Archived: Patricia Venton House

Updated 25 October 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This focused inspection was undertaken by one inspector on the 6 September 2016 and was unannounced. This inspection was carried out to check that improvements to meet legal requirements after our comprehensive inspection on 22, 29 and 31 March and 2 April 2016 had been made. We inspected the service against two of the five questions we ask about services: is the service safe and is the service well led? This is because the previous breaches were in relation to these two questions.

Prior to the inspection we reviewed the information held by us including the information sent to us by the registered provider in response to the warning notices. We also looked at previous inspection reports.

During the inspection we looked at the care of four people in detail to check they were receiving their care as planned. We spoke with the manager and two senior staff members about their infection control training. We also looked at the medicines records for five people in the service and the audits for medicines and care plans.

Updated 25 October 2016

We carried out an unannounced comprehensive inspection of this service on 22, 29 and 31 March and 2 April 2016. Breaches of legal requirements were found and enforcement action was taken.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to Safe care and treatment and Good governance.

This was because people’s medicines were not always managed safely or properly. There were gaps in Medication Administration Records (MAR) where staff had not signed to show that medicines had been given. People who had declined medicines did not have the reason for this documented to ensure any resultant needs were monitored. Information recorded in the MAR charts was conflicting. MAR charts in use had some hand-written changes. These changes had not been rechecked, including the strength of medicines prescribed, to ensure they were accurate. A record of the temperature for the fridge used to store medicines was not always completed.

Systems were not in place to review infection control practices. Infection control procedures were not always updated as required to ensure service users were protected from the possibility of cross infection. Not all staff had undertaken training in infection control.

Systems and processes were not in place to identify and assess risks to the health, safety and welfare of people who used the service. Some people had risk assessments but these were not updated or were an accurate reflection of people’s needs. Some people did not have a risk assessment in place. There was no clear link between risk assessment and care planning. Some people’s risk assessments were not factually correct.

There were no systems or processes in place to ensure there were sufficient staff to meet the needs of people using the service. There were no assessments of people's level of dependency or learning from audits of falls and call bells, to help establish the required number of staff to meet peoples' needs.

Accurate, complete and contemporaneous records were not kept to ensure the service had sufficient information to meet people's needs. Systems and processes were not in place to update people’s assessments following changes in their health. Records gave conflicting information about people's health needs. Visits by health care professionals were not always documented in the correct section of the care records. Changes to people's care plans following medical advice or changes to their health and well-being were not completed. Records of the care and treatment provided to people and decisions taken in relation to the care and treatment provided were absent.

After the comprehensive inspection the provider submitted an action plan, to tell us what they would do to meet the legal requirements in relation to the breaches. We undertook this focused inspection on 6 September 2016 to check improvements had been made. Included in this action plan was the following statement; “We have also engaged an independent, external consultant who will be offering guidance and support in the areas of quality and compliance, who will also be undertaking monthly visits to the service to monitor progress and will be reporting back (to the Board).”

Patricia Venton house provides accommodation for up to 25 people who require support with their personal care. The service mainly provides support for older people who may be living with dementia. There were 14 people living at the service at the time of our inspection.

The service has been without a registered manager since May 2015. 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.

The provider/trustees of Patricia Venton House had employed a manager to run the service locally. The manager intended to register with us. The action plan stated; “We have employed a suitably qualified and experienced manager who plans to make an application to register with the CQC on completion of her probationary period.”

At this inspection we found people's medicines were not always managed and administered safely. The service had started a new system for the administration of medicines. Records of the amount of medicines held for each individual were not all correct. One medicine was not held in the original package. Changes to people’s medicines recorded onto a MAR (Medication Administration Record) were not signed by two members of staff as required. A faxed confirmation sent to the service from the GP stating when a change in medicines was required, had not been completed with sufficient detail. For example, confirmation that the service had added the change of medicines to the MAR. This meant it was possible that information was recorded incorrectly and might lead to a medicines error.

Staff who administered medicines had received up to date training and their competency checked.

People’s care plans showed some areas of improvement. An external auditor had been employed to advise in the updating of all care records. However, some improvements were needed to meet the requirements of the warning notice. For example, some care records still had hand written changes and suggestions made by the auditor. All risk assessments were not yet completed.

Systems and processes were in place to update people’s assessments following changes in their health.

There were sufficient staff to meet the current number of people living in the service. Staff had completed training from the local pharmacist and were in the process of completing accredited training. Staff had also received infection control training.

Clear infection policies and practices had been introduced. Audits of infection control had taken place. Most staff had received training in infection control.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see what action we told the provider to take at the back of the full version of this report.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (Patricia Venton House) on our website at www.cqc.org.uk.”