Viera Gray House

Viera Gray House is a residential ‘care home’ providing personal care and support to up to 41 people. At the time of our inspection 20 older people were living at the care home. Viera Gray House accommodates people across 4 separate wings, each of which has separate adapted facilities. 1 of the wings specialises in providing care to people living with dementia.

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

At this inspection we found enough improvement had been made and the provider was no longer in breach of regulations in relation to the management of staffing levels, medicines, safeguarding, and distressed behaviours and governance.

People living in Viera Gray House told us they were happy with the quality of the care they received there. However, we received mixed comments from community and health and social care professionals we spoke with, although most agreed the service was beginning to improve and move in the right direction.

People were kept safe and were confident any concerns they raised would be listened to. Staff now understood how to safeguard people. People told us staff always treated them with respect and dignity.

Medicines systems were now well-organised, and people received their prescribed medicines as and when they should.

The care home was adequately staffed by people whose suitability and fitness to work there had been thoroughly assessed. Staff now had the right levels of training, support, and experience to deliver safe care to the people they supported.

People were cared for and supported by staff who knew how to manage risks they might face. People now had up to date, detailed, person-centred risk assessments and management plans in place, which were routinely assessed, monitored, and reviewed. This enabled staff to understand and meet their needs and expressed wishes and preferences.

The quality and safety of the service people received was now reviewed regularly, and appropriate changes made to improve people’s care and support if required. Complaints, concerns, accidents, incidents, and safeguarding issues were appropriately reported, investigated, and recorded.

People living at the care home and staff working there were complimentary about the way the service was managed, and how approachable the managers in-charge all were.

However, the service remains without a registered manager, which the provider is legally required to have in post to oversee the delivery of regulated activities at this location. We discussed this management issue with the provider at the time of this inspection. A new manager was appointed in April 2023 and the provider assured us they would apply to be registered with the Care Quality Commission (CQC) by June 2023. Progress made by the service will be closely monitored by the CQC.

The premises were kept hygienically clean and staff followed current best practice guidelines regarding the prevention and control of infection including, and those associated with COVID-19.

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 care home’s culture was now more positive, open, and honest, with leadership and management that was clearly identifiable and transparent.

The provider worked in close partnership with various community health and social care professionals and agencies to plan and deliver people's packages of care and support.

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

This service has been in Special Measures since 22 December 2022 when we rated them inadequate overall. During this inspection, the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions and is therefore is no longer in Special Measures.

However, despite improvements made the provider will still need to demonstrate they can continue to move in the right direction and consistently keep people safe over a more sustained period of time.

Why we inspected

We conducted an unannounced inspection of this service on 11 and 13 November 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to comply with urgent imposing conditions and outstanding requirements we previously served in relation to Regulations 12 (Safe care and treatment), 13 (Safeguarding service users from abuse), 17 (Good governance), and 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this unannounced focused inspection to check they 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 safe 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 inadequate to requires improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID19 and other infection outbreaks effectively.

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

Follow up

We will collaborate with the provider to monitor how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Viera Gray House is a residential care home providing personal to up to 41 people. The service provides support to people aged 65 and over. At the time of our inspection there were 30 people using the service.

Viera Gray House accommodates people across four separate wings, each of which has separate adapted facilities. One of the wings specialises in providing care to people living with dementia.

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

People were not protected against the risk of harm and abuse. Staff did not have clear guidance on how to mitigate known risks as the provider failed to develop risk assessments. Incidents and accidents weren’t always recorded or managed effectively. Not everyone within the service received support in a timely fashion as the provider failed to deploy sufficient numbers of staff to keep people safe. People’s medicines were not managed in line with good practice. People did not receive a service that ensured lessons were learned when things went wrong.

People did not receive care and support from a service that was well-led. The provider failed to ensure adequate oversight and monitoring of the service to drive improvements. Audits undertaken failed to identify issues found at this inspection. Records were not easily accessible or in place. There was a closed culture whereby staff were not always confident in speaking out against poor practice. The provider failed to ensure guidance provided by partnership working was implemented.

The provider followed current guidance on the management of infection prevention and control.

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 acting manager was aware of their responsibilities under the duty of candour.

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 7 October 2021).

At our last inspection we recommended that provider review their staffing, at this inspection we found the provider needed to make further improvements.

Why we inspected

We received concerns in relation to staffing levels, incident management, safeguarding and medicines management. As a result, we undertook a focused inspection to review the key questions of safe 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 inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Viera Gray House 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 will take further action if needed.

We have identified breaches in relation to risk assessments, protecting people from harm and abuse, medicines, staffing levels and the oversight and monitoring of the service at this inspection.

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 request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘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.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Viera Gray is a residential care home providing personal and nursing care to 39 people aged 65 and over at the time of the inspection. The service can support up to 41 people.

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

We have made a recommendation that the provider review their staffing levels to ensure people receive stimulating activities.

Care plans did not always contain information identified in people’s pre-admission assessment.

People’s risk management plans were not as robust as they could be.

People received care and support from staff that knew how to identify, respond to and escalate suspected abuse. People received their medicines as intended. The provider’s recruitment practices ensured only suitably qualified staff members were employed. The registered manager was keen to ensure lessons were learned when things went wrong.

Staff continued to receive training to enhance their skills and knowledge. Newly employed staff underwent an induction programme and received one-to-one supervisions to reflect on their working practices.

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 health and well-being was regular monitored and people were supported to access food and drink that met their dietary needs and preferences.

People and their relatives told us, staff treated them with respect and catered to their diverse needs. People had their dignity promoted and were encouraged to make decisions about the care they received.

People were aware of how to raise any concerns or complaints they may have. The provider responded to complaints in line with their complaints policy. The service had an end-of-life policy in place. People’s communication needs were met.

People, their relatives and staff spoke positively about the registered manager and management team. The registered manager was aware of their responsibilities in notifying us of reportable incidents.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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 25 March 2021).

Why we inspected

The inspection was prompted in part by concerns raised about staffing levels and the management of risks within the home. We also received notification of a specific incident in which a person died. This inspection did not look at the specific circumstances of the incident, however a decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe sections of this full report.

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

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.

Viera Gray House is a residential care home providing accommodation and personal care for up to 41 people, some of whom may be living with dementia. There were 38 people using the service at the time of our visit.

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

Improvements had been made in relation to how the service responded to behaviour that may present a challenge. Closer working relationships with external involved health and social professionals included regular multidisciplinary meetings to discuss any issues or concerns. Additional training had also been facilitated for care staff.

Risks were regularly assessed and managed to keep people safe. There were enough staff for people to be supported safely, and where COVID-19 had affected staff attendance, there was use of consistent agency staff. Effective support for staff through training and supervision was in place. Safeguarding procedures were followed and staff were encouraged to report any concerns.

We were assured the service met good infection prevention and control guidelines. People were protected from the risk of acquiring infections and the premises were kept clean and hygienic. Personal protective equipment (PPE) was in good supply and staff were following the latest guidance for its use.

Access to the home was restricted for non-essential visitors due to the COVID-19 lockdown restrictions in place at the time of our visit.

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 May 2018).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns about the service in relation to responding to behaviour that may be challenging. A decision was made for us to inspect and examine those risks.

CQC have introduced targeted inspections to follow up on a Warning Notice or other specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We also looked at infection prevention and control measures under the Safe key question. We look at this in all care homes even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Viera Grey House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The home provides accommodation for frail elderly people some of whom may have dementia. It is located in Barnes.

The home had a registered manager. A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

At the last inspection in February 2016 all the key questions of safe, effective, caring, responsive and well-led were rated good. The overall rating was good.

People and their relatives said the home supplied very good care and support in a friendly and relaxed atmosphere. There were suitable numbers of staff to meet people’s needs and they did so in a respectful, compassionate and kind way.

The home’s recording systems were thorough, comprehensive and up to date with regularly reviewed information presented in a clear and easy to understand way.

People and their relatives were encouraged to discuss health needs and had access to community based health professionals as required as well as care staff. People’s diets were balanced, protected them from nutrition and hydration associated risks and also met their likes, dislikes and preferences. Most people and their relatives told us the meals provided were of good quality and there were choices available. Staff prompted people to eat their meals and drink as required whilst enabling them to eat at their own pace and enjoy their meals.

The home was clean, well-furnished and maintained and provided a safe environment for people to live and staff to work in.

Staff had a thorough knowledge of the people they supported and appropriate skills and training to meet people’s needs competently. They provided people with individualised care that was provided in a professional, friendly and supportive way.

Staff were aware of their responsibility to treat people equally and respect their diversity and human rights. They treated everyone equally and fairly whilst recognising and respecting people’s differences.

The Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) required the provider to submit applications to a ‘Supervisory body’ for authority. Applications had been submitted by the provider and applications under DoLS had been authorised, and the provider was complying with the conditions applied to the authorisation.

Staff said the registered manager and organisation provided good support and there were opportunities for career advancement.

People and their relatives thought the registered manager and staff were approachable, responsive and encouraged feedback from people.

The home had systems that consistently monitored and assessed the quality of the service provided.

Viera Gray House is a care home with accommodation for frail elderly people some of whom may have dementia.

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.

This was the first inspection following the change of ownership to a new provider. At this inspection the home met the regulations inspected against.

People and their relatives said the home provided a good service, there was no discernible difference in the standards of care by the new providers and they enjoyed living at Viera Grey House. Many of the staff had been retained and were friendly, caring, attentive and provided the care and support people needed and in a way they liked. They thought the home’s atmosphere was relaxed and enjoyable.

The new providers were using the same recording systems as they gradually introduced new ones to promote continuity of care for people as staff were familiar with the systems in place. We looked at a sample of records that were clearly recorded, comprehensive, regularly reviewed and up to date. This enabled staff to continue to perform their duties well. People and their relatives were encouraged to discuss health needs with staff if they wished and they had access to community based health professionals, as required. They were protected from nutrition and hydration associated risks with balanced diets that also met their likes, dislikes and preferences. People said there was a variety of well-presented meal choices, the quality of the food was good and it was the type of food they liked.

The home was well maintained, comfortably furnished, clean and provided a safe environment for people to live and staff to work in.

There was a thorough staff recruitment process that files demonstrated was followed. The staff knew people using the service well and were familiar with their likes, dislikes, wishes and needs. Staff had appropriate skills, training and were focussed on providing individualised care and support in a professional, friendly and supportive way. They said they were well supported by the management team who were approachable, open and honest. People using the service and relatives said they felt comfortable talking with the management team, who were responsive to their views and encouraged feedback from them. We saw that the home consistently monitored and assessed the quality of the service provided.