St Vincent's Nursing Home

We found the following examples of good practice.

• People living at the home were supported to have visitors, but issues were identified in relation to three days when the home closed to all visitors including essential care givers, against government guidance. This was discussed with senior staff at the home and they confirmed that any further decisions regarding visiting would be in line with guidance in place at the time.

• Relatives and friends carried out a COVID-19 test when they arrived at the home and temperature checks were carried out before entering the home. Visitors were provided with appropriate personal protective equipment (PPE). The provider checked and ensured the vaccination status was recorded for professionals and contractors visited the home and they ensured a COVID-19 test was completed and PPE was used.

• We saw the home was clean and cleaning was underway during the inspection. Care workers had access to PPE and hand gel which was located around each unit. There were signs in communal areas indicating the total number of people allowed into the room to ensure social distancing was possible. The chairs in the chapel, located within the home, were arranged to enable people to attend Mass and to socially distance. People could also access the garden.

• People were supported to take part in activities in a safe way and to interact with other people in their unit.

• The provider had a clear process for COVID-19 testing of both people living at the home and staff.

• Risk assessments had been completed to identify any possible issues including when people left the home to go out with relatives and friends.

St Vincent’s Nursing Home is a residential care home providing personal and nursing care to up to 60 people aged 65 and over with general nursing needs and end of life care. At the time of the inspection there were 54 people living at the home. The service had four separate units, each of which have individual bedrooms with en-suite facilities and communal living, dining, bath, shower and toilet facilities.

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

The provider had a procedure in place for infection prevention and control but Covid-19 risk assessments for people living at the home were not always in place. We have made a recommendation about the management of risks in relation to infection control.

People we spoke with told us they felt safe when receiving care. The provider had made improvements in the way medicines and risks were managed. Improvement had also been made in relation to the recording and investigation of incidents and accidents. There were appropriate processes for the recruitment of care workers.

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. Assessments of people’s support needs were carried out before the person moved into the home.

People told us they felt care workers respected their dignity and privacy. People’s religious and cultural wishes were identified and supported. People felt care workers provided support in a kind and caring way.

The provider had made improvements to the way care plans were recorded to ensure they identified how the person wanted their care and support provided. The provider responded to complaints in a timely manner.

The provider had a range of quality assurance audits and checks in place to monitor how care was being provided. People receiving care, relatives and care workers told us they felt the service was well run.

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 December 2019).

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Vincent’s Nursing Home 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.

St Vincent’s Nursing Home is a residential care home providing personal and nursing care to up to 60 people aged 65 and over with general nursing needs and end of life care. At the time of the inspection there were 56 people living at the home. The service had four separate units, each of which have individual bedrooms with en-suite facilities and communal living, dining, bath, shower and toilet facilities.

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

Risk management plans were not always in place when a specific risk had been identified to provide staff with guidance as to how they could reduce possible risks. Records relating to possible risks did not always contain accurate information to provide staff with guidance.

Medicines were administered appropriately but information relating to how medicines should be administered was not always accurate.

Incident and accident records were completed but actions were not always identified to reduce potential risks to people using the service. This meant the provider could not ensure the learning from the investigation into incidents and accidents was used to reduce the risk of reoccurrence.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Staff were not up to date with some of the training identified as mandatory by the provider. This meant staff may not be aware of current best practice when providing support.

Records relating to people using the service did not always provide accurate information relating to the care and support they needed, so staff had all the information they needed to care for people.

The provider had a range of audits in place, but these did not always provide appropriate information to identify where actions for improvement were required for example in relation to the care plans.

People told us they felt safe when they received care and support from staff. The provider had systems to investigate safeguarding concerns and complaints with any lessons learned identified. There was a recruitment process in place. The provider had appropriate procedures for preventing and controlling infection.

People felt the care workers provided care in a kind and caring way as well as treating them with respect and dignity. The cultural and religious preferences and needs were identified in people’s care plan.

People living at the home and staff felt the service was well led.

For more details, 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 22 January 2019 ). The service remains rated requires improvement. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made/ sustained and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Responsive 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 St Vincent’s Nursing Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to person centred care, the need for consent, safe care and treatment, good governance and staffing 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 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.

St Vincent's Nursing Home 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. St Vincent's Nursing Home can provide accommodation and nursing care for up to 60 people with general nursing needs and end of life care. The service has four separate units, each of which can accommodate up to 15 people in single rooms with en-suite facilities. Each unit had communal living, dining and bathing facilities. At the time of the inspection there were 56 people living at the care home.

We inspected the service in October 2017 and identified breaches of two Regulation. These breaches related to safe care and treatment (Regulation 12) and good governance of the service (Regulation 17). The service was rated Requires Improvement in the key questions of safe and well-led with effective, caring and responsive rated as Good. The overall rating for the service was Requires Improvement. We then inspected the service on 7 and 8 June 2018 and found improvements had been made with the service being given an overall rating of Good.

At the time of the inspection the home did not have a registered manager. The previous registered manager had left the service in July 2018 and a person (the matron) was in the process of applying to become the registered manager for 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. The service had a matron who was responsible for all the care aspects of the service and a general manager who was overall responsible for the management of the home.

Incident and accident records were not always reviewed and actions were not always identified to reduce potential risks to people using the service. This meant the provider could not ensure the learning from the investigation into incidents and accidents was used to reduce the risk of reoccurrence. Risk assessment and management plans in relation to specific issues did not provide staff with all the necessary information to enable them to reduce the risks people faced appropriately.

The provider had a range of audits in place, but the audits in relation to care records had not identified the concerns we found in relation to care plans and risk assessments to ensure that appropriate actions were taken to make the necessary improvements.

Medicines were managed and administered safely with clear processes and procedures in place.

People told us they felt safe when receiving care and the provider had procedures developed to respond to any concerns relating to the care provided. Assessment of people’s support needs were carried out before the person moved into the home.

The provider as a robust recruitment process in place and staff received the training and supervision they required to provide them with the knowledge and skills to provide care in a safe and effective way.

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

People were supported to eat healthy meals that met their dietary, cultural and religious needs.

People were happy with the care they received and they felt staff treated them in a kind, caring way and respected their privacy and dignity.

The provider had a complaints process and we saw complaints were investigated and responded to in line with the provider’s procedure. People were aware of how to raise concerns.

People’s preferences were identified in relation to their daily routine and how they wanted their care provided. A range of activities were organised and we saw people enjoyed taking part in these.

People and staff we spoke with told us they felt the home was well led. All staff we spoke with told us they felt supported by the management of the home.

We found two breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to safe care and treatment (Regulation 12) and good governance of the service (Regulation 17). You can see what action we told the provider to take at the back of the full version of this report.

No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

St Vincent’s Nursing Home 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.

St Vincent's Nursing Home provides accommodation for a maximum of 60 people. The service has four units each of which accommodates 15 people in single rooms with en-suite facilities. Each unit has communal dining, sitting rooms and bathing facilities.

Although there had been improvements with the provider’s auditing and monitoring processes there was still work needed for some aspects to ensure they were all robust and any shortfalls could be identified and addressed promptly.

Improvements had been made with the management of medicines to ensure people received their medicines safely. Improvements had also been made with the identifying and recording of risks. Risk assessments for individuals, equipment and safe working practices were in place to mitigate risks and were followed by staff.

Recruitment procedures were in place and being followed to ensure staff were suitable to work at the service. Infection control procedures were also appropriately implemented. Incidents were discussed with the staff team and where required action was taken to learn from them.

People and relatives felt confident to approach the management team with any issues and said these were addressed. Staff said the registered manager and deputy manager were approachable and supportive. Meetings for staff, people and relatives took place so they could express their points of view and help improve any areas that required attention.

The provider worked with other agencies to meet the health care needs of people using the service. They followed good practice guidance and legislation to keep up to date with changes relevant to the service.

St Vincent's Nursing Home provides accommodation for a maximum of 60 people. The service has four units each of which accommodates 15 people in single rooms each with en suite facilities. Each unit has communal dining, sitting rooms and bathing facilities.

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.

We identified a number of shortfalls with medicines management which could place people at risk of not receiving their medicines safely.

Individual risk assessments were in place but risks were not always accurately recorded. The staff had not always identified risks in the care records and updates did not always accurately reflect changes in people’s needs and risk levels so appropriate plans could be put in place to mitigate these risks.

Input from people and, where appropriate, their representatives was not evidenced in care plan reviews. Although the service had auditing and monitoring processes in place, these were not robust and did not always identify changes and shortfalls so they could be addressed.

People, visitors and healthcare professionals were happy and praised the good quality of care being provided at the service. Staff treated people with dignity and respect and care was person centred. The service was homely and staff worked hard to cater for each person’s individual needs and preferences. People’s religious needs were identified and being met and the service offered care to people from any faith or culture and respected diversity.

Recruitment procedures were being followed so that only suitable staff worked at the service. There were enough staff to meet people’s needs and staffing was reviewed if dependency levels changed. Staff received safeguarding training and knew to report concerns.

Risk assessments for equipment and safe working practices were in place to mitigate risks to people visiting and working at the service and were updated annually.

Infection control procedures were in place and being followed to maintain a clean environment and protect people from the risk of infection.

Staff received training to provide them with the skills and knowledge to care for people effectively. The provider was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and Mental Capacity Act 2005 (MCA).

People's dietary needs were identified and met. People enjoyed the food provision and choices were available to meet people’s preferences. People received input from healthcare professionals and changes in care and treatment were recorded and implemented.

Care plans were person-centred and reflected people’s individual care and support needs. There was a wide range of activities that were provided and people were encouraged to join in as much or as little as they wished to.

The complaints procedure was available and people, relatives and staff felt able to express concerns so they could be addressed.

Staff said the registered manager was visible and very supportive. Meetings and surveys took place so people, relatives and staff could discuss any matters and provide their feedback about the service.

We found two breaches of regulations at this inspection. These were in regards to safe care and treatment and good governance. You can see what action we have asked the provider to make at the end of this report.

The provider told us that arrangements would be reviewed and action would be taken to ensure compliance by February 2014.

During this inspection we found that the provider had addressed shortfalls identified with the recruitment procedures.

People and their relatives expressed satisfaction with the care being provided at the home. We saw people were encouraged to be as independent as they were able, and staff were available to provide the help and support they required.

People's nutritional needs were being met and their weights were monitored so that any concerns could be identified and input from healthcare professionals sought. The food provision was good and staff understood the importance of ensuring the food had good nutritional values and met people's needs.

Equipment in use in the home was being maintained and staff received the training they required to use it safely and effectively.

Staff recruitment procedures were not always being followed and this could place people at risk of receiving care from staff for whom required checks had not been effectively carried out prior to commencing work at the home.

Systems were in place for monitoring the service for quality assurance purposes. Results were analysed and used to implement improvements to the service.

Comments we received from people included, 'I'm very happy here', 'absolutely fantastic, so friendly' and 'they can't do enough for you." Relatives comments included, 'a very professionally run place' and 'staff are lovely, very helpful and very caring.' Staff enjoyed working at the home and one said, 'It is a pleasure to work here.'

People were assessed to make sure the home was able to meet their needs before coming to live at the home. People said they were able to make choices about the care and support they needed and the staff respected their choices. One person said 'I get up and go to bed when I like.' Meetings and surveys took place to give people the opportunity to express their views and people confirmed they were listened to. Care records identified the care and treatment people needed and staff ensured they received this.

Medicines were being well managed at the home and people knew about their medicines and received them as prescribed. The home was being appropriately staffed to meet people's needs. Staffing levels reflected the dependencies of the people on each unit and were kept under review. People expressed their satisfaction with the staff and the care they received. Comments included, 'it couldn't be better in any way, largely due to the staff' and 'it is wonderful'.the staff are so well trained.'

A complaints procedure was in place and people said were confident to raise any concerns and that they would be addressed. People said the manager and deputy manager were approachable and dealt with any issues raised. One person said, 'The office door is always open'.