We carried out a review of the data available to us about Villa Maria Private Nursing Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Villa Maria Private Nursing Home, you can give feedback on this service.
Villa Maria Private Nursing Home is a care home providing personal and nursing care to people aged 65 and over and people with a disability. The service can support up to 26 people in one adapted building. There were 22 people living there at the time of the inspection.
People’s experience of using this service and what we found
People chose how they received their care and support. For example, people chose the times at which they got up in the morning and when they when to bed at night. They chose how they received personal care, the activities they engaged in and what they ate. 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.
The provider monitored the quality of the service people received and made improvements where shortfalls were identified. Management arrangements had changed since our last supervision with a new registered manager in post supported by an operational manager. The registered manager and staff where clear about their roles and responsibilities and worked in partnership with health and social care professionals to meet people’s needs. The provider sought feedback from people and their relatives and used this information to improve the service.
Rating at last inspection and update
The last rating for this service was requires improvement (published 06 May 2021). 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
We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions responsive and well-led which contain those requirements. 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 requires improvement to good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Villa Maria Private Nursing Home on our website at www.cqc.org.uk
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Villa Maria Private Nursing Home is a residential care home providing personal and nursing care to people aged 65 and over, people with a disability and younger adults. The service can support up to 26 people in one adapted building. There were 22 people living there at the time of the inspection.
People’s experience of using this service and what we found
People were supported to have choice and control of their lives most of the time and staff usually supported them in the least restrictive way possible and in their best interests; the policies and systems in the service were designed to support this practice.
However, during the Covid-19 pandemic and the third national lockdown, there had been occasions when some people had not always been given maximum choice and control over their care and had at times been restricted more than necessary. The provider had stopped visits from people’s families and reduced the amount of time a person could spend out in the community.
Some people were not aware that they could choose when to have their breakfast and other meals and the provider had not always asked people the time they preferred to eat their meals or recorded it in their care plans. This had lead to some people being given their breakfast earlier than they would have liked.
The provider had not always recorded all people's communication needs and preferences in enough detail for staff to know how to communicate with them effectively.
People's lack of choice and control at times meant the provider had not always given all people person-centred care because they had not always responded to people's personal preferences.
There were audit systems and training in place to support continuous learning. However, the provider's auditing systems had not identified the areas of concern we found during our inspection.
People received safe care and treatment and there was a stable staff team with a positive and supportive staff culture.
The provider had robust and effective infection prevention and control policies and procedures in place to protect people from Covid-19 infection.
The provider's policies and practice promoted a positive culture in the home and involved people and their families and staff in the development of the service. People's personal cultural requirements were taken into consideration. People achieved good health outcomes.
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 Good (published 11 July 2019).
Why we inspected
We undertook this targeted inspection to follow up on specific concerns we had received about the service. The inspection was prompted in part due to concerns received about person-centred care, staff culture and staff turnover, safe care and treatment and infection prevention and control practice. A decision was made for us to inspect and examine those risks.
We inspected and found there was a concern with person-centred care, so we widened the scope of the inspection to become a focused inspection which included the key questions of responsive and well-led.
We looked at infection prevention and control measures under the Safe key question. This was to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
We have found evidence that the provider needs to make improvement. Please see the responsive and well-led sections of this full report.
The overall rating for the service has changed to Requires Improvement. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Villa Maria Private Nursing Home on our website at www.cqc.org.uk.
Enforcement
We have identified breaches in relation to Regulation 9 (Person-centered care) and Regulation 17 (Good governance.)
You can see what action we have asked the provider to take at the end of this full report.
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.
Villa Maria Private Nursing Home is a care home which can support up to 26 people in one adapted building. At the time of this inspection, the service was providing personal and nursing care to 21 people.
People’s experience of using this service and what we found
The quality and safety of the service had improved for people since our last inspection. There was better information about people and the care they required to help staff deliver support which met their needs. Staff knew people well and understood how their needs should be met. Staff were patient and respectful with people. They supported people in a dignified way which maintained their privacy and independence.
Systems for assessing, monitoring and managing risks had also been improved to help reduce risks to people’s safety and wellbeing. Staff knew how to manage and minimise identified risks to people. People said they were safe at the service and staff had been trained to safeguard people from abuse. The provider carried out checks on staff to make sure they were suitable to support people. Staff were provided relevant training to help them meet people’s needs. There were enough staff to support people.
All medicines were now stored safely. People were supported to take their prescribed medicines when they needed these. People were encouraged to stay healthy and well and helped to eat and drink enough to meet their needs. When people became unwell, staff sought assistance for them promptly. Recommendations from healthcare professionals were acted on so that people received the relevant care and support they needed in relation to their healthcare needs.
The provider was now meeting their legal duty under the Mental Capacity Act 2005. 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.
The provider had improved the range of activities for people to enjoy and supported people to maintain relationships that were important to them. People had a choice of spaces to spend time in when at home. The provider had been redecorating and refurbishing the premises to make this a more comfortable and pleasant place for people to live. The provider carried out health and safety checks of the premises and equipment to make sure they were safe. The premises was clean and tidy, and staff followed good practice when providing personal care and when preparing and handling food which reduced hygiene risks.
People knew how to make a complaint if needed. The provider had arrangements in place to make sure any accidents, incidents and complaints were fully investigated which included keeping people involved and informed of the outcome. Learning from complaints and investigations was shared with staff to help them improve the quality and safety of the support they provided.
People spoke positively about the management of the service. The provider made sure staff were well supported, motivated and clear about their duties and responsibilities and encouraged to help people achieve positive outcomes in relation to their care needs.
The provider encouraged people and staff to have their say about how the service could improve. They used this feedback along with other checks, to monitor, review and improve the quality and safety of the support provided.
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 26 June 2018) and there were multiple breaches of regulation. 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.
This unannounced inspection took place on 26 April 2018.
At our last inspection in 17 September 2015 we found the service was ‘Good’ in all the key questions we ask of services and so we rated the service ‘Good’ overall.
The service had 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.
The provider did not always ensure bed rails were used safely to protect people from the risk of harm. Pressure relieving mattresses were not always used appropriately to reduce the risk of pressure ulcers, although the service reduced the risk of pressure ulcers in other ways. People received their medicines are required.
The provider did not always follow the Mental Capacity Act (MCA) 2005 in assessing whether people lacked capacity to consent to their care. In addition the provider had not always followed their legal duty when depriving people of their liberty.
Although people received care which met their needs and preferences care plans required improvement to act as suitable guides for staff. Care plans, including end of life care plans, were not always ‘person-centred’ setting out the best ways to care for individuals.
The provider lacked suitable systems to check they were providing care in line with Regulations. The provider had not identified the breaches we found before we inspected the service and so had not taken the necessary action to improve.
The premises met people’s needs in relation to their disabilities. A programme was in place to maintain the safety of the premises.
Systems were in place to safeguarding people from abuse and improper treatment. There were enough staff deployed to care for people and the provider checked staff were suitable to work with people through recruitment checks.
Staff were supported with a programme of supervision and training and were encouraged to do diplomas in health and social care.
The provider consulted with people as part of assessing their needs and also reviewed any professional reports. People were involved in decisions regarding their care. People were supported in relation to their health.
People developed good relationships with staff who were caring. Staff were respectful and understood the people they cared for. Staff treated people with respect and maintained people’s privacy and dignity.
The complaints process was suitable and the provider responded to any concerns raised appropriately.
Leadership was visible and the registered manager acted as a role model to staff, interacting with people and providing personal care to people in their daily work. The directors were also visible in the home and accessible for people, relatives and staff.
The provider gathered feedback from people and relatives regarding the quality of care and the communicated openly with staff and external professionals.
At this inspection we identified some breaches of regulation. You can see the action we asked the provider to take on the back of our full-length report.
This was an unannounced inspection that took place on 17 September 2015.
Villa Maria Private Nursing Home provides accommodation and nursing care for up to 26 people, who have various complex needs. There were 23 people living in the home when we visited.
The home had 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 and associated Regulations about how the service is run.
In August 2013, our inspection found that the home met the regulations we inspected against. Since then changes had taken place, and in May 2014, a new provider purchased the service.
People and their relatives told us the home had a new owner. They said that it still provided a “great service”, an atmosphere that was enjoyable and they liked living there. Three generations of one family had used the service over the years.
Health and social care professionals told us they felt it was a caring and homely service which met people’s needs effectively. They said people liked the small scale environment and found it a welcoming alternative to larger scale establishments whilst maintaining the high standard of care. A health professional involved with people in the home said there was “good communication and plenty of engagement with professionals.” They also told us staff were proactive in addressing people’s health care needs.
Staff provided good quality care with tenderness and compassion at the end of people’s lives that took their wishes into account. The care records were sufficient detailed and up to date. These provided the correct information for staff to enable them deliver the care and nursing people required.
Referrals to other health and social care professionals were made when appropriate to maintain people’s health and well-being. People and their relatives were encouraged to discuss health needs with staff and had access to community based health professionals, such as GPs as required. People were protected from risks associated with nutrition and hydration. People were positive about the choice and quality of food available, they had a variety of menus to choose from that met their likes, dislikes and preferences.
The home was safely maintained, suitably furnished, clean and fresh smelling. A refurbishment programme was underway to help improve the environment.
Staff engaged with people in a friendly manner and assisted them as required, whilst encouraging them to be as independent as possible. Staff were very knowledgeable about the people they cared for and the field they worked in. They had appropriate skills, training and were focussed on providing individualised care and support in a professional, friendly and supportive way. Staff said they had access to good support and career advancement.
Staff were supported through an induction support network and on-going training, based on the needs of the people who used the service. People’s consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards were met.
Good leadership was present in the home. People using the service and staff reported on strong and clear direction given by the manager within the home. Relatives said the manager inspired them with confidence, she was approachable and responsive. The provider consistently monitored and assessed the quality of the service provided to drive improvement.