Archived: Sovereign House

Sovereign House provides residential and nursing care for up to 60 people, who are living with dementia or have physical disabilities. The bedrooms are located across the ground, first and second floor which are accessible by stairs or elevator. The service is split into three floors; the ground floor offers residential care whilst the first and second floor offer nursing care for people with more complex needs. At the time of our inspection there were 60 people using the service.

A registered manager was in post. 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 on 5 February 2015 when we found the provider was not meeting the required standards. We identified two breaches in the legal requirements and regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to improve staffing arrangements and record keeping.

The provider sent us an action plan outlining how they would improve. At this inspection we checked improvements had been made. We found improvements had been made and sufficient action had been taken in response to the breaches in regulations .

People told us their care and support needs were met by staff who were knowledgeable and knew them well. Staff had undertaken training relevant to the specific needs of people who lived at the home and staff told us they were supported within their job roles.

Everyone we spoke with said they thought the home was a safe place to live and that they were well cared for. Staff had a good understanding of how to report any safeguarding concerns and how to keep people safe from avoidable harm.

The provider used a dependency tool to assess the number of staff needed and told us that staffing was provided at a level higher than the dependency tool stated. We observed that there were enough staff to meet the personal and health care needs of people and to keep them safe.

People received their medicines as prescribed and checks were undertaken to ensure they received them in a safe way.

The provider followed the principles of the Mental Capacity Act (2005). Mental capacity assessments were completed when needed and specified the nature of the decision the person was being asked to make. When people had a Deprivation of Liberty Safeguards (DoLS) authorisation in place for continuous monitoring, it was reviewed within the specified time frame to ensure that people were not being deprived of their liberty unlawfully.

Staff ensured they maintained people’s privacy and dignity and treated people with compassion and respect.

Health and safety risk assessments had been completed. Specific risk assessments had been completed about the risks associated with people’s care and staff had a good understanding of the support to be provided to keep people safe. Any incidents were logged and an analysis of accidents and incidents was completed so the provider and staff could identify any trends and manage them accordingly.

There were robust recruitment procedures in place to reduce the risk of unsuitable staff being employed at the service.

People’s nutritional and hydration needs were being met. People had a choice of meals which met their dietary requirements and preferences. People were supported to maintain their health and wellbeing.

People had opportunities to maintain relationships with people important to them. Group activities were provided, however people had limited opportunities to pursue their individual hobbies and interests.

People and their relatives knew how to raise complaints and were confident actions would be taken in response to these. People had opportunities to put forward their suggestions about the service provided.

There were processes to monitor the quality and safety of the service provided and actions were taken to drive improvement in the service.

We saw improvements had been made to the middle floor to make it more dementia friendly. We saw staff attending to people's care and welfare satisfactorily. We saw people were stimulated in their environment and staff interacted with people positively. We saw that complaints were addressed satisfactorily.

We noted two areas of concern. The lift had been out of order for a week. The meal time for people on the upper floor could have been better. The high number of wheelchair users in the dining room and the layout of the tables resulted in space restrictions. This, added to the difficulties caused by the lift not working, resulted in some poor practice. We observed a staff member not seated whilst helping someone to eat and a staff member helping two people to eat at once. Apart from this we saw very good practice and support throughout the home.

The manager of the home had not yet applied to become registered manager. She told us she would now apply.

We found that the home had made many improvements. It was clean and uncluttered, staff were attentive to the needs of the people who lived at the home and complaints were being listened to and acted upon. A new manager had been appointed from within the home. They were not present when we visited. The provider's's Clinical Lead Nurse Manager and the Quality and Compliance Manager were present. We had favourable comments from relatives and people who lived at the home. In particular, some people who had previously been critical now noted improvements. 'Great improvements,' 'More approachable' and 'Better care now' were some of the things people told us.

One person said 'Staff are still stretched, but not as much as before.' We noted staff struggling to assist everyone who needed help at meal times, particularly on the ground floor, where most people required two staff to assist with mobility. Many people required assistance with eating.

We saw that the two managers present were a visible presence on the floors and were aware of and acting on issues of concern brought to their attention. The home still had some way to go before the middle dementia floor was 'dementia friendly'.

On the day of our visit the home was generally clean, well maintained and free from unpleasant odours. We saw many examples of good care and support where staff took their time supporting people by guiding, encouraging, explaining and helping at a pace people were comfortable with. Where people were challenging in their actions or words, staff were calm and patient.

Relatives and people in the home had mixed views of the care. Comments included: 'Marvellous', 'I'm happy here', 'Some carers are better than others' and 'General level of care is good, but there is a lack of communication.'

Prior to our visit, there had been some recent serious incidents where the home had been slow to recognise or act on concerns about people's deteriorating conditions. We saw the home was putting into place new systems to minimise the risk of this recurring and had taken disciplinary action where staff shortcomings may have contributed to this. We found that further improvements were needed. We could not be confident that improvements were fully embedded in staff practices at Sovereign House or that they could be sustained.

We spoke with four relatives who during our visit. 'Very happy with the care' was the comment from one person. Another told us 'I am very confident in the staff here.'

Members of staff were very attentive, positive, gentle and calm in their approach to people. We saw little evidence of items such as old photographs, magazines or other materials that might have been used to help stimulate people with dementia.

At times, some care staff performed care tasks with very little communication with the person they were helping. This was most noticeable when some people were moving people in wheelchairs. Some staff were very good at engaging positively with people who lived at the home, reassuring them and putting them at ease.