Villa Maria

We found the following examples of good practice.

¿ Staff had received training in infection control and how to use personal protective equipment (PPE) effectively. Staff changed into their uniforms when arriving at the service and had the option to have uniforms washed at the correct temperature at the service.

¿ People and staff had regular tests for COVID. Lateral flow tests (which give a result in 30 minutes) were used for anyone who entered the service including staff for each shift they worked.

¿ The service was clean and additional cleaning had been added to the cleaning schedule including disinfecting door handles and all areas after use by people or staff. Furniture had been moved to promote social distancing including reducing the number of people at each dining table for meals.

Villa Maria is registered to provide accommodation and personal care for 29 older people, people who live with dementia and people with physical or sensory adaptive needs. There were 22 people living in the service at the time of our inspection visit. The service was owned and operated by the Marist Sisters. They are a charitable, religious order. Sixteen of the people living in the service were Marist Sisters with the other residents being ‘lay guests’.

The service was administered on a day to day basis by another charitable, religious body who had been commissioned by the Marist Sisters to run the service. This management charity was responsible for undertaking a range of tasks including the delivery care services and the recruitment, training and deployment of staff. The management charity was also responsible for ensuring compliance with regulatory requirements. The Marist Sisters had formed a Provincial Council formed of three of their number, one of whom was the chair. The council was responsible for managing the service’s finances and for liaising with the management charity.

There was a registered manager 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. In this report when we speak about both the Marist Sisters and the registered manager we refer to them as being, ‘the registered persons’.

At the last comprehensive inspection on 14 February 2017 the overall rating of the service was, ‘Requires Improvement’. We found that there were four breaches of the regulations. The first breach of regulations was because sufficient provision had not been made to provide people with safe care and treatment. This included an instance on which a person was not provided with the right assistance to keep their skin healthy. It also included oversights in the steps taken to monitor some people’s blood pressure and to ensure that other people had enough to drink. The second breach of regulations referred to shortfalls in staffing arrangements because sufficient numbers of suitably qualified care staff had not always been deployed in the service. Another breach of regulations involved oversights in the steps taken to obtain people’s consent to elements of the care that they received. The fourth breach referred to shortfalls in the arrangements used to monitor and improve the service including consulting with people to obtain feedback about suggested improvements.

We told the registered persons to send us an action plan stating what improvements they intended to make and by when to address our concerns and to improve the key questions of 'safe', 'effective' and' well led' back to at least, 'Good'. After the inspection the registered persons told us that they had made the necessary improvements.

At the present inspection we found that sufficient progress had been achieved to meet all of the breaches of regulations. People received safe care and treatment. Enough suitably qualified care staff had been deployed. Suitable arrangements had been made to obtain consent to care and treatment in line with legislation and guidance. The systems and processes used to assess and monitor the operation of the service had been strengthened to ensure that the service could learn, innovate and ensure its sustainability.

Our other findings were as follows. People were safeguarded from situations in which they may be at risk of experiencing abuse. Medicines were managed safely. Background checks had been completed before new care staff were appointed. Suitable provision had been made to prevent and control the risk of infection. Lessons had been learned when things had gone wrong.

Appropriate arrangements were in place to assess people’s needs and choices so that care was provided to achieve effective outcomes. This included providing people with the reassurance they needed if they became distressed. People were helped to have a balanced diet and suitable provision had been made to help people receive coordinated care when they moved between different services. People had been supported to access all of the healthcare services they needed. The accommodation was designed, adapted and decorated to meet people’s needs and preferences.

People were treated with compassion and respect. They were also given emotional support when it was needed. People had been supported to express their views and be actively involved in making decisions about their care as far as possible. This included them having access to lay advocates. They could also obtain support from one of the sisters who was the community leader and who provided pastoral assistance to everyone who lived in the service. Confidential information was kept private.

People received responsive care that met their needs for assistance including care staff supporting them to have access to written information that was relevant to them. Suitable arrangements had been made to promote equality and diversity including provision for the sisters to honour their religious observances. There were suitable arrangements for managing complaints and provision had been made to support people at the end of their life to have a comfortable, dignified and pain-free death.

There was a registered manager who had been supported and encouraged by the Marist Sisters and the management charity to develop an inclusive culture in the service. Suitable arrangements had been made to ensure that regulatory requirements were met. The registered persons were actively working in partnership with other agencies to support the development of joined-up care.

Villa Maria is owned by the Sisters of the Marist Congregation. It provides accommodation and personal care for up to 29 older people and is suitable for those with poor mobility. At the time of the inspection 21 people were living at the service, the majority of whom were Sisters of the Marist Congregation. The service is a detached purpose built building and it is set within large gardens overlooking the sea in Hythe and within walking distance to local amenities. Bedrooms are set over three floors with access via a passenger lift. Each person has a single room, with ensuite and there are further assisted bathrooms. People have access to two large lounges and further quiet seating areas, a dining room, conservatory and chapel. There is a well maintained garden, set on a slope with a level paved access around the building and pretty flower tubs and baskets. There is parking available.

Following the last inspection the registered manager resigned and a new manager, who was previously the deputy manager, was appointed in January 2017. 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 the time of the inspection the manager was not registered with the Commission.

People spoke positively about the service they received and were satisfied with the care and support provided.

Most risks associated with people’s care and support had been assessed, but there was not always clear or up to date information about how staff should manage these risks in order to keep people safe. There was conflicting information and practices about monitoring people’s health needs to ensure they remained well.

People may be at risk of not have all their needs consistently met as there was not sufficient numbers of competent, skilled and experienced staff on duty. The use of agency staff was high and these staff did not know people and had not all had a thorough induction or read people’s care plans. People told us they felt staff were caring although there had been some incidents of poor practice were people’s dignity had not been respected, which were being investigated. Most of the staff showed care and compassion towards people and respected their dignity and privacy.

People received their medicines when they should, but the medicines policy and competency assessments could be improved to help mitigate risks.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. People’s rights were restricted and not all had been considered for a DoLS. The Mental Capacity Act 2005 (MCA) provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant. Staff did not always follow the principles of the MCA to ensure they were acting legally and in line with people’s wishes.

There were audits and checks undertaken, which were meant to identify shortfalls and where improvements were needed. However these had not identified all the shortfalls found during the inspection. Due to trained staff shortages the manager was required to spend time undertaking care and support tasks, which took them away from their management role. There was no deputy manager and staff shifts lacked leadership.

People were involved in the assessment and the initial planning of their care and support and some had chosen to involve their relatives as well. Care plans reflected people’s preferred routines. Although the method used to update care plans could make it difficult to ascertain people’s current needs. People told us their independence was encouraged wherever possible.

People could choose from a varied menu and enjoyed their meals. People attended regular chapel services each day and in addition there were opportunities to join in a range of activities, which people enjoyed. People did not have any concerns, but felt comfortable in raising issues. Their feedback was gained both informally and formally.

Management had an open door policy and they took action to address any concerns or issues to help ensure the service ran smoothly.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.

Villa Maria is owned by the Sisters of the Marist Congregation. It provides accommodation and personal care for up to 28 older people and is suitable for those with poor mobility. At the time of the inspection 22 people were living at the service, the majority which were Sisters of the Marist Congregation. The service is a detached purpose built building and it is set within large gardens overlooking the sea in Hythe and within walking distance to local amenities. Bedrooms are set over three floors with access via a passenger lift. Each person has a single room, with ensuite and there are further assisted bathrooms. People have access to two large lounges and further quiet seating areas, a dining room, conservatory and chapel. There is a well maintained garden, set on a slope with a level paved access around the building and pretty flower tubs and baskets. There is parking available.

The service is run by a registered manager. 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 and relatives spoke positively about the service received and were happy with the quality of care and support provided.

Most risks associated with people’s care and support had been assessed, but there was not always clear or up to date information about how staff should manage these risks in order to keep people safe.

People received their medicines when they should, but guidance in relation to medicines prescribed ‘as directed’ required more detail, to ensure people received these safely and consistently.

People were involved in the assessment and the initial planning of their care and support and some had chosen to involve their relatives as well. However care plans varied in the level of detail and all required further information to ensure people received care and support consistently and according to their wishes. Some care plans did not reflected people’s current care and support needs. People told us their independence was encouraged wherever possible, but this was not always supported by the care plan.

New staff underwent an induction programme, which included shadowing experienced staff, until staff were competent to work on their own. Staff received training relevant to their role. However staff did not have regular opportunities for one to one meetings, to monitor their practice and enable them to carry out their duties effectively. Some staff had gained qualifications in health and social care.

There were audits and checks undertaken to ensure the service was effective. However action was not always taken in a timely way to address shortfalls that had been identified.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. At the time of the inspection no one at the service had their liberty restricted. People were supported to make their own decisions and choices and these were respected by staff. Staff had received training in the Mental Capacity Act (MCA) 2005. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant. The registered manager understood this process.

People were protected by safe recruitment procedures and had their needs met by sufficient numbers of staff. People were relaxed in staff’s company and staff listened and acted on what they said. People were treated with dignity and respect and their privacy was respected. Staff were kind and caring in their approach and sometimes used banter and good humour.

People had a varied and healthy diet. People were supported to maintain good health and attend appointments and check-ups. Appropriate referrals were made to health professionals when required.

People attended regular chapel services each day and in addition there were opportunities to join in a range of activities, which people enjoyed. People did not have any concerns, but felt comfortable in raising issues. Their feedback was gained both informally and formally.

The registered manager had an open door policy and they took action to address any concerns or issues straightaway to help ensure the service ran smoothly.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.

At the time of this inspection there were 21 people accommodated at Villa Maria. We spoke with seven people who used the service. We observed how people spent their time and their interactions with staff. We also spoke with the deputy manager, five staff and a visiting district nurse during our inspection. We reviewed care plans and other records relating to the management of the service.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

Is the service safe?

The service was safe. People told us they felt the service was 'very' safe.

The service had systems in place to keep people safe and we saw that risks associated with people's care and support had been assessed. Assessments promoted the rights of people and gave staff clear guidance about how to support a person safely.

There was an effective system to manage accident and incidents and learn from them, so they were less likely to happen again. This reduced the risks to people and helped the service to continually improve.

We found that people's medicines were handled safely.

The service had policies and procedures in relation the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Most staff had received training in the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). There were no Deprivation of Liberty Safeguards authorisations in place, and no applications had been made.

Is the service effective?

The service was effective. People told us they were happy with the care and support they received. They said that they liked living at the service because it was 'very homely' and they felt their needs were met. One person said, 'I am as happy as can be'. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew people very well.

People's needs were assessed by the service. Care plans were in place for each person, which detailed people's wishes and preferences, in order that care and support could be delivered in a safe and consistent way. People had access to health care professionals to help make sure their health care needs were met.

People said the food was 'excellent' and people had an adequate, varied and wholesome diet. We saw that healthcare professionals had been involved in nutritional assessments and clear guidance about how to meet people's nutritional needs were recorded in their care plan.

Is the service caring?

The service was caring. People told us, 'The staff are excellent and some have been here a good while and respect us all and never grumble' and 'The staff are very caring'. People felt their privacy and dignity was always maintained.

During the inspection we saw that staff adopted a kind and caring approach when dealing with people. Staff were patient when supporting people. We saw good interactions between staff and people who lived at Villa Maria.

People were treated with dignity and had their privacy respected. Staff demonstrated a kind and patient approach when discussing people that used the service during the inspection.

Is the service responsive?

Staff were responsive to people's needs. People said, 'They come when we press the buzzer' and 'They always come when you need them and make sure I have everything I need'. We saw and heard during the inspection that some people were able to make their views known about what they wanted in relation to their day to day care and support. We saw that staff respected these wishes. Care plans were regularly reviewed and updated with people or their representatives to make sure people received the care they needed.

People told us that there were regular opportunities to offer their views and feedback, such as at meetings with the sisters and registered manager. People were aware of the complaints procedure, but at this time had no complaints.

People were happy with the range of activities that were available. We saw that people were able to spend time quietly if they wished within the service. People told us they enjoyed the afternoons and often there was 'lots of fun and laughter had during this time'.

Is the service well-led?

The service was well-led. There was a clear management structure in place. Staff knew their roles and responsibilities. Staff had an understanding of the ethos of the service and quality assurance processes were in place. People felt that communication and accessibility of the registered manager was good. One person said, 'I am very pleased with the way the place is run'. Another said, 'Things are always running smoothly and we are kept informed about what's happening'.

When investigations had been required, for example, in response to accidents and incidents, the service had completed a detailed investigation. This included what actions had been taken to resolve the issues so that risks to people of future occurrences were minimised.

During this inspection we spoke with four people who used the service, the registered manager and one member of staff.

People spoken with told us they continued to be satisfied with the service received. People said they got their medicines when they should. No new staff had been recruited since the last inspection and we found recruitment records had been reviewed and met with the regulations.

People told us their privacy and dignity was always respected. They confirmed that they had given their consent and been involved in discussions about their care, some with a family member. People spoken with told us they were satisfied with the service they received and that their care was personalised to their needs. One person said, 'Please don't change anything about how this place operates as it's just perfect and the staff couldn't do enough for us all'. Another person said, 'We just love it here'. People were aware of their care plan although could not always recall the detail. People said they usually got their medication when they should. One person said, the care worker always 'discussed the medication before giving it'. However we found shortfalls in the systems to manage people's medication safely.

People felt that the service recruited the right calibre of staff. However we found shortfalls in recruitment procedures. People told us they had opportunities to express their views and give feedback about the service.

Two people had previously each described an area of their care that could have been improved. One person had wanted a bath every day. We saw that this person's care plan had been updated to reflect this and we saw in the reports made by staff that the individual was offered a bath every day. This person was not available to speak with on the day of the inspection.

The other person whose first language was not English had told us 'young staff did not always speak slowly and clearly', so they had difficulty in understanding them. We saw that the care plan had been updated to reflect their first language and there was clear guidance to staff about communicating with the individual. This person was not available to speak with us at the time of our inspection.