Veronica House Nursing Home

Veronica House is a care home providing personal and nursing care to up to 52 people. The service provides support to older people and people living with dementia, younger people, people with a physical disability and people living with a learning disability and autistic people. At the time of our inspection there were 37 people using the service.

People’s experience of the service and what we found:

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessment and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

There continued to be a high number of agency staff deployed around the home and people, relatives and staff told us this had impacted on consistently meeting people's needs in a timely way. People also told us the high use of agency staff meant care was sometimes provided by staff who did not know their choices and preferences. Risks were assessed and planned for to keep people safe. However, staff did not always have all the necessary skills and knowledge to effectively support people. Medicines were safely managed. Staff were recruited safely. People were protected from the risk of abuse and staff knew what action to take to keep people safe from risk of abuse. People were protected from the risk of infection.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care:

People's social activity needs were not always met. People’s mealtime experience was not consistently positive. People had varying levels of access to the community. There was improvement required in communicating with people whose first language was not English. Relatives felt able to raise concerns, if needed. There were processes in place to support people nearing the end of their life.

Right Culture:

Quality assurance system to monitoring and improve the quality and safety of the service were not always effective at identifying the issues identified at this inspection. There had been a number of improvements made to the governance systems, however these needed time to become embedded into practice. We found more work was needed to ensure the service was operating in accordance with best practice particularly in relation to a home environment because it did not consistently support people living with dementia. The provider was trying to develop an open and empowering culture. The registered manager and deputy manager were person-centred and were working on making improvements with the service. The service worked in partnership with external professionals and organisations.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Requires Improvement (published on 6 December 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve

At this inspection we found improvement had been made and the provider was no longer in breach of regulations, however the service remains requires improvement This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

The inspection was prompted in part by the increased number of notifications of specific incidents, particularly the high number of falls and unexplained injuries. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from these concerns.

Please see the Safe question section of this full report.

We initially undertook a focused inspection to review the key questions of Safe, Effective and Well-led key questions only. During the inspection we found there was a concern with a poor and undignified interaction with one person and accessible information so we widened the scope of the inspection to become a comprehensive inspection.

Follow Up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Veronica House Nursing Home is a care home providing personal care and nursing for up to 52 people. The service supported people with mental health conditions, physical disabilities, older people and people living with a learning disability and/or Autism. At the time of the inspection, the service supported 37 people, of whom only a small number required learning disability and/or Autism support.

The home is a purpose-built property set over three floors each separated into two smaller units. Each floor has communal lounge areas and separate dining areas. All bedrooms have en-suite toilet and showers. At the time of our inspection the third floor of the home was not in use, but the provider planned to re-open this again in the future.

People’s experience of using this service and what we found

The provider’s oversight of the service had not identified some of the shortfalls we found at this inspection. Systems and process in place to monitor the safety and effectiveness of the service required improvement.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

The provider was able to demonstrate how they were meeting some of the underpinning principles of right support, right care, right culture.

Right support

People, relatives and staff told us more staffing was required to ensure people's holistic needs were met in a timely way. People also told us the high use of agency staff meant that care was sometimes provided by staff who did not know their choices and preferences. The provider told us they had recently completed recruitment of staff to address these issues. Staff recruitment is a known difficulty across the adult social care sector. Peoples risks had been assessed; however incomplete records meant we could not be assured all risks were fully addressed. People were supported with their medicines safely.

Right Care:

Staff received training to support people’s individual needs. New processes were in place following previous incidents relating to people’s specific dietary needs to ensure they were supported effectively. However, people, relatives and staff all told us the choice and quality of food required improvement. Staff took part in regular testing for COVID-19. People told us staff respected their privacy and dignity when providing care and support.

Right Culture:

There were a number of areas we identified as requiring improvement during the inspection. Whilst the provider had systems in place to identify these, the systems had not been effective in ensuring the required changes had been made in a timely way. The recruitment process could be improved further to ensure it contained all relevant documents such as staff photographs. Staff had training on how to recognise and report abuse and felt confident that action would be taken. People were supported to access healthcare services where required and we received some positive feedback from healthcare professionals. We saw the service worked closely with healthcare professionals. The environment did not support people living with dementia and the provider had not provided information such as menus in a format that supported people’s needs.

We have made a recommendation that the provider implement best practice and follows current guidance on providing dementia friendly environment, communication and care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for the service was good, (published on 18 December 2019).

Why we inspected

We received concerns in relation to the safety of people with allegations of abuse and poor care standards. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Veronica House Nursing Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and take further action if needed.

We have identified two breaches of regulation in relation to safe care and treatment and governance processes in monitoring the overall quality of the service being delivered to people.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Staff were wearing personal protective equipment (PPE) correctly and there was enough PPE available throughout the home.

There was a clear process in place to monitor vaccination status and testing for staff and people at the service.

The service was clean and effective systems were in place.

Veronica House is a care home that was providing personal and nursing care to 29 younger adults and older people at the time of the inspection. The service can support up to 52 people. Veronica House is a purpose-built care home registered to accommodate up to 52 people across three floors.

People’s experience of using this service and what we found

Following the last inspection, the management team at the service had strengthened and the registered manager was supported by a deputy and a clinical lead. A variety of processes were in place to audit the quality and safety of the service and where these identified the need for improvements, they were quickly acted on. People and staff were involved in the running of the service and their opinions were listened to and valued. Feedback of the service was sought from people and visitors through meetings and surveys and areas for improvement identified and acted on. The service worked alongside other agencies and worked to form partnerships with the community to improve service delivery.

People were supported by a group of safely recruited staff who had received training and guidance in how to safeguard people from abuse. Risks had been identified and were well managed by staff who knew people well. Risk management plans were kept up to date and gave staff information they needed to reduce risks of harm or injury to people. People received their medicines as prescribed. Accidents and incidents were reported and acted on appropriately and analysed for any trends.

Staff felt well trained and spoke positively of the help, guidance and support they received from their colleagues and members of the management team. New staff benefitted from an induction which included being supported by more experienced members of staff. People had choices about drinks and what they ate for their meals and their nutritional needs were met. Staff were aware of people’s healthcare needs and assisted people to access a variety of healthcare services. Staff understood the importance of promoting people’s independence whenever possible. The home was well-maintained and good level of cleanliness reduced risks of cross infection.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People’s needs were assessed, and information was used to form personalised plans of care. People were supported to take part in a wide variety of activities that were of interest to them. Visitors were made welcome and their views of service sought. People felt listened to, had no complaints about the service and were confident that if they raised concerns, they would be acted on.

Staff presented as kind and caring and shared positive relationships with the people they supported. People were treated with dignity and respect and supported to maintain their independence where possible.

The service worked alongside other agencies and worked to form partnerships with the community to improve service delivery.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 3 July 2019) and we found two breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

There were a lack of effective systems and processes in place to assess, monitor and improve the quality and safety of the services provided. Regular audits were not taking place which would provide the management with reassurances that people were being cared for safely and in line with their care needs. Accidents and incidents were not routinely analysed and opportunities were lost for lessons to be learnt. People were not involved in the planning of their care and care plans seen held inconsistent information. Risk assessments were not always fully evaluated or were missing and daily charts were not completed consistently.

Staff had not received training in specialist areas such as epilepsy and had only received basic training in dementia care. Systems were not in practice to observe staff competencies in areas such as tracheostomy and/or peg feed care. Systems were not in place to provide management with the assurances that people were supported safely and effectively in line with their care needs.

Staff felt well trained and supported in their role. People were happy with the care they received and felt it met their needs.

Staff were aware of people’s health needs and liaised with other health care professionals to support their wellbeing. People were supported where appropriate at mealtimes. People continued to be asked to make choices regarding meal times 48 hours prior to having that meal, despite inspectors previously being told this would change to 24 hours. Evening meal remained at 4.00pm giving rise to concerns that people who may not be able to communicate that they were hungry (and could ask for supper in the evening), going without another meal until breakfast the next day.

We were told people could ask for snacks in the evening such as toast, soup or biscuits, but not everyone spoken to was aware of this and there was no routine supper trolley in place which would alert people to these options.

People were supported to have maximum choice and control of their lives, and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff obtained people’s consent prior to supporting them, but staffs’ knowledge regarding which people were deprived of their liberty was limited.

People were well cared for by staff who treated them with dignity and respect and encouraged them to maintain their independence. People were supported to be involved in decisions regarding their day to day care decisions but were not involved in the planning of their care.

There was no documented evidence available to show that where complaints had been received they had been responded to and acted on appropriately.

People and staff were not involved in the running of the home. Staff had not received regular supervision or had not had the opportunity to discuss any concerns or issues they may have at team meetings. Staff did not feel able to contribute to the running of the service. Quality audits were not in place to assess quality of care or drive improvement in the service. The service had been without a registered manager since August 2018.

Rating at last inspection: Good published 5 January 2018

Why we inspected: Concerns regarding the governance of the service were bought to our attention by the local authority.

Enforcement : Action we told provider to take. Please refer to the end of the full report.

Follow up: We will meet with the provider following the publication of this report to discuss how they will make changes to ensure the rating of the service improves to at least Good. We will re-inspect Veronica House within our published timescales to what improvements have been made.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Following the inspection, the provider sent us an action plan, telling us how they intended to meet the legal requirements in relation to the breaches identified.

We undertook an unannounced focused inspection on 8 March 2017. That inspection was to check that the provider had followed their action plan and to check that they were meeting the legal requirements. At that inspection, we found that the areas for improvement identified on the action plan and in relation to meeting the legal requirements, had been met.

Veronica House provides accommodation for up to 52 people who require nursing or personal care, for younger or older people, people with a learning disability or a physical disability. At the time of the inspection there were 37 people living at the home.

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.

The introduction of an electronic system for the recording and administration of medicines was not as effective as hoped and had created a number of problems for the service. Systems in place for the management of medicines could not demonstrate that people always received their medicines as prescribed.

People felt safe and were supported by staff who had receiving training in how to recognise signs of abuse and were aware of what actions to take should they suspect someone was at risk of harm.

People were supported by staff who were aware of the individual risks to them on a daily basis. Staff were aware of how to manage those risks and how to keep people safe. Where accidents and incidents took place, they were reviewed and lessons were learnt.

Staffing levels were based on the dependency levels of the people living at the home. The deployment of staff across the home was under review in order to ensure staff responded to people’s needs in a timely manner.

Staff benefitted from an induction that prepared them for their role. Staff received specialist training in order to meet the needs of the people they cared for.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported to have sufficient amounts to eat and drink and were offered choices at mealtimes that were tailored to their individual preferences and dietary needs.

People were supported to access a variety of healthcare professionals to ensure their health and wellbeing.

People were supported by staff who were kind and caring and treated them with dignity and respect. Staff were aware of people’s preferences with regards to their care and what was important to them.

People were involved in the development of their care plan. Care plans included information which reflected people’s likes and dislikes and family history.

People were supported to take part in a variety of activities that were of interest to them. The activities co-ordinator had a comprehensive knowledge of people and what was important to them and developed activities that were of interest to people.

People felt listened to and were confident that if they had any concerns or complaints they would be dealt with appropriately. Where complaints had been received, they were investigated and responded to and where appropriate, lessons were learnt.

People and staff had confidence in the registered manager and considered the service to be well led. Staff felt supported in their role and were confident that they would be listened to. Systems and processes were in place to monitor the effectiveness of the service provided. Where issues were highlighted, lessons were learnt and acted upon.

Following the inspection, the provider sent us an action plan, telling us how they intended to meet the legal requirements in relation to the breaches identified.

We undertook this unannounced focused inspection on 8 March 2017. This inspection was to check that the provider had followed their action plan and to check that they were meeting the legal requirements. At this inspection, we found that the areas for improvement identified on the action plan had been met. This report only covers our findings in relation to the regulations that had not been met at the previous inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Veronica House on our website at www.cqc.org.uk.

Veronica House provides accommodation for up to 52 people who require nursing or personal care, for younger or older people, people with a learning disability or a physical disability. At the time of the inspection there were 21 people living at the home.

There was a new manager who had been in post since November 2016 and had recently become registered manager of the home. 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.

Improvements had been made in relation to how medicines were managed and administered to people. People received their medicines safely and effectively and staff practice was regularly observed and additional training provided where required.

There was a robust recruitment system in place to ensure that people were supported by staff who were safely recruited.

People and relatives were complimentary about the care and support received. People and staff all told us that the registered manager was approachable and supportive and commented positively on the improvements made to the service since his arrival. The registered manager had worked hard to engage staff and bring them on board with his vision of the service. There was a positive and open culture and staff were enthusiastic about the improvements planned.

The registered manager had introduced a number of audits in order to assess the quality of care delivery. The audits covered all aspects of care delivery and provided the registered manager with the information required to enable him to identify any areas for improvement.

We carried out an unannounced comprehensive inspection of this service on 1 September 2015 at which a breach of legal requirements was found. This was because people’s medicines were not always managed safely.

We carried out a further inspection on 7 March 2016 to look at how the provider had made improvements to their medicines management processes. At this inspection we found that although some improvements had been made, there still remained a number of areas outstanding.

Veronica House provides accommodation for up to 52 people who require nursing or personal care, for younger or older people, people with a learning disability or a physical disability.

Prior to our inspection, we were told that the registered manager had left the home. 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.

On the day of the inspection we were shown round by the manager of the home’s sister home, who had stepped in to oversee the home whilst another manager was recruited into post.

People told us they felt safe in the home and were supported by staff who had been trained to recognise abuse.

People did not always receive their medicines as prescribed by their doctor. A number of concerns highlighted at previous inspections remained in place and had not been addressed.

A number of staff had been recruited without references being sought and management had failed to identify this as a concern.

Staff felt well trained to do their job, and were supported to attend specialist training. Not all staff benefitted from an induction process that equipped them with the skills to do their job.

Staff understood the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards, but information relating to this was not reflected in people’s care records and where some people had the capacity to make their own decisions, this was not taken into account.

People were supported to have a nutritionally balanced diet and adequate fluids throughout the day.

Staff were concerned that information was not always communicated to them in a timely manner.

People benefitted from access to a number of healthcare services such as their GP, the dentist and physiotherapy services.

Most people told us staff were kind and caring but not all people agreed with this statement. People’s privacy and dignity was not always positively promoted.

A number of people told us they were not involved in the development of their care plan or asked how they wished to be supported. Care plans did not hold information regarding peoples likes, dislikes or preferences.

Activities were available but did not reflect the personal interests of the people living in the home.

People and staff had not been made aware and reassured regarding the recent management changes in the home. Audits that were in place did not fully reflect an accurate picture of what has happening in the home.

Staff were not confident that if they raised concerns regarding the running of the home, that they would be listened to.

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

Veronica House provides accommodation for up to 52 people who require nursing or personal care, for younger or older people, people with a learning disability and or a physical disability.

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.

There was also a new manager in post, who had recently taken over responsibility for the running of the home and had submitted her application with CQC to become the registered manager.

Improvements had been made in relation to how medicines were managed and administered to people. However, the provider remained in breach of Regulation 12.

More improvements were required in relation to the management of out of stock medicines. When medicines have been administered, refused or omitted records must clearly record this information in order for staff to ensure medicines are given consistently and safely.