We undertook an unannounced inspection of St Vincent's Nursing Home on 4 and 5 December 2018.

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

We undertook an unannounced focused inspection of St Vincent’s Nursing Home on 7 and 8 June 2018. This inspection was done to check that improvements to meet legal requirements planned by the provider after our 24 and 25 October 2017 comprehensive inspection had been made. The team inspected the service against two of the five questions we ask about services: is the service safe? and is the service well led? This is because the service was not meeting some legal requirements.

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.

The unannounced inspection took place on 24 and 25 October 2017. During the last comprehensive inspection in August 2015 we found the service was meeting our regulations.

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.

Following our inspection that was carried out 29 October 2013, we issued a compliance action to the provider because they were not compliant with Regulation 21 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We found that recruitment procedures were not always followed, which meant that information was not always available to evidence that people were cared for, or supported by, suitably qualified, skilled and experienced staff.

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.

We spoke with eight people using the service, four relatives and eight staff.

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.”

We spoke with six people using the service and seven staff.

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”.

People told us that they or their representatives chose the home after they had received information about the services it offered and had carried out a visit. People said that the home is like a “first class hotel” and one person reported that they had wanted to come in the minute their relatives visited the home.

People said that they could make decisions about what they wanted to do in the home and that their choices were promoted. All people reported that staff involved them in their care and support. Care records confirmed this. Relatives said that staff kept them informed of changes in people’s conditions and would consult them where decisions had to be made in people’s interests.

People and relatives told us that they contributed their views to the way the services were provided in meetings that were arranged for them. They said that the provider also carries out an annual satisfaction survey to get their views about the quality of services provided in the home and where necessary action is taken to address areas that require improvement.

People reported that staff understood their needs and they received a good standard of care, treatment and support. One person said that “it is very nice here”. Another said that “it is the best place for me to be”. All people in the home appeared well cared for and visitors said that people were always dressed appropriately when they visited.

People told us they benefitted from a range of activities that took place in the home and had the opportunity to go for outings in the local community. People said that they do not get bored in the home and that they have enough to keep them occupied.

The inspection was carried out on 20 and 21 August 2015 and the first day was unannounced. The last inspection took place on 18 March 2014 and the provider was compliant with the regulations we checked.

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 has communal dining, sitting rooms and bathing facilities.

The service is required to have a registered manager in post, and there is a registered manager for this service. 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 were very happy with the service and we received positive feedback from people, relatives and visiting healthcare professionals, all of whom praised the service and the high quality of care it provided. Staff showed respect for people, listening to them and supporting them in a caring and gentle way.

Risk assessments had been completed to reflect the risk to individuals and the care and support they required to minimise these. Systems and equipment were being maintained to keep them in good working order and infection control procedures were in place and being followed. The environment was well maintained and provided a clean, homely place for people to live.

Staff recruitment procedures were in place and these were followed to ensure only suitable staff were employed at the service. The service had a long serving and stable staff team, providing good continuity of care.

Staff understood safeguarding and whistleblowing procedures and were clear about the process to follow to report any suspicions of abuse. Complaints procedures were in place and people and relatives were positively encouraged to express any issues so they could be addressed.

People received their medicines safely and as prescribed, however current medicines good practice guidance was not always followed. The registered manager responded promptly to implement good practice improvements. Input from the GP and other healthcare professionals was available to address any health concerns.

Staff received regular training and updates and had a good understanding of people’s individual choices and needs and how to meet them.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and Mental Capacity Act 2005 (MCA). DoLS are in place to ensure that people’s freedom is not unduly restricted.

Care records reflected people’s individual needs, interests and wishes and staff demonstrated a good understanding of these and provided person-centred care. People’s religious and social needs were identified, respected and were being met. People’s wishes in respect of their end of life care were discussed and recorded so these were known and could be met.

The registered manager was experienced and provided good leadership for the service, promoting good practice and effective communication with people, relatives and staff. Feedback was encouraged and action taken to respond to any points raised, to improve the service provision.

Systems were in place for monitoring the service and these were effective so action could be taken promptly to address any issues identified.