Sovereign House

Sovereign House is a nursing home providing personal and nursing care to up to 60 people across 3 different floors. The service provides support to adults, including people living with dementia. At the time of our inspection there were 34 people who lived at the home permanently and 18 people were staying at the home for a short period of assessment or rehabilitation following time spent in hospital.

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

Assessment of risk to people’s health and safety were not always robustly completed or mitigated. We found concerns regarding the lack of risk assessments and care plans for some people.

The management and administration of medicines was not always completed safely and maintenance of the home environment did not always promote effective infection control.

Staff supporting people living with dementia or communication difficulties required further training; however, there were enough suitable staff working at the home to support people's needs. People were safeguarded from the risk of abuse and the provider had systems and processes in place to respond to concerns.

The management team did not always have effective oversight of risk within the service. Clinical governance was not always completed to ensure staff had the training and competence to provide care and treatment safely.

People and staff were asked to provide feedback to obtain their views and experiences which was analysed and action plans put in place.

The registered manager and provider understood their legal duties and requirements and responded to risks identified within the service. The provider supported the management team to drive improvement in the home. The service worked with other health and social care professionals effectively.

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.

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 06 January 2022) and there were 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 the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about the management of continence products used at the service and the findings from the last inspection. 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.

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.

We have found evidence the provider needs to make improvements. Please see the safe and well-led sections of this full 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 Sovereign House on our website at www.cqc.org.uk

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account when it is necessary for us to do so.

We have identified continued breaches in relation to the assessment of risk, medicines management, infection prevention and control and the lack of management oversight at this inspection.

Please see the action we have told the provider to take at the end of this report.

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.

Sovereign House is a care home set over three floors providing personal and nursing care to 56 people aged 65 and over and those living with dementia. The service can support up to 60 people. Thirty-one people lived at the home permanently and 25 people were staying at the home for a short period for assessment or rehabilitation following time spent in hospital.

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

People identified as at risk from pressure ulcers were not repositioned in bed in line with their care plans during the evenings placing them at greater risk of harm. Medicines were not always safely managed. Systems in place were not robust enough to identify errors or issues with the storage of medicines.

The provider had systems in place that gave oversight of the service, but these did not always identify issues such as those around infection prevention and control or identify areas for improvement.

The management team was working with an external provider to improve medicines management and took appropriate action to address the concerns we raised during the inspection.

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 22 October 2019) with no breaches of regulation. The service remains rated requires improvement.

Why we inspected

We received concerns in relation to staffing, completion of records and responses to complaints. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 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.

The overall rating for the service has not changed from requires improvement. This is based on the findings at 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 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 Sovereign House on our website at www.cqc.org.uk.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

Where enforcement action has been taken add the following sentences as required:

We have identified breaches in relation to medicines, repositioning of people who are in bed all day, Infection prevention and control and the lack of management oversight at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

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

Sovereign House is a purpose-built residential care home that provides personal and nursing care for up to 60 younger adults or older people, some of whom, may have a diagnosis of dementia. The ground floor of the home is mostly allocated to people on short term six-week placements. These are for people have been discharged from the hospital to the home to continue their care. People are then assessed to check if they are well enough to go back home or continue their care with the right support in the right place. At the time of our inspection the service supported 47 people.

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

Systems and processes to check the quality of the service were in place but these had not been consistent in identifying areas of risk to make sure people’s needs were met safely.

People's needs were assessed before they moved into the home to identify their needs and ensure these could be met. Care records did not always identify risks associated with people’s care to ensure they were safely managed. Staff did not always know about and follow risk assessments to manage risk. This included risks around nutrition.

Enough staff were on duty to meet people's needs and people felt safe and spoke positively of the staff that supported them. Staff were recruited safely and received on-going support, training and supervision to be effective in their roles. Staff understood what signs to look for of potential abuse and knew what process to follow to keep people safe from the risk of abuse.

People received their medicines when they needed them from suitably trained staff. Arrangements for the storage of medicines were not consistently safe but this was addressed during the inspection visit.

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. Where people lacked capacity, this had been identified and people were supported with decision making when needed.

There were two activity co-ordinators employed at the home to support people with social activities to help maintain their wellbeing. This included spending one-to-one time with people cared for in bed.

People were offered a choice of meals and snacks to maintain their nutrition and hydration needs but some staff were not clear about people’s dietary and support needs to ensure these were met safely consistently.

Staff cared about people and were responsive to their needs. Staff understood how to respect people privacy and dignity and people told us this was maintained. Care plans contained some personalised information to support staff in delivering individualised care. People had opportunities to maintain positive links with the community and stay in touch with people who were important to them.

People were supported to be independent. Signage and visual prompts were available to support people to find their way around the home and picture cards were used to help effective communication and involve people in their care.

Some information about people's end of life wishes had been obtained and documented in their care plans to ensure their wishes were respected.

People and their relatives felt at ease to raise any concerns or complaints with staff and had confidence these would be acted upon. Complaints received had been responded to.

Systems were in place to ensure staff followed good infection control practice and to make sure the home was kept clean. Overall these systems had been effective.

Systems to monitor the quality and safety of the service were in place to help ensure staff followed the required policies and procedures. However, audit systems had not consistently identified areas needing improvement. This included staff having access to accurate information to ensure they were clear about people’s current needs and the safe storage of medicines.

People, staff and relatives had opportunities to voice their views of the service through planned meetings or quality questionnaires. Feedback from people, their relatives and staff was welcomed to drive improvement. Responses showed positive feedback.

Health and safety checks were carried out to make sure the environment was safe for people and checks completed were within the required timescales.

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 (9 August 2018) and there was one breach in the 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.

The service remains rated requires improvement as at the previous inspection.

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.

Sovereign house is a care home registered to provide nursing care and accommodation for a maximum of 60 people. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The accommodation is provided over three floors. The ground floor provides residential accommodation for both younger adults and older people (including those people living with dementia). This floor also has 19 beds known as “pathway 2” beds which are used for short term placements from hospital to help rehabilitate people prior to going back home. The first floor provides accommodation for people requiring nursing care who may also be living with dementia. The second floor has 21 beds to accommodate older people. Seven beds on this floor are referred to as “discharge to assess” beds where people from hospital are again supported with a view to going home once they are well enough.

Sovereign House was previously registered under a different provider. This is the first inspection of Sovereign House under the new provider. However, many of the staff who were at the home prior to the new provider taking over, continued to work at the home.

The service has a registered manager. This is a requirement of the provider's registration. 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 home was managed by an experienced management team who aimed to provide good standards. The provider and registered manager completed a range of quality monitoring checks to ensure the care and services provided were in accordance with the standards people should expect. However, our inspection process identified some areas needing improvement, this included a breach in the regulation related to person centred care and we also found staffing arrangements were sometimes not effective to ensure people’s needs were met. . This suggested the audit check process was not always effective.

Staff were recruited following a number of checks to ensure they were suitable to work with people.

They received appropriate training and support, understood their roles and responsibilities and had confidence in the management team.

People felt safe and at ease with staff, and staff understood their responsibilities to protect people from the risk of harm and discrimination. We saw staff were caring in their approach to people, but they did not always have time to spend with people or listen to what they had to say. People said sometimes they had to wait for support. People had some opportunities to engage in, and experience, stimulating activities within the home to help support their mental, physical and emotional wellbeing.

Risks related to people’s health were identified in their care plans to help minimise those risks.

People were able to access healthcare professionals when needed to support their healthcare needs. Staff who administered medicines understood what was required to manage these safely, although some medicine records were not accurate.

People's ability to make decisions was assessed in line with the Mental Capacity Act 2005. Staff offered people choice and respected the decisions they made. Where restrictions on people had been identified, Deprivation of Liberty Safeguards authorisations were in place to lawfully deprive people of their liberty for their own safety.

People were encouraged and supported to eat and drink and were mostly positive about the quality and choice of their meals.

The design of the premises meant there was sufficient space for people to move around easily to access the communal areas of the home. The home was clean and tidy and staff followed the provider’s policies and procedures to ensure people were protected from the risks of infection. Health and safety checks were completed to protect people from environmental risks within the home.

People knew the registered manager and spoke positively of them. We saw where concerns had been raised, these had been taken seriously, investigated and responded to within a timely manner. Where accidents and incidents had occurred, action had been taken to minimise the risk of them happening again. The registered manager worked closely with the provider and understood their regulatory responsibilities such as those related to the submission of statutory notifications and the completion of a provider information return.

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