Venville House

Venville House is a residential care home providing the regulated activity of personal care for up to eight people. At the time of our inspection there were eight people using the service.

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

People told us they felt safe and loved living at Venville House and spoke positively about the manager and staff team. People were protected from the risk of abuse and avoidable harm as staff were aware of their safeguarding responsibilities and knew how to report any concerns.

There were sufficient numbers of staff available to meet people’s needs. Staff had the skills, knowledge and experience to care and support the people living at the service. Staff were recruited safely. Staff followed infection control guidance and had access to Personal Protective Equipment (PPE).

People were supported by staff who treated them with dignity, respect and were kind, patient and caring. People’s needs, and choices were known and respected. Staff understood their roles and responsibilities. Staff liaised with health and social care professionals to ensure people’s health and care needs were met.

People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported to maintain relationships with their families and enjoyed being part of the local community.

We have made a recommendation about the management of some medicines and the development of up to date care records.

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 12 December 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made however the provider remained in breach of regulation.

At our last inspection we recommended that the provider sought advice in developing care plans that were reflective of people current need. At this inspection we found further improvements were required.

Why we inspected

We undertook this inspection to check they had followed their action and to confirm they now met legal requirements.

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

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.

Enforcement and Recommendations

We have identified breaches in relation to the governance processes at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Venville House is a residential care home providing personal care to up eight older people. At the time of the inspection there where eight people living at the service. The service accommodates people across two floors. People had access to communal areas and a garden.

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

People told us they were very happy and felt safe living at Venville House. One person said, “I feel so safe here. They [staff] are all concerned and make sure I’m alright.” People said staff were always kind to them and respected their privacy and dignity. Staff had built caring relationships with people and knew people well.

Quality assurance systems and processes to monitor the safety and quality of care at the service were either not in place or had not been effective in ensuring the provider could assess, monitor and then use this information to improve the service. This had allowed the quality of the service to deteriorate. Systems had failed to identify the shortfalls found during this inspection.

Medicines were not always managed or stored safely. Guidance was not always in place for as required medicines, the application of medicated creams or medicines administered through a skin patch. Staff had not been appropriately trained in medicines management or had their competencies checked. Since the inspection the provider has made changes to the management of medicines to address the concerns.

People’s care plans and risk assessments were not always written in a person-centred way or contained sufficient guidance for staff about how to meet people’s needs and preferences. However, staff knew how to support people in the way that they preferred and understood people’s risks and how to support them in a safe way. We made a recommendation about person-centred care plans.

Risks to the environment including infection control concerns had not always been assessed or identified. Environmental and infection control audits were not taking place. Cleaning records were not completed. Staff had not received infection control training.

The provider did not have sufficient oversight of training to ensure staff had sufficient training to support people's individual needs.

Staff told us they felt supported by the provider, however, formal supervisions and staff appraisals were not taking place.

People's capacity had not always been assessed following the principles of the Mental Capacity Act 2005 (MCA). Mental capacity assessments for people who were considered to lack the capacity to make decisions about their care and support, were not in place. Therefore, the provider could not be certain people were supported to have maximum choice and control of their lives and were supported by staff in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People were supported by an established staff team who knew them well. People, relatives and staff told us there was enough staff available to meet people’s needs. Recruitment procedures were in place to ensure only suitable staff were employed.

Systems were in place to protect people from abuse. Staff described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported.

People knew how to make a complaint if necessary. They said if they had a concern or complaint they would feel happy to raise it with the provider.

The service had established links in the local community and worked in partnership with health and social care professionals to ensure good outcomes for people.

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 17 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the management of medicines, environmental risks, safe recruitment, staff training and support and person centred care planning. We also found concerns with the governance in the home as systems and audits were not in place to identify areas of improvement.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection in October 2014 the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated good:

The service continued to provide safe care to people. One person commented: “The staff keep me safe.” Measures to manage risk were as least restrictive as possible to protect people’s freedom. People’s rights were protected because the service followed the appropriate legal processes. Medicines were safely managed on people’s behalf.

Care files were personalised to reflect people’s personal preferences. Their views and suggestions were taken into account to improve the service. People were supported to maintain a balanced diet, which they enjoyed.

Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them.

There were effective staff recruitment and selection processes in place. People received effective care and support from staff who were well trained and competent.

The service was caring and people had built strong relationships with each other and staff. People engaged in a wide variety of activities and spent time in the local community going to specific places of interest.

Staff spoke positively about communication and how the registered manager worked well with them and encouraged their professional development.

A number of methods were used to assess the quality and safety of the service people received and made continuous improvements in response to their findings.

A health care professional told us that the home was extremely good at meeting people's individual needs and would go to any length to do so. She said she had enormous confidence in the ability of the staff working at the home. We found that the home was calm and relaxing and people appeared very contented as they did different activities during the day. We also found that people had regular opportunities to leave the home for shopping, walking and other activities of interest.

We found that people's care and health needs were well promoted. External health care professionals were contacted for advice on a regular basis. These had included hospital, GP and district nurse visits. People received support and assistance to achieve a good standard of personal care.

People received drinks and food which suited them and provided a nutritious diet. One person said how much they liked a roast dinner and the day we visited the lunch was roast pork and vegetables.

There had been no new staff at the home for several years. There was continuity of care.

Record keeping was good, which ensured people's needs were planned and monitored effectively.

There was evidence in care plans of people's needs being assessed, plans being drawn up, implemented and reviewed. We found the provider was regularly reviewing how the service was meeting people's needs.

Staff told us of action they would take if abuse was suspected, witnessed or alleged. We saw staff were trained in safeguarding people. One staff member told us "the residents come first" another said "providing care and attention and listening to people is top of the list".

We found by looking at staff rotas and training records and speaking with the provider that there was sufficient qualified, skilled and experienced staff to provide care and support for people. People told us there were enough staff with one person saying "I go out to places when I want."

The provider had systems in place to assess and monitor the quality of service provided. We saw evidence of these systems having been used effectively in order to identify, assess and manage risks to the health, safety and welfare of people. An example being that the provider had taken steps to minimise potential trips hazards and obstacles.