to do their job well and are supported in their roles. People’s consent to care was sought. The principals of the MCA were being met.

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 support this practice.

Staff were caring, attentive and kind. Staff interacted with people in a friendly and supportive manner. People were provided with opportunities to express their views and were involved in their care. People’s privacy and dignity was respected.

Care planning reflected people’s needs. Staff knew people well and understood their needs. Care records were person centred. People knew how to complain, raise concerns and were listened to.

The registered provider demonstrated enthusiasm to provide good standards of care to people. The team were supported by experienced leaders who led by example. Processes to ensure that the delivery of care was monitored and checked regularly were in place. Managers effectively used governance systems to improve the quality of care in the home.

Rating at last inspection

At the last inspection the service was rated Requires Improvement and was published on 16 May 2017.

Why we inspected

This was a scheduled 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.

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

The home is registered to provide accommodation and personal care for up to 33 older people some of who may be living with a dementia. There were 28 people living at the home on the day we visited.

There was a registered manager for the home. 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.

At our last inspection in February 2016 the provider was not meeting the legal requirements in relation to medicines. At this inspection we saw that the provider had taken action to ensure people were consistently offered their medicines and was meeting the regulations. However, more improvement was needed around the recording of medicines prescribed as required (known as PRN). At this inspection the provider was not meeting the legal requirements in relation to providing person centred care. They had not ensured that care was planed to reflect people's needs or that people were involved in planning their care. You can see what action we told the provider to take at the back of the full version of the report.

The rating for our inspection in February 2016 was requires improvement and this has not changed at this inspection. Therefore, the registered manager and provider had failed to make the changes needed to provide a good level of care for people. This was because while the care was safe it did not reflect the standards of good practice that we expect to see in the environment for people living with dementia or the care plans in place to support people. The systems in place to monitor the quality of care had not identified these concerns.

People had all their basic needs met and received safe care which met their needs. Staff were trained to recognise situations in which people may be at risk of abuse and to take the appropriate action. However, the registered manager had not always reported this type of incident in an appropriate way.

People received appropriate food and drink to stay healthy and had access to healthcare professionals when needed. However, some people living with a dementia liked to spend time walking around the home and this impacted on others living at the home. There were no care plans or activities in place to manage this behaviour.

We have recommended that the provider review the guidelines for providing care for people with long term conditions and for those living with dementia.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect

themselves. We found the registered manager had taken appropriate action to comply with the requirements of the MCA and therefore people’s rights were protected.

The staff at the home were kind, caring and considerate of people’s needs and constantly monitored them to ensure they were safe and their needs were being met. There were enough staff to meet people’s needs and they received appropriate training and support to develop the skills needed to provide safe care.

The home is registered to provide accommodation and personal care for up to 33 older people some of who may be living with a dementia. There were 33 people living at the home on the day we visited.

There was a registered manager at the home. 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 provider was not meeting the legal requirements in relation to the administration of medicines. While medicines were stored and administered safely, people were not always receiving their medicines as prescribed. You can see what action we told the provider to take at the back of the full version of the report.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect themselves.

The registered manager was approachable and people living at the home, their visitors and staff told us that they could speak to the registered manager about any concerns. They were confident that the registered manager would take appropriate action to keep people safe and ensure that the care provided met their needs.

People were supported by kind and caring staff who received appropriate training and support. Staff knew how to keep people safe from harm and how to report any concerns. The registered manager ensured that there were enough staff available to meet people’s needs and that staff were safe to work with the people living at the home.

People were supported to make decisions about their lives and the care they received and were offered choices to tailor their care to their individual needs. Advice and support from healthcare professionals was accessed when needed. Risks to people were identified and appropriate equipment was available to keep people safe. A choice of meals were available to meet people’s nutritional needs and people had access to hot and cold drink whenever they wanted.

The provider had systems in place to monitor the quality of the service provided and support the registered manager to stay up to date with changes in legislation and best practice. However, we found that these systems were not always effective and that at times this impacted on the care people received.

We were concerned that although the provider had taken action to respond to and maintain records regarding deprivation of liberty arrangements and injuries sustained by people, they had not submitted appropriate notifications to us about these events.

We asked the provider to send us an action plan which would set out the actions they had taken to address the concerns we had. The action plan we received showed us the manager had taken action and put plans in place to meet the standards.

We observed the support staff gave to people. We also looked at records, including the care files of four people who lived at the home. Throughout our visit we saw staff supported people in a dignified and respectful way.

We found people were involved in making decisions about the support they needed and staff were caring and responsive to changes in their care needs.

We asked people who used the service what they thought of the food that was provided for them, one person told us, 'The staff make sure you get just enough and I think it is very good.'

People also made comments such as, "The staff are very good, I feel comfy here" and 'I don't think I can think of anything I would change the care is good."

We saw systems for recruiting staff were safe and the proper checks were carried out in advance of any new staff starting to work at the home.

We found the manager responded and maintained records regarding deprivation of liberty arrangements and injuries sustained by people who used the service but had not sent notifications to us about these events.

Overall we found the service was well led and the manager had training and supervision arrangements in place to support staff to enable them to carry out their work safely.