Background to this inspection
Updated
5 January 2024
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection took place over 2 days and consisted of 2 inspectors and a nursing specialist advisor on the first day and 2 inspectors on the second day.
Service and service type
Veronica House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Veronica House is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was a registered manager in post.
Notice of inspection
The inspection was unannounced on the first day with an announced visit on the second day.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used all this information to plan our inspection.
During the inspection
We spoke with 11 people, 4 people's relatives. We spent time observing care and support. We spoke with 14 members of staff, including the registered manager, deputy manager, area manager, nursing staff, lead, activity, domestic and care staff. We looked at a range of records, including 8 care plans and medicines records, 3 staff recruitment files and the provider's policies and procedures.
Updated
5 January 2024
About the service
Veronica House is a care home providing personal and nursing care to up to 52 people. The service provides support to older people and people living with dementia, younger people, people with a physical disability and people living with a learning disability and autistic people. At the time of our inspection there were 37 people using the service.
People’s experience of the service and what we found:
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessment and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
Right Support:
There continued to be a high number of agency staff deployed around the home and people, relatives and staff told us this had impacted on consistently meeting people's needs in a timely way. People also told us the high use of agency staff meant care was sometimes provided by staff who did not know their choices and preferences. Risks were assessed and planned for to keep people safe. However, staff did not always have all the necessary skills and knowledge to effectively support people. Medicines were safely managed. Staff were recruited safely. People were protected from the risk of abuse and staff knew what action to take to keep people safe from risk of abuse. People were protected from the risk of infection.
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.
Right Care:
People's social activity needs were not always met. People’s mealtime experience was not consistently positive. People had varying levels of access to the community. There was improvement required in communicating with people whose first language was not English. Relatives felt able to raise concerns, if needed. There were processes in place to support people nearing the end of their life.
Right Culture:
Quality assurance system to monitoring and improve the quality and safety of the service were not always effective at identifying the issues identified at this inspection. There had been a number of improvements made to the governance systems, however these needed time to become embedded into practice. We found more work was needed to ensure the service was operating in accordance with best practice particularly in relation to a home environment because it did not consistently support people living with dementia. The provider was trying to develop an open and empowering culture. The registered manager and deputy manager were person-centred and were working on making improvements with the service. The service worked in partnership with external professionals and organisations.
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 on 6 December 2022).
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 improvement had been made and the provider was no longer in breach of regulations, however the service remains requires improvement This service has been rated requires improvement for the last two consecutive inspections.
Why we inspected
The inspection was prompted in part by the increased number of notifications of specific incidents, particularly the high number of falls and unexplained injuries. A decision was made for us to inspect and examine those risks.
We found no evidence during this inspection that people were at risk of harm from these concerns.
Please see the Safe question section of this full report.
We initially undertook a focused inspection to review the key questions of Safe, Effective and Well-led key questions only. During the inspection we found there was a concern with a poor and undignified interaction with one person and accessible information so we widened the scope of the inspection to become a comprehensive inspection.
Follow Up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.