Vecta House

Vecta House is a residential care home that was providing personal and nursing care to 54 people at the time of the inspection. Vecta House provides a service for people living with dementia who also require nursing care. The service can support up to 54 people.

The home was purpose built as a nursing home and provides all single ensuite bedrooms on the ground floor. The home is divided into three separate units each having a range of suitable communal facilities including dining rooms, lounges and bathrooms. Safe accessible gardens and courtyards provide access to outside areas and fresh air.

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

People and their relatives all gave us positive feedback about the home and told us that staff were kind and caring. We observed positive communication between staff, people and their relatives.

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 care plans contained detailed information about them and their care and support needs, to help staff deliver care that was individual to each person. Care and support provided to people was regularly reviewed to make sure it continued to meet their needs.

Individual and environmental risks were managed appropriately. People had access to any necessary equipment where needed, which helped ensure people were safe from harm. The environment was well maintained, warm and homely.

There were appropriate policies and systems in place to protect people from the risk of abuse and the management team and staff understood their responsibilities and actions they should take.

People were supported to take their medicines safely and as prescribed. They were able to access health and social care professionals if needed, received enough to eat and drink and were happy with the food provided.

Appropriate recruitment procedures were in place to help ensure only suitable staff were employed. There were enough staff to support people’s needs. Staff had received training and support to enable them to carry out their role safely. They received supervision to help develop their skills and support them in their role.

Staff showed an understanding of equality and diversity. People were treated with dignity, and their privacy was respected. Activities had been developed in line with people's wishes to promote health and well-being.

The management team (regional director, registered manager and deputy manager) carried out regular checks on the quality and safety of the service and understood their regulatory responsibilities. People and their relatives said the registered manager was approachable and supportive. Staff were positive about the registered manager and told us she was supportive and approachable.

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 16 March 2019).

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 reinspection programme. If we receive any concerning information we may inspect sooner.

During the previous inspection in May 2018 we identified eight breaches of regulations three of which had been repeated from the inspection in April 2017. We met with the provider and registered manager and told them they must make improvements to ensure effective systems were operated to ensure compliance with regulations and to monitor and improve the quality of the service provided. At this inspection we found improvements had been made; however, there was a need to sustain the improvements made and to make further improvements. The service has been rated requires improvement as it met the characteristics for this rating in most key questions. More information is in the full report.

People’s experience of using this service:

¿ People were happy living at Vecta House. Their relatives told us their needs were met by staff who were competent, kind and caring.

¿ However, not all individual and environmental risks such as ensuring people always received the correct texture of food were managed appropriately.

¿ Relatives were involved in the development of care plans that were reviewed regularly. However, some people had a specific known health care need of epilepsy which was not well managed.

¿ There were times when staff were not readily available for people.

¿ People's rights and freedoms were upheld and they were empowered to make choices and decisions where able. People were treated with dignity and respect.

¿ Staff were well trained and received support and supervision. Medicines were usually managed safely and risks of infection control were well managed.

¿ The provider’s quality assurance system helped the management implement improvements that would benefit people. Action had been taken to become compliant with the eight breaches of regulation identified at the previous inspection.

Rating at last inspection: At the last inspection the service was rated Inadequate. (Report published 31 October 2018).

This service has been in Special Measures. Services that are in special measures are kept under review and inspected again within six months. We expect services to make significant improvements within this time frame. During this inspection the service demonstrated to us that improvements have been made and is no longer rated inadequate overall or in any key questions. Therefore, this service is now out of Special Measures.

Why we inspected: This was a scheduled/planned inspection based on the service’s previous rating.

Follow up: We will continue to monitor the service to ensure the improvements we found are maintained.

Vecta House is a ‘care home’ and is registered to accommodate up to 54 people. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The CQC regulates both the premises and the care provided, and both were looked at during this inspection. This home provides a service to older people with dementia or mental health needs.

The home had a manager who had recently taken up this position; they were not yet registered with the Commission. 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 last inspected the service in April 2017 and rated it ‘Requires Improvement’ overall. We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment, good governance and safeguarding service users from abuse and improper treatment. At this comprehensive inspection we found eight breaches of regulations. All three regulatory breaches from the last comprehensive inspection in April 2017 were repeated. There were systemic failings identified during this inspection that demonstrated a significant deterioration in the quality and safety of the service since its last comprehensive inspection.

The provider had failed to ensure effective oversight of service provision. Quality and safety monitoring systems were ineffective in identifying and directing the service to act upon and mitigate risks to people who used the service and ensure the quality of service provision.

Following the inspection we wrote to the provider informing them of our concerns and requiring them to send us weekly action plans detailing how they were addressing the areas of immediate concern. These have been received as required. The provider has also voluntarily agreed not to admit new people to Vecta House until they are satisfied that all necessary action has been taken and people will be safe.

Statutory notifications are information about specific important events the service is legally required to send to us. We found that these had not always been made as required.

Records relating to the management of the service had not been effectively reviewed and assessed; we found errors and discrepancies that had not been identified by the quality assurance systems in place.

Care plans were not consistently person centred and lacked detailed guidance for staff to ensure people received care in a person centred and safe way. Risk assessments that related to peoples health, safety and the environment did not ensure that all risks were effectively assessed. Action had not always been taken to reduce identified risks to ensure the safety of people. This exposed people to a risk of neglect and unsafe or inappropriate care or treatment.

People were not always treated with dignity and respect; we observed occasions when staff treated people without compassion and kindness. People living with dementia were not always treated as adults.

Staff said they knew how to prevent and report abuse. We were concerned however that staff practice which amounted to omissions of care had not been considered as neglect by them.

There were not enough sufficiently skilled staff to meet people’s needs. Staffing needs had not been fully assessed and there was a high reliance on agency staff; we observed that the staff on duty lacked the skills and knowledge to care for the people in residence. People therefore did not receive person centred care.

Staff received training and supervision however we were not assured of quality of this given the widespread failings found at this inspection.

The provider had appropriate staff recruitment procedures however these were not followed; not all employment checks were completed before staff started working with people.

Emergency evacuation procedures and arrangements were flawed and staff were unprepared for emergency evacuations.

The administration, safe management and security of medicines was not in line with best practice or followed the provider’s policies at all times. Medicines were not always administered as prescribed and there was a lack of lack of recording of why ‘as required’ medicines had been given and the effectiveness of their action. This information would be needed to determine if the PRN medicines had resolved the problem or if alternative medicine or action was required.

Records of the assessment of people's ability to make some informed decisions had not been undertaken as required. The principles of the Mental Capacity Act 2005 were not being applied in respect of best interest decisions to provide care or use restrictive practices.

Staff, people and visitors gave varied feedback about the service. Our observations of how care was provided to people was reflective of the varied feedback. Staff were positive about the recent change in management.

There was a complaints policy in place. People and relatives knew how to raise concerns.

We found eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 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.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

There was a registered manager at 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. People's families told us they felt the home was well-led and were positive about the registered manager who understood the responsibilities of their role.

The provider’s quality assurance procedures had failed to identify the areas of concern we found. These included the recording of restraint and the failing to ensure all medicines were administered as prescribed. Nursing and care staff had failed to self-monitor their practice such as leaving potentially dangerous fluid thickening powder available to people and not following up on gaps in administration records for insulin.

There were generally enough staff to meet people's needs although activities staff were supporting care staff meaning they were unable to provide a full range of activities and management staff were supporting nursing shifts meaning they were not able to complete all management tasks. Relatives identified that people would benefit from additional mental and physical stimulation. We have made a recommendation about this.

Whilst the majority of interactions we observed between staff and people were positive, with people being cared for with kindness and compassion we also observed occasions when this was not the case. People felt safe and staff knew how to identify, prevent and report abuse. Staff offered people choices and respected their decisions. People were supported and encouraged to be as independent as possible and their dignity was promoted.

Care plans provided comprehensive information about how people wished to be cared for and staff were aware of people's individual care needs and preferences. Reviews of care were conducted regularly. People had access to healthcare services and were referred to doctors and specialists when needed.

Relatives and external health professionals were positive about the service people received. People enjoyed their meals and received support if required to ensure they had a nutritious diet. At the end of their life people received appropriate care to have a comfortable, dignified and pain free death.

The recruitment process helped ensure staff were suitable for their role. Staff received appropriate training and were supported in their work.

People and relatives were able to complain or raise issues on a formal and informal basis with the registered manager and were confident these would be resolved. This contributed to an open culture within the home. Visitors were welcomed and there were good working relationships with external professionals.

Staff worked well together, which created a relaxed and happy atmosphere that was reflected in people's care.

We found three breaches of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the end of the full version of the report.

A visitor said 'I'm [x] friend and come in 3 times a week. [X] is looked after very well. There is always someone available to feed and dress them. She's always clean and dressed nicely. It's a happy place. When someone has a birthday everyone gets involved, Christmas is great'. A relative told us 'It's a lovely atmosphere, beautiful really. No one is ill-treated, you see some awful things on the telly but that's not what happens here'. Other relatives expressed similar positive comments about the home and staff.

We spent time observing care in communal areas. We found people had positive experiences. We observed staff were courteous and respectful of people's dignity. Choices were offered and people's preferences were respected. The care we observed corresponded with care plans and risk assessments viewed. There were sufficient staff who had received training, support and supervision giving them the skills required to meet people's needs.

We spoke with nursing and care staff. Staff were aware of how people should be supported, individual likes and dislikes and the help they required. Staff stated they felt they had sufficient time to meet people's needs. Staff also told us they had attended relevant training and had all the necessary equipment to safely care for people.

There was a complaints procedure. Relatives felt able to raise issues and said these were resolved to their satisfaction.

Other people were unable to tell us about their experiences as they had dementia. We observed that interactions between staff and people were friendly and positive and staff were responsive to people's needs. Choices were offered and where necessary informal consent was obtained. Staff knew what support people needed and respected people's wishes. The support that we saw being given to people matched what their care plan said they needed.

We also spoke with nine visitors to the service. They were all very positive about the home and care people received. We found that people received an appropriate diet, medication was correctly managed and care plans were relevant to people. Recruitment procedures were in place with pre employment checks completed. All necessary records were maintained.