Archived: Vera James House

Vera James House is a residential care home that was providing personal care to 32 older people at the time of this inspection.

People’s experience of using this service:

People we met and spoke with were happy with the care home and the staff that provided their care. A visitor told us that the home was, “Overall really good.”

People felt safe living at the home because staff knew what they were doing, they had been trained and cared for people in the way people wanted. Risks in the home were assessed and reduced as much as possible. There were enough staff, and the registered manager also spoke with people regularly. Key recruitment checks were obtained before new staff started work.

People received their medicines and staff knew how these should be given. Medicine records were completed accurately and with enough detail. Staff supported people with meals and drinks. They used protective equipment, such as gloves and aprons. Staff followed advice from health care professionals and made sure they asked people’s consent before caring for them.

People liked the staff that cared for them. Staff were kind and caring, they involved people in their care and made sure people’s privacy was respected. Staff worked well together, they understood the home’s aim to deliver high quality care, which helped people to continue to live as independently as possible.

Staff kept care records up to date and included national guidance if relevant. Complaints were dealt with and resolved quickly.

Systems to monitor how well the home was running were carried out well. Where concerns were identified, the registered manager followed this up to make sure action was taken to rectify the issue. Changes were made where issues had occurred elsewhere, so that the risk of a similar incident occurring again was reduced. People were asked their view of the home and action was taken to change any areas they were not happy with.

Rating at last inspection: Requires Improvement (last report published 25 April 2018)

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor information we receive about the service until we return to visit as scheduled in 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

Vera James House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care home accommodates up to 41 people in one purpose built property. There were 41 people living at the home at the time of our inspection visit.

At our previous inspection the service was rated as Good. At this inspection the service had deteriorated to Requires Improvement. This was because incidents of possible harm or abuse were not reported to us (CQC), which is a legal requirement. They were also not referred to the local authority safeguarding team. This put people at risk of further harm and prevented independent investigation of these incidents if this was appropriate. This was a breach of our regulations. You can see what action we told the provider to take at the back of the full version of the report.

People’s personal and health care needs were met but care records did not provide staff with guidance in how to meet people’s diabetes needs. There were activities for people to do and take part in but not everyone was able to continue hobbies or pastimes, or use social media to keep in touch with relatives. A complaints system was in place, although not all people knew who to speak with if they had concerns.

The provider’s monitoring process looked at systems throughout the service and identified issues. Not all of these issues were addressed and not all of the issues found at this visit had been identified.

There was a registered manager at the service. 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.

People felt safe and staff knew how to respond to possible harm and how to reduce risks to people. Lessons were learnt about accidents and incidents and these were usually shared with staff members quickly to ensure changes were made to staff practise or the environment, to reduce further occurrences. There were enough staff who had been recruited properly to make sure they were suitable to work with people. Medicines were stored and administered safely, and records were completed correctly. Regular cleaning made sure that infection control was maintained and action was taken to address issues.

People were cared for by staff who had received the appropriate training and had the skills and support to carry out their roles. People received a choice of meals, which they liked, and staff supported them to eat and drink. People were referred to health care professionals as needed and staff followed the advice professionals gave them. Adaptations were made to ensure people were safe and able to move around their home as independently as possible. Staff members understood and complied with the principles of the Mental Capacity Act 2005 (MCA). People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff were caring, kind and treated people with respect. People were listened to and were involved in their care and what they did on a day to day basis. People’s right to privacy was maintained by the actions and care given by staff members. Staff gathered information about people’s end of life wishes, so that they could support and care for them in the right way.

Staff worked well together and felt supported by the management team, which promoted a culture for staff to provide person centred care. People’s views were sought and changes made if this was needed.

We found one breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.can see what action we told the provider to take at the back of the full version of the report.

Further information is in the detailed findings below

This unannounced inspection took place on 25 July 2017. At the last inspection on 23 July 2015 the service was rated as ‘good’. At this inspection we found overall the service remained ‘good’.

A registered manager was in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People and their visitors said that staff were kind and caring. People’s privacy and dignity was not always respected.

Staff were only employed after the provider had obtained satisfactory pre-employment checks. Staff understood their roles and responsibilities and were supported by the registered manager to maintain and develop their skills and knowledge by way of supervision, observations, and appraisals. Staff were trained to provide safe and effective care which met people’s individual needs and they knew people’s care requirements well.

Staff were clear about the procedure to follow to protect people from being harmed. Risks to people who lived at the service were identified, and plans were put into place by staff to minimise these risks and enable people to live as independent and safe life as possible.

People had health, care, and support plans in place which took account of their needs. These recorded people’s individual choices, their likes and dislikes and any assistance they required.

Medicines were well managed and people received their medicines as prescribed.

Staff supported people to make everyday decisions in the least restrictive way as possible; the policies and systems in the service supported this practice.

People and their visitors were able to raise any suggestions or concerns they might have with the registered manager and team of staff. They said that they felt listened to as communication with the registered manager and staff team was good.

Arrangements were in place to ensure the quality of the service provided for people was regularly monitored. We found that people who lived at the service and their visitors were encouraged to share their views and feedback about the quality of the care and support provided.

Further information is in the detailed findings below.

We found that improvements had been made to people's risk assessments and care plans so that staff had the information they required to meet people's individual needs. Staff were able to tell us how they met people's needs and records confirmed that people received appropriate care and support when they needed it.

Discussion with staff and looking at records confirmed that an effective quality assurance system was in place. This meant that improvements had been made to ensure that people received the care and support they needed.

Below is a summary of what we found. The summary describes the number of different methods we used to help us understand the experiences of people who used the service.

During our inspection we looked at four out of 34 people's care records. We saw the provider's policies and procedures; we undertook observations, we spoke with people who used the service, a relative of a person who used the service and members of staff. We also spoke with the manager.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

In the care records we looked at we saw that there were some risk assessments regarding people's individual health, care and support but they hadn't all been regularly reviewed to ensure that the information was current. We saw that measures weren't always in place to minimise those risks. This meant that people were being placed at risk from receiving care or treatment that was inappropriate or unsafe.

We found that there was not always enough staff available to ensure that people received the assistance they required in a timely manner.

The records showed that people were receiving their medication as prescribed. Steps had been taken to reduce the risks of staff making errors when administering medication.

Is the service effective?

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care services. The provider advised us that, at the time of our inspection, no Deprivation of Liberty Safeguard (DoLS) applications had been made for people who used the service. However the manager had arranged for staff to complete training in these areas so that the necessary actions could be taken to ensure that they complied with the requirements of the Mental Capacity Act 2005.

We found that people had not always been referred to the relevant healthcare professionals in a timely manner. This has resulted in an increased risk to their health and wellbeing.

Is the service caring?

We saw some staff caring for people in a kind manner and taking the time to reassure people when they were anxious. However one person who lived in the home told us that they felt staff did not take the time to listen to them or assist them with personal care in a caring and dignified manner. The manager reassured the person that they would observe the staff caring for the person, make suggestions to ensure that this improved and provide a detailed care plan so that all staff were aware of how the person would like to be cared for.

Is the service responsive?

The care records that we looked were incomplete, out of date and did not sufficiently guide staff on people's current care and support needs. This put people at risk of inappropriate care.

Is the service well-led?

Although there was a manager in place they were not yet registered with the Commission. The manager told us that they had appointed a new management team who would be in place from the end of September. The manager stated that there were plans to increase staff training, observation and supervision to ensure all staff were aware of their roles and responsibilities.

The quality assurance system had not been effective in assessing the risks to people and taking the appropriate action to minimise those risks.

Overall, we found that the provider had taken sufficient action to ensure that there were accurate records kept in relation to the care and treatement people had received.

We found that improvements had been made to people's risk assessments and their care plans and staff were able to tell us how they cared for and supported people.

People were provided with a choice of suitable and nutritious food and drink. We observed the lunchtime and found that people were supported to eat and drink when needed.

Staff members confirmed that they felt staffing levels were adequate and this allowed them to provide timely care to people.

We found that there were not always accurate records of the care people had received.

You can see our judgements on the front page of this report.

People did not always receive the care and support they required to improve their health and well-being. Some assessments were completed, although these did not always identify actions that were required to reduce risks. Care records were not written in enough detail to provide clear guidance to staff members and evaluations of care plans did not lead to care plans being updated to reflect peoples changing needs.

People were offered a choice of meals and people told us that they enjoyed the food. Nutritional assessments had not been completed for all people and there was minimal guidance about what action staff should take to ensure people were not a risk from not having enough to eat or drink.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. People told us that they felt safe.

Discussion with the manager, care staff and people living in the home found that there were not always enough staff available to meet people's needs.

Complaints were appropriately investigated and any necessary actions had been taken to make improvements.

We found that the home was compliant with those regulations where there had been non compliance identified during our inspection in April 2012.