St Vincents House

We found the following examples of good practice.

The provider had enhanced measures to reduce the risk of infection entering the service. This included using thermal imaging systems to check people for high temperatures before they entered the building and lateral flow testing for visitors. Lateral flow testing is a fast test to detect when people may be carrying the virus which causes COVID-19. Fogging machines were used to disinfect communal areas in addition to enhanced cleaning.

There were facilities to permit safe visiting when restrictions on visitors are lifted. This included a visiting room with a glass partition and sound relaying systems, which is accessed through a separate entrance.

There were separate break facilities for staff members on each floor to reduce the risk of mixing between different staff groups.

Staff were encouraged to be vaccinated against Covid-19. Staff had had the opportunity to raise any questions they may have about the vaccine with a local GP.

We found the following examples of good practice:

Staff conducted wellbeing assessments on people who were isolated in their rooms to help them recognise signs of deteriorating mental health. Activities staff scheduled individual time with people to improve their wellbeing.

There were routine temperature checks in place for staff and visitors and staff were regularly tested for COVID-19. Staff had accessed antibody testing and the manager was able to explain to staff the meaning of these results and their limitations.

The provider had accessed counselling services from a recognised charity to help staff manage their feelings relating to the pandemic.

Further information is in the detailed findings below.

St Vincent’s House is a care home which provides personal care and nursing care to up to 91 older people and people living with dementia. At the time of our inspection there were 82 people using the service.

People’s experience of using this service

People told us they were treated well and with respect by staff. People’s likes and life story work was documented and people interacted with positively with pet birds, dolls and toy animals.

Staffing levels had increased following our last inspection. People told us that sometimes they had less positive experiences with agency staff, and the provider was working to reduce their usage. There was a new electronic system which helped the service to manage medicines safely. Risks to people were assessed and managed effectively. The service reviewed incidents and accidents to learn from these.

Staff received the right training and supervision to carry out their roles. There were new kitchen facilities, a new catering team and menu. People received the right support to eat and drink well. People had access to appetising meal options and well-presented specialist options. People received appropriate input from health services and support to maintain oral health. 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.

There were measures in place to ensure a safe environment. Aspects of the service were adapted to meet the needs of people with dementia but in some areas this could improve;, for example using more high contrast materials. We have made a recommendation about this. The overall environment was more homely and relaxed.

People and their families were involved in planning and reviewing their care. This included supporting people to make plans for the end of their lives. People were encouraged to take part in the activities programme.

The provider and registered manager had a clear vision on how to improve the service and there had been substantial investment in new facilities and activities. The service worked with people and their families and the local authorities to deliver an effective improvement plan. A family member told us “A lot of changes were made, I have been more contented than I have ever been.”

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 20 December 2018).

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.

We last inspected this service in February 2018 where we rated the service ‘good’. At this inspection we have changed the rating to ‘requires improvement’.

‘St Vincent’s House’ is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of the inspection there were 90 people using the service.

The service had not had a registered manager since the previous registered manager had resigned in April 2018. 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.

Since the resignation of the previous registered manager there had been several interim managers, the most recent of which had started work at the service on 29 October 2018. None of these managers had applied to become the registered manager. It is a condition of the provider’s registration that they have a registered manager in place at this location.

Staff were recruited in line with safer practices. There were assessments carried out of staffing levels but we found at times there were not enough staff to safely meet people’s needs. In the early morning hazards were not addressed promptly. The provider intended to improve allocations and include falls champions to reduce risks to people but these were not yet in place. People using the service told us that staff appeared very busy.

There were systems in place to assess risks to people and manage these. Care workers were trained in safe moving and handling but lacked an awareness on how to prevent falls. Records were kept of actions staff had taken to keep people safe, such as welfare checks or repositioning people, but sometimes these were filled in later. People were safeguarded from abuse and care workers understood their responsibilities to report this.

The provider kept records of incidents and accidents and had an appropriate response to falls. However, systems were not used effectively to record and detect trends accurately. There were suitable infection control measures in place.

There had been frequent changes of manager due to the provider being unable to recruit a permanent home manager. People and their relatives told us they didn’t always know who was in charge and that this impacted on communication. There was good joint working with health professionals and medicines were safely managed.

There were governance systems including internal and external audit. These were effective at detecting issues with the service but were not always consistently applied. Care plans and risk assessment were stored in different locations which sometimes lead to confusion about the contents.

We found breaches of regulations relating to staffing and good governance. You can see what action we told the provider to take at the back of the full version of this report.

At this inspection we found that the service had significantly improved in many areas, but that this improvement needed to continue to reach a consistently good standard in some areas.

St Vincent’s House is a care home with nursing. 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.

St Vincent’s House accommodates up to 92 people across four separate units, each of which have separate adapted facilities. There are shared facilities such as a coffee bar and cinema on the ground floor. Two of the units specialises in providing care to people living with dementia. At the time of our inspection there were 82 people using the service.

The service had a registered manager who had been registered since January 2018. 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 registered manager had clear systems in place for monitoring the performance of the service, and when areas were identified for improvement there were action plans in place. There were good systems of communication with staff and relatives, including surveys and regular meetings. Where relatives had expressed concern about staff communication regarding their family member’s wellbeing, the provider had implemented a resident of the day system, which combined a holistic review of the person’s care with updating relatives. Relatives we spoke with told us they were now kept informed of their family member’s care.

Managers had improved systems of recording, which were well maintained. We saw that risk management plans and care plans were of a greatly improved standard, but in some areas lacked detail on some areas of healthcare needs.

The service worked well with other agencies to promote good health, and we saw that there were good standards of wound management and pressure sore prevention in place. People’s needs were assessed at the time of admission to the service and this was used to put together personalised and detailed care plans which staff followed to meet people’s needs and preferences. People received well planned care at the end of their lives.

The provider was actively recruiting staff in order to reduce their reliance on agency staff, and this was carried out in line with safer recruitment measures to make sure staff were qualified and suitable for their roles. We found that staffing levels were safe to meet people’s needs, but sometimes staff were stretched and were not always effectively deployed. The service was in the process of reorganising staffing roles; we have made a recommendation about this. Medicines were safely managed by staff with the skills to do so.

The building was clean and well maintained, and was designed in order to meet peoples’ needs in a dementia-friendly way. There were thorough systems of checks to ensure it remained a safe environment. A system of key pads had been implemented to prevent people leaving the building in a way which may not be safe, but we have made a recommendation about how this was applied to the lift system, as people were able to operate lifts without knowing the code. People were assessed to see if restrictions were placed on their movement and the provider had applied to the local authority in line with legal requirements. The provider was meeting its responsibilities to assess people’s ability to make decisions and to work in people’s best interests in line with the Mental Capacity Act 2005.

People were consistently treated with kindness and dignity by staff, and received good support in order to eat and drink well. Concerns about people’s nutrition were appropriately followed up and action taken to address this. People and their relatives felt involved in the planning of their care, and people were regularly consulted in order to contribute to a varied and interesting activity programme.

This report only covers our findings in relation to this area. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Vincents House on our website at www.cqc.org.uk.

St Vincents House is a 92 bedded care home for older people. The service comprises four separate units and provides care and accommodation for older people with general health care needs and older people living with dementia. Accommodation is located over three storeys and the building has a passenger lift.

There was a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager was present for part of the inspection.

We arrived at the service at 6.20am and did not find any evidence to indicate that there was a planned approach in place for getting people up at an unacceptably early hour. The vast majority of people were asleep in their beds and the small number of people who were sitting in their armchairs within their bedrooms confirmed that this was in accordance with their own wishes. People who were out of bed told us they were comfortable, had been offered the support they needed and had been provided with fluids.

The staff on duty consisted of health care assistants and registered nurses. The staff team told us they did not routinely get people out of bed early and demonstrated that they were aware of people’s individual sleep routines and their preferred times to get up. We spent time on each of the three floors and did not find any evidence to suggest that staff proposed to get up more people, for example trolleys with fresh linen or hot drinks had not been prepared. The communal lighting was still subdued and staff conducted themselves in a quiet manner so that people who wished to continue sleeping were not unnecessarily disturbed.

The service is rated as Requires Improvement. We will review the rating at our next comprehensive inspection.

We carried out this inspection to check that the provider had adhered to their action plan, to establish if they now met legal requirements and to examine these concerns. This report only covers our findings in relation to these areas. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for St Vincents House on our website at www.cqc.org.uk.

St Vincents House is a 92 bedded care home with nursing for older people, and there were 76 people using the service at the time of the inspection. The service comprises four separate units and provides care and accommodation for older people with general health care needs and older people living with dementia. Accommodation is located over three storeys and the building has a passenger lift.

There was a registered manager at the service. A registered manager is a person who has registered with The Care Quality Commission to manage the service. Like registered providers, they are registered ‘persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At this inspection we found that the provider had improved the quality of record keeping and was continuing to support staff to maintain satisfactory record keeping. The improvement in record keeping meant that staff now had clear information to enable them to identify if people were not receiving the care they needed, for example if people were at risk of malnutrition, dehydration and either the development of new pressure ulcers or the further deterioration of existing skin damage. There were systems in place for staff to liaise with other professionals when they identified concerns, so that people’s needs could be promptly addressed. The management team had established a programme of monitoring and auditing of care practices and accompanying records, in order to ensure that all staff were aware of their role and responsibilities. Following this inspection, we concluded that the provider had met the legal requirements of the Warning Notice we had issued.

At this inspection we found that staffing levels had not been decreased, which was a potential concern expressed by staff at the previous inspection. The provider stated that ongoing recruitment was needed in order to reduce the use of agency staff, so that people using the service and the permanent staff team benefitted from better continuity and stability. We noted that improvements had been made since the previous inspection in order to promote people’s safety. There was a noticeable increase in staff compliance with wearing an identification badge, to enable people and visitors to identify who they were speaking with. The cleaning programme had addressed issues of clutter and dust within the premises.

We did not observe any concerns with the care and support provided for people living with dementia. Comments from relatives and external professionals indicated that people’s needs were understood and met.

St Vincents House is a 92 bedded care home with nursing for older people, and there were 72 people using the service at the time of the inspection. The service is divided into four separate units and provides care and accommodation for older people with general health care needs and older people living with dementia. Accommodation is provided over three storeys and the building is served by a passenger lift.

At the previous inspection we noted that the provider had appointed a new permanent manager, who has subsequently been confirmed as the registered manager of the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered provider, 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 told us they felt safe with staff and systems were in place to protect people from abuse. The provider had supported staff to confidently increase their understanding about whistleblowing so that they understood how to protect people through reporting poor conduct in the workplace.

Recruitment practices were thorough and there were sufficient numbers of staff deployed to meet people’s needs. Comments from people, their relatives and staff, along with our own observations, indicated that staffing levels would need to be closely monitored as and when more people move into the service. Staff were provided with the training and support they needed to effectively carry out their roles. They had been provided with training about how to maintain accurate record keeping to demonstrate that people were given the level of care and support they needed, and the provider was committed to continuing to support staff to achieve this.

The Care Quality Commission is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report on our findings. DoLS are in place to protect people where they do not have capacity to make decisions and where it is necessary to restrict their freedom in some way, to protect themselves or others. The provider demonstrated that people’s capacity was assessed where necessary and the principles of DoLS were understood and correctly applied.

Systems were in place to consult with people about their food choices. A range of home cooked foods was produced to accompany the meals provided by the external catering company. People told us that they were suitably supported to meet their health care needs and the provider had worked with local health services to address concerns about the quality of documentation sent by care home staff to local hospitals when people were admitted for inpatient care. Measures were in place to make sure that people were safely supported to take their prescribed medicines.

People were provided with a comfortable and homely environment, which offered facilities for getting together with visitors or quietly enjoying the ambience in one of the small lounges decorated with reminiscence items. The provider had established links within the local community so that people could join in with a wider range of activities if they wished to. We saw many examples of positive interactions between staff and people, and people and their relatives told us staff were kind and friendly. Although staff had a clear understanding of how to promote people’s entitlement to respect, dignity, privacy and confidentiality, we noted some issues that needed to be addressed to ensure people received a consistent service that embedded these values.

The written responses for complaints needed to demonstrate the empathy that people and relatives felt was otherwise offered by the management team at the service. Regular checks were carried out by the provider to ensure that people received appropriate care and support to meet their needs.

We found a continued breach of regulation in relation to good governance. You can see what action we asked the provider to take at the end of the report.

St Vincents House is a 90 bedded care home with nursing for older people, and 69 people were using the service at the time of this inspection. It is divided into four separate units and provides care and accommodation for older people with general health care needs and older people living with dementia. The original premises was formerly a convent and residential home for older people. Accommodation is provided over three storeys and the building is served by a passenger lift.

During this inspection St Vincents House did not have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The service was being managed by a peripatetic manager. The provider had appointed a new permanent manager, who we met during the inspection as they were at the service attending their induction training.

Staff were safely recruited in order to ensure that they were suitable to work with people who used the service. Staff told us they were pleased with the quality of training that the provider supported them to undertake. The provider had introduced a new system for providing staff with regular supervision and an annual appraisal, so that staff had appropriate support to carry out their roles and responsibilities.

Although staff demonstrated that they understood how to identify the signs of abuse and report their concerns to their line manager, some staff did not fully understand the provider’s whistleblowing policy, in relation to what is meant by whistleblowing and the legal protection afforded to employees who whistleblow.

Risks to people’s safety and welfare were identified in the risk assessments, and guidance was in place to mitigate these risks. Appropriate systems were in place to make sure that people safely received their prescribed medicines, which included medicines training for nursing staff and regular medicines audits.

The Care Quality Commission is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report upon our findings. DoLS are in place to protect people where they do not have capacity to make decisions and where it is regarded as necessary to restrict their freedom in some way, to protect themselves or others. Staff had received training and we noted that there were DoLS authorisations in place. However, we found limited evidence to demonstrate that people’s capacity was assessed and recorded in their care files. There was also a lack of documentation in relation to people giving their consent for their care and support.

People expressed some mixed views about the quality of the food service. We observed that they were offered a range of choices and provided with staff support for eating and drinking, where applicable. Discussions with people and their representatives, and notes within people’s care files, indicated that they were able to access appropriate health care.

People told us that staff were kind and patient. We observed that interaction by staff with people tended to be in connection to the delivery of their personal care. People’s dignity was promoted and their confidentiality was maintained.

Care plans showed that people’s needs were assessed and these assessments were used to develop individual care plans. However, the record keeping was incomplete at times and did not satisfactorily demonstrate that people’s needs were met in accordance with their care plans.

Satisfactory information was provided to people and their representatives about how to make a complaint. The complaints investigations showed that complaints were taken seriously by the provider.

People, relatives and staff spoke positively about how the service had been managed by the peripatetic manager. A new manager had been appointed and they confirmed they would be applying to CQC for registration.

The provider had plans to improve the quality of the service, for example in relation to the quality of activities for people living with dementia, which were being implemented at the time of this inspection. The provider’s own quality assurance system did not wholly identify the range of issues detected at this inspection.

We found two breaches of regulation, in relation to ensuring that people’s capacity was identified where necessary so that their human rights were upheld, and ensuring that record keeping was maintained to demonstrate that people received safe care and support that met their identified needs. We have made a recommendation in regards to staff training and support to ensure that all staff understand the provider’s whistleblowing policy.

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

We found that although appropriate care plans and risk assessments were in place, some risk assessments needed more frequent reviewing. We also found that some of the Do Not Attempt Resuscitation (DNAR) forms that we looked at did not have sufficient evidence that discussions had taken place with people and/or their representatives. Most of the people we spoke with said they felt the food service could be improved and some people wanted to be offered more frequent activities and entertainments.

Staff spoke positively about their training and said they felt supported. The training records showed that staff were provided with mandatory training and could also attend other training to meet the needs of people using the service, for example palliative care training sessions. There were some gaps in the provision of supervision for staff, particularly supervision for night duty registered nurses employed via the provider's bank staffing arrangements.

The service had sought the views of people who use the service and their representatives, however we were not shown how people's feedback about improvements needed was acted on. People said they were confident about making a complaint and the complaints we looked at had been fully investigated. The service did not have a system in place for recording complaints made verbally to the manager or other staff.

Regular staff were present and provided a consistent level of care, they were familiar with the people they looked after and knew their life histories, they were able to apply this knowledge to the care and support they offered to people on a daily basis.

Staff training provided care staff with essential knowledge and skills to care for and understand the needs of people with dementia.

We saw that care staff interacted with and engaged well with people using the service, these interactions were a positive experience for people. When staff offered people assistance and support including at mealtimes they focused on the person and gave them their undivided attention which made them feel valued.

Throughout the inspection we observed the environment was calm, people's requests for assistance were responded to promptly by staff.

People using the service and their families and friends were listened to and included in the decision making, One person told us, 'I am happy here and wherever I am as long as people consider my point of view and do not do things over my head, staff always ask my views, they are a good group of people .'

Staff at the home worked well with other health and social care professionals and were actively involved in promoting and supporting the health needs of people living in the home.

Staff demonstrated an awareness of the benefits of reducing hospital admissions for older people especially those with dementia. Staff worked together with other health and social care professionals in reducing unscheduled hospital admissions, and of making the most of community based services to enable them support people appropriately in the home.

People told us they were happy at this home. One person we spoke with said 'We're well looked after. Everyone knows me". Another person said the information provided in the home's brochure was "useful" and they "knew what to expect" .

We observed staff knocking on doors and waiting for a response before entering and introducing themselves to the person in the room.

We saw care records had detailed moving and handling care plans. We spoke with staff and they were able to describe the moving and handling care plan as recorded in the care record.

Staff at the home had received mandatory training in safeguarding adults. This was refreshed on an annual basis. Staff we spoke with were able to describe how to recognise signs of abuse. People we spoke with said they felt safe at the home.

All staff were required to complete mandatory induction training. There were annual mandatory training courses for all staff relevant to their role. Staff we spoke with said the induction and annual training was relevant and helpful in supporting them to carry out their role.

We saw that the provider carried out separate annual feedback surveys from people who use the service and relatives. The majority of comments from people who responded were positive and people said they were satisfied with the service provided.