Archived: Patricia Venton House

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.”

Patricia Venton House provides care and accommodation for up to 25 people, some of whom are living with dementia. The service is run by Plymouth Age Concern. On the days we visited 19 people lived at the home and five people were staying for short stay respite care.

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 2008 and associated Regulations about how the service is run.

At our last inspection on 25 June and 2 July 2015 we asked the provider to take action to make improvements to staffing levels, staff training, risk assessments, emergency plans, and documentation in relation to the completion of charts and daily records including people’s skin integrity charts and food and fluid charts, to help monitor people’s wellbeing.

Prior to this inspection we received information of concern about the service, saying temporary staff did not have full information on people’s personal details, for example who the person’s GP was.

People’s medicines were not always managed and administered safely. The system of checking in new medicines, recording their use and assessing any risks was not robust enough to keep people safe. For example, records showed a GP had decided to stop two of one person’s medicines. However, one of these medicines had been administered on two occasions following instructions by the GP to cease its use. The medicine was still showing as current on the medicines administration record (MAR). There was conflicting information about people’s medicines in their care plans and daily handover notes. There were gaps in people’s MARs where staff had not signed to confirm medicines had been administered so it could not be guaranteed people had been given their medicine as prescribed. If people declined medicines, the reasons were not always documented which meant any patterns or issues could not be identified and referred to the appropriate professional. Information about people’s allergies was not always recorded on people’s MARs. This could lead to them being given a medicine to which they are allergic.

People had their medicines given covertly (without their knowledge) in their food. There was no recorded evidence of a mental capacity assessment and best interest meeting, if those people lacked mental capacity to make their own decisions in relation to how the medicines were given.

Medicines were not always stored at the correct temperature. For example, the fridge temperature record for February 2016 showed that temperature reached minus three degrees, meaning some medicines may have been frozen and so were not suitable for use.

People’s health, nutrition and hydration needs were met however, the recording of this was not complete or did not hold enough detail to ensure consistency of care. People’s health care records were inconsistent, incomplete, disordered and in some cases contained incorrect information. For example, one person who had diabetes and was living with dementia had conflicting information recorded about how staff should manage their diabetes. The manager stated they would review this person’s care and update this person’s records so staff were clear how to support this person.

Records of people’s care were not always complete and lacked essential details to ensure care given was appropriate and as desired by the person. People’s individual risk assessments were not reviewed regularly to ensure they reflected people’s current risk. People did not have risk assessments for individual health needs in place therefore we could not be sure staff had full information to meet those needs.

Staff said they felt unsupported by senior management and had not received regular individual meetings to enable them to raise issues. Staff meetings had not been held to offer support to staff. Staff said they did not feel valued or listened to.

Not all staff were trained to meet people’s needs and keep them safe. For example the staff confirmed and the training matrix showed not all staff had completed training in fire safety. Staff had also not completed additional training, for example in the Mental Capacity Act (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Staff understood how to identify and report abuse.

Staff spoken with confirmed there were insufficient staff. They expressed concerns about times when they had not been able to meet people’s needs. Staff felt people receiving respite care had higher care needs which were not assessed to ensure there were enough staff available to meet their needs. Staff then had little time to spend with other people. Staff said one person had managed to leave the building unaccompanied. It was unsafe for them to leave alone and there was a high risk of it happening again as staff were unable to monitor them at all times. We observed this person leaving the residential area and going down the stairs. Assistance from staff was sought to help keep this person safe. Staff felt this person was at risk of falling.

The provider did not have robust quality assurance processes in place to identify the issues raised. Systems of auditing aspects of the service had lapsed or were not currently in use. The service had introduced quality monitoring forms. This included audits on medicines. At this inspection we found audits were not conducted regularly. Audits of medicines, infection control, care plans and falls were not completed as often as the provider stated they should be done and did not identify themes or areas to improve practice. The service had not notified the Care Quality Commission of all significant events as required. There were systems in place to maintain the passenger lift, lifting equipment and utilities in the service.

People could see their GP and other health professionals as required. However records showed the staff did not always record the advice given or follow up health care issues. District Nurses told us they were happy with how the service provided for people’s health needs.

People said they were happy with the care they received. People told us staff treated them with respect and ensured their dignity was respected. People and visitors spoke highly of the staff.

There was a complaints policy in place. People’s concerns were dealt with when they arose. People, staff and visitors described the nominated individual as approachable and people told us they felt comfortable speaking with them if they had any concerns. However staff described the senior management as unapproachable.

We found a number of breaches of the regulations. You can see what action we told the provider to take at the back of the full version of the report.

We saw people's privacy and dignity being respected at all times. We saw and heard staff speak to people in a way that demonstrated a good understanding by staff of people's choices and preferences.

Staff we spoke with who were clear about the actions they would take should they have any concerns about people's welfare.

We looked at care records for four people. We spoke to staff about the care given, looked at records relating to them, met with them and observed staff working with them.

We saw that people's care records described their needs and how those needs were met. We saw that people's mental capacity had been assessed to determine whether they were able to make particular decisions about their lives.

During our visit to the home we saw sufficient staff on duty to meet the needs of people living in the home and we spoke with some of the staff working during our visit.

We saw that Patricia Venton House held all records securely to protect people's confidentiality.

We saw people living and currently staying in the home being involved in many decisions about how the home was being run, including being involved in upgrades to the home and if staff should wear uniforms or everyday clothing. However, people's needs were not always taken into account in the way the service was provided and delivered in relation to their care.

Staff were clear about the actions they would take should they have any concerns about people's safety.

Comments from people who lived in the care home included "Staff are lovely'.

We saw and heard staff speak to people in a way that demonstrated a good understanding of people's choices and preferences. We looked in detail at the care four people received.

Many of the people we spoke with were unhappy that the lift had broken down again and were unable to access the lower floors.

We looked at care files belonging to four people and found the care/support plans did not identify people's needs and were not all completed accurately. This may mean that staff did not have the information they needed and people's care needs may not be met.