St Vincent House - Southsea

St Vincent House Southsea is a residential care home providing personal care for up to 27 people, some of whom live with dementia. At the time of our inspection there were 24 people living at the service. Accommodation is provided over four floors which are accessed by a lift. There were communal areas such as lounges and dining rooms and a small courtyard style garden.

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

People were supported by staff who were kind, caring and who understood their likes, dislikes and preferences. People were happy living at St Vincent House Southsea and told us they felt safe.

Staff understood their safeguarding responsibilities and knew how to keep people safe from harm.

Recruitment practices were safe and there were sufficient numbers of staff available to meet people’s needs. Quality assurance processes were robust, risks to people and the environment were managed safely and people had access to appropriate equipment where needed.

Staff had received training in infection control, including additional training since the start of the coronavirus pandemic. They followed good infection control processes, which met government guidelines for care homes.

There were suitable systems in place to ensure that medicines were securely stored, ordered and disposed of correctly and safely and people received their medicines as prescribed. However, some areas of medicine management required more robust systems to be put in place to ensure the management of medicines remained safe.

People were supported by staff who treated them with dignity, and their privacy was respected. People's care plans contained information about their individual needs, wants and wishes, to help staff deliver personalised care.

There were meaningful activities available to people that were person centred. Dedicated staff were employed to provide activities, which took into account people’s choices and interests and promoted their health and well-being.

People, relatives and staff were positive about the running of the service and the support they received from the management team and provider. Staff felt there had been improvements in all aspects of the service since the last inspection.

The management team were open and transparent. They understood their regulatory responsibilities. People, relatives and staff said the management team were approachable and supportive. There were effective governance systems in place to identify concerns in the service and drive improvement.

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 27 February 2020) and there were four breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when, to improve safe care and treatment, dignity, good governance and when to notify CQC of events.. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this 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, Caring, Responsive and Well-led which contain those requirements.

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 coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Vincent House Southsea 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 House – Southsea is a residential care home providing personal care for up to 27 people, some of whom live with dementia. At the time of our inspection there were 27 people living at the service. Accommodation is provided over four floors which are accessed by a lift. There were communal areas such as lounges and dining rooms and a small courtyard style garden.

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

People told us they felt safe living at the home, but we found some systems were not always safe. Medicines were not always managed safely. There were not ‘as required’ protocols in place for all of these types of medicines. There was not enough guidance in place for staff to know when and where to apply topical creams. The provider put some systems in place during our inspection.

Risks had not all been robustly assessed so that safety measures could be put into place. Accidents and incidents had not been reviewed by a manager consistently. This meant not all the required action had been taken where needed. The provider had not notified CQC of all of the specific events and incidents that they are required to do by law.

Whilst we observed some positive interactions between people and staff, people were not always treated with dignity and respect. We observed and heard some interactions that were not always dignified. People had not always been involved in their care and support and it had not always been consistently reviewed.

People had a personalised care plan, but this had not always been updated. This meant there was not accurate guidance for staff to follow to provide people with effective care and support. People we spoke with about activities told us there was enough activities for them. However, people’s daily notes did not demonstrate their social needs were being met. Some monitoring was not carried out as per people’s care plan guidance.

Quality monitoring systems were not robust. Whilst the provider had identified some improvements, they had not identified all of the issues we found during this inspection. There was no registered manager at the service though a manager was in post. They had applied to become registered.

Staff had been recruited safely and there were enough staff deployed. Staffing numbers had increased recently in response to feedback and the provider was recruiting more staff. Staff received an induction when they started at the home and training updates as needed. Staff all told us they felt supported in their jobs by the provider.

People who lacked capacity had their needs assessed and staff supported them in the least restrictive way possible and in their best interests. Where needed staff referred people to see healthcare professionals. Any guidance given by any professionals was followed by staff. People had access to sufficient food and drinks and had a choice of meals.

People told us they found staff to be kind and caring. Comments about the staff included, “[Relative] is well cared for” and “Staff here are very nice and kind.” People were being supported by staff who enjoyed their work and felt supported by the provider. Staff were positive about the recent management changes and told us improvements had been carried out.

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 (report published 3 March 2017).

Why we inspected - This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to dignity and respect, safe care and treatment, good governance and failing to notify CQC 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.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We carried out a previous inspection of this service on 4 November 2013 where we found the service was meeting the requirements in the areas we looked at.

This inspection took place on 26 January 2017 and was unannounced. At the time of our inspection there were 26 people living in St Vincent House – Southsea. Although the home is registered for up to 27 people the registered manager told us the maximum number of people they accommodated was 26 and the home was at full capacity. People had a range of needs, with some being more independent and others requiring a significant amount of support relating to their physical health, mental health, dementia and wellbeing.

People were protected from risks relating to their health, mobility, medicines, nutrition and behaviours. Staff had assessed individual risks to people and had taken action to seek guidance and minimise identified risks. Where accidents and incidents had taken place, these had been reviewed and action had been taken to reduce the risks of reoccurrence. Staff supported people to take their medicines safely and as prescribed by their doctor.

Staff treated people with kindness and respect. People enjoyed pleasant interactions with staff which demonstrated people felt comfortable in their presence. During our inspection we saw positive and caring interactions between people and staff. We found staff had caring attitudes towards people and provided people with affection and humour. Staff knew people’s needs, preferences, likes and dislikes and spoke about people with respect and admiration.

Staff knew how to recognise possible signs of abuse which also helped protect people. Staff knew what signs to look out for and the procedures to follow should they need to report concerns. Safeguarding information and contact numbers for the relevant bodies were accessible. Staff told us they felt comfortable raising concerns.

Recruitment procedures were in place to help ensure only people of good character were employed by the home. Staff underwent Disclosure and Barring Service (police record) checks before they started work in order to ensure they were suitable to work with people who were vulnerable.

Staffing numbers at the service were sufficient to meet people’s needs and provide them with the care and support they required. Staff had the competencies and information they required in order to meet people’s needs. Staff received sufficient training as well as regular supervision and appraisal. Staff had a good understanding of the Mental Capacity Act 2005 (MCA) and put it into practice. Where people had been unable to make a particular decision at a particular time, their capacity had been assessed and best interests decisions had taken place and had been recorded. Where people were being deprived of their liberty for their own safety the registered manager had made Deprivation of Liberty Safeguard (DoLS) applications to the local authority.

People were supported to have enough to eat and drink in ways that met their needs and preferences. People were supported to make choices about what they wanted to eat and food was presented in ways which met people’s individual needs. People spoke highly of the food and where people had specific needs relating to their diet, these were responded to. Great care was taken to encourage people to eat and where people were provided with pureed food to meet their needs; this was presented in a way in which each item was moulded into its original shape to look appetizing.

People’s care plans contained detailed information about people’s histories, their individual needs, preferences and interests. This information was used to create personalised activity plans for people to ensure they had stimulation and activities that met their desires, interests and needs. Enabling people to take part in varied activities which increased their quality of life was a priority for the provider and the registered manager. Staff were encouraged to spend time with people individually, engage people in different types of activities that met their needs and take people on trips out in the community and for organised activities and outings. People had enjoyed such activities as speedboat rides, raising chickens, trips out, cooking, gardening and arts and crafts.

There was open and effective management at St Vincent House – Southsea. The providers and registered manager led by example to ensure best practice was followed. People, relatives, staff and healthcare professionals were asked for their feedback and suggestions in order to improve the service. There were effective systems in place to assess, monitor and improve the quality and safety of the care and support being delivered. The registered manager worked hard to improve the community links with the home.

On the day of our visit we observed care being given by experienced and caring staff. People were treated with dignity and respect. People's wishes were, as far as possible, taken into account when receiving care and the home provided an appropriate range of activities for people to take part in.

During our visit we particularly noted that the home had an innovative and enthusiastic manager in place who had already started to implement procedures to care for people with complex mental health needs more effectively. We saw the results of this intervention by the staff members' positive attitude to work and the wellbeing of people living in the home.

We spoke with four people, two of whom were able to tell us about their experiences of living in the home. One person told us "they're all very nice" and another person said they felt safe. We spoke with two relatives, one of whom told us "we can't fault it".

We spoke with four members of staff who all told us they felt well supported in their work.

People said they received the care and support they needed and that staff treated them with respect and kindness.

Each person had a care plan with information about how staff supported them. People said they were consulted about their care needs but we noted care plans were not signed by people or their representative.

Health and social care professionals told us the home looked after people well.

People told us they felt safe in the home and that there were sufficient numbers of staff on duty to meet their needs.

During the lunchtime we used our SOFI (Short Observational Framework for Inspection) tool to help us see what people's experiences at mealtimes were. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time and whether they have positive experiences. This includes looking at the support that is given to them by the staff. We spent 45 minutes observing at lunchtime and found that people had positive experiences. Staff were observed assisting people in a calm, friendly and polite manner. We saw staff dealt with people’s behaviour needs as set out in care plans. The meal time was calm and well organised.