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The provider of this service has requested a review of one or more of the ratings.

Reports


Inspection carried out on 17 April 2019

During a routine inspection

About the service:

Canal Vue is a care home that provides personal care for up to 70 people. The accommodation is available over three floors. However, at the time of the inspection only the ground floor was in use. The ground floor contains bedrooms, bathing facilities, a communal lounge, with a dining area and a further two communal spaces. At the time of the inspection there were 13 people using the service.

People’s experience of using this service:

Some improvements had been made to some areas of the home. However, the provider had not ensured the required improvements had been made to all areas of the service. Good care is the minimum that people receiving services should expect and deserve to receive and we found the systems in place to ensure improvements were made and sustained were not effective.

Systems to monitor the service had not identified the improvements that were still needed. People were not always protected from harm as action had not been taken where risk had been identified. Quality monitoring had been inconsistent, we saw that audits had been completed, however they did not always identify concerns. Any concerns raised were not always addressed to ensure changes and improvements were embedded.

Notifications had not always been completed to inform us of events or concerns.

During the inspection we saw there were sufficient staff to support people’s needs. However, it was identified by the staff that at some periods in the day and night there were not always enough staff to ensure people’s safety.

People’s risks had been identified, however these were not always followed or reflective when people’s needs changed. Some areas of the home were not always cleaned to a standard to reduce the risk or control of infection.

Lessons had been learnt in some areas, however other areas still required further commitment in ensuring when changes were required they were carried through and sustained.

Some people’s independence had not been promoted when they had their meals. When people spent time in their rooms they did not always have access to a call bell to enable them to request support.

The summary care plans were not always up to date to reflect people’s needs at a glance. However, the main care plans were detailed and reflected people’s needs.

Improvements had been made in relation to the activities and daily choices being made available to people.. The care people received was respectful and caring. Relatives were welcome. Their views had been considered and these had influenced the food choices available.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Staff were recruited to ensure the relevant checks had been completed. People’s weight had been monitored

The service worked in partnership with a range of health and social care professionals and these relationships had supported peoples to have good health outcomes and consider their wellbeing.

Rating at last inspection: Inadequate (Published November 2018)

Why we inspected: This was a planned inspection based on the rating at the last inspection which was Inadequate. Which means the location was placed in special measures. At this inspection we saw improvements had been made, however not enough for us to remove the rating of ‘Inadequate’ and remove the service from ‘special measures’.

This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

Enforcement: At our last inspection we placed positive conditions on the provider in relation to this location. These required the provider to consult us ahead of any new admissions and to provide us with a monthly report in relation to quality improvements. Although improvements had been made, this did not reflect a sust

Inspection carried out on 12 September 2018

During a routine inspection

This unannounced inspection took place on 12 September 2018. At the last inspection the overall rating for this service was Inadequate which means it was placed in special measures. At this inspection the overall rating for this service is ‘Inadequate’ and the service will remain in 'special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Canal Vue is a 'care home'. People in care homes receive accommodation and nursing or personal care as a 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 is provided in one building across three floors. At the time of this inspection people were only living on the ground floor. There are communal living areas and a separate dining area on that floor. The home provides accommodation and nursing care for up to 70 people who are living with dementia. However, after our last inspection they were not able to take any new admissions and there were now 13 people living at the home.

There was not 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. There was an interim manager on the day of the inspection visit and a new manager due to start the following week.

We found that risk was not managed sufficiently to ensure that people were kept safe. Staff had not received additional training in supporting people living with dementia and we found that they were not always skilled in assisting people whose behaviours put themselves or others at risk of harm. Risk assessments and care plans were not always regularly reviewed to take account of all incidents which had occurred. Staff did not always recognise and report suspected abuse. The provider did not always learn from when things went wrong to ensure that action was taken to avoid it happening again. They did not ensure that staff understood how to avoid further recurrence.

At the previous three inspections we found that the Mental Capacity Act 2005 (MCA) was not fully embedded, we found some improvements at this inspection. Capacity assessments had been completed to assist people to make decisions which were in their best interest. However, staff were not aware who

Inspection carried out on 13 March 2018

During a routine inspection

This unannounced inspection took place on 13 March 2018. At the last inspection there were regulatory breaches in safe care and treatment, recruiting fit and proper persons and good governance. At this inspection there were still regulatory breaches in these areas and further breaches in other regulations. Following the last inspection on 8 June 2017, we asked the provider to complete an action plan in July 2017 to show what they would do and by when to improve the key questions of safe and well led to at least good. They had not met the actions on this plan and had been in breach of regulations and rated as requires improvement at the past three inspections. At this inspection the overall rating for this service is Inadequate which means it will be placed in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures

Canal Vue 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 is provided in one building across three floors. There are communal living areas and dining areas on each of the floors. The home provides accommodation and nursing care for up to 70 people who are living with dementia. There were 58 people living at the service when we visited; although two moved out on the day of inspection.

There was 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.

We found that risk was not managed sufficiently to ensure that people were kept safe. Plans were not followed to ensure that people received safe care. Risk was not reviewed when people’s needs changed to prevent further harm; for example, from falls. When people’s behaviour put themselves and others at risk of harm staff did not always respond and there was not always detailed plans to direct them how to. Medicines were not always managed and administered to ensure that people had them as prescribed. Records which were in place to support the care people received so that staff understood what they needed to do were not always up to date or clear.

Staff did not always recognise and r

Inspection carried out on 8 June 2017

During a routine inspection

We inspected Canal Vue on 8 June 2017 and it was an unannounced inspection. The home provides accommodation and nursing care for up to 70 older people, some of whom are living with dementia. At the time of our inspection 61 people were living at the home. The home had a registered manager in place. 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. This report reflects our findings as on 8 June 2017. However since concluding our inspection we have been made aware that the situation has changed and the registered manager is no longer in place. The service remains under review.

We completed a previous comprehensive inspection on 11 May 2016 and found that improvements were required in a number of areas. This included regulatory breaches in the amount of staff available to meet people’s needs safely and staff understanding of restrictions under the Mental Capacity Act 2005 (MCA). After the comprehensive inspection the provider sent us an action plan within the timescales we requested to demonstrate how they would make improvements. At this inspection we found that some of these actions had been put in place; for example, staffing levels had been reviewed and we saw that there were enough to support people. We saw that people did not have to wait for assistance and that staff had time to spend socialising and reassuring them. However, the staff’s understanding of the MCA was still not fully embedded. Some improvements had been made in applying for legal safeguards when people did not have the capacity to consent; however, staff were not aware what these were. Also, best interest decisions had not been considered for every restriction in place. Furthermore, some improvements that we found at the comprehensive inspection in May 2016 had not been sustained. For example, safe recruitment procedures had not been in place in the comprehensive inspection in May 2015 and were found to require improvement again at this inspection.

At each inspection (in May 2015, May 2016 and June 2017) we found that staff needed to be provided with training in supporting people who live with dementia and who may behave in a way which is challenging. We found that this had not been provided and staff recognised that it was required. The plans in place to support staff to know how to assist people when they behaved in a way which could harm themselves or others were not detailed enough to assist them. There was limited recording of when these behaviours occurred or when people took medicines to assist them to become calmer when it happened.

Other risks associated with medicines were not managed to ensure that people received them as required. The audits which were completed were not effective in identifying these issues. The high turnover of staff and managers impacted on the ability to manage quality improvement and to sustain it.

People were kept safe by staff who understood their responsibilities to protect them. Posters helped to explain to people how to raise a concern or make a complaint. They were also assisted to make choices about their care and how they wanted to be supported. They had care plans in place to support this and these were regularly reviewed.

Staff were knowledgeable about people’s needs and understood the risks to people’s health and wellbeing. They supported them to see healthcare professionals regularly to maintain good health. Mealtimes were well planned to ensure that people received the support they needed, including specialist diets.

Staff had positive relationships with people and respected their privacy and dignity. People were encouraged to participate in activities and important relationships with frien

Inspection carried out on 11 May 2016

During a routine inspection

We inspected Canal Vue on May 11 2016 and it was unannounced. At our previous inspection in May 2015 the provider was not meeting all of the regulations and needed to improve safe recruitment procedures to ensure that staff were safe to work with people, providing care which met the needs of people living with dementia, meeting legal requirements for people to consent to their care and notifying us of significant events in line with their registration. The provider sent us a report explaining the actions they would take to improve. At this inspection, we found that some improvements had been made since our last visit but further improvements were needed to ensure people’s needs were fully met.

Canal Vue provides personal and nursing care for up to 70 older people. It is a purpose built establishment over three floors. There were 43 people living at the home at the time of our inspection.

The home is required to have 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. There was no registered manager in post at the time of inspection.

At the last inspection we saw that safe recruitment procedures were not always followed. At this inspection we saw the provider had ensured that staff were safe to work with people. Improvements had been made to ensure that the provider met their legal requirements to ensure that people consented to their care. However, some people’s capacity to make certain decisions had not been assessed or decisions made in their best interest.

At the last inspection the provider was not always meeting the needs of people living with dementia. Some activities were now being offered and the environment had been designed to assist them. However, people we spoke with and their families said that there was not always enough to do. At the last inspection we saw that the provider had not notified us of all significant events and now they had, which enabled us to ensure that they took the appropriate action.

We saw that there were not always enough staff to safely meet people’s needs and that people had to wait for support and assistance. This impacted on the lunchtime experience in one area of the home as people had to wait for a significant amount of time in a hot environment. Staff did not always have the skills and understanding to effectively support people with their health needs and communication with healthcare professionals was not always maintained to ensure that relevant referrals were made.

There was no registered manager in post but the provider had established a leadership team and there was recently a temporary manager in place who staff said was approachable. Quality systems had been implemented which were driving improvements and complaints were responded to in a timely fashion with learning recorded.

Medicines were administered and managed safely to reduce the risks associated with them. Other risks to people’s health and wellbeing had been assessed and actions put in place to address and reduce them. People had care plans which were detailed, reviewed and altered to represent their changing needs. We saw that staff followed the guidance and supported people in a caring manner. Staff developed meaningful relationships with people and were aware of their likes and dislikes. People had their privacy and dignity upheld and visitors were welcomed at any time.

You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 18 and 19 May 2015

During a routine inspection

This inspection took place on the 18 and 19 May and was unannounced. At our previous inspection in September 2014 the provider was not meeting all the regulations relating to the Health and Social Care Act 2008. There were breaches in meeting the legal requirements regarding care and welfare, staffing and the quality assurance systems in place. The provider sent us a report in January 2015 explaining the actions they would take to improve. At this inspection, we found improvements had been made since our visit in September 2014, although further improvements were needed to ensure people’s needs were fully met.

Canal Vue provides personal and nursing care for up to 70 older people. It is a purpose built establishment over three floors. There were 36 people who used the service at the time of our inspection.

The home is required to have 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. There was no registered manager in post at the time of our inspection.

The recruitment practices were not thorough to ensure the risks to people’s safety were minimised. Plans were in place to respond to emergencies but the information provided was not detailed to ensure people could be supported appropriately.

Legal requirements of the Mental Capacity Act 2005 (MCA) were not always followed when people were unable to make certain decisions about their care. The MCA and the Deprivation of Liberty Safeguards (DoLS) set out the requirements that ensure where appropriate; decisions are made in people’s best interest. Where people lacked capacity to make decisions they had not been assessed appropriately to ensure their rights were upheld. People and their relatives were not always involved in planning and agreeing on how they were supported.

Risks to people’s nutrition were not monitored effectively to ensure people maintained their nutritional health. People were in general supported to access the services of health professionals but this was not always done in a proactive way.

The needs of people living with dementia were not fully met because people’s social and therapeutic needs were not addressed and staff’s understanding was limited.

People told us they felt safe and staff demonstrated a good awareness of the importance of keeping people safe. They understood their responsibilities for reporting any concerns regarding potential abuse. Staff had all the equipment they needed to assist people. The provider checked that the equipment was regularly serviced to ensure it was safe to use. Safe medicine management procedures were in place and people received their medicines as prescribed.

Staff gained people’s verbal consent before supporting them with any care tasks and promoted people to make decisions. People liked the staff and their dignity and privacy was respected by the staff team. Visitors were made to feel welcome by the staff.

Quality assurance checks had been put into place to monitor and improve the service.

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

Inspection carried out on 16, 22 September 2014

During an inspection in response to concerns

This was the service’s first inspection since the provider’s registration in March 2014. We visited the service on 16 September and 22 September 2014 in response to concerns raised about staffing levels and the lack of leadership within the home as the registered manager and another staff member with specialist knowledge about dementia care had left the service in July 2014. We were concerned about the impact this had on the care provided. As part of our joint working with the local authority and the Clinical Commissioning Group (CCG), we were able to follow up on the concerns raised about people’s safety. The local authority and CCG fund people’s care needs and when people were identified as having continuing health needs the CCG helped to fund this.

There were 38 people using the service, two people were in hospital on the days of the inspection. We spoke with four people who used the service, seven staff and five relatives or friends and three visiting professionals. We spoke to the provider, a senior manager from the organisation, and registered manager from another home owned by the provider. They were all supporting the manager. There was no registered manager in post at the time of the inspection. A registered manager is a person who has responsibility with the Care Quality Commission (CQC) to manage the service and has legal responsibility for meeting the requirements of the law: as does the provider. However a new manager was appointed into a management position. They told us they had no previous experience of managing a care service and received support through other managers.

During our inspection we wanted to understand people’s experience of the service they were using. We did this by spending time sitting and talking with people. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. SOFI allowed us to observe the care experiences of people who had communication difficulties. SOFI was used in the communal setting of the dining rooms. We observed the way staff responded to people. We read three care records about people’s care and spoke with staff about people’s needs.

The evidence we collected helped us to answer five key questions;

Below is a summary of what we found.

Is the service safe?

People we spoke with told us that they felt safe living at the home. We saw that staff were able to meet people’s basic needs but there were times when they were not available to provide extra support to people. Agency staff when available were appointed to provide cover at the home.

Staff told us that they often worked without sufficient staff to maintain cover for the three floors. They told us that they found it difficult to perform their roles safely. This meant people could be placed at risk from receiving care that was not always safe because of inadequate staffing numbers, supervision and support.

Staff recruitment was underway to address staff shortages. However, we found unsafe recruitment practices had taken place historically because relevant safety checks were not always undertaken before staff were employed. The provider told us that adjustments were made to ensure safer practices were followed.

Is the service effective?

We saw that people with capacity to make decisions chose whether they took part in activities. We found from reviewing some people’s care records, their rights were protected because meetings had been held to determine that actions taken were in people’s best interests. Deprivation of Liberty Safeguard (DoLS) applications had been made to ensure people’s rights were appropriately protected. This is where a person is restricted of their freedom and considerations are made in the person's best interest.

We saw that people received a diet that was varied, nutritional and prepared so that they could eat it safely. We saw improvements could be made to the management of meal times. This could include having more staff available to help serve and assist people at meal times.

Staff received training to enable them to provide care in an effective way and communicated with other professionals including community nurses, chiropodists and doctors when people were unwell. Care records and assessments were in place and were kept under review. Regular staff understood people’s support needs and people were asked for their consent to care.

Is the service caring?

People told us that they received care provided by staff that were kind to them and knew their individual needs well.

Is the service responsive?

People and their family representatives were provided with an opportunity to attend and share their views at regular meetings where they were able to comment on the care received. They told us they were listened to and actions were taken to address their comments. Concerns and complaints were taken seriously and investigated.

Is the service well led?

People were positive about their life at the home. They told us the staff were helpful and the nurses were approachable.

A registered manager was not in post. However, a manager was in post and they were supported by the management team. This was because the manager did not have the knowledge and relevant experience for managing a care home with nursing. The provider told us that managers were supported for up to three weeks and further time was given to support this new manager.

Staff did not always feel supported by the management team and did not always feel confident to report their concerns directly to them. We found that the management team needed more time to improve and build relationships with the staff team.

Quality assurance systems meant that people’s views and those acting on their behalf were obtained and acted on. Although, checks were made by the provider for the quality of the service, people were not always protected from some of the risks associated with regular staff shortages. This could have an adverse impact on the care people received.